Psychiatric Disorders of Childhood & Adolescence - Meyer Flashcards
There are many classifications of mental illness. Try to categorize 6-7 of them.
(Hint: Mood disorders is #1)
Mood disorders (eg Major Depressive Disorder)
Psychotic disorders (eg Schizophrenia)
Anxiety disorders
Adjustment disorders
Substance use disorders
Personality disorders
Disorders secondary to other neurological or medical illness
How do most psych disorders of childhood arise?
How can they vary?
A strain on the child’s ability to cope with his or her development.
The level of strain experienced, as well as individual variation in the child’s flexibility and biologic variation.
How do child psychopathologies prevent differently from those of adults?
Psychopathologies in children fluctuate, and different disorders may present in different ages.
Additionally, children will not seek help for psych disorders.
What are some generic signs of stress?
Changes in the patterns of eating, sleeping and general activity. Possible regression to a more childlike state.
Try to recall some specific manifestations of stress in the following age cohorts:
Infant
Toddler
Preschool
School age
Adolescence
Infant: Stranger anxiety
Toddler: Tantrums, elimination, stuttering
Preschool: “Intrusiveness, masturbation”
School age: Behavioral & learning problems
Adolescence: Identity crisis, sexual disorder, substance abuse, delinquency
What defines mental retardation, and who does it affected?
What are some possible causes?
Significant sub-average intelligence (probably IQ < 70), hitting 3% of school-age children (usually boys).
Lack of stimulation, malnutrition, toxin exposure, chromosomal/metabolic abnormalities, traumatic pregnancy, infections, and many others…
Name two pervasive development disorders.
How are they treated?
Autism and Asperger’s disorder.
No curative medical treatments; special programs and support.
Contrast and distinguish between Autism and Asberger’s Disorder.
Autism features stunted social & language development, avoidal of interaction, and restricted/stereotyped behavioral patterns (may see “Savant behaviors”)
Asberger’s disorder does not feature the language deficit, and is generally milder.
What are learning disorders?
Who do they affect?
How are they treated?
A deficit in learning in one or more specific areas of study (eg Math, writing, reading, coordination).
Affects 10% of children, mostly boys.
Remediation.
What are unclassified speech disfluencies?
Who do they affect?
How are they treated?
Impairments of speech including (but not limited to) stuttering.
3-4 year olds
99% require no intervention (self-resolve), while the other 1% persists and requires speech therapy.
What is oppositional defiant disorder characterized by?
Who does it affect?
At least 6 months of: Bad temperament, argumentation, being resentful, vindictive, and generally a little shit.
Children and adolescents, generally boys.
What is a proposed cause of oppositional defiant disorder?
How is it treated?
Environmental cause–parent’s being too over-assertive!
Parent training (lol), psychotherapy, social training and CBT.
Describe the classic ADD patient.
How common is it?
A young child who is fidgety, easily distracted, and forgetful. He or she may have difficulties at school or at home because of this behavior.
About 5% of children have ADD! Many persist into adulthood.
What can cause ADD?
How is it treated?
Not clear, though heretidary linkages have been established.
Various CNS stimulants, psychotherapies (behavioral, parent management), special education.
What is conduct disorder characterized by?
Who does it affect, and why?
Lying, stealing, truancy, fighting, property destruction; general delinquency.
Tends to affect older children (usually boys), stemming from backgrounds of family trouble, low self-esteem, depression, substance abuse, etc.
Distinguish generalized anxiety disorder and separation anxiety disorder.
SAD: Affects younger children (7-10yo), who cannot leave parents for fear of harm.
GAD: Affects teenagers (12-15yo), with constant worrying that many have somatic manifestations (aches, pains)
What causes anxiety disorders?
How are they treated?
Not known, but there is hereditary linkage, and stress is almost certain to play a role.
Anxiolytics (eg Xanaz, buspirone), CBT/family therapy
Describe the behavior pattern seen in OCD.
Who does it affect?
How is it treated?
Obsessions invade one’s thoughts, while compulsions are actions that the patient “must” execute driven by anxiety or worry.
Affects both chlidren and teenagers (and adults).
Medications (clomipramine/fluoxetine/sertraline/fluvoxamine), CBT.
Panic Disorder
- Symptoms?
- Age on onset?
- Which part of the brain is likely part of the pathogenesis of this disorder?
- Periods of extreme fear or anxiety that begin suddenly and may last minutes to hours
- SoB, dizziness, nausea, sweating, racing heartbeat
- Thoughts of loss-of-control
- Rare in young children. More frequent in teenagers.
- Locus ceruleus (anxiety control center) may react for no reason, triggering a fear/anxiety response
Post-traumatic Stress Disorder (PTSD)
- What is the unifying event sufferers of PTSD share?
- In what context does it generally occur in children?
- Symptoms?
- Duration of illness?
- Sequelae?
- Treatment?
- Trauma with continued intense feelings of threat and helplessness
- Children: often due to abuse or witness of serious accident or injury
- Symptoms
- nightmares and flashbacks
- avoidance of situations that bring trauma back to memory
- losing interest in things and hopelessness (depression)
- Constant fear and concern for safety
- Weeks to years
- Untreated PTSD can lead to depression, substance abuse, aggressive behavior, or personality changes
- Treatments for depression or anxiety may be useful
Depressive disorders
- symptoms?
