PYSCH FINAL CHILD DEVELOPMENT Austism Predom social interaction & comm impairment.

. Stereotyped behaviors Aspergers Predom social impairment but with normal language and intelligence. Learning Disorder Performance below IQ in reading, math and writing. - Preoperational egocentric, playful, pretending. - Concrete knowing rules. Stuck = hard to navigate normal life situations. - Formal operational Abstract thinking only about 75% reach. Developmental Milestones: 6 Months: Rolls over, pass obj hand to hand, turn to voices, imitate sounds 3 Years: 3-4 word sentences, hop and skip, 2-3 part command 5 Years: >5 words sentence, count 10, gender aware, address, dress, utensils. Conduct Disorder: Rep, persistent pattern of antisocial or social norms violated. Opp defiant disorder: Anger-guided disobedience towards authority figure. ^^Both of these are much worse when they start at early age.^^ Comorbid Learning disorder, ADHD, Mood disorder, Substance abuse Protective: good relationships, teen onset Risk: fire setting, cruel animals Separation Anxiety unreal recurrent worry harm to loved ones when separated. Has distress/worry, clinging behaviors and somatic (headache, nightmare)
**Important to look at somatic w/ kids manifestations of psych turmoil.**

Social Phobia in kids manifests as fear of going to school BUT MUST ASK WHY!! Separation Milestones: Stranger Anxiety (6-12 months) distress when exposed to strangers Good because it means baby can tell mom or dad from not Babies like to be explored while held but not when held be stranger. Object permanence (18-24 months) Things continue to exist. Object Constancy (2-3 years) Form own independent self, mom reliable Secure Attachment-explore from mom, upset when she departs/happy when return Adult: Meaningful relationships+appropriate boundries Anxious resistant-anxious explore even with mom, extreme distress/ambivalent Adult: Controlling, unpredictable Anxious avoidant-Avoid or ignore mom Adult: distant, avoids emotional connection with others Disorganized-cry during separation but avoid when mom returns Chaotic, abusive, untrusting Becareful when you see a mentally retarded person might mistake agitation and distress for psychosis. Mental retardation on Axis II. DSM IQ: Borderline 70s Mild 50-70 Moderate 35-50 Severe 20-35 Profound <20 Downs: Impulsive, poor judgment, short attention, slow learning *single crease palm Fragile X: Autistic behaviors, poor sensory skills, large ears, long face, poor muscle.

PYSCH FINAL ADHD 6 inattention (inapp), 6 hyperactive(inapp), 6 months before age 7 in 2 settings. In adults: diff sustain attn., procrast, poor time manage, excessive talk, interrupt. Persistence of ADHD is more likely than not. Low treatment. Only MDD more prev. Comorbid with Conduct disorder, Opp. Defiant disorder, ANXIETY (most common) Want to r/o substance abuse, mood or anxiety disorder + current meds/endocrine ADHD have educational (few college), social (>divorce), employment probs (fired), riskier sexual behavior, worse driving record, more criminal (mainly those with adolescent conduct disorder). Decreased substance abuse risk if ADHD treated earlier = lower rate + later onset Neuro: <dop transp on left, small cereb, mature delay, red prefrontal, diff networks Runs in families could be due to maternal smoking, drugs, malnutrition. Treament plan: educate, reasonable exp, resources, acoom, vocational assessment. Can use meds (primary) then behavioral therapy (mild sympt or w/ meds). Meds: all equally effective. XR initial, greater compliance, less abuse risk Each patient requires a unique dosage monitor side effects Adderall inc dop release, AMPH+Atomoxetine are reuptake inhibitors Amphetamines increase focus. **MAKE SURE TO DO CARDIAC + MED/PSYCH COMORBID SCREEN** EATING DISORDERS Disorders of maladaptive eating behavior that results in distress/impairment. Have a behavioral, cognitive and medical components. Anorexia <85% weight, intense fear of gaining, percep vs reality difference Clinically: Thin hair, anemia, amen, decreased HR nutritional depletion Binge-purge subtype - <85% + binge-purge Bulima Recurrent Binge w/ reccurant inappropriate compensation (purge, excesive exercise, lax) at least 2/week for 3 months. Loss of control with food Clinically: Normal weight, chipmunk sign, russel sign (knuckle scar) Eating Disorder NOS Loss of control, binge with no purge, lots of guilt/shame. Lost of medical complications MEDICAL EMERGENCY! Hypokalemia/dehydration, lax abuse, **<75%**, inabil eat, most day purge SCOFF Sick, lost Control, One stone, Fat perception, Food dominates. Multifactorial Sociocultural/Genetic/Biological Treat Bulima with Fluxetine ultimately it takes a multidisciplinary approach. SEXUAL DISORDERS Sexual behavior varies greatly evaluate with honest, consenting, responsible? Diff cultures = diff values dont pathologize behavior you dont understand.

