child and adolescent emotional disorders

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jroy6102
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51584
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child and adolescent emotional disorders
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2010-12-05 12:51:33
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emotional disorders
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Psychology
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  1. strong negative emotion and tension in anticipation of future danger or threat (worry)
    ANXIETY
  2. emotional reaction to present
    danger, characterized by alarm and strong
    escape tendencies (fight/flight response may occur)
    FEAR
  3. sudden fight/flight response in absence of obvious, real danger/threat
    PANIC
  4. sympathetic nervous system initiates fight/flight response
    Physical System
  5. attentional shift, hypervigilance,
    nervousness, difficulty concentrating
    Cognitive System
  6. aggression and/or avoidance
    Behavioral System
  7. % of parents report that their children are too nervous, fearful, anxious
    25%
  8. Excessive anxiety about being away from
    home or apart from parents.
    Must last >= 4 weeks Must occur before age 18. 4% prev, child>teen, girl>boys
    Separation Anxiety Disorder (sad)
  9. Extreme, disabling fear of specific
    objects or situations that pose little or no danger. Avg onset 7-8yrs; peaks by 10-13yrs
    2-3% prev, child>teen, girl>boys
    Specific Phobia (sp ph)
  10. Excessive, uncontrollable anxiety and
    worry about numerous events and activities.
    Must last >= 6 months, Boys=girls, 2-4% prev, teen>child, girl>boys
    Generalized Anxiety Disorder (gad)
  11. Marked, persistent fear of being the
    focus of attention or doing something humiliating. 1-3% of children (more common
    in girls) Avg onset is 11-14 yrs (rare before
    10yrs, BUT often described
    as “always shy”)
    Social Phobia (SoPh)
  12. Persistent failure to speak in social
    situations, despite ability and willingness to speak in private with close
    family/friends 90% also meet criteria for Social Phobia. Must last >= 1 month,
    1% prevalence, child>teen, girls>boys
    Selective Mutism (sm)
  13. recurrent uncued panic attacks, plus persistent concern about having another attack or its consequences/implications. only 1% or less will actually have panic disorder.
    Avg onset is 15-19 yrs. More common in girls.
    Panic Disorder
  14. a sudden, overwhelming period of
    intense fear/discomfort accompanied by characteristics of the flight/fight
    response. Panic attacks (3-4% adolescents) more common than panic disorder.
    Panic attack
  15. Anxiety about being in places where
    escape would be difficult or embarassing, or where help is unavailable if have
    panic attack or panic-like sx. can have it without panic disorder but it is rare (it
    would mean that they did not have recurrent uncued panic attacks)
    Agoraphobia
  16. Exposure to Traumatic Event,
    Afterwards, show 3 core features for > 1 month
    1)persistent re-experiencing of the event,
    2)avoidance of associated stimuli and numbing of general responsiveness, and
    3)symptoms of extreme, increased arousal
    Text says 3.7 for boys and 6.7 for girls (6month prevalence)
    Posttraumatic Stress Disorder (ptsd)
  17. Innate variation in reaction to novelty
    (overactive Behavioral Inhibition System)
    Temperament
  18. releasing hormone (CRH) gene associated with proneness to anxiety (overactive Behavioral Inhibition System)
    (It works on HPA axis and limbic system to produce increased CRH in nucleus of amygdala,and thus heightened fear in response to stressful situations – these
    individuals have a stronger fear reaction to potentially dangerous situations)
    Corticotrophin
  19. Little Hans & horse
    Psychoanalytic Theory (Freud)
  20. Little Albert & white rat
    Learning Theory (Watson)
  21. insecure attachment
    Attachment Theory (Bowlby)
  22. corticotrophin-releasing factor systems become hyper-reactive to stress
    Behavioral Inhibition System
  23. >75% response rates for our most effective treatments. Some studies have found 95% response rates when combine effective treatments.
