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Complex Disorders in Pediatric Psychiatry

Complex Disorders in Pediatric Psychiatry

David I Driver | Shari Thomas

(2018)

Additional Information

Book Details

Abstract

Get a quick, expert overview of complex childhood psychiatric disorders from Drs. David I. Driver and Shari Thomas of Healthy Foundations Group. This practical resource presents a summary of today’s current knowledge and best approaches to topics from gender dysphoria to childhood onset schizophrenia and other complex psychiatric disorders.

  • Comprehensive guide for any professional working with children.
  • Consolidates today’s evidence-based information on complex childhood psychiatric disorders into one convenient resource.
  • Provides must-know information on evaluation and management.
  • Covers a range of psychiatric disorders of children including drug-induced mania and psychosis, concussions, ADHD, technology addiction, sleep disorders, and eating disorders.

Table of Contents

Section Title Page Action Price
Front Cover Cover
Complex Disorders in Pediatric Psychiatry: A Clinician’s Guide i
Complex Disorders in Pediatric Psychiatry: A Clinician’s Guide iii
Copyright iv
List of Contributors v
Preface ix
Contents xi
List of Tables and Boxes xiii
LIST OF TABLES xiii
LIST OF BOXES xiv
1 - Gender Dysphoria in Childhood and Adolescence 1
DEVELOPMENT OF GENDER IDENTITY 1
DIAGNOSTIC CRITERIA FOR GENDER DYSPHORIA IN CHILDHOOD AND IN ADOLESCENCE 2
EPIDEMIOLOGY AND ETIOLOGY 2
SCREENING/DIAGNOSIS 3
PSYCHOTHERAPY 5
MEDICAL INTERVENTIONS 5
COOCCURRING MENTAL ILLNESS 7
PROTECTIVE FACTORS AND CLINICAL IMPLICATIONS 7
REFERENCES 8
2 - School Refusal 11
INTRODUCTION 11
DIAGNOSTIC ASSESSMENT 12
DIMENSIONAL ASSESSMENT 13
FUNCTIONAL ASSESSMENT 15
COGNITIVE BEHAVIORAL TREATMENT 15
PHARMACOTHERAPY 15
COMPREHENSIVE TREATMENT DESIGN 15
CHILD GROUP THERAPY FOR SCHOOL REFUSAL 17
PARENT MANAGEMENT TRAINING 18
SCHOOL CONSULTATION 18
CONCLUSION 19
REFERENCES 19
3 - Attention Deficit Hyperactivity Disorder and Anxiety 23
INTRODUCTION 23
BACKGROUND 23
PREVALENCE 23
AGE AND DEVELOPMENT 23
GENDER 24
SCREENING 26
DIAGNOSIS 26
CLINICAL WORKUP 27
NEUROPSYCHOLOGIC TESTS 27
PATHOPHYSIOLOGY/ETIOLOGY 27
Is Comorbidity Due to Overlapping Symptoms? 27
Does Anxiety Modulate Attention Deficit Hyperactivity Disorder Symptoms or Vice Versa? 28
GENETICS 28
SIGNALING PATHWAYS 29
TREATMENTS 29
Behavioral Interventions 29
PHARMACOTHERAPY 29
Stimulants: Effect on Attention Deficit Hyperactivity Disorder 29
Stimulants: Effect on Anxiety 30
Multimodal Therapy+Stimulants 31
ATOMOXETINE 31
ATTENTION DEFICIT HYPERACTIVITY DISORDER MEDICATIONS+ANTIANXIETY MEDICATIONS 31
Stimulant+Selective Serotonin Reuptake Inhibitor 31
Atomoxetine+Selective Serotonin Reuptake Inhibitor 32
IMPLICATIONS FOR CLINICAL PEDIATRIC PRACTICE 32
SUMMARY 33
REFERENCES 33
4 - Tourette Syndrome 37
INTRODUCTION 37
BRIEF HISTORY 37
CLINICAL PRESENTATION 38
PATHOPHYSIOLOGY 40
COMORBIDITIES WITH FOCUS ON ATTENTION DEFICIT HYPERACTIVITY DISORDER AND OBSESSIVE-COMPULSIVE DISORDER 40
