Child and Adolescent Psychopathology Midterm Exam Study Guide Fall 2011 Introductory Lectures Students will be able to 1 Describe the historical relative neglect that child and adolescent mental health has suffered as a field 2 Identify various theories of normal child development risk factors for child mental illness and gender and socio cultural differences responsible for mental wellness and illness 3 Explain the health paradox of adolescence 1 2 3 a multifinality Various outcomes may stem from similar beginnings b equifinality Similar outcomes may follow from different early experiences Terms etiology nosology a Etiology the cause of an illness b Nosology the classification system e g the DSM c DSM is a phenomenological tool what it looks like not the causes d Epidemiology the study of a disease in a population numbers s History of DSM major differences between versions a B4 DSM i ii ancient magic Then Galen 4 biles imbalance kill kids put in cages locke tabula rasa rights children should be raised with care nurture over nature pinel father of French psychiatry first psychotherapist discarded demons as the reason iii iv Benjamin rush first textbook on psychiatry compassion reforms for mentally ill v dorothea dix social reformer for mentally ill to get mental out of cages cellars into special humane mental hospitals she established 32 then lots of bad stuffhappened freud psychoanalytic theory imp b c linked d o to childhood experiences first time that the course of mental disorders was not seen as inevitable vi vii b DSM I 1952 i All disorders of psychogenic origin or without clearly defined physical cause were considered reactions 1 Schizophrenic reaction 2 Antisocial reaction 3 Psychoneurotic reactions included a Anxiety reaction Dissociative reaction Conversion reaction Phobic reaction Obsessive compulsive reaction Depressive reaction ii Following upon Freud s emphasis on the importance of mastering anxieties generated by characteristic conflicts at identifiable stages of psychosexual development and attributing psychopathology to failure to resolve these conflicts it was implied in the DSM I if not specifically stated that anxiety was at the core of all diagnoses c DSM II 1968 i Provided brief descriptions of characteristic signs and symptoms of the disorders but no criteria as such In 1973 during the 6th printing of the DSM II homosexuality was finally removed ii d DSM III 1980 i A similar approach to the DSM II was followed here but now diagnostic criteria for the various disorders were provided like if meet 6 9 symptoms than u have it checklists ii Better inter rater reliability and evidence of predictive reliability iii Specified a group of disorders as usually first evident in infancy childhood or adolescence a whole section now for kids iv Reactive attachment disorder separation anxiety disorder overanxious disorder and avoidant disorder v Additionally the anxiety diagnoses applicable to adults were available for diagnosing children e DSM III R 1987 i Both the DSM III and the DSM III R were criticized by some researchers particularly regarding childhood diagnoses due to limited evidence of validity ii Many clinicians of the psychodynamic tradition objected to the atheoretical approach of the DSM III and to the elimination of the term neurosis f DSM IV Diagnoses i DSM Diagnostic and Statistical Manual of the American ii Statistical because a given number of symptoms are necessary to Psychiatric Association make a diagnosis iii Diagnoses are phenomenological or symptom driven and may be the result of biological psychological and social factors 4 Most common causes of mortality in adolescence 1 Accidents 2 Homicide 3 Suicide 5 Health paradox of adolescence a Rebel Without a Cause movie i Adolescence marks vast changes in motor function cognitive capabilities and emotions ii Life doesn t seen so easy anymore iii Rebel dramatizes well some of the typical troubles of adolescents b Adolescence 15 24 y o is the physically healthiest time of life prior to c adult declines Improvement in strength speed reaction time reasoning and immune function d Increased resistance to extremes of heat cold hunger dehydration and most types of injury e Yet overall morbidity and mortality rates increase by 200 between late childhood 10 14 and adolescence 15 19 f Why The primary reasons for the increase in mortality and morbidity seen in adolescence are related to control of behavior cognition and emotions 1 Depression increases from a 4 prevalence in childhood to around 17 in adolescence lifetime prevalence 2 Substance abuse eating disorders psychotic disorders etc all increase greatly during teen years and lead to major increases in morbidity approaching or reaching adult levels 3 Adolescence also heralds high rates of risk taking behavior sensation seeking and erratic emotionally influenced behavior Romeo and Juliet ii Darwinian argument You need to become more of a risk taker and sensation seeker and adventurer when you strike out on your own and leave your safe home environment in order to survive iii Peer pressure iv Brain development Adolescence is like starting the engines with an unskilled driver 6 Child mental health service delivery a who does the work i Need in short supply Child and Adolescent psychiatrists the most underserved of all medical subspecialties social workers educational specialists and psychologists 1 what psychiatrists psychologists do Works with children adolescents and families who have problems with their a Emotions b Behavior c Cognition thinking ii In reality vast majority of child and adolescent mental health services provided by primary care practitioners psychologists and all manner of therapists ranging from masters level social workers to marriage and family therapists 1 Nearly 85 of all psychotropic medications prescribed to children are written by primary care practitioners 2 These individuals generally receive no formal training in child and adolescent mental health b What s the need i estimated 20 of adolescents and young adults have mental health issues cause better diagnosis or higher prevalence 15 mil out of 75 mil total US pop have psychiatric LD s but 70 don t receive help who get 1 3 caucasian 1 5 af americ 1 7latino less than 10 of public schools in US have comprehensive mental health services 1 17 of young have severe depression 2 anxiety 13 3 ADHD 7 4 Bipolar mood disorder 1 5 substance abuse is very common 50 of hs kids have used drugs 23