Exam 3 - mental health

Temperament

a combination of personality traits made up of nine different areas: activity level, biological rhythms, sensitivity, intensity of reaction, adaptability, approach/withdrawal, persistence, distractibility, and mood.

Temperament is thought to be both genetically influenced and learned through relationships with family members and caregivers

Resilience

factor associated with temperament. A child who is resilient can adapt to and overcome stressors, and resilience is a trait that can be learned

Autism spectrum disorder (ASD)

now encompasses former diagnoses of Asperger’s syndrome and pervasive developmental disorders. ASD presents with deficits in social and emotional interactions, as well as repetitive patterns of behavior, interests, or activities

Present with

• Deficits in social and communication interactions

• Repetitive patterns of behavior, interests, or activities

• Severity based on functional ability

Levels

1. Level 1: noticeable social deficit, but language and speech are normal

2. Level 2: noticeable deficit in verbal and nonverbal social and communication skills

3. Level 3: social deficits are severe, with communication being limited and needs-based

self-stimulatory or “stimming”

seen in ASD, repetitive patterns

can be mild and barely noticeable (tapping fingers on leg) or severe (banging head on floor or biting) and can cause injury and scarring.

Attention-deficit/hyperactivity disorder (ADHD)

Symptoms:

• Problems with concentration such as making careless mistakes, difficulty remaining focused, being easily distracted, etc.

• May also avoid tasks that require sustained mental effort, misplace items, and tend to be messy.

• Children may fidget, run or climb when not appropriate, interrupt, or talk excessively.

• As adults, this may present as an internal restlessness more than as physical impulsivity.

Tourette’s disorder

The symptoms of this disorder include motor as well as vocal tics, with an onset in early childhood.

• Tics can be mild, such as clearing the throat or jerking a limb, or as severe as loudly yelling out an animal noise or curse word, with spasms intense enough to cause the patient to be flung out of a chair

• Tics can be very embarrassing to children and adolescents as they attempt to navigate social and dating relationships.

DSM5

• Presence of Tics: Both multiple motor tics (e.g., eye blinking, shoulder shrugs) and at least one vocal tic (e.g., grunting, throat clearing) must be present, although they do not need to occur at the same time. [1, 2]

• Duration: The tics must occur many times a day, nearly every day, or intermittently, for a period of more than 1 year. [1, 2]

• Wax and Wane: The tics may wax and wane in frequency, but there must not be any tic-free period lasting longer than 3 consecutive months. [1]

• Age of Onset: The first tics must begin before the individual turns 18 years old. [1, 2]

• Exclusions: The symptoms must not be caused by medications, substances (like stimulants), or other medical conditions (e.g., Huntington's disease)

Specific Learning Disorders

Difficulty in learning and academic skills, often in a specific area (Reading, written expression, math)

• E.g., Dyslexia, dyscalculia

• Onset: Elementary school years (5% to 15%)

Assessment, diagnosis, and implementation

• Parents may report problems

• Diagnosis through testing

• Learning accommodations such as tutoring can be made

Oppositional Defiant Disorder (ODD)

• Goes beyond the normal limit testing typical of children

• Symptoms displayed with at least one non-sibling person

DSM 5:

• At least four criteria must be present

  • 1. Angry / Irritable Mood

    • Frequently loses temper

    • Is easily annoyed or touchy

    • Is frequently angry and resentful [1]

    2. Argumentative / Defiant Behavior

    • Often argues with authority figures (or adults)

    • Actively defies or refuses to comply with rules or requests

    • Deliberately annoys others

    • Blames others for their own mistakes or misbehavior [1]

    3. Vindictiveness

    • Is spiteful or vindictive (at least twice in the past 6 months

• Frequency & Duration: The behaviors must happen frequently and last for at least 6 months. [1, 2]

• The Sibling Rule: For children under 5, the behavior should occur on most days. For those 5 and older, it must occur at least once a week. The behavior must also be directed toward at least one individual who is not a sibling. [1, 2, 3]

• Functional Impairment: The symptoms must cause significant distress for the individual or others, or negatively impact their social, educational, or occupational life. [1, 2]

Conduct disorder (CD)

• More severe than ODD

DSM5:

• Before age 10, and 1 symptom for childhood onset

• At least three criteria must be present in the past 12 months, with 1 present in the last 6 months

  • Aggression to People and Animals

    • Bullies, threatens, or intimidates others.

    • Initiates physical fights or is physically cruel to people or animals.

    • Uses weapons that could cause serious harm.

    • Steals while confronting a victim (mugging, extortion) or forces someone into sexual activity. [1]

    Destruction of Property

    • Intentionally sets fires to cause serious damage.

    • Deliberately destroys the property of others. [1]

    Deceitfulness or Theft

    • Breaks into someone else's house, building, or car.

    • Lies to obtain goods/favors or avoid obligations (cons others).

    • Steals items of nontrivial value without confronting the victim (e.g., shoplifting). [1, 2]

    Serious Violations of Rules

    • Stays out at night despite parental prohibitions (beginning before age 13).

    • Runs away from home overnight at least twice.

    • Is truant from school (beginning before age 13). [1, 2, 3]

Dramatic play therapy

also called psychodrama, is a treatment modality that uses dramatic techniques to act out emotional problems, examine the experience, develop new perspectives, and try out new behaviors.

Play therapy

the notion that play is the work of childhood and the way a child learns to master impulses and adapt to the environment

Bibliotherapy

using children’s books and literature to help the child express feelings in a supportive environment, gain insight into feelings and behavior, and learn new ways to cope with difficult situations

movement and dance therapy

a direct expression of the self that helps the youth become more aware of feelings and thoughts, dissipate tensions, develop greater body awareness, improve or correct a distorted body image, improve coordination, and increase social interactions

music therapy

instigates changes in both the physiology of the nervous system and social interactions. Music therapy may incorporate recorded music, songs, songwriting, or the use of a musical instrument

recreational therapy

generally takes place off the unit and is often conducted by a recreational therapist with assistance from the nursing staff. Activities are often organized around a game that teaches psychomotor and social skills, such as volleyball or swimming

therapeutic drawing

allows children to spontaneously express themselves in artwork that captures thoughts, feelings, and tensions they may be unable to express verbally

therapeutic games

deal assessment tool for children who may have difficulty talking about their feelings and problems, and they also allow a nonthreatening way to develop rapport with health care workers. The game might be as simple as checkers, but therapeutic games are more effective in eliciting children’s fears