* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Anxiety and Children
Pyotr Gannushkin wikipedia , lookup
Major depressive disorder wikipedia , lookup
Freud's psychoanalytic theories wikipedia , lookup
Autism spectrum wikipedia , lookup
Posttraumatic stress disorder wikipedia , lookup
Substance use disorder wikipedia , lookup
Schizoaffective disorder wikipedia , lookup
Excoriation disorder wikipedia , lookup
Obsessive–compulsive personality disorder wikipedia , lookup
Factitious disorder imposed on another wikipedia , lookup
Controversy surrounding psychiatry wikipedia , lookup
Antisocial personality disorder wikipedia , lookup
History of psychiatry wikipedia , lookup
Mental status examination wikipedia , lookup
Mental disorder wikipedia , lookup
Classification of mental disorders wikipedia , lookup
Diagnostic and Statistical Manual of Mental Disorders wikipedia , lookup
Emergency psychiatry wikipedia , lookup
Dissociative identity disorder wikipedia , lookup
Conduct disorder wikipedia , lookup
Abnormal psychology wikipedia , lookup
Narcissistic personality disorder wikipedia , lookup
Conversion disorder wikipedia , lookup
Depersonalization disorder wikipedia , lookup
Spectrum disorder wikipedia , lookup
Asperger syndrome wikipedia , lookup
Causes of mental disorders wikipedia , lookup
Obsessive–compulsive disorder wikipedia , lookup
Selective mutism wikipedia , lookup
History of mental disorders wikipedia , lookup
Child psychopathology wikipedia , lookup
Claustrophobia wikipedia , lookup
Panic disorder wikipedia , lookup
Anxiety disorder wikipedia , lookup
Anxiety and Children (Albano, Chorpita, Barlow, 2005) Anxiety and Youth Anxiety disorders are among the most common Psychiatric disorders affecting children and adolescents Anxiety disorders tend to have an early onset in childhood and adolescents and run a chronic course well into adulthood Anxiety symptoms may worsen over time (kindling, Physiological effects and learning) and may lead to depression, suicide, Substance use, and Psychiatric hospitalizations. When do they worsen? Yet Anxiety Disorders are not well understood with youths Normal Childhood Anxiety All children are expected to display separation anxiety or specific fears at various times in their lives The intensity and duration of this “normal anxiety” has not been well studied Anxiety is a normal aspect of moving from dependency to autonomy that resolves thru repeated exposure to new experiences (habituation) and successes (efficacy) Pathological Anxiety Measured by: Intractability Pervasiveness or fear and avoidance Degree of interference on daily functioning For example: Continued school refusal Assess: 1) Avoidance of negative affect 2) escape from aversive social and evaluative situations 3) attention seeking 4) Positive reinforcement (TV Watching) A note about Panic Disorder Adult Panic Disorder requires metathinking, thus children tend to present differently prior to adolescence (hormone shift tends to exacerbate the disorder) Fear of becoming sick/vomiting Refusal to eat Avoidance of places where escape is difficult or endured activities with a “safety person” The Biopsychosocial Model As you have already begun to see, psychopathology must be assessed in context and I use the Biopsychosocial model. All aspects are important None are independent of the others We could argue chicken or egg…… Etiology-Triple Vulnerability or BioPsychoSocial Model Heritable Biological Diathesis Generalized Psychological Vulnerability (Temperament) Specific Psychological Vulnerability (Psychosocial Factors) Etiology-Genetics Anxiety is highly heritable A shared genetic risk factor may be responsible for a general vulnerability for anxiety or depression, and unique experiences modify the specific expression of this vulnerability. Etiology-Temperament A general vulnerability may be connected to temperament identifiable at 21 to 31 months. When exposed to unfamiliar settings, people, or objects is the child: Inhibited Uninhibited Etiology-Temperament (2) Looking at the biological system that underlies motivation and emotion, we can explore the behavioral inhibition system or BIS. (hippocampus, hypothalamus, prefrontal cortex, locus coeruleus) The BIS is activated by signals for punishment, nonreward and novelty resulting in narrowing of attention, inhibition of gross motor behavior, increased scanning/vigilance, increased central nervous system arousal (alertness), and activation of the fight flight system. This system becomes “primed” if the cortisal levels remain elevated for long periods of time, thus reacting more quickly and not “shutting down” as easily resulting in anxiety disorders. If the BIS is activated over time…depression may develop. Interestingly, we often see anxiety preceding depression, but not the reverse. Etiology-Psychological Factors Aspects that may increase the risk for negative emotions Coping Social/familial transmissions Information processing Perceptions of Control Etiology-Psychological Factors (2) A history of lack of control may lead to vulnerability to stressful events leading to anxiety disorders. An early lack of control high BIS processing of events as uncontrollable higher BIS… Etiology-Psychological Factors (3) Parenting: Parent modeling, prompting and rewarding of anxiety leads to learned anxiety. Parental distress related to child trauma also impacts the development of child anxiety disorders. Children in early years