PYSCH FINAL Paraphilias RECCURING, intense, sexually arousing fantasies w/ non-human, suffering, child, non-consent. >6 months w/ marked distress or impairment. In response to dysphoria (anx, dep, stress, bored) Sometimes person has dec sense of self turns to obj that wont reject ****NOT PARAPHILIA IF YOU CONTROL BEHAVIOR***** Sadism humiliate others Masochism humil self (BOTH NON-CONSENT) Exibitionism showing self to UNSUSPECTING others Frotteurism rub on people on bus Trasvestic Fetishism X-dress for SEXUAL GRATIFICATION Starts as late teen/early adult but contrib factors way earlier (+ reinforce) Many people are NOT impulsive this takes lots of planning, seeking, thought Many people are compulsive must do it to reduce stress, inc pleasure. (- reinforce) Treat: Psychologic>Genetic. MA+opiate play role. Use naltrexone+SSRI (sexual sideffects). Can use CBT + behavioral therapy (ammonia sniff or satiation[edging]) SEXUAL DYSFUNCTIONS Desire Excite/arousal Orgasm Relaxation (ALL w/ distress/impairment) Common, F>M, under-reported due to shame/anxiety, universal or partner-specific Desire for women is willingness to participate not being turned on. Hypoactive Sexual Desire: Absent fantasy/desire. Stress, anx, sec other probs (pain) Sexual Aversion: no genital contact due to anxiety, shame guilt Tx: desensitize F Sexual Arousal: no lub/swell. Meds, anx, shame, guilt. Tx: experiment, Sensate M Erectile: no attain/maintain. Disease, anx, shame. Tx: Meds, pumps, thrpy, sensate F Orgasmic: delay or absence w/ norm cycle. FEAR Tx: Explore, commun, sensate M Orgasmic: delay or absence. NOT part-spec FEAR Tx: Sensate, psycho, comm Premature Ejac: Common college-ed, diff wiring (symp), neg twrd F. Tx: Squeeze Tq Dyspareunia: Genital pain. Rape/pelvic pain/child abuse. Tx: Psycho, relax, sensate Vaginismus: Invol spasm. FEAR/ANX. More comm college. Tx: Psycho, relax, sensate Substance Induced: Alc, amph, cocaine, opioid, sed ALTERNATIVE MED Psych patients around 70% lifetime prevalence. Higher in MDD+panic disorders Adrenal fatigue is when you have desensitized receptors at the HPA. Cortisol levels: MDD Constantly high PTSD/chronic pain constantly low More stress = more brain remodeling + body wear/tear. Poor HRV patterns in MDD, anx, ADHD, PTSD improved w/ improved condition Depression: Increased depression = increased inflammatory markers (lo3/hi6) omgs (adjuct, tox=bleed), D(mod), B12/6/Zn/Sel, 5HTP (btr thn SSRI), RRosea (-) sideffect @ SSRI @ brainstem. SAM(risk of mania) Anxiety Reiki=dec length of stay+need meds PTSD meditation

PYSCH FINAL PSYCHOPHARMACOLOGY Tricyclics: 3 NTs. (-)rptk@MDD, GAD, OCD, PanD. 3-4wks s/e Anti-chol, a-ad, hist MAOI: (-)MAO @ gut= Inc synaptic dop/NE @ MDD, atyp dep, anx. 3-4 weeks s/e inc tyramine absincBP (-wine/meat/cheese), fatal overdose, -combine SSRI: (-)Ser rptk. 2-4wks, fewer s/e, sexual s/e, inc suicide teens. SNRI: 50/50 NE/Ser, for MDD/anx/pain. s/e inc BP, dscnt syndrm = feel like shit Buproprion: (-)NE rptk. No sex s/e, smoke cess, NO@eatingD, s/e anxiety BZD: lng(dia,chlor), med(alp), shrt(lor). (+)GABA, lng-trm dep, s/e sed+amnesia Antipsychotics: (T) Haldol(hi pot/lo dose)=(-)D2R, s/e EPS=dyston, prolac, neuromusc (T) Thorazine(lo pot/hi dose)=s/e <EPS but >anti-chol, a-ad, histaminic S/e bad (-)D2R@otherpaths. cort(mood), Nig(EP), Tub(prolac),limb(halluc) (AT) (-)D2R&Ser2A(< limb) dec EPS/lac/mood s/e cuz inc dop/dec 5HT Lithium blocks inositol-1-Pase, prev suicide, danger overdose s/e tremor, CV, renal Anticonvulsants-cabzepine, valpro acid, lamotig prevents kindling ECT/EMERGING THERAPY Insulin Therapy drop glucoseseizures (convulsions) = less depressive episodes ECT for mood dsrdr, depression, high suicide risk, PREGNANT. Anesthesia+muscle relaxant + ECT = seizure in controlled setting w/ meds to prevent normal dangerous s/e. Short mem loss (recover) & long term (rare). USED IN SEVERE CASES. Contraindication brain or heart condition VNS anxiety+alzheimers + DEPRESSION. Use afferent vagal fibers for impulses. TMS Magnetic impulses to stimulate neurons release more NT DBS- Electrodes in specific region of the brain to turn on/off. PSYCHOTHERAPY Psychodynamic therapy patient talks and better grasps underlying dynamics. CBT- people have schemas for reaction/adaption. Most common for dep/anx Cognitive triad: Neg view of self, interp of exp and view of the future. Auto thoughts: automatic in a given situation. Arbitrary inference error in conclusion from experience Selective abstraction: Take small detail out to make something shitty Overgeneralize: general conclusion based on single experience Magnify/minimize: altering significance of negative exp Personalization: interpret things that have nothing to do with you Dichotomous thinking: all or nothing Interpersonal therapy focus on present interpersonal relationships. Transference: Patients thoughts about you could be bad Counter-Transf: Your thoughts about patient could be bad