Child and Adolescent Psychiatry: A Comprehensive Guide to Disorders, Symptoms, and Treatment
Stages of Psycho-Social Development (E. Erikson)
5 Stages:
Stage 1 – Trust vs Mistrust (0-18 Months)
– 0-18 Months
– Most fundamental stage in life
– Because infant’s development is based on trust, dependability, and quality of child caregiver
– If child develops trust, they will feel secure and safe in the world!
– If caregiver is unavailable or rejecting…
…Failure to develop trust will result in fear and a sense that the world is unpredictable
Stage 2 – Autonomy vs Shame & Doubt (18 Months – 3 Years)
– 18 Months – 3 Years
– Greater sense of personal control
– Toilet training, learning body functions
– Food choices
– Toy preference
– Clothing
– If stage is completed = Secure + Confident
– The word ”NO”
Stage 3 – Initiative vs Guilt (3-5 Years Old)
– 3-5 Years Old
– Assert power + control
– Social interaction
– Success —> Capable to lead others
Stage 4 – Industry vs Inferiority (6-11 Years Old)
– 6-11 Years Old
– Children begin to develop a sense of pride in accomplishments
– If +, develop feeling of confidence and belief in skills
– If -, —> doubt
Stage 6 – Identity vs Confusion (12-18 Years Old)
– 12-18 Years Old
– Children explore their independence and developing sense of self!
– Encouragement —> Sense of secure + control
– Lack of encouragement —> Insecure!!
Specific Development Disorder of Scholastic Skills!
– Specific learning disability affects language learning, doing math, and calculation
– Child needs to hear in order to learn language
1- Dyslexia —> Problem reading
2- Phonologic Dyslexia —> Problems with sound analysis memory!
3- Surface Dyslexia —> Problems with visual recognition of form + word structure
4- Dysgraphia —> Problem with spelling/written expression
5- Dyscalculia ———-> Problem with math/problem solving
6- Ageometria————> Problem with disturbed mathematical reasoning
7- Anarithmia———> Disturbance in basic concept formation
8- Dysnomia—–> Difficulty recalling words from memory
– Trouble learning alphabet
– Speech perception limited!
– Language slower
– Problems understanding what is read
^^Tx
1- Psychological therapy!
2- Specialized instructions
3- Separate and intense educational programs
(some children)
Childhood Autism: Symptoms, Correction, and Pervasive Development!
| Asperger Syndrome | – Language and cognition better than autism – Social isolation – Odd – Eccentric – Clumsy – Repetitive patterns/behavior – Atypical sensory response – Pragmatic deficit |
| Autism | – 3 Years Old – (-) Social interaction – Repetitive behavior – Intellectual disability – Severe regression in language & sociability between 18-24 months |
| Childhood disintegrative disorder | – Marked regression after 2 Years Old – More severe than autism – May mimic schizophrenia Affected areas: – Social skills/Language/Bladder/Motor skills |
| Pervasive development disorder | Does not meet criteria of any other subtypes Wide range of cognitive & behavioral problems |
| Rett Syndrome | – Affects after 6 Months of normal development – Deceleration of head growth – Severe intellectual disability – (-) Social interaction – Loss of speech and purposeful use of one hand – Seizures – Autistic features – Ataxia – Mostly girls |
^^Tx:
1- Behavioral Tx —> Psychologist + Educator
2- Speech & Language Tx
————> Should begin early via use of media, singing, picture exchange
3- Physical occupational therapy!
4- X therapy! —> SSRI to improve behavior
ADHD Symptoms, Diagnosis, and Treatment:
^^Symptoms:
– Loss of normal asymmetry in the brain
– Smaller brain volume of specific structures
(Prefrontal cortex + basal ganglia)
– Reduction 5-10%
– Low BF to striatum
– Prefrontal cortex and ganglia rich with dopamine receptors
– Dopamine hypothesis
—-> Disturbance of dopamine systems leads to ADHD
^^Diagnosis: Criteria 1 or 2)
+ of the following symptoms of inattention in the last 6 months to a degree that is maladaptive & inconsistent: INATTENTION A- Fail to give close attention, makes careless mistakes B- Difficulty sustaining attention in tasks/play activities C- Does not seem to listen when spoken to directly! D- Does not follow through instructions! E- Difficulty organizing tasks & activities! F- Avoids mental effort tasks G- Easily distracted by external stimuli I- Forgetful |
Hyperactivity: – Fidgets with hands/feet – Leaves seat when shouldn’t – Runs around – Difficulty playing/engaging with other activities!! – Talks excessively Impulsivity: – Blurts out answers before the question is complete – Difficulty waiting turn – Interrupts or intrudes! |
Conduct Disorder (CD)
– Recurrent, persistent behavior that violates the rights of others!
