What s the Diagnosis? A Developmental Perspective

Transcription

1 What s the Diagnosis? A Developmental Perspective Larry Pezor, MD Medical Director Eastern Shore Psychological Services Staff Child Psychiatrist Adventist HealthCare Behavioral Health & Wellness Services, Eastern Shore

2 Objectives Attendees will be able to describe various presenting behavioral symptoms from a developmental perspective. Utilizing a developmental understanding of mental illness, attendees will be able to correctly identify and diagnose patients. Attendees will be able to discuss the current data on suicide in children and adolescents; risks and interventions

3 A Developmental Perspective Ages of Onset Risk 0 3 years Autistic Spectrum Disorder 4 7 years ADHD 6 12 years Anxiety years Depression >16 years Bipolar Disorder and Psychosis Across the ages Disruptive behaviors John T. Walkup, MD, AACAP 2015

4 Is My Child Bipolar? Mood Swings 0 3 years Congenital abnormalities / Sensory/ speech / learning disabilities Developmental behavioral issues including Autism Neglect / abuse /trauma 4 7 years Abuse / Neglect / trauma ADHD; Three areas of dysregulation

5 Is My Child Bipolar? Mood Swings 6 12 years Volatility, irritability and fight or flight response Trauma or abuse years Mood Dysregulation / Trauma history Early onset Mood Disorders Substance abuse >16 years Traditional Bipolar Disorder and Psychosis

6 Is it Schizophrenia? Psychotic symptoms Voices Visions Imaginary friends Rare in children 1:40,000 (compared to 1:100 adults)

7 Is it Schizophrenia? Psychotic symptoms 0 3 years Trauma / Abuse / Neglect Sensory abnormalities Normal developmental processes ASD 4 7 years Trauma / Abuse Early Anxiety Medication side effects (stimulants)

8 Is it Schizophrenia? Psychotic symptoms 6 12 years Anxiety Disorders Substance abuse / intoxication Abuse / trauma years Depression with psychosis Substance abuse / intoxication Early psychotic illness >16 years Early Psychotic illnesses / Depression Substance abuse / intoxication

9 Is she trying to kill herself? Self Injurious Behaviors 0 3 years ASD; hitting self, biting Congenital Metabolic Syndromes 4 7 years Accidental Trauma / Abuse 6 12 years Trauma / Abuse

10 Is she trying to kill herself? Self Injurious Behaviors years Depression Trauma Gender Identity Issues >16 years Bipolar Disorder. Depression, Psychosis Trauma Substance Abuse

11 Suicidal Behavior in Children and Adolescents

12 A Leading Cause of Death 3rd Leading cause of death in 15 to 24 year-olds. 6th Leading cause of death in 5 to 14 year-olds. AACAP, Facts for Families, 2013 AACAP, Facts for Families, 2013

13 Suicide Statistics Among year-olds, suicide accounts for 12.9% of all deaths annually*. Suicide rate among children aged was 1/100,000**. Suicide rate among adolescents aged was 11.6/100,000**. Males complete suicide at nearly four times the rate of females. During their lifetime, women attempt suicide 2-3 times as often as men (Krug et al., 2002). * CDC, 2005 ** CDC, 2014

14 Suicide Related Behaviors in US High School Students 16.9% of Students, grade 9 12, seriously considered suicide in the previous 12 months (23.4% females and 12.2% males). 8.4% of students reported making at least one suicide attempt in the previous 12 months (11.6% of females and 5.5% of males). 2.3% of students reported making at least one attempt in the previous 12 months that required medical attention (2.9% of females and 1.8% of males). CDC High School Youth Risk Behavior Survey, 2015

15 Racial and Ethnic Disparities Hispanic female 9 12 graders reported a higher percentage of suicide attempts than their non-hispanic peers (Eaton et al., 2006). Suicide rates among Native Americans/Alaskan Natives is 1.9 times higher than the national average for year-olds (CDC, 2014).

16 Potential Risk Factors Prior suicide attempts Substance Abuse Mental Illness Firearms in the home Low self esteem Non-suicidal self injury Exposure to friends/family suicidal behaviors More severe psychiatric symptoms (psychosis) Complain of feeling bad or rotten inside Put his or her affairs in order Verbalize suicidal thoughts or feelings AACAP, 2014

17 Self Injurious Behavior Differentiate from suicidal gestures/attempts Emotional tension/discomfort Cognitive/developmental disorders Take threats seriously Be suspicious when there are serious psychiatric symptoms or substance abuse issues Keep lines of communication open Seek professional support

18 Summary Remember to assess presenting symptoms in their developmental context If you hear hoof beats look for horses not zebras