look to emotional reactions of others to novel stimuli to determine the meaning of the stimuli. Empirical treatment that focus on family interventions vs. child interventions have higher response rates. Etiology-Psychological Factors (4) Attachment Theory: Insufficient emotional attention or over control are problematic thus, “Affectionless control” Anxiety Circular process: Anxious child may draw intrusive and controlling parenting more than non anxious child. Etiology-Psychological Factors (5) Trauma Abuse Loss Oppression, Discrimination/Isms Overt Covert Other events All have aspects of lack of control, punishment, injury to self Diagnosis and Treatment of Anxiety Diagnosing Anxiety Disorders Anxiety Disorders Panic Attack Agoraphobia Panic Disorder w/out agoraphobia Agoraphobia w/out hx of panic disorder Specific Phobia Social Phobia OCD PTSD Acute Stress Disorder GAD Anxiety due to Medical condition Substance induced Anxiety NOS Anxiety due to a Medical Condition Cardiopulmonary disorders Hyperthyroidism-may include heat intolerance and tremor Hypoglycemia- reduced by eating candy Alcohol ingestion Caffeine overdose Must cause distress or impaiment Specify: with generalized anxiety, with panic attacks, or with oc symptoms Panic Attack- not a diagnosis, but specified with anxiety diagnosis Four or more that develop abruptly and peak with in 10 minutes Pounding, racing, palpitating heart Sweating Trembling, shaking Short of breath or smothering Feeling of choking Chest pain, discomfort Nausea/abdominal stress Dizzy, lightheaded, faint Derealization (detached from reality) or depersonalization (detached from oneself) Fear of losing control or going crazy Fear of dying Paresthesias (numbness/tingling) Chills/hot flashes Panic Attacks After the first one, people tend to become afraid of further attacks, making symptoms worse and causing anxiety between attacks (anticipatory anxiety) If cued, people begin avoiding triggersleading to agoraphobia at times Teach to breath (they are hyperventilating) or use paper bag. Educate about attacks and cycles. Ensure they are not going crazy. Agoraphobia- also not codable, but occurs with other disorders Anxiety about being in places from which escape might be difficult: Being outside the home alone, being in a crowd, on a bridge, on a bus, train or car, etc. Situations are avoided, endured with much distress, or require a companion Not a social or specific phobia Panic Disorder Usually begins prior to 35 yrs Separation anxiety or childhood loss may predispose Runs in families Has fluctuating course and tx has not failed if some symptoms persist or reoccur Catastrophobic thinking needs to be addressed Imipramine, SSRIs, MAOIs, Benzodiazepines Presentation of Panic Disorder In some cultures: Intense fear of witchcraft or magic More often in women than men Onset is typically between adolescents and mid-30’s Chronic, but waxes and wanes Familiar pattern Panic Disorder Presence of recurrent, unexpected panic attacks with at least 1 month of persistent concern about having another, consequenses, or sig behavior change related to attack Not substance or medical Not social, specific, OCD, PTSD, or Separation Anxiety Panic Disorder With agoraphobia or without agoraphobia Agoraphobia w/out history of Panic Disorder Focus of fear is on having panic like symptoms or embarrassing/incapacitating symptoms (no full panic attacks) Does not meet criteria for Panic Disorder Not Substance or Medical Not better accounted for by another disorder or Axis II avoidant More often diagnosed in females May persist for years and has much impairment Specific Phobia (formerly Simple Phobia) Marked and persistent fear of an object or situation Exposure provokes anxiety response Avoided or endured with dread Realization in adolescents and adults that the fear is excessive (as opposed to delusions) Marked distress or interference with functioning Not better accounted by another mental disorder If under 18, at least 6 months Specific phobia subtypes Animal Type, Natural Environment Type, BloodInjection-injury type (may have genetic link), Situational Type, Other Type Often results in restrictive lifestyle Children may express with crying, tantrums, freezing, or clinging and do not have the cognitive abilities to recognize the fears are excessive Predisposing factors: traumatic events, pairing w/ unexpected panic attacks, or informational transmission Familial link Specific Phobia researched Treatment Desensitization: exposure, relaxation, mental rehearsal, supportive therapy Flooding, graduated exposure, systematic desensitization MAOIs and SSRIs Social Phobia 300.23 Marked and persistent fear of social or performance situations in which embarrassment may occur. May also be hypersensitive to criticism, negative evaluation, or rejection, trouble with assertiveness, low self-esteem and feelings of inferiority, poorer social skills Typical onset in mid-teens, but can begin in childhood and may be continuous depending on environmental demands Familial link Social Phobia & Culture Japan and Korea: fears of giving offense to others in social situations (blushing, eye contact, or one’s body odor will offend others) Social Phobia Criteria Fear of social or performance situations, and provoke anxiety. Situations are either avoided or endured with extreme distress. Person recognizes the fear is excessive The avoidance or distress impairs functioning Under 18, must