– Diagnosis is by history
– Treatment: Needs supervision
– 10% of population during childhood/early adolescence
– Boys >> Girls
^^Etiology:
– Genetic + environmental factors!
– Parents engaged in substance abuse
– Parents at risk of ADD, schizophrenia, antisocial
^^Symptoms:
– Lack of sensitivity/feeling well-being of others
– Misperceive behavior of others as threatening
– May be aggressive
– Bully
– Making threats
– Cruelty to animals
– In adolescents, destroy property
– Poor tolerance of frustration
– Boys tend to fight, girls lie/run away
ADHD + Hyperactivity Treatment:
^^ADHD Treatment:
1- Behavioral Tx
2- X
– Behavioral Tx + X is more successful!
– X are used to alleviate symptoms and stop the cycle of inappropriate behavior!
^^X
– Stimulant preparation = methylphenidate/dextroamphetamine!
– Response is dose-dependent
1- Methylphenidate start -0.3 mg/kg/day!
…and then increased!
2- Dextroamphetamine:
– 0.15-0.2 mg/kg
./..then can be raised
– Once the optimal dose is reached,
3- Atomoxetine:
– Selective NE reuptake (-)
– ADR nausea/sedation, irritability/temper/tantrums!/Liver toxicity!
– Atypical starting dose 0.5mg/kg!/day
4- Antidepressant (bupropion2 agonist):
– Clonidine + guanfacine!
^^Behavior:
– Counseling
– Cognitive behavioral therapy!
– Classroom behavior is improved by environmental control!
– Techniques for parents!
– Elimination diets
– Megavitamin Tx
– Antioxidants!
^^Conduct Treatment:
– X —> Comorbid disorder
– Psychotherapy
– Residential center
…Helps self-esteem/self-control/
– X such as stimulants, mood stabilizers, antipsychotics
^^Do NOT:
Moralize + dire admonition NO effective!
Substance Use Disorder:
^^Symptoms:
– Common among children/adolescents
– X: OH/Tobacco/Marijuana
– Other X: Amphetamine/Methamphetamine/Cocaine/…
^^Causes:
– Reason for substance use is to escape pressure/challenge authority/
– Just novel experience
^^Diagnosis:
I- Screening:
– Screen adolescents for use of OH + X
– Provide counseling
– Referral to Tx services & resources!
– CRAFFT questionnaire
– 2+ means further evaluation!
^^CRAFT:
1- C
(Ride in a car driven (including themselves) who is “high” or has been drinking alcohol or using)
drugs
2- R:
(Drink alcohol or use drugs to relax,)
(feel better about themselves, or fit in)
3- A:
(Drink alcohol or use drugs while they are alone)
4- F:
(Forget things they did while drinking or using drugs)
5- F:
(Are ever told by family members or friends)
(that they should drink or use drugs less)
6- T:
(Get into trouble while drinking or using drugs)
Depression in Childhood (Risk Factors)
^^Symptoms:
– Persistent sadness and loss of interest + pleasure
– Decreased sleep
^^Prevalence:
– 2% children
2-8% in adults
Male: Female 1:1
^^Etiology:
1- Genetics —> First-level relative risk 2-4x
2- Environment:
– Parent behavior
– Substance abuse
– Lack of family cohesion
– Neglect!!
Low functioning NE + serotonin are believed to be important markers of depression!!!