TREATMENT OF TOURETTE SYNDROME—GENERAL COMMENTS 41
PHARMACOLOGIC TREATMENT OF TICS 41
TREATMENT OF TICS AND ATTENTION DEFICIT HYPERACTIVITY DISORDER 43
TREATMENT OF TICS AND OBSESSIVE-COMPULSIVE DISORDER 44
DIFFERENTIAL DIAGNOSIS 44
CONCLUSIONS: COMMUNICATION AND COUNSELING 45
REFERENCES 45
5 - Management of ADHD in Youth With Comorbid Epilepsy 49
INTRODUCTION 49
Attention Deficit Hyperactivity Disorder 49
Epilepsy 51
COMORBIDITY OF ATTENTION DEFICIT HYPERACTIVITY DISORDER AND EPILEPSY9 51
PATHOLOGY 52
Other Pathogenic Mechanisms 52
Effect of subclinical epileptiform activity 52
CLINICAL PRESENTATION 54
TREATMENT 55
Case Report 59
DISCLOSURE STATEMENT 60
REFERENCES 61
6 - Evolution From Feeding Disorders to Avoidant/Restrictive Food Intake Disorder 63
INTRODUCTION 63
DEFINITIONS OF FEEDING DISORDERS 63
HISTORY AND COMPARATIVE NOSOLOGY 63
SPECIFIC FEEDING DISORDERS SUBTYPES OF AVOIDANT/RESTRICTIVE FOOD INTAKE DISORDER (DSM-5) 64
I. ARFID Subtype: “Apparent Lack of Interest in Eating or Food” (DSM-5) 64
Clinical features 64
Risk factors 65
Differential diagnosis 65
Etiology and course 65
Treatment 67
II. ARFID Subtype: Avoidance Based on the Sensory Characteristics of Food (DSM-5) 68
Clinical features 68
Risk factors 69
Differential diagnosis 69
Etiology and course 70
Treatment 70
III. ARFID Subtype: Concern About the Aversive Consequences of Eating (DSM-5) 71
Clinical features 72
Risk factors 72
Differential diagnosis 72
Etiology and course 72
Treatment 73
COMORBIDITIES OF FEEDING DISORDERS 74
COMORBIDITIES OF FEEDING, SLEEP, AND ANXIETY DISORDERS 74
TREATMENT OF COMORBID ANXIETY AND SLEEP DISORDERS 74
CONCLUSION 74
REFERENCES 75
7 - Eating Disorders 77
DIAGNOSTIC CRITERIA AND EPIDEMIOLOGY 77
Anorexia 77
Bulimia 78
Binge Eating Disorder 78
Avoidant-Restrictive Food Intake Disorder 79
Differentiating avoidant-restrictive food intake disorder from anorexia 79
DIFFERENTIAL DIAGNOSIS OF EATING DISORDERS AND DIAGNOSTIC DILEMMAS 79
Obsessive-Compulsive Disorder Differential 80
Social Anxiety 80
Clinical Implications 80
Medical Differential 81
TREATMENT OF EATING DISORDERS 81
TREATMENT OF ANOREXIA NERVOSA 82
Behavioral Treatments 82
Psychopharmacology 83
TREATMENT OF BULIMIA NERVOSA 85
Behavioral Treatments 85
Psychopharmacology 85
TREATMENT OF AVOIDANT-RESTRICTIVE FOOD INTAKE DISORDER 85
Behavioral Treatment 86
8 - Childhood Stress and Trauma 93
INTRODUCTION 93
CLARIFICATIONS 93
PATHOPHYSIOLOGY: THE INJURY PARADIGM 93
STRESS-RELATED DIAGNOSES 94
Posttraumatic Stress Disorder Changes in Diagnostic and Statistical Manual of Mental Disorder-5 94
Diagnostic Dilemmas—Trauma Syndrome Continuum 95
Complex Trauma 96
PREVALENCE AND EPIDEMIOLOGY 96
PREVENTION 97
CONCEPTUALIZING TRAUMA AND THE CLINICAL WORKUP 98
Trauma Assessment 98
TREATMENT 98
Pharmacology 99
REFERENCES 100
9 - Factitious Disorder Imposed on Another 105
INTRODUCTION 105
DEFINITION/SYMPTOM CRITERIA 105
EPIDEMIOLOGY 106
ETIOLOGY 106
SCREENING 106
DIFFERENTIAL DIAGNOSIS 107
Additional Somatic Symptom and Related Disorders 107
Malingering 107
