Psychiatry - Pediatric diseases, dissociative disorders, somatoform disorders, eating disorders, sle

• Trisomy 21
• Common cause of mental retardation

• second most common cause of retardation
• Males > females

• Toxoplasmosis
• Other (syphilis, AIDS, alcohol/illicit drugs)
• Rubella (German measles)
• Cytomegalovirus (CMV)
• Herpes simplex

• achievement in reading, mathematics, written expression that are lower than expected for age, education, intelligence
• Epidemiology: 5 to 10% of school-age children
• Boys: girls (3 to 4:1)

• Pattern of behavior that involves violation of the basic rights of others or social norms, plus at least three acts within...
• 1. Agression toward people and animals
• 2. Destruction of properties
• 3. Deceitfulness
• 4. Serious violation of rules

• Prevalence: 6 to 16% of boys, 2 to 9% of girls
• 40% risk of developing antisocial personality disorders
• Increase incidence of comorbid mood disorders, substance abuse, criminal behavior in adulthood

• At least 6 months of negative, hostile, defiant behaviors, during which at least 4 of the following:
• 1. Frequent loss of temper
• 2. Arguments with adults
• 3. Defying adults' rules
• 4. Deliberately annoying people
• 5. Easily annoyed
• 6. Anger and resentment
• 7. Spiteful
• 9. Blaming others for mistakes or misbehaviors

• Prevalence: 15 to 22% in children >6
• Onset: usually before 8

• Inattentive type
• Hyperactive-impulsive type
• Combined type

• 1. At least six symptoms involving inattentiveness, hyperactivity, or both for at least 6 months:
• -inattention: problems listening, concentrating, paying attention to details...
• -hyperactivity-impulsivity: blurting out, interrupting, fidgeting
• 2. Onset before age 7
• 3. Behavior inconsistent with age and development

• 3 to 5% prevalence in school-age children
• Boys: girls (3 to 5 times)

• CNS stimulants:
• methylphenidate (Ritalin)
• dextroamphetamine (Dexedrine)
• pemoline (Cylert)

• problems with social skills, language, behaviors
• Autistic disorder
• Asperger's disorder
• Rett's disorder
• Childhood disintegrative disorder

• at least 6 of the following:
• 1. Problems with social interaction (at least two):
• -Impairment in nonverbal behavior
• -Failure to develop peer relationships
• -Failure to seek sharing of interests or enjoyment with others
• -Lack of social/emotional reciprocity
• 2. Impairments in communication (at least one)
• -Lack of or delayed speech
• -Repetitive use of language
• -Lack of varied, spontaneous play, and so on
• 3. Repititive and stereotyped patterns of behavior and activities:
• -Inflexible rituals
• -preoccupation with parts of objects, and so on

• Incidence: 0.02 to 0.05% in children under age 12
• Boys: girls (3 to 5 times higher)
• some familial inheritance
• Treatment: neuroleptics (help control aggression, hyperactivity, mood lability); SSRIs (helps control sterotyped and repetitive behaviors)

• 1. Impaired social interaction (at leasta two):
• -Failure to develop peer relationships
• -Impaired use of nonverbal behaviors
• -Lack of seeking to share enjoyment or interests with others
• -Lack of social/emotional reciprocidy
• 2. Restricted or stereotyped behaviors, interestes, or activities
• -inflexible routines, repetitive movements, preoccupations, etc.

• Normal prenatal and perinatal development
• Normal psychomotor development during the first 5 months after birth
• Normal head circumference at birth, by decreasing rate of head growth between ages 5 and 48 months
• Loss of previously learned purposeful hand skills between ages 5 and 30 months, followed by development of stereotyped hand movements (hand wringing)
• Early loss of social interaction, usually followed by subsequent improvement
• Problems with gait or trunk movements
• Severely impaired language and psychomotor development
• Seizures
• Cyanotic spells

Rett's disorder: MECP2 gene mutation on X chromosome

• 1. Normal development in the first 2 years of life
• 2. Loss of previously acquired skills in at least two of the following areas: language, social skills, bowel or bladder control, play, motor skills
• 3. At least two of the following: impaired social interaction, impaired use of language, restricted, repetitive, and stereotyped behaviors and interestes

• Onset: age 2 to 10
• Boys: girls (4 to 8 times higher)
• Rare

• most common: motor tics
• vocal tics: copralalia, echolalia
• Criteria: multiple motor and vocal tics, many times a day for > 1 year, onset prior to age 18, distress or impairment in social/occupational functioning
• Genetics: 50% concordance rate in monozygotic 
• Neurochemical: impaired regulation of dopamine in the caudate nucleus

• Rare
• More common in girls
• Not speaking during certain situations
• onset: age 5 or 6

• excessive fear of leaving one's parants
• effects up to 4% of school age children
• boys:girls equal

• amnesia is a prominent symptom in all of the dissociative disorders except depersonalization disorder
• Criteria:
• - At least one episode of inability to recall impersonal information
• - Amnesia cannot be explained by ordinary forgetfulness
• - Symptoms cause significant distress or impairment

• sudden, unexpected travel away from home
• inability to recall parts of one's past or identity
• Patients often assume an entirely new identity
• They are unaware of their amnesia and new identity