    Evidence-Based Treatments (EBT)
  24. Step 1: Relaxation Training
    Step 2: Generation of Hierarchy
    Step 3: Graded Exposure using Relaxation to
    keep anxiety level down
    Systematic Desensitization
  25. (1)Recognize anxious thoughts,
    (2)Modify/challenge anxious thoughts
    Identify/ recognize / monitor automatic thoughts,
    CognitiveRestructuring:
  26. Parent/family add-on to child CBT
    (1) psychoeducation
    (2) behavioral parenting skills
    (3)family communication and problem solving skills
    (4)personal anxiety management
    Family Anxiety Management (FAM)
  27. Obsessions: repeated, intrusive,
    irrational, and anxiety-provoking thoughts,
    images or impulses
    Compulsions: ritualized and/or excessive behaviors to relieve anxiety
    or discomfort
    2-3% of children (boys>girls; males=females in adults)
    Obsessive-Compulsive Disorder (OcD)
  28. sudden, rapid, recurrent, nonrhythmic, stereotyped behavior
    Motor vs Vocal Simple vs Complex
    Tics
  29. <1% of children (2-5x more likely in
    boys) Modal onset 6-7 years (tics often
    decrease in adulthood) Very high co-morbidity with OCD (35-50%); also some comorbidity with ADHD, behavior problems
    Tic Disorder
  30. Recurrent pulling out of one’s hair
    Must result in noticeable hair loss
    Increasing tension before pulling, or
    when try to stop
    Pleasure, gratification, or release of
    tension when pull
    Less than 1%, Modal onset in early adolescence
    Trichotillomania
  31. Skin-picking, wound-picking
    ¨Finger and thumb-sucking
    ¨Nail biting¨ Cutting, burning and other self-injurious behaviors
    Other repetitive behaviors
    Impulse-Control Disorder, NOS
  32. Extreme, persistent, or poorly regulated
    emotional states
    2 types: Unipolar Depression (MDD, DD)
    Bipolar Depression (BPI, BPII, Cyclothymia)
    Mood (or Affective) Disorder
  33. depressed mood (in children, it can be predominantly irritable mood)*** (Intense
    depression – can’t snap out of it; Excessive crying; Irritability / anger diminished
    interest/pleasure in activities*** (Anhedonia – things aren’t fun anymore; Social
    withdrawal)
    Major Depressive Episode (MDE)
  34. 1 or more Major Depressive Episodes
    Lifetime Prevalence: Less common in preschool and school-age
    children@ 2% in children
    Increases in adolescence and adulthood
    @ 5-20% in adolescents
    (up to 20% adults; @ 1 in 5 will have a
    depressive episode in their lifetime)
    Major Depressive Disorder (MDD)
  35. At least 2 years (1 year) with depressed mood (irritable) most of the day, most days
    Plus 2 or more: poor appetite or overeating
    insomnia or hypersomnia
    low energy or fatigue
    low self-esteem
    poor concentration or difficulty making decisions
    feelings of hopelessness
    No more than 2 months (1 month) without
    depressive symptoms
    Lifetime Prevalence:
    Less common than MDD @ 1%
    of children ; @ 5% of adolescents (about
    6% of adults) Male= Female
    Dysthymic Disorder
  36. Abnormally and persistently elevated, expansive or irritable mood, lasting at least 1 week (or causing hospitalization)
    Excessive involvement in pleasurable activities with high potential for negative
    consequences (e.g.,reckless behavior, out of control spending, gambling, high-risk sex,
    investments)
    Manic Episode
  37. Abnormally and persistently elevated, expansive or irritable mood lasting at least 4 days 3 or more of the same symptoms as Manic Episode
    Hypomanic Episode
  38. Manic Episode or Mixed Episode (Mania
    + Depression)
    Note: Usually also have MDE but not required for dx
    About 20% of adults with bipolar had 1st
    onset during adolescence 15-19, (early adulthood is big time; then another
    small peak is in later life like age 50)
    Bipolar Disorder 1 (BD)
  39. Hypomanic Episode + MDE
    Bipolar disorder 2 (BD0
  40. Hypomanic Episode + Depressive Symptoms
    Cyclothymia
  41. : Anger turned inward is
    short description – depression results from the actual or symbolic loss of a
    love object - mad at loved one for abandonment/rejection but turn it against
    self bc would be too terrible to express it outward (superego stops you) – Since Freud
    felt kids did not have a mature superego, they would not do this and so would
    not experience. Anger turned inward Children incapable of depression
    Psychodynamic theory
  42. Unresponsive or emotionally unavailable caregiving leads child to see self as unworthy and unlovable and others as undependable, so at risk for depression esp
    in response to interpersonal stress
    Attachment theory:
