“I guess what I miss most is being drunk.”

SUD AssessmentSUD Assessment

Parental valuesGeneticsCultureIndividual characteristicsPeer group

SuicideSuicide

Epidemiology

Impulse control risk factorsBiopsychosocial etiologyGender differences

Tic DisordersTic DisordersSudden, rapid, recurrent non-rhythmic, stereotyped, motor

movement or vocalizationTourette’s Disorder

motor before vocalautosomal dominant

Symptoms of Depression in Young People

Irritability

Low self-esteem

Denial of depression

Somatic Complaints Depressed appearance

Diagnosis of Dysthymia

Depressed or irritable mood lasting a year or longer

Never symptom free for longer than 2 months

Diagnosis of Dysthymia(Cont’d.)

Symptoms–pessimism

–social withdrawal

–decreased energy

–low self-esteem

–poor concentration

–hopelessness

–sleep and appetite changes

Risk Factors for MDD and Risk Factors for MDD and DysthymiaDysthymia

Stressful life events

Parental dysfunction and lossBoys - neonatal health problemsGirls - perceived unpopularity, anxiety

Early Onset Bipolar Early Onset Bipolar DisorderDisorder

Changes in mood, sleep pattern and energy

Hyperactivity and irritabilityDistractibilityPressured speech

Early Onset Bipolar Early Onset Bipolar Disorder (Disorder (Cont’d.Cont’d.))

Affective symptomatologyVisual hallucinationsUnreasonable irritability

and anger

Epidemiology of Epidemiology of DepressionDepression

Incidence increasing

4.7% MDD among adolescents

Mean age of onset 11 years0.7% bipolar among adolescents

“Son, it’s important to remember that its O.K. to be depressed.”

Depression Biologic Depression Biologic EtiologyEtiology

Genetic influencesStructural and functional changesSerotonin and norepinepherineCortisol and growth hormoneAttachment experience

Depression Depression Psychosocial EtiologyPsychosocial Etiology

Developmental dynamicsLife stressFamily dysfunctionCultural support

Depression DDX and Depression DDX and Co-mobidityCo-mobidity

Bipolar Disorder

Anxiety and PTSD

ADHD

•Medical causes

Separation Anxiety Separation Anxiety DisorderDisorder

Differential DiagnosisPhobia LD

Conduct Disorder Depression

Excessive anxiety about separation from the home or from significant others

Selective MutismSelective Mutism

Failure to speak in specific social situations despite speaking in other situations.

Reactive AttachmentReactive Attachment DisorderDisorder of Infancy or of Infancy or

EarlyEarly ChildhoodChildhoodDevelopmentally

inappropriate social relatedness beginning before age 5 associated with pathological care.

Inhibited and Disinhibited Type

Generalized Anxiety Generalized Anxiety DisorderDisorder

Excessive anxiety and worry for at least 6 months

Worry about performance at school and sports

DSM IV criteria less stringent

PhobiasPhobias

Most common disorder in childhoodFears and anxieties decrease with

age. About 2 - 3% of adolescents have significant fears.

Phobias (Phobias (Cont’d.Cont’d.))Fear of loud noises, the dark,

animals, or imaginary creatures are common in younger children. In older children, fears are more focused on health, social and school problems.

Obsessive-Compulsive Obsessive-Compulsive DisorderDisorder

High incidence in TourettesAge of onset younger in

malesBasal ganglia disorders

(PANDAS)

PTSDPTSDFear of separation, withdrawal,

reenactment, sleep disturbance, regression, impulsivity

Anxiety, psychosisPhysical symptoms, nightmares

Response to Traumatic Response to Traumatic EventsEvents

The effect of trauma depends on the mediating processes

– developmental level

– biology of the trauma experience

– social context

– coping skills, protective factors, resilience

Childhood TraumaChildhood Trauma

Type I

– full detailed memories

– “omens” and misperceptions

Type II

– denial and numbing

– self-hypnosis, dissociation, rage

DissociativeDissociativeexperiences bothexperiences bothduring the traumaduring the traumaand afterward is relatedand afterward is relatedto the later developmentto the later developmentof PTSDof PTSD

Biologic Response to StressBiologic Response to Stress

Genetics Fight or flight Norepinepherine linked to immediate and

prolonged response Serotonin linked to anxiety and panic in

PTSD

Biologic Response to StressBiologic Response to Stress(Cont’d.)(Cont’d.)

Brain regions involved include locus coeruleus, ventral tegmental region, and amygdala

Increase glucocorticoid release results in loss of neurons and decreased dendritic branching in hippocampus and cognitive dysfunction.

The Child Interview (Pynoos)The Child Interview (Pynoos)

Stage 2

– relive experience

– coping themes

– closure, recapitulation, courage/strengths

Stage I

– focus and traumatic reference

Associated ProblemsAssociated Problems

Co-morbid psychiatric disorders

Substance abuse

Sexual/intimacy problems