Schizophrenia Spectrum and Other Psychotic Disorders 108
Anxiety Disorders 108
Neurodevelopmental Disorders 108
COMMON COMORBID DIAGNOSES 108
ASSESSMENT 108
The Record Review 109
Mental Health Assessment 109
Collateral Interviews 111
The Separation Test 111
Clinical Evaluation of Suspected Victim 112
Profiling Abusers 112
CASE MANAGEMENT, TREATMENT, AND RECOMMENDATIONS 112
Working as a Team 112
Placement 112
Supervised Visitation 113
Medical Care for Child 113
School 113
Psychotherapy for Abuser, Spouse, and Child Victim 113
Reunification 114
CONCLUSION 114
DISCLOSURE STATEMENT 114
REFERENCES 114
10 - Pediatric Sleep Disorders 117
INTRODUCTION 117
NORMAL SLEEP DEVELOPMENT 117
Newborns (0–2Months) 117
Infants (2–12Months) 118
Toddlers (12Months–3Years) 118
Preschoolers (3–5Years) 118
School-Aged Children (6–12Years) 119
Adolescents (12–18Years) 119
PEDIATRIC SLEEP DISORDERS 119
Clinical Evaluation 120
Partial arousal parasomnias 122
Rhythmic movement disorders 123
Restless legs syndrome 123
Common Pediatric Disorders in Children in Preteens and Young Adolescents 123
Circadian rhythm disorders—delayed sleep phase syndrome 124
Pediatric narcolepsy 124
Insomnia 125
Sleep bruxism 125
PEDIATRIC PSYCHIATRIC DISORDERS AND SLEEP 125
Sleep Disturbance in Attention Deficit Hyperactivity Disorder 125
Sleep Disturbance in Autism 126
Sleep Disturbance in Generalized Anxiety Disorder 126
Sleep Disturbance in Posttraumatic Sleep Disorder 126
Sleep Disturbance in Panic Disorder 127
Bipolar disorder 127
SUMMARY 128
REFERENCES 128
11 - Concussion in Children and Adolescents 129
INTRODUCTION 129
DEFINITION/SYMPTOM CRITERIA 129
PREVALENCE/EPIDEMIOLOGY 129
ETIOLOGY/PATHOPHYSIOLOGY 130
SCREENING/DIAGNOSIS 130
Baseline Testing 131
DIFFERENTIAL DIAGNOSES 131
WORKUP/CLINICAL FINDINGS 132
Physical Examination 132
TREATMENT 132
REFERENCES 133
12 - Pediatric Delirium 135
INTRODUCTION 135
DEFINITION/SYMPTOM CRITERIA 135
PREVALENCE/EPIDEMIOLOGY 136
PATHOPHYSIOLOGY/ETIOLOGY 137
Neurotransmitter Deficiency/Dysregulation 137
Neuroinflammation 138
Oxidative Stress 138
ASSESSMENT 138
Screening 138
Electroencephalogram Findings 141
Developmental Concerns 141
DIAGNOSTIC DILEMMAS 141
Delirium Versus Catatonia 141
Delirium Versus Psychiatric Illness 143
TREATMENT 143
Nonpharmacologic Management 143
Pharmacologic Management 144
Benzodiazepine Withdrawal–Induced Delirium 145
Treatment of Behavioral Symptoms With Medications 145
Pharmacologic Strategies to Reduce the Incidence of Delirium 147
Integrative Management 147
SEQUELAE 148
Cognitive Outcomes 148
Psychiatric Outcomes 148
CLOSING 149
REFERENCES 149
13 - Pediatric Catatonia 155
INTRODUCTION 155
BACKGROUND 155
PREVALENCE 155
SCREENING 155
DIAGNOSIS 155
LABORATORY TESTS 156
ELECTROENCEPHALOGRAM 157
BRAIN IMAGING 157
PATHOPHYSIOLOGY/ETIOLOGY 159
Animal Models 159
Neurotransmitters Imbalances 159
Glutamatergic 159
Dopaminergic 159
Serotonergic 159
Cholinergic 159
Infectious/Autoimmune 160
Oxidative Damage 160
Genetic Risks 160
Physical and Psychological Trauma 160
TREATMENTS 160
TREATMENTS FOR CATATONIA 160