• Sudden, unexpected travel away from home or work plus inability to recall one's past
• Consfusion about personal identity or assumption of new identity
• Not due to dissociative identity
• Symptoms cause impairment in social or occupational functioning

• two or more distinct personalities that alternately control their behaviors and thoughts
• Patients are often unable to recall personal information

• persistent or recurrent feelings of detachment from one's self, environment, or social situation
• Patients feel separated from their bodies and mental processes
• Often accompanied by anxiety or panic
• Reality testing remains intact during episode

• physical symptoms that have no organic cause
• They truly believe that their symptoms are due to medical problems
• Somatization disorder
• Conversion disorder
• Hypochondriasis
• Pain disorder
• Body dysmorphic disorder

Expression of unacceptable feelings as physical symptoms in order to avoid facing them

Use of symptoms to benefit the patient (increased attention from others, decreased responsibilities, avoidance of the law)

• At least two GI symptoms
• At least one sexual or reproductive symptom
• At least one neurological symptom
• At least four pain symptoms
• Onset before age 30
• Cannot be expalined by general medical condition or substance use

• Incidence in females: 5 to 20 times that of males
• Lifetime prevalence: 0.1 to 0.5%
• Greater prevalencec in low socioeconomic groups
• Fifty percent have comorbid mental disorder
• First-degree female relatives have 10 to 20% incidence
• 30% concordance in identical twins

• At least one neurological symptom that cannot be explained by medical condition
• Onset: preceded or exacerbated by a psychological stressor
• Pts often calm and unconcerned when describing their symptoms

• At least one neurological symptom
• Psychological factors associated with initiation or exacerbation of symptom
• Symptom not intentionally produced
• Not explained by general medical condition or substance abuse
• Cause significant distress or impairment in social or occupational functioning
• Not limited to pain or sexual symptoms

• prolonged, exaggerated concern about health and possible illness
• Patients either fear having a disease or are convinced that one is present
• Fear must persist for at least 6 months

• preoccupied with body parts that they perceive as flawed or defective
• physical imperfections are either minimal or completely imagined, patients view them as severe and grotesque
• 90% have coexisting major depression
• 70% have coexisting  anxiety disorder
• 30% have coexisting psychotic disorder

• prolonged, severe discomfort without adequate medical explanation
• Pain often co-exists with a medical condition, not directly caused by it
• Analgesics are not helpful

• intentionally produce medical or psychological symptoms in order to assume the role of the sick patient
• Primary gain is a dominant feature of this disorder
• No external incentives (monetary reward, etc.)

factitious disorder with predominantly physical complaints

producing symptoms in someone else who is under one's care in order to assume the sick role by proxy

patient believes they are ill

Patients pretend to be ill with no obvious external reward

• Most common
• Patients pretend they are ill with obvious external incentive

• Body weight at least 15% below normal
• Intense fear of gaining weight or becoming fat
• Disturbed body image
• Amenorrhea

• bing eating combined with behaviors intended to counteract weight gain (vomiting, laxatives, diuretics, excessive exercise)
• Patients are embarrassed by their bingeing and are overly concerned with body weight
• usually maintain a normal weight (and may be overweight)

• Recurrent episodes of binge eating
• Recurrent, inappropriate attempts to compensate for overeating and prevent weight gain
• Binge eating and compensatory behaviors occur at least twice a week for 3 months
• Perception of self-worth is excessively influenced by body weight and shape

• Recurrent episodes of binge eating
• Severe distress over binge eating
• Bingeing occurs at least 2 days a week for 6 months and is not associated with compensatory behaviors
• Three or more of the following:
• 1. Eating very rapidly
• 2. Eating until uncomfortably full
• 3. Eating large amounts when not hungry
• 4. Eating alone due to embarrassment over eating habits
• 5. Feeling disgusted, depressed, or guilty after overeating

Disturbances in the amount, quality, or timing of sleep

Abnormal events in behavior or physiology during sleep

• Difficulty initiating or maintaining sleep, resulting in daytime drowsiness or difficulty fulfilling tasks
• 3 or more times per week for at least 1 month
• Affects 30% of the general population

At least 1 month of excessive daytime sleepiness or excessive sleep not attributable to medical condition, medications, poor sleep hygiene

• Repeated, sudden attacks of sleep in the daytime for at least 3 months
• Short REM latency
• Sleep paralysis
• Hypnagogic: as patient falls asleep or is falling asleep

• collapse due to sudden loss of muscle tone
• occurs in 70% of narcolepsy patients

• Sleep disruption and excessive daytime sleepiness (EDS) caused by abnormal sleep ventilation from either central or obstructive sleep apnea
• Epidemiology: up to 10% of adults, men > women

• Disturbance of sleep due to mismatch between circadian sleep-wake cycle and environmental sleep demands
• subtypes: jet lag, shift work, delayed sleep, advanced sleep phase

• Repeated awakenings with recall of extremely frightening dreams
• Occurs during REM sleep and causes significant distress

• Repeated episodes of apparent fearfulness during sleep
• Episodes occur during first third of the night during stage 3 or 4 sleep (non-REM)
• No memory of the episodes

• Repeated episodes of getting out of bed and walking
• Episodes occur during the first third of the night