Module 19 behavior/mental health childhood disorders Flashcards
risk factors for anxiety
genetics
temperamental disposition for behavioral inhibition and/or shyness
social environment or life circumstances
Clinical findings of GAD
- worry about future events
- preoccupation with past behavior
- poor-quality sleep and unexplained fatigue
- irritability and tantrums in young
- over concern about competence and marked preoccupation with performance
- self-consciousness, unusual need for reassurance
- restless, difficulty concentrating
- somatic complaints without physical basis
- comorbidity: other anxiety, ADHD, mood disorder
PTSD screen TRAUMA
T: trauma: known traumatic experience
R: re-experience: flashbacks, nightmares
A: avoidance, avoids stimuli
U: unable to function
M: month or longer
A: arousal: hypervigilant, sleep disturbances, concentration difficulties, exaggerated startle
depression common findings
mood: sad, blue, down, angry, bored loss of interest in usual activities change in appetite or wt insomnia or hypersomnia low energy and fatigue difficulty concentrating, indecision feelings of worthlessness inappropriate or excessive guilt recurrent thoughts of death or SI
Warning signs for suicide change in behavior
accident prone or risk taking drug/ETOH physical violence loss of appetite sudden alienation worsening performance at work or school putting personal affairs in order loss of interest in personal appearance disposal of possessions writing notes/letter/poems with suicidal content buying a gun or weapon
warning signs for suicide changes in mood
expression of hopelessness or impending doom explosive rage dramatic swings in affect crying spells sleep disorders talking about suicide
warning signs for suicide changes in thinking
preoccupation with death difficulty concentrating irrational speech hearing voices, seeing visions sudden interest, or loss of interest, in religion
warning signs for suicide major life changes
death of a family member or friend separation or divorce public humiliation or failure serious illness or trauma loss of financial security recent relationship loss
dyslexia
difficulties with word recognition, decoding, and spelling
difficulties in writing
- spelling, punctuation, grammar, organization, clarity of written expression
dysgraphia
difficulty with handwriting
dyscalculia
difficulties with learning math facts and performing calculations
eating disorder with highest mortality rate
anorexia
risk factors for developing eating disorder
athletes - especially those who compete in sports that are based on wt middle to high socioeconomic status divorced families chronic disease recent wt loss in a previously obese person personality disorders strong will hx of child abuse
Dx criteria for anorexia
- refusal to maintain body weight at least 85% expected for age and ht, or failure to gain wt during growth periods
- intense fear of wt gain or being fat
- body dysmorphism
- binge eating/purging subtype
- assoc. with purging though binging is rare
Dx criteria for bulimia
- consuming large quantities of food in a short period of time (2 hours)
- loss of control during binge episodes
- engaging in repeated behaviors to lose wt, including purging, excessive exercise, fasting
- bingeing or purging behaviors that occur at least once a week x 3months
wt and eating disorders
anorexia: underwt
bulimia: average wt or overwt
SCOFF
screening to detect red flags regarding wt
- S: do you make yourself SICK because you feel so full
- C: Do you worry you have lost CONTROL over what you eat?
- O: Have you lost OVER 10 lbs in the last 3 months
- F: do you believe you are FAT when others say you are thin?
- F: would you say FOOD dominates your life?
comorbidities associated with eating disorders
depression anxiety suicidality risk of physical harm menstrual irregularity body dysmorphism pre-occupation with food desire to lose wt, hx of dieting wt fluctuation guilt about eating social isolation, mood changes fixed, highly structured schedule, inflexible cold intolerance, fatigue, myalgias, GI distress sore throat dizzy, syncope substance abuse, self-harm
common physical findings with eating disorder
altered growth parotid gland enlargement fluid retention -> facial edema thin body type, low temp hypoTN, bradycardia, orthostatic hypoTN, shallow resp dental enamel erosion, dental caries russell sign: knuckle cuts/callus from inducing vomiting thinning hair, alopecia, dec. DTR abd. distention, altered bowel sounds lanugo, dry skin muscle atrophy mental torpor
substance abuse
maladaptive pattern of the use of ETOH or drugs manifested in significant impairment or distress
substance abuse contributing factors
genetic vulnerability parental substance use dysfunctional family relationships negative life events psych conditions low self-esteem/body image ineffective coping skills poor sleep hygiene school failure low religiosity competitive athleticism
CRAFFT questionnaire
2 or more positive responses
-> high likelihood for substance abuse and merits further evaluation and tx
substance abuse behavioral changes infants and young children
excessive crying poor feeding FTT irritability jitteriness excessive lethargy poor eye contact sleep disorders
substance abuse behavioral changes older children and adolescents
dec. school performance lethargy hyperactivity or agitation hypervigilance dec. attention deviant or risk taking behavior repeated absences or suspensions loss of interest withdrawal from family and friends fighting, acting out hypersexuality exaggerated mood swings sleep pattern changes nightmares altered menstruation
substance abuse physical signs
- wt loss
- red eyes with inhaled substances
- hoarseness, chronic cough, wheezing, freq. colds or allergy s/s, epistasix, perforations of nasal septum with cocaine and inhalant
- accidents, trauma, injuries
- intoxication
- complete or partial amnesia
- dilated or constricted pupils
- gynecomastia, irregular periods, small testes with marijuana
- needle tracks with IM or IV use
- generalized pruritus with opiate use
- reflux, diarrhea, gastritis and consitpations with opiate and ETOH
- perioral sores or pyodermas from huffing and bagging