- Which pediatric age range is more common?
- Heritability?
- Symptoms
- feeling sad
- losing interest in things
- sleep problems
- changes in appetite, weight
- tired, difficulty concentrating
- feelings of worthlessness, hopelessness
- feeling that life is not worth living
- teens > young children
- Some types appear to be heritable
Bipolar disorder: describe
Which pediatric age range is most affected?
Depressive symptoms at some times, and manic symptoms at other times. Mania may include abnormally high mood, impulsive behavior, irritability, unusually talkative, racing thoughts, decreased sleep, impaired concentration, etc
teens > children (rare)
Explain the difference between hallucinations and delusions
Hallucination: hearing or seeing things that are not there (as if your mind is playing tricks on you)
Delusions: beliefs that are impossible or unrealistic. People experiencing delusions may have a hard time organizing and communicating delusional thoughts.
Is psychosis on its own a disorder?
Psychosis is always a symptom of what disorder?
No. Psychosis is a symptom.
Schizophrenia always has psychosis as a symptom. Other disorders (bipolar, etc) may or may not feature psychosis.
Overproduction of which neurotransmitter may be implicated in psychosis?
Dopamine
Elimination disorders:
- Define encopresis
- Define enuresis
Which sex is most affected? Which age range is typical for each?
- Encopresis: inappropriate passage of feces
- Enuresis: inappropriate passage of urine (may be nocturnal or diurnal)
Boys > Girls
Encopresis: ~ age 4
Enuresis: > age 5
Reactive Attachment Disorder
- Age range?
- Symptoms?
- Cause?
- Untreated sequelae?
- Treatment?
- <5 years old
- Inhibited, withdrawn, hypervigiant, excessive/inappropriate sociability with strangers, limited eye contact
- Repeated changes in primary caregiver, maltreatment, deprivation, impaired parenting (substance abuse, mental retardation)
- Spontaneous remission, malnutrition, infection, death, long-term behavioral and IQ problems, short stature
- Medical care, nutrition, foster care, parental counseling
Eating disorders are more common with which sex?
- Define: anorexia
- Define: bulemia
Girls (often starts in teenage years)
- Anorexia: loss of weight through diet/exercise/starvation with intense fear of gaining weight and thoughts that one is fat despite weight loss
- Bulimia: brief periods of intense eating (bingeing/purging), feeling that one cannot control eating, obsessions/worries with weight
Give 3 factors that may contribute to the development of an eating disorder
Stress
Belief that it is important to be thin (social?)
Dysfunctional hypothalamic control of appetite and hunger
What is a tic? What is Tic Disorder?
What is the typical age of onset for Tourett’s Disorder?
Which part of the brain may be implicated in development of tics?
Quick body movement, sounds, or words that one cannot control. Tic disorder is a transient disorder that features single or multiple motor and/or verbal tics.
Mostly boys, age 7-10. May be associated with OCD or ADHD.
Basal ganglia (exact cause is unknown)
Give a few disorders that should be ruled out before the diagnosis of Tic Disorder is made
Huntington’s chorea
Wilson’s disease
Post-viral encephalitis
medication side effects
Explain the mental symptoms that may present during medical illness in children and adolescents of the following age ranges:
- Infancy (0-2)
- Early childhood (2-6)
- School age (6-12)
- Adolescence
What about their parents?
- Infancy - stranger anxiety, issues with routine changes
- Early childhood - aggression towards physicians, regressed bowel/bladder control, fear of procedures and bodily harm
- School age - behavioral regression, opposition, irrational understanding/explanation of illness
- Adolescence - suffering due to loss of privacy and autonomy
Parents may experience feelings of mourning, anger, resentment, guilt, and denial
Discuss some (non-family) factors in non-compliance among children
- Denial
- Frustration/anger with outcome of treatment
- Wish for attention or priviledges via symptoms
- Wish to regain control
- Rebellion
- Lack of knowledge, understanding
- Peer pressure
- Lack of relationship or communication with healthcare personnel (disinterest, inconsistency, etc)
- Psych disorders: depression, suicidal intent, ADHD, anorexia or bulimia
- Disruption of routine
- Side effects or drugs and treatments
- Inability to connect noncompliance with sequelae
Discuss some family factors in pediatric non-compliance
- Unreloved guilt, denial, anger
- Lack of knowledge or inability to encourage child/adolescent
- Caregiver competition with medical personnel
- Lack of support system (job and personal life concerns?)
- Family conflicts that may be acted out though the child’s care
- Rivalry (asymmetric attention with healthy siblings?)
Give some strategies for anticipating and coping with emotional and behavioral problems in children in the medial setting
- Thorough explanation (as much as developmental age allows)
- Minimize separation from parents (especially if <8 years old)
- Understand and correct misconceptions
- Understand and enable need for children (especially adolescents) to control something in their encironment
- Avoid criticism (of child or parents)
Give several indications for consultation with child/adolescent psychiatry
- Physical symptoms with unexplained cause or etiology
- Noncompliance with medical treatment
- Developmental delays
- Physician observation of depression, anxiety, or hyperactive behavior
- Impaired or regressed school performance
- Suspicion of substance abuse
- Parental difficulties with child rearing (including abuse)
