EM psych Flashcards
______ is characterized by either single or multiple vocal and/or motor tics that occur frequently, many times during a day, and last for at least 4 weeks, but no longer than 12 months. The age of onset is before 18 years. The tic(s) tend to increase with excitement or fatigue and distress the patient and/or interfere with social or other areas of function, such as school or work. During school age, 5% to 20% of all children have a tic1. As with all tics, boys are 3 to 4 times more likely to be affected than girls. Most children with tics do not require treatment.
Transient tic disorder
Tourette Disorder is characterized by the presence of multiple motor tics and 1 or more vocal tics, although all are not necessarily present at the same time. Tics occur frequently over a period of at least a year, and there is no tic-free period greater than 3 months. Onset is in childhood or adolescence before the age of 18 years, and Tourette disorder is more common in boys. The tics tend to cause significant distress or impairment in function, such as in social settings or work or school environment. Tourette Disorder may be inherited as an autosomal dominant disorder.
Sporadic occurrences may be linked to low birth weight, maternal stress during pregnancy, complications during delivery, maternal use of alcohol, cigarettes, or caffeine during pregnancy, androgenic hormones, or PANDAS (Pediatric autoimmune disorder associated with streptococcal infections.) Many children with tics do not require treatment. Because of the fluctuating nature of the tics, it is often difficult to assess response to medication. Medications that have been used include clonidine, guanephezine, pimozide, fluphenazine, and haloperidol. Psychological counseling, behavior modification, support groups, and biofeedback are other treatment modalities and have variable success.
Separation Anxiety Disorder, a disorder usually found in infancy, childhood, or adolescence, has as essential feature of excessive anxiety related to separation from the home or someone to whom the child is attached. The disturbance, which is in excess of what is normally expected for the child’s age, must be present for a minimum of 4 weeks, begin prior to age 18, and cause significant impairment in social, academic, occupational, or other important areas of the individual’s life.
If the disorder appears before 6 years of age, it is specified to be Early Onset. Somatic problems may accompany the disorder, as well as frequent nightmares with a theme of murder, fire, or other catastrophe to the family.
When the disorder occurs in an adult, it frequently involves an excessive need to make telephone calls to keep in contact with the attachment figure, show a preoccupation with fear of harm coming to that person, and an inability to change their circumstances (e.g. moving or getting married). It may be more frequent in females.
The largest and most consistently reported adjustment effects of marital transitions involve
externalized behavioral disorders, such as conduct disorders, noncompliance, aggression, lack of self-regulation, and decreased academic and economic attainment.
Conduct disorder is a disruptive behavioral disorder that typically violates the personal or property rights of others, as well as the basic expectations of society. Symptoms include
aggressive behavior that harms or threatens other people or animals, destructive behavior that damages or destroys property, lying or theft, truancy or other serious violations of rules, early tobacco, alcohol and substance use and abuse, and precocious sexual activity.
Vigorous crying is followed by breath holding, after which the child becomes limp. The child can have a tonic-clonic seizure followed by a postictal state. In pallid spells, the child is startled; he or she then lets out a quick cry, becomes pale, and loses consciousness. In both types of spells, the child recovers completely and is acting normally shortly after the spell.
The behavior described is most consistent with a breath-holding spell. Breath-holding spells are a benign childhood event and have the highest incidence in the 1st 2 years of life. They are classified as pallid or cyanotic. In cyanotic spells, the child usually begins crying after being startled or after becoming angry.
Simple tics are often considered part of normal childhood development and they occur in 10-20% of children. Only if the tics last
longer than 6-12 months and progress to include vocalizations are they considered chronic in nature.
Gilles de la Tourette syndrome is a rare movement disorder in childhood, with a lifetime prevalence estimated to be between 0.1 and 1 in 1,000. It is characterized by the occurrence of vocal and motor tics daily or nearly every day for a period of at least one year. Typical onset is around 7 years of age. 50-60% of patients develop coprolalia and echolalia.
Obsessive- compulsive behavior, attention deficits, learning disabilities, and sleep disorder are commonly seen with the disorder. Etiology is unclear, though drugs that increase dopaminergic action have been known to precipitate or worsen the tics.
The third leading cause of death in the United States among adolescents and young adults ages 10 to 24 is suicide. Suicide rates declined from 1990 to 2003, but between 2003 and 2004 the rate saw a slight increase. This increase is due to upward trends in 3 groups:
females aged 10 to 14 and 15 to 19, and males aged 15 to 19. Among the females in all age groups, hanging/suffocation was the most common cause and thus the most likely cause of potential suicidal death in this girl, while firearms were most commonly used by males.
Among the females, ______ ,have a higher percentage of suicide attempts than their peers.
Native American, Alaskan Native, and Hispanic youths
It is helpful to assess the risk/rescue ratio for any child or adolescent who has attempted suicide. This assesses the risk of the action or attempt made in relation to the likelihood of a ‘rescue.’ For example,
an attempt made alone without any prior indication would have a higher ratio than an attempt made in front of a parent. This girl took an overdose of medications alone while her family was away, but knew that they would be back after a short time, thus lowering the risk/rescue ratio.
simple _____ can give valuable information about the cause of enuresis. The presence of albuminuria, or hematuria, or red blood cell casts, or bacteria will indicate renal pathology or a urinary tract infection responsible for enuresis.
urinalysis. Presence of glucosuria indicates diabetes mellitus, and low specific gravity on urinalysis may indicate diabetes insipidus or psychogenic polydipsi
are indicated in the children with enuresis who do not respond to traditional therapy and in patients suspected of tethered spinal cord.
Urodynamic studies. This condition is suspected in children having nocturnal enuresis, daytime incontinence, and encopresis.
Childhood grief reactions following the death of a loved one or family member are individual, but are also influenced by a child’s developmental stage, family coping style, cultural and religious background, and the circumstances surrounding the death.
Emotional stages of grief experienced include denial, anger, bargaining, depression, and acceptance. States can occur in any order and may frequently recur many times as one moves toward acceptance.
Common expressions depending on developmental stage can include repeated questioning, regressive behaviors, and extreme emotions.
Bereavement in school-age children is considered complicated when there is:
·
· evidence of detachment from peers.
· persistent or worsening school phobia or academic performance evident 3 months after the death, not just 6 weeks as in this patient.
· increasing depression, moodiness or anger evident 3 to 6 months after the death and not just 6 weeks as in this patient.
· physical complaints without organic cause evident 3 months after the death and not just 6 weeks as in this patient.