**Depression Symptoms by Age:**
ICD-10 depressive episodes:
– Depressed mood
– Loss of interest and enjoyment
– Reduced energy and increased fatigability
(at least 2 of these)
Other:
1- ↓ concentration
2- ↓ self-esteem and self-confidence
3- Ideas of guilt and unworthiness
4- Bleak and pessimistic views of the future
5- Ideas of self-harm and suicide
– Disturbed sleep
– Decreased appetite
*Minimum duration of whole episode is about 2 weeks
Not depressed —–> Fewer than 4 symptoms
Mild depression ———> 4 symptoms
Moderate depression ——–> 5-6 symptoms
Major depression ———–> 7 or more with or without psychotic symptoms
| Infant | Preschool | School |
Increased crying – ↓ expressiveness – Increased irritability – Altered eating behavior – Lack of interest in play | Preschooler depression: – Seems sad – Psychomotor inhibition – Anguish, phobias – Diminished appetite – Sleep disturbance – Aggressiveness | Preschooler depression: – Seems sad – Psychomotor inhibition – Anguish, phobias – Diminished appetite – Sleep disturbance – Aggressiveness |
^^Adolescence:
↓ self-confidence
– Apathy/lack of interest
– Concentration problems
– Psychomotor complaints
– Loss of weight
– Sleep disturbance
– Circadian oscillations
Suicide Behavior: Symptoms, Risk Factors, and Treatment
^^Symptoms:
I- Genetics
– Twin studies that control for life events
– More common in monozygotic twins than dizygotics!
– Pedigree analyzes confirm
II- Serotonin System:
– Hereditary alteration in serotonin system!
– Serotonin is important for regulation of impulse/aggression/mood!
III- Male > Female:
– Reverse in adolescents!
– Males are more aggressive + impulsive than females!
– Males have conduct disorder + chronic anxiety!
– In females, chronic anxiety is related to suicide!
IV- Psychological and social factors:
– History of child mistreatment
– Sexual assault
– Family conflict
^^In older adolescents:
– Relationship breakup
– Homosexual behavior
– Gender dysphoria!
– Hopelessness
– Psychological state
^^Intervention:
1st Principle:
1- Take suicide ideation SERIOUSLY!
(No sarcasm, no joking, no belittling)
2- History of ingestion is necessary
3- Aggressive management of poisoning!
II 2nd Principle:
– Biopsychosocial framework
– Psychiatry status is primary concern!
– Careful psychiatry history!
Anorexia Nervosa:
^^Etiology:
| I- Biological vulnerability: | II- Social influences: | III- Family |
Changes in NE or DA (endorphin neurotransmission) – Changes in endocrine – Reversible CT changes – Unclear mechanisms | Slender —> Attractive – Dieting for professional – Advertisements – Requirements for social achievements for children | Avoiding conflict Rigidity Enmeshment |
IV- Psychological Predisposition:
– Perfectionism
– Low self-esteem
– Sexual/physical abuse!
– Phobic food avoidance
– Alexithymia
^^Diagnosis:
I- History + complaints
– 2 sources: patient/parent/friends
– Inquiry about eating habits/physical activity!
– Somatic complaints: arrhythmia
II- Symptoms:
– Intense fear of becoming obese
– Claiming to ”Feel Fat”
– Refusal to maintain normal weight for age + height
— Denial of hunger
– Weird eating behaviors!
– Purging (hiding food/induced vomiting)
– Restrictions (limit carbs)
III- Assess height + weight with respect to normal curve
IV- Tests
CBC: Leukocytosis, leukopenia, thrombocytosis, anemia (result of malnutrition)
– Serum electrolytes: Hypokalemic alkalosis
– Glucose tolerance test: Oral glucose tolerance test to assess the ability of the body to metabolize
glucose
– Secretin-CCK test: To assess function of pancreas and gallbladder
– Serum cholinesterase test: To test liver function
– LH response to GnRH
– CK test
– BUN test for kidney function
– Thyroid screen: TSH, T4, T3
^^Differential Diagnosis:
1- Mental disorder: Depression/somatization/anxiety
2- Chronic mental illness: IBG
^^Treatment:
– Team of professionals
– Depends on severity of illness!
