problem with communication with normal hearing

, forming social relationship,

repetitive purposeless behavior,

MR,

savant skills,

before 3 years old,

more common in boys,

mom has perinatal complication,

baby has ccerebral dysfunction,

genetic component

problem with communication with normal hearing, forming social relationship,

repetitive purposeless behavior,

, normal cognitive development,

no language delay,

diminished social,verbal, cognitive development after 4 years,

only in girls,

stereotype hand-wringing movmeent,

hold breath,

MR

diminished social, verbal, cognitive, mortor development after 2 years of normal function,

MR

hyperactive in boys

inattention in girls

before 7 in 2 setting such as home and school

genetic

antisocial personality disorder + smoking + lead poisoning

more likely abused by caretaker

early diagnosis

CNS stimulant: methylphenidate/ritalin

dextroamphetamine sulfate/dexedrine

adderall

TCA

alpha 2 agonist: clonidine, guanfacine

involuntary movement and vocalization

coprolalia

before 18

start with motor tic at 7 y.o.

then vocal

dysfuncction in caudate nucleus

genetic

M:F=3:1

with ADHD and OCD

atypical antipsychotic: riseridone

typical antipsychotic: haloperidol

child refuse to go to school

overwhelming fear of loss of major attachment figure, usually mother

complains of physical symptom

at risk for anxiety disorder in adulthood, agoraphobia

child, more girls

speak at home but not at school,

whisper or communicate with hand gesture.

primary disturbance in internal emotional state,

M: 5-12%

F: 10-20%

recurrent episode of depression

at least 2 weeks

excessive guilt

anhedonia

decrease appetite or over eat/sleep

1% overall, no sex difference

elevated mood,

grnadiosity, expansiveness

disinhibition-ask doc out

flight of ideas

pressured speech

impaired judgement

delusion

genetic

both mania and depression

vs.

both hypomania and depression

bipolar 1

bipolar 2

highest risk factor is previous suicidal behavior

1/3 attempt try again, 10% succeed

<3 month

close family mem. cocmmitt suicide

have divorced parents

<11 when parent dies

initial stage of recovery in depression

alcohol, drug

divorced

>65 man

middle age: >55F and >45M

adolescent copycat TV

M>F, W>B

no religion, jewish, protestant

access to gun

treatment for mood disorder

untreated for depression? mania?

treatment successful?

% sought treatment?

Sex sought treatment?

most effective treatment?

self-limiting: depression 6-12 m, mania 3m

yes

25% cuz social factor

F>M

pharmacology

antidepressant agent

SSRI

MAO

Li

anticonvulsant

atypical antipsychotics

sedative agent

mood stabilizers:

Li

anticonvulsant: carbamazepine, divalproex

heterocyclic antidepressant

electroconvulsive therapy

MAO I

psychotherapy

primary indication is major depressive disorder when symptoms do not respond to antidepressant medication,

elderly patients

rapid resolution is needed or patient turn suicidal

enlarge bladder capacity in 2 y.o

voluntary control of sphincter muscle in 3 y.o

voluntarily learns to suppress micturition reflex

1st 2 years voiding is reflex

develop continence 3 stages:

repeated voiding of urine during day, at night in bed, clothing

2x/week

3 consecutive month

impaire social/academic functioning

at least 5 years old

genetic, 75%, ENUR1, 2.

enuresis

primary: patient never achieve continence

2ndary: regression from stress, severe neglect from 6 month of total potty training.

diurnal vs. nocturnal.

repeated passage of feces in inappropriate places

1 / month

at least 3 months

at least 4 years.

encopresis

most common: with constipation + overflow incontinence

or without constipation

behavior:

education: do not push

1st line if fam cooporative: bell and pad,

bladder biofeedback: not effective.

pharmacological:

what to do?

enuresis,

daytime wetting, abnormal voiding such as posturing, discomfort, straining, poor urine stream

UTI

genital abnormalities

repeated passage of feces into inappropriate places

attept to prevent involuntary passage of liquid faces

kids ostrecized by stink

increase amount of retained feces

weakens internal anal sphincter with rectal distention

loose awareness of passage stool

intentional depositing or smearing of fecs in prominent location b/c tries to clean or hide feces passed involuntarily

risk of ODD+risk

primary: risk in boys with enuresis

treatment of encopresis with constipation and overflow incontinence

encopresis without constipation

pcp with bowel regimens

behavioral:

education

sitting on toilet after medication

reward accident free day

pharmacological:

bowel evacuation

laxative

fibers

recurrent pulling out of one's hair

noticeable hair loss

increase sense of tension immediately before pulling out or when attept to resist

show pleasure, gratification, or relief when pulling out of hair

oral fixation

F>M, G=B

risk with mood, anxiety, personality disorders, stress.

fam has tic disorder

NOT a derm problem or other mental problem

NOTcausing social/occupational distress.

trichotillomania

early onset <6 remit easier

late onset >13 is chronic

refer to psychiatry and derm together

SSRI

hydroxyzine: anxiolytic + antihistaminic

antipsychotic: orap

Li

insite oriented psychotherapy, hypnosis.

marked disturbed and developmentally inappropriate social relatedness before age 5

fail to initiate response in most social interaction

diffuse attachments by indistriminate sociability and exhibit appropriate selective attachment.

due to grossly pathogenic care.

most at risk: those can't see solution to problem

feeling down, ''cant just snap out of it'

trouble paying attention

feel mad

tires easily

feeling of worthlessness, bored

sleep problem

appetite problem

stay in room instead of go out

decreased interest or pleasure

thought of death

school age: B=G

adolescent: G>B

comorbidity: anxiety, ADHD, LD

2 affective problems

G w/ ADHD more common than B

anxiety

depression

i feel like a bad person, i feel rotten inside

i won't be a problem for you much longer

nothign matters, its no use

give away fav. possession

clean room

throw away important belonging

suddenly is cheerful

hallucination/bizarre thoughts

most common internalized disorder in kids.

can't stop or ignore their worries

separation anxiety disorder

generalized anxiety disorder

social phobia

panic disorder w/ agoraphobia

dogs, spiders

overly clingy, extreme fear of being away from parents

being lost,

crawl to parents'bed

nightmare

refuse to go to schoool

worries when there is really no problem.

excessive and uncontrollable worry

excessive fear of being negatively evaluated, rejected, humiliated or embarrassed in front of others

fear unfamiliar person: difficulty making friends or meet new people

painfully shy

shortness of breath, pounding heart, tingling and numbing sensation, hot/cold flushes/terror

during panic attack: intense fear or discomfort, impending doom, unreality

 fear of being stuck in situation where help or escape is unavailable

more common in teens than kids

panic disorder w/ agoraphobia

agoraphobia: fear of being stuck in situation where help or escape is unavailable

diagnosed with ODD

IQ > 60, academicc achievement < 60

comorbidity with ADHD, disruptive, MDD,

LD:

MR is: both IQ and academic achievement are less.

dyslexia:

distortion, substitution, omission,

slowness, errors in comprehension.

most frequent LD

comorbid: mathematics disorder + disorder of written expression.

dyscalculia/acalculus/gerstmann's syndrome

PALM:

perceptual: can't see numerical symbols

attention: observe operational signs

linguistic: can't figure out math

mathematics: can't calculate

alone: 1/5 LD

writing skills fall substantially below expected level.

not when show only spelling error/poor handwriting

dysgraphia, agraphia

co-occur w/ other LD

Educational Intervention: special education, remedial programs: F

assistive device

psycchosocial support