  43. Similar to attachment, in that relationships are the key stressors for individual
    Interpersonal theories
  44. difficulty regulating negative emotions
    may lead a child to be prone to depression, avoidance or negative behavior may
    be used to regulate distress, rather than problem-focused and adaptive coping
    strategies
    Self-control theories
  45. Depression results from lack of
    response-contingent positive reinforcement
    Behavioral
  46. Our thoughts determine our feelings and actions; changing the way we think can change the way we feel and act.
    make internal, stable, and global
    attributions for the cause of negative events (my fault bc I suck and will always suck at everything)
    Cognitive (Beck)
  47. CBT conceptualization
  48. Chronic medical condition: excessive body fat (BMI > 95th percentile)
    Pediatric Obesity
  49. Binge eating: Excessive amount of food in a short period of time. Sense of loss of control (eat fast, not hungry, well past fullness)
    Guilt/remorse and embarrassment afterward (often done in secret)
    No purging or compensatory behaviors
    3.1% of girls, and 0.9% of boys
    Binge Eating Disorder (BED)
  50. a)Refusal to maintain minimally normal body weight,
    b)Intense fear of gaining weight, and
    c)Disturbance in body
    size perception (often see denial of thinness)
    Anorexia Nervosa
  51. individual loses weight through diet, fasting, or excessive exercise
    Restricting type
  52. individual engages in episodes of binge eating or purging, or both
    Binge-eating/Purging type
  53. Recurrent episodes of binging (eating more in short time than most would and feel lack of
    control over it)
    Binging and purging at least 2x wk for 3 mos
    Much more common than AN – about 1-3% in
    adolescent/adult females. Avg onset 17-24
    Bulimia Nervosa
  54. What drugs are used by teens?
    • #1 = Alcohol
    • #2 = Cigarettes
    • #3 = Marijuana
    • #4 = Other illegal drugs (rates are
    • increasing)
  55. 1 or more in a 12 month period
    Failure to meet work, school, home
    obligations due to recurrent use
    Recurrent use in hazardous situations
    Legal problems due to use
    Use despite having social or
    interpersonal problems caused or worsened by use
    Substance Abuse
  56. 3 or more during 12 month period
    Tolerance
    Withdrawal
    Use more or longer than intended
    Persistent desire or unsuccessful efforts
    to cut down/control
    Spend a lot time getting, using or
    recovering
    Give up or decrease social, occupational
    or recreational activities bc of use
    Use despite knowledge of having physical
    or psychological problem caused or worsened by use
    Subtypes: With or Without Physiological
    Dependence
    Substance Dependence
  57. % of adolescents (12-17 yo)
    meet criteria for substance abuse or dependence
    2-8%
  58. % adolescents (12-17 yo) with other problems meet criteria for SUD
    11-37%
  59. 12-17 yo meet criteria for substance abuse/dependence
    2-8%
  60. Of all psychological disorders covered in class, this disorder shows the highest death rate due to the disorder (or its complications).
    • Anorexia has the highest mortality rate of all mental disorders. The mortality rate is about 5% for each
    • decade and increases up to 20% for patients that have the illness for more than 20 yrs.
  61. Like OCD, an imbalance in this hormone is implicated in Eating Disorders
    Serotoin

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