I- Indications for hospitalization:
– Weight loss > 4 kg/month, systolic BP
– Suicidal behavior
– Severe depression
– Ineffective outpatient treatment
II- Goals:
– Weight restoration
– Nutrient rehab!
– Feeding 6/day
– Start 1000-1200 kcal/day then increase 200-500 kcal/week
– Enteric and parenteral feeding
– Liquids – nutrition additives
– Normal defecation
Discharge i”
1- Weight gain
2- No suicide risk
3- Normal weight range (10% of normal)
III- Psychiatry Tx:
– IV nasogastric tube
IV- Nutritional counseling:
Find target weight
Educational diet information
– Levels of exercise!
V- X:
Antidepressant SSRI
– Off label: Olanzapine/clozapine/haloperidol!
Bulimia Nervosa:
(Etiology/Diagnosis/Treatment)
^^Etiology:
| Biological Vulnerability | Social Influence | Family Character |
– Change in NE or DA – Change in Endocrine – Reversible CT | Slender —> Attractive – Diet | Avoid conflict – Rigidity |
| Psychological |
– Low Self-esteem – Sexual abuse |
+ Inadequate Impulse Control (5-HT dysfunction)
+ Strong Dependency needs with feelings of loneliness, emptiness
^^Symptoms:
– Depression
– Anxiety
– Impulse control (-)
– Self-harm
– ↓ Libido!
^^Diagnosis:
– Episodes of binge eating!
(2 x/week 300K-4000 Kcal week excess for 3 months)
– Not being able to stop eating
– Self-evaluation
– Feeling of remorse/depression after episode
It is hard to diagnose because bulimic weight can be normal!
^^Types:
I- Purging:
Self-induced vomiting, may exercise
II- Non-purging: Exercise excessively
^^Differential Diagnosis:
1- Anorexia nervosa:
– Binges + purges can occur
– But weight low
– Menses irregular
2- Kleine-Levin:
– More psychological features
3- Depressive disorder:
– Patients don’t give too much concern for body and weight!
^^Treatment:
GOAL
1- Restore normal weight
2- Treat complications
3- ↑ Motivation to change
4- Relapse prevention
5- Getting family involved
I- Hospitalization:
– If symptoms are severe
– Suicidal
– Psychiatric disturbance
– Pregnancy
– Treatment (R)
II- Outpatient
Uncomplicated cases
III- Psychotherapy:
Cognitive behavioral therapy
IV- Interpersonal therapy:
Focuses on relationship stressors!
V- Nutritional counseling:
↓ Behavior of eating disorder
↓ Food restriction
↑ Variety
VI- Healthy exercise + behavior
VII- X:
1- Antidepressant/Tricyclics
2- SSRI
***Somatic Complications of Eating Disorder Treatment:Eating disorders cause a wide variety of complications
—–> Some are life-threatening
1- Cachexia: ↓ Fat and muscle mass, / thyroid function, cold intolerance
2- Cardiac: ↓ In cardiac muscle, bradycardia, sudden cardiac death
3- Digestive – GI tract: Bloating, constipation, abdominal pain
4- Reproductive: Amenorrhea, decrease in LH and FSH
5- Dermatologic: Lanugo (fur on body)
6- Hematologic: Leukopenia, anemia
7- Osteoporosis
8- Neuropsychiatric: Seizures
9- Depression, suicidal thoughts or behavior
10- DM II
11- Gallbladder disease
12- Stunted growth
13- Kidney damage
14- Severe tooth decay
15 High or low blood pressure
16- Death
Treatment same as Anorexia + Bulimia
***Non-organic encopresis:Definition: Passage of feces in inappropriate places after > 4 Years Old
^^Cause:
1- Primary:
———-> Global development + enuresis
2- Secondary:
——> High levels of psychosocial stress + conduct disorder!
3- Constipation:
————-> Withholding of stool due to stressors
^^Forms:
1- Retentive:
—-> Constipation + overflow incontinence
—-> 2/3 of cases
2- Non-retentive:
No constipation & overflow incontinence
3- Primary:
From infancy onward
Secondary:
Appear after successful toilet training!
^^Treatment:
– Clear fecal material + mineral oil/laxative to prevent constipation
– Behavior management
– Postprandial toilet sitting
– Manual disimpaction (some cases)
– Encourage the child to go to the bathroom
– Biofeedback to train anal sphincter
– TCA in some cases!
Non-Organic Enuresis
Definition:
– Voluntary/involuntary repeat discharge of urine in clothes/bed
> 5 Years Old
– Most children should control bladder by 5!
^^Etiology:
– Family history
(Chromosome 22)
– Na/K exchange in kidney
– Hyposecretion of arginine vasopressin
^^Forms:
I- Primary Enuresis:
—-> Delayed maturation of bladder function
II- Secondary enuresis:
——> Stress/traumatic event
III- Persistent:
– Child has never been dry at night
– 90% of cases
IV- Nocturnal:
Voiding urine at night
V- Diurnal enuresis:
– Voiding while awake
– Common in girls
^^Treatment:
– Make child cooperate + reward
– Void before bedtime
– Voiding devices!
– Bathroom 1/3 hours in sleep
– Psychotherapy for traumatic
– Adjunctive Tx: Increase bladder capacity
NO punishment or humiliation
^^Tx (X):
-imipramine( Tofranile) :
10-25 mg>5YO
75 mg
-Desmopression
OP / Intranasaly
***TICS
-Sudden Rapid involunatry Movement of muscle group/Vocliazation!
^^Forms:
-Simple—>1 muslce group( eye blinking), shoulder Shrugging!
-Complex: x Muscle Group !
-simple Vocalization : grunting & throat lcearing
-Complex vocalization : repetitive obscentitis
-Trnasient: Motor/vocal Tixs
-Chronic : LAst >1 years
^^Dx:
-No Dc Lab test
-Physcal / neurolgcal cet
-Hx ( Prenatal events/ birth Hx/ encephalitits/ meningitis)
^^Diff Dx:
-Tics unlike dystonia dont stop in Sleep!
-Stress makes them worse
-fasculation onl few muscle
-MRI rule out bran abnormlaty
-TSH level for hypothyrodism
-Autism Spectrum (Hx)
-huntigtons
-Duchee msuclar dystrophy
-Acquired causes of Tics (Ecephalitits/ Trauma)
^^Tx:
-educating the pts abotu what is happeneing
-Doing Sx Test to rule out causes
-Assesment of Motor Skill/cognitice abiities!
-Cognitice therapy!
PANDA(pedaitric autoimmun Neuropsychiatri Disorder of strep)
–>pencillin//erythromycon!
***Children Psychaitry Crises:
^^DeF:
-Face-Face shrot term intensive Mental health servies
-Aim:
1- cope with immediate stressors and lessen suffering!
2-Id and use available resoueces and recepient strengths
3-Avoid unessesy Hospitlalization
4-Return to basesline function
^^Crises Intervention Tx:
-initial crises plan iwthin 24 Hours!
-List childs need & probllem in Crises assement
-ID Frequnecy and tp of Servies provdied
^^Short Term Goals:
-Specifcy Objectives
-Note cultural consideration
-crises staiblziation
-track progress
***Forms of Abuse In Children /Sx/ Tx:
I- Neglect :
-Child Neglect is where the Responsible Adult Does Not provide needs:
1-Physical( Food/ Cloth /Hygiene)
2-Emotional ( Nurture/Affection)
3-Educational (School)
4- Medical ( Not medical the child!
II-Physical abuse:
-Physical Aggression Toward child
..Any type of Biolence esp Physical!
III-Sexual Abuse:
IV-Physiological /Emotional Abuse:
-Name Calling /bullying/ Desturction
^^Physical Sx of Abuse:
-Severe : Bone Fracture
-Minor: Bruises/ Cuts
-Poor physical condition (arhtritis/ Asthma.Bronchitis/ hgih BP)
-Transmisison of Toxins to a child through mother
-Long Temrm:
Shakcing a child ,Shking baby syndrome!
—> increasee intercranail pressure
—>O2 dperie
—>failture to thrive
^^Psychological Sxo f abuse:
-Vitim Guilt , Trauma,Insominia
-Sx of child neglect
^^Tx:
-Tx physcical injires
-Trauma Focus on Cognitive behavioral therpay!
(PTSD. Depression anxiety)
-Abuse Focus ….
-Child Psychotherpay
-group therapy
-Art therapy
^^Prevention:
-Child protective Servies
-Contraceltive+ Pregnancy Planning!
***Delirium in Childre:
^^DEG:
Most common + severe Neuropsychiatirc sundrome!
-Acute onset
-A
^^CF:
attneion Devifict!
-Arousal Change( Hypo/Hyperactive)
-Perceptial deficit
-Alternd Sleep-wake cycle
-Psychotic feautes!
^^Causes:
1-Infection
———>acute systemic Viral Ifnecion / Acute systemic bacteiral infection/
Meningitis/ encephalitis/ Brain Abscess/ Malaria/ Rabies!
2-Metabolic:
—–>hypoglycemia/Diabetic Ketoacidocis/ Hyponatrueia / uremia!
3- cirulatory:
——>hypocia/Hea Stroke
4- structural Brain change
(Due to concuiso/bleeding)
5-Neutpogical
(epilepsie)
6-X
(opaites/ BZDS)
7- X:
(Oh / Anesthics)
8- Autoimmune:
SLE
9-Mental illness:
Manai Acute psychosis!
^^DX:
1-CF
(hyperitivue as +ve sign )
(hypoactiie as -ve signs)
2-PRevious assemsent andk noowledge of affeced person basleine
3- Diff Dx
^^Tx
-Tx underlying cause
-Optimising condition of brain
-O2
-hydrate
-Treat Pain
-Tx constipation
-Non X
(Avoid uneccassary movement)
-Verbal + non erbal de-excalatio
-X (depends on cause)
(include anti psychotics)
****Diff Dx of Acute Psychosis
^^Psychosis:
-Disruption in thinking ,Accompanied by delusion or hallucination!
^^Delusion:
-False , Fixed BeliefsThat cannot be resolved through logical arguments!
^^Halucinations :
False perception that have no basis in external stimuli!
^^Delisium:
Alternal Sensory with waxingwaning deficit!
Also consider Hypoglycemia/Cerebral Hypocia/X Toxicity!
^^Substrate Def :
1-hypoglycemia : rare but important Cause of psycosis + Hallucination!
—->Reuire immediate bedside cappillary glucose testing!
2-Cerebral Hpoxia( Lack of O2)
—>Alterned mental status
***Prcinciple of Early Schizo Tx:
-Early Schizo occurs in Puberty+ early Adolescence!
^^Sx:
-Social Withdraw
-Disruptive Behavior!
-Development Delay
-Speech + language!
^^Tx:
I-Parent Training to Teach effective Technique
II-Individual therapy to Build +ve alliance
III- Scheol And lesson work
IV- NEuroleptic therpy
—> For hallucination + Delusion
1-Risperidone
2-Olanzapine
***Somatization Disorder:
^^Gx:
-Presenting Complaint >13 Physical Sx
-Sx Not caused by physiological /Px Machnism
-Sx to need to matian sick role!
I-Pain SX:
Head
back
Joints
Chest
Rectum
Adomen
Extrmities
urination
mesnturation
II-GI Sx:
-Nausea
-Food Intolerance
III-Seual Sx:
-Sxual apathy
-Erectile dysfnction
-Vommit
IV-Pseudoneurological:
-Diff Swallowing
-Loss of Touch senstion
-Hallicunation
-Aphonia!
-Seizures
-Blindness
-Deafness
-Urinary retention
*** Somatization :PRinciple of Dx+ Tx
-Each of the folloign must be met
-4 Pain sx:
-Hx of pain in 4 Sites
-2 GI Sx :
(Nausea/bloating/ vommiting…)
-1 Sexual Symptomn :
(Sexual apathy , ejaculatory dysfunction)
-1 Pseudoneurologic Sx:
^^Dx:
1- check the Sx
2-check for Socialpx Causes ( if psosible)
3-Clinical assesment
^^Tx:
-where No PX finding avoid Tx!
-Intervention and address psychological Factor
-Psychoactive X may be useful for anxiety /Depression
-Talk to Pts and reaasure them!
—> Tell them they need to carr on living!
***Anxiety Disorder:
-if it itnervetion with everyday life!
-most common psychaitry Disorder in childhood!
^^Forms:
1-Seperation anxiry disorder(SAD)
2-Chilldhood-onset
3- general Anxiety disorder(GAD)
4-Phoias
5- PTSD
6-Panic disorder
^^Diff Dx:
I-Diff Tpes of Anxieties
(Stranger wariness 7-9 M)
(Prescool Fear of Dark/animal)
(Adolescene General worry)
I-SAD:
-unrealizric persistant of worry
of possible had!
-afraid to go to school
-Constant need to be clsoe to parents!
II-Childhood Onset Phobia:
-Ecessive Anxiety
-Leading sial isolation!
-still have want to be involevent!
III-Selective Mutism:
overlaps with Social phboia
***Tx of Anceity disorder:
I-Separation anxiety disorder
| cause Mothers of children with SAD are likely to have a history of an anxiety disorder.these children are at a risk of developing panic disorder in adolescence |
• screen for parental depression or anxiety. • When a child reports recurring acute severe anxiety, antidepressant or anxiolytic medication is often necessary.. Data support the use of selective serotonin reuptake inhibitors (SSRIs) . • Cognitive behavioral therapy benefits children with SAD, especially when the parents are |
II-childhood onset social phobia
| A family history of social phobia or extreme shyness is common. |
| • SSRIs are considered the treatment of choice. • Antianxiety agents are not effective. likely to have SAD, • Management of school refusal requires parent management or even family therapy. • Working with school personnel is always indicated; anxious children often require special attention from teachers, counselors, or school nurses • Parents who are coached to calmly • In cases of ongoing school refusal, referral to a child psychiatrist is indicated. |
III-Selective mutism
| Cause It is a disorder that overlaps with social phobia.Stressors exist such as a new classroom or parental or sibling conflict, will drive an already shy child to become reluctant to speak. |
• Fluoxetine in combination with behavioral therapy has been shown to be effective for children whose school performance is severely limited by their symptoms IV-Panic disorder Treatment • SSRIs have shown effectiveness in the treatment of adolescents .The recovery rate is |
IV-General anxiety disorder
Cause
– It has been linked to disrupted functional connectivity of the amygdala
– triggered in response to life stressors
– may run in families
– grows worse during stress.
Treatment
• cognitive-behavioral therapy (CBT),
• a trial of buspirone or an SSRI may be indicated when symptoms are particularly limiting.
Cause
– It has been linked to disrupted functional connectivity of the amygdala
– triggered in response to life stressors
– may run in families
– grows worse during stress.
Treatment
• cognitive-behavioral therapy (CBT),
• a trial of buspirone or an SSRI may be indicated when symptoms are particularly limiting.
V-Obssesive:
Cause • Neuroimaging studies have documented abnormalities in the frontal lobes, the basal ganglia, and their associated pathways. • symptoms are triggered or exacerbated by group A B-hemolytic streptococcal infection (GABHS). |
| Treatment • Combined treatment (CBT plus SSRI) experience remission in 50%, it is less successful if each therapy is taken alone . • Referral of patients with OCD to a mental health professional is always indicated. • The pediatrician should be aware of the infectious cause and follow management guidelines |
VI-Phobia:
| Cause Phobias are generally caused by an event recorded by the amygdala and hippocampus and labeled as deadly or dangerous; thus whenever a specific situation is approached again the body reacts as if the event were happening repeatedly afterward |
| Treatment • The parents of phobic children should remain calm in the face of the child’s anxiety or panic. • Systematic desensitization is a form of behavior therapy |
VII-PTSD:
| Previous trauma exposure, a history of other psychopathology, and parental symptoms of PTSD predict childhood- onset PTSD. PTSD is linked to mood disorders, disruptive behavior, and other diagnoses in childhood. |
| Treatment • Initial interventions after a trauma s • Aggressive treatment of pain • Long-rerm treatment may include individual, • Group work is also helpful for identifying which children may need more intensive assistance. • Clonidine or guanfacine may be helpful for sleep disturbance, persistent arousal, and exaggerated response. |