last at least 6 months Not substance or medical Specify Generalized if fears include most social situations ( and consider avoidant personality disorder) Tx of Social Phobia SSRIs Beta Blockers for performance Social Skill training and Assertiveness training Exposure CBT Obsessive Compulsive Disorder Obsessions- persistent, disturbing, intrusive, thoughts or impulses which the patient finds illogical but irresistible These obsessions are considered absurd and client’s actively resist them Compulsions- obsessions expressed in action. Rituals used to prevent or reduce anxiety (repetitive behaviors) Both are used to reduce anxiety Symptoms take up time, interfere with routine or functioning, and marked distress Not specific to another mental disorder Specify with poor insight if excessiveness is not recognized OCD Presentation People keep symptoms a secret, due to embarrassment Thoughts or images can be violent or disgusting. “I want to stab my cat” which disturb the client. Compulsions must be completed or the client believes something bad will happen. Forms of OCD Washers Checkers Doubters and Sinners Counters and Arrangers Hoarders OCD 2/3rds had symptoms prior to 15, and most had some symptoms in childhood. Chronic, lifelong, waxing and waning illness Attempts to resist obsessions and compulsions increases anxiety Familial link Obsessions are overvalued ideas, not delusions OCD vs OCPD OCPD- ego syntonic No true obsessions/compulsions OCD- ego dystonic OCD Presentation May avoid situations related to obsessions, such as dirt/germs Guilt and sleep disturbances may be present Excessive use of substances or sedatives may occur Equal in males and females Onset: males 6 to 15, females 20-29. Chronic, waxing and waning course Familial link OCD Treatment SSRIs Need Continued medication due to chronic nature of disorder Behavior therapy with graded exposure and response prevention Address catastrophic thoughts PTSD Exposure to trauma that involved actual or threatened death or serious injury, or threat to physical integrity of self or others A stressor is followed by either 1) reexperiencing (intrusion) Hypervigilant, on edge, flooded by intrusive images (hallucinations, nightmares, mental images), poor sleep and concentration, ruminate about stressor, cry “without reason”, emotionally labile, easily startled, somatic anxiety, fear going crazy and are unable to think about anything except the stressor And 2) avoidance of the event May deal with denial w/ psychic numbing, minimizing the significance of the stressor, forgetting it, feeling detached from others, losing interest in life, constricted affect, daydream and abuse drugs PTSD Increased arousal: difficulty falling or staying asleep, irritable or anger outbursts, poor concentration, hypervigilance, exaggerated startle response Lasts more than 1 month Significant distress or impairment PTSD Acute: less than 3 months Chronic: 3 months or more With delayed onset: 6 months after stressor (worst prognosis) Triggers worsen symptoms Natural events cause less distress than People distress (torture) PTSD Auditory hallucinations and paranoid ideations can occur in severe cases PTSD Diversity In Men, more common military/war In women, more common rape, sexual and physical abuse Immigrants from war areas may be hesitant to talk about experiences PTSD Treatment Debriefing immediately after event can prevent PTSD Support groups Confronting feared memories/topics Examining misinterpretations of events Development of coping EMDR, TFT Trazodone for sleep Acute Stress Disorder Briefer form of PTSD lasting 2 days to 4 weeks Plus 3 symptoms immediately after stressor (with in 4 weeks): subjective numbing, reduced awareness of surroundings “being in a daze”, derealization, depersonalization, dissociative amnesia (inability to remember important aspects of the trauma) Persistent reexperience of trauma Avoidance of triggers High Anxiety Impairment Not substance or medical Generalized Anxiety Disorder Excessive anxiety and worry occurring more days than not for at least 6 months, about a number of things. Person has trouble controlling the worry. 3 or more: Restless/keyed up/on edge, easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbance Anxiety or worry not confined to other Axis I disorder Cause distress or impairment in functioning Not substance or medical GAD Presentation Chronic worry warts Tense Highly distractible Irritable Restless On edge Fatigued and mildly depressed Physical complaints Depression and Anxiety 50% comorbid Treat depression with antidepressants and this will help with anxiety GAD Treatment ID stressors that exacerbate anxiety Eliminate dietary and physical sources of anxiety Increase exercise with physician’s approval Deep Muscle relaxation, meditation, biofeedback Buspar, SSRIs, Benzos Generalized Anxiety Disorder Culture: In many cultures, anxiety is expressed somatically or cognitively Children: performance in school, sports, punctuality, catastrophying about war/earthquakes/etc, seek excessive approval and reassurance, things need to be perfect Somewhat more frequent in women Chronic but fluctuating course Familial association Others Anxiety due to a general medical disorder Substance-induced anxiety disorder Anxiety Disorder NOS Treating Anxiety Teaching Relaxation Breathing Techniques Desensitization (Approach vs. Avoidance) Cognitive Triad All/Nothing Future Focus Catastrophyzing Internal Conflicts