MEDICATIONS 160
ELECTROCONVULSIVE THERAPY 161
Implications for Clinical Pediatric Practice 162
SUMMARY 162
REFERENCES 163
14 - Pediatric Inflammatory Brain Disease 169
INTRODUCTION 169
BRAIN IMMUNOLOGY 169
CLINICAL PRESENTATION OF INFLAMMATORY BRAIN DISEASE 170
DIAGNOSTIC EVALUATION 170
Physical Examination Findings 170
Laboratory Studies 171
Imaging 173
Electroencephalogram 173
Neuropsychiatric Testing 173
Diagnosis 173
DIFFERENTIAL DIAGNOSIS 173
OVERVIEW OF INFLAMMATORY BRAIN DISEASES 175
Immune-Mediated Causes 177
Autoimmune encephalitis 177
Limbic Encephalitis (N-Methyl-d-Aspartate Receptor and Others) 177
Basal Ganglia Encephalitis 178
Steroid-Responsive Encephalitis Associated With Thyroiditis (Hashimoto’s Encephalitis) 178
Demyelinating inflammatory brain disease 179
Central nervous system vasculitis and rheumatologic diseases associated with central nervous system inflammation 179
Central Nervous System Vasculitis 179
Systemic Lupus Erythematosus and Antiphospholipid Antibody Syndrome 180
Behcet’s Disease 180
Sjogren’s Syndrome and Sarcoidosis 180
Cytokine-associated encephalopathy 180
Infection-associated relapsing/remitting central nervous system disorder: neuropsychiatric symptoms that follow infections outsi... 180
TREATMENT 181
THREE PEDIATRIC ACUTE-ONSET NEUROPSYCHIATRIC SYNDROME CONSENSUS GUIDELINES: A POSSIBLE MODEL FOR PEDIATRIC INFLAMMATORY BRAIN DI... 181
ROLE OF PSYCHIATRIST IN MANAGING INFLAMMATORY BRAIN DISORDER 182
Recognition 182
Psychiatric Evaluation 182
REFERENCES 184
15 - Disruptive Mood Dysregulation Disorder 189
INTRODUCTION 189
DEFINITION/SYMPTOM CRITERIA 190
PREVALENCE/EPIDEMIOLOGY 190
ETIOLOGY/PATHOPHYSIOLOGY 190
DIFFERENTIAL DIAGNOSES AND DIAGNOSTIC DILEMMAS 191
WORKUP 191
TREATMENT 192
RISK FACTORS 193
POTENTIAL OUTCOMES 193
COMORBIDITIES 194
IMPLICATIONS FOR CLINICAL PRACTICE 194
REFERENCES 195
16 - Pediatric Bipolar Disorder 199
INTRODUCTION 199
DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS, FIFTH EDITION DEFINITION 199
DIFFERENTIAL DIAGNOSIS 200
EPIDEMIOLOGY AND GENETICS 200
COMMON COMORBIDITY 200
Substance Use Disorders 200
Anxiety Disorders 201
Attention Deficit Hyperactivity Disorder and Disruptive Behavior Disorders 201
Learning Disabilities 201
Suicide 201
Medical Comorbidity 202
Treatment 202
Pharmacology, immediate and long-term 202
Failed or Negative Trials 202
Positive Double-Blind Trials 204
Positive Open-Label Trials 205
Federal Treatment Trials 205
Combination Trials 206
Long-term trial 206
Psychotherapy 206
CONCLUSIONS 207
REFERENCES 207
17 - Childhood-Onset Schizophrenia 211
INTRODUCTION 211
DEFINITION/SYMPTOM CRITERIA 211
EPIDEMIOLOGY 213
SCREENING/DIAGNOSIS 213
Differential Diagnoses 213
EVALUATION AND WORKUP 213
Screening and Diagnostic Tools 214
Comorbidity 214
INTERVENTION 216
Nonpharmacologic 216
Pharmacologic 216
IMPLICATIONS FOR CLINICAL PRACTICE 218
REFERENCES 218
Clinical Pearls Appendix 225
Index 231
A 231
B 231
C 232
D 233
E 233
F 233
G 234
H 234
I 234
K 234
L 234
M 234
N 234
O 235
P 235
R 236
S 236
T 237
U 237
V 237
W 237
Z 237