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“I guess what I miss most is being drunk.”

“I guess what I miss most is being drunk.”. SUD Assessment. Parental values Genetics Culture Individual characteristics Peer group. Suicide. Epidemiology. Impulse control risk factors. Biopsychosocial etiology. Gender differences. Tic Disorders.

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“I guess what I miss most is being drunk.”

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  1. “I guess what I miss most is being drunk.”

  2. SUD Assessment • Parental values • Genetics • Culture • Individual characteristics • Peer group

  3. Suicide • Epidemiology • Impulse control risk factors • Biopsychosocial etiology • Gender differences

  4. Tic Disorders • Sudden, rapid, recurrent non-rhythmic, stereotyped, motor movement or vocalization • Tourette’s Disorder • motor before vocal • autosomal dominant

  5. Symptoms of Depression in Young People • Irritability • Denial of depression • Low self-esteem • Somatic Complaints • Depressed appearance

  6. Diagnosis ofDysthymia • Depressed or irritable mood lasting a year or longer • Never symptom free for longer than 2 months

  7. Diagnosis ofDysthymia(Cont’d.) • Symptoms • pessimism • social withdrawal • decreased energy • low self-esteem • poor concentration • hopelessness • sleep and appetite changes

  8. Risk Factors for MDD and Dysthymia • Stressful life events • Parental dysfunction and loss • Boys - neonatal health problems • Girls - perceived unpopularity, • anxiety

  9. Early Onset Bipolar Disorder • Changes in mood, sleep pattern and energy • Hyperactivity and irritability • Distractibility • Pressured speech

  10. Early Onset Bipolar Disorder (Cont’d.) • Affective symptomatology • Visual hallucinations • Unreasonable irritability and anger

  11. Epidemiology of Depression • Incidence increasing • 4.7% MDD among adolescents • Mean age of onset 11 years • 0.7% bipolar among adolescents

  12. “Son, it’s important to remember that its O.K. to be depressed.”

  13. Depression Biologic Etiology • Genetic influences • Structural and functional changes • Serotonin and norepinepherine • Cortisol and growth hormone • Attachment experience

  14. Depression Psychosocial Etiology • Developmental dynamics • Life stress • Family dysfunction • Cultural support

  15. Depression DDX and Co-mobidity • Bipolar Disorder • ADHD • Anxiety and PTSD • Medical causes

  16. Separation Anxiety Disorder • Excessive anxiety about separation from the home or from significant others • Differential Diagnosis Phobia LD Conduct Disorder Depression

  17. Selective Mutism • Failure to speak in specific social situations despite speaking in other situations.

  18. Reactive AttachmentDisorderof Infancy or EarlyChildhood • Developmentally inappropriate social relatedness beginning before age 5 associated with pathological care. • Inhibited and Disinhibited Type

  19. Generalized Anxiety Disorder • Excessive anxiety and worry for at least 6 months • Worry about performance at school and sports • DSM IV criteria less stringent

  20. Phobias • Most common disorder in childhood • Fears and anxieties decrease with age. About 2 - 3% of adolescents have significant fears.

  21. 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.

  22. Obsessive-Compulsive Disorder • High incidence in Tourettes • Age of onset younger in males • Basal ganglia disorders (PANDAS)

  23. PTSD • Fear of separation, withdrawal, reenactment, sleep disturbance, regression, impulsivity • Anxiety, psychosis • Physical symptoms, nightmares

  24. 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

  25. Type I full detailed memories “omens” and misperceptions Type II denial and numbing self-hypnosis, dissociation, rage Childhood Trauma

  26. Dissociativeexperiences bothduring the traumaand afterward is relatedto the later developmentof PTSD

  27. Biologic Response to Stress • Genetics • Fight or flight • Norepinepherine linked to immediate and prolonged response • Serotonin linked to anxiety and panic in PTSD

  28. 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.

  29. Stage 2 relive experience coping themes closure, recapitulation, courage/strengths Stage I focus and traumatic reference The Child Interview (Pynoos)

  30. Associated Problems • Co-morbid psychiatric disorders • Substance abuse • Sexual/intimacy problems

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