Download Slides 25 - Association for Academic Psychiatry

“I guess what I miss most is being drunk.”
SUD Assessment
Parental
values
Genetics
Culture
Individual
Peer
group
characteristics
Suicide
Epidemiology
Impulse
control risk factors
Biopsychosocial etiology
Gender differences
Tic Disorders
Sudden, rapid, recurrent nonrhythmic, stereotyped, motor
movement or vocalization
Tourette’s Disorder
motor
before vocal
autosomal dominant
Symptoms of Depression in
Young People
Irritability
 Denial of depression
 Low self-esteem
 Somatic Complaints
 Depressed appearance

Diagnosis of Dysthymia
Depressed
or irritable mood
lasting a year or longer
Never symptom free for
longer than 2 months
Diagnosis of Dysthymia
(Cont’d.)
 Symptoms
–poor
–pessimism
concentration
–social
–hopelessness
withdrawal
–sleep and
–decreased
appetite changes
energy
–low self-esteem
Risk Factors for MDD and
Dysthymia
Stressful life events
Parental dysfunction and loss
Boys - neonatal health problems
Girls - perceived unpopularity,
anxiety
Early Onset Bipolar
Disorder
 Changes
in mood, sleep pattern
and energy
 Hyperactivity and irritability
 Distractibility
 Pressured speech
Early Onset Bipolar
Disorder (Cont’d.)
Affective
symptomatology
Visual hallucinations
Unreasonable irritability
and anger
Epidemiology of
Depression
Incidence increasing
4.7%
Mean
MDD among adolescents
age of onset 11 years
0.7% bipolar among adolescents
“Son, it’s important to remember that its
O.K. to be depressed.”
Depression Biologic
Etiology
Genetic influences
Structural and functional changes
Serotonin and norepinepherine
Cortisol and growth hormone
Attachment experience
Depression
Psychosocial Etiology
Developmental
dynamics
Life stress
Family dysfunction
Cultural support
Depression DDX and
Co-mobidity
Bipolar
Disorder
ADHD
Anxiety
and PTSD
•Medical causes
Separation Anxiety
Disorder
 Excessive anxiety about
separation from the home
or from significant others
Differential Diagnosis
Phobia
Conduct Disorder
LD
Depression
Selective Mutism
 Failure
to speak in
specific social situations
despite speaking in other
situations.
Reactive Attachment
Disorder of Infancy or
Early Childhood
 Developmentally
inappropriate social
relatedness beginning before
age 5 associated with
pathological care.
 Inhibited and Disinhibited Type
Generalized Anxiety
Disorder
Excessive anxiety and worry
for at least 6 months
Worry about performance at
school and sports
 DSM IV criteria less stringent
Phobias
 Most
common disorder in
childhood
 Fears and anxieties decrease
with age. About 2 - 3% of
adolescents have significant
fears.
Phobias (Cont’d.)
Fear of loud noises, the dark,
animals, or imaginary
creatures are common in
younger children. In older
children, fears are more
focused on health, social and
school problems.
Obsessive-Compulsive
Disorder
High
incidence in Tourettes
Age of onset younger in
males
Basal ganglia disorders
(PANDAS)
PTSD
Fear
of separation, withdrawal,
reenactment, sleep disturbance,
regression, impulsivity
Anxiety, psychosis
Physical symptoms, nightmares
Response to Traumatic
Events
 The
effect of trauma depends on the
mediating processes
– developmental level
– biology of the trauma experience
– social context
– coping skills, protective factors,
resilience
Childhood Trauma

Type I
– full detailed
memories
– “omens” and
misperceptions

Type II
– denial and
numbing
– self-hypnosis,
dissociation, rage
Dissociative
experiences both
during the trauma
and afterward is related
to the later development
of PTSD
Biologic Response to Stress
Genetics
 Fight or flight
 Norepinepherine linked to immediate and
prolonged response
 Serotonin linked to anxiety and panic in
PTSD

Biologic Response to Stress
(Cont’d.)
 Brain
regions involved include locus
coeruleus, ventral tegmental region,
and amygdala
 Increase glucocorticoid release results
in loss of neurons and decreased
dendritic branching in hippocampus
and cognitive dysfunction.
The Child Interview (Pynoos)
 Stage
I
– focus and
traumatic
reference
 Stage
2
– relive experience
– coping themes
– closure,
recapitulation,
courage/strengths
Associated Problems
 Co-morbid
 Substance
psychiatric disorders
abuse
 Sexual/intimacy
problems