PSYCHIATRIC DIAGNOSES. James R. (Bob) Batterson, MD Associate professor, UMKC School of Medicine

Transcription

1 PSYCHIATRIC DIAGNOSES James R. (Bob) Batterson, MD Associate professor, UMKC School of Medicine

2 4 Key Diagnoses for the School Nurse 1. ADHD 2. Autistic Spectrum 3. Anxiety Disorders 4. Bipolar Disorder

3 ADHD Attention Deficit/Hyperactivity Disorder Inattentive Hyperactive Combined

4 ADHD More common in boys Girls often missed because they have the inattentive type Combined Type ADHD is most common of all 40% have learning delays Depression and frustration issues common as patients get older

5 ADHD 40% get better by age 24, but many are continue to have inattention problems Substance abuse is common especially in the untreated patients Controversial due to lack of a blood test or X Ray to confirm Present in about 6-9% of children, 4-6% of adolescents, 2-3% of adults

6 Autsim Disorders in the Spectrum Autistic Disorder Asperger Disorder Pervasive Developmental Disorder NOS Rett s Disorder Childhood Disintegrative Disorder

7 Autism May have normal or above average IQ Higher incidence of seizure disorders but many do not have seizures Key differentiation from other members of the spectrum is language delay Course of Autism may include normal development of language until age 2, then regression

8 Autism: Asperger Similar symptom set to Autism except Language Development is normal Same diagnostic criteria in Social Interaction and Stereotyped interest areas Must have IQ in at least the normal range Mental retardation or a history of language delays rules out Asperger

9 Autism: Asperger Little Professors -interests are restricted Frequently very literal and rule bound Few to no friends of their age Tend to make those in authority angry with them Most lack an appropriate or typical sense of humor Texture issues-clothing or food

10 Anxiety Disorders Specific Phobia Panic Disorder Social Phobia (Social Anxiety Disorder) Obsessive-Compulsive Disorder (OCD) Generalized Anxiety Disorder (GAD) Posttraumatic Stress Disorder Acute Stress Disorder

11 Anxiety Social Phobics worry about meeting new people or approaching people, or worry about scrutiny by others of their performance. They worry about humiliation or being embarrassed. Panic Disorder patients have recurrent panic attacks that are unexpected and worry about having more of them (anticipatory anxiety)

12 Anxiety Disorders Panic Disorder can either be with or without Agoraphobia-the fear of public places where they can t escape or can t get help if they have an attack. Generalized Anxiety Disorder patients have excessive worry about a number of things more days than not for more than 6 months.

13 Anxiety: OCD Obsessions are recurrent thoughts, impulses or images that are intrusive, inappropriate and cause distress Compulsions are repetitive behaviors that a person feels driven to do The person recognizes the obsessions or compulsions are excessive or unreasonable Can consume greater than 1 hour per day

14 Anxiety: OCD Germ phobics-handwashers Checking-either to make sure something was done or a bad thing was not done Counting-or doing things in series Hoarding-keeping things of no value

15 Bipolar Disorder Mania is defined as 1 week at least of elevated, expansive or irritable mood that is abnormal for the patient and persistent with 3 or more the following symptoms (or 4 if irritable mood): Grandiosity Decreased need for sleep Pressured speech or highly talkative Flight of ideas or subjective thought racing

16 Bipolar Disorder Distractible Increase in goal directed activity (incl. hypersexuality) or psychomotor agitation Excessive involvement in pleasurable activities that have a high potential for neg. consequences (buying sprees, sexual indiscretions, foolish business investments)

17 Bipolar Disorder Incidence of Bipolar Disorder in youth has increased 40-fold based on review of outpatient office Dx. One inpatient study found that ½ of Bipolar diagnoses were invalidated when research criteria were used-dx were changed to Conduct Disorder or Major Depression -Moreno, Arch Gen Psych 2007

18 Bipolar Disorder: DSM 5 Disruptive Mood Dysregulation Disorder with Dysphoria A. The disorder is characterized by severe recurrent temper outbursts in response to common stressors. 1. The temper outbursts are manifest verbally and/or behaviorally, such as in the form of verbal rages, or physical aggression towards people or property.

19 Bipolar: DSM 5 2. The reaction is grossly out of proportion in intensity or duration to the situation or provocation. 3. The responses are inconsistent with developmental level.

20 Bipolar: DSM 5 B. Frequency: The temper outbursts occur, on average, three or more times per week. C. Mood between temper outbursts: 1. Nearly every day, the mood between temper outbursts is persistently negative (irritable, angry, and/or sad). 2. The negative mood is observable by others (e.g., parents, teachers, peers).

21 Bipolar: DSM 5 D. Duration: Criteria A-C have been present for at least 12 months. Throughout that time, the person has never been without the symptoms of Criteria A-C for more than 3 months at a time. E. The temper outbursts and/or negative mood are present in at least two settings (at home, at school, or with peers) and must be severe in at least in one setting.

22 Bipolar Disorder: DSM 5 Chronological age is at least 6 years (or equivalent developmental level). G. The onset is before age 10 years

23 Questions??????

24 Psychiatric Medications 1. ADHD 2. Autism 3. Anxiety Disorders 4. Bipolar Disorder

25 ADHD Medications Stimulants: Long vs. Short acting Stimulants: What is available and what is not Non Stimulants: Intuniv : guanfacine Kapvay : clonidine Strattera : atomoxetine

26 Autism No medication reverses Autism s core symptoms Two medications are FDA indicated for Irritability in Autism Abilify Risperidone Both are associated with weight gain and loss of feeling of fullness

27 Autism Co-morbid psychiatric problems common in Autism include: Anxiety ADHD Aggression

28 Anxiety Disorders Primary treatment is psychological, not medication Often medication is combined with therapy when the situation is more severe SSRI s are first line: Prozac, Zoloft, Celexa BuSpar is an option Benzodiazepines are typically avoided, but sometimes used.

29 Bipolar Disorder Most research to date on medications for Bipolar Disorder is from trials on classic Bipolar Disorder Type 1 with grandiosity The new DMDD with D is not yet in DSM The first line treatment for Bipolar Disorder is medication and Second Generation Antipsychotics are FDA indicated in Adolescents and Adult

30 Bipolar Disorder Second Generation Antipsychotics Risperidone Abilify Geodon Seroquel Zyprexa clozapine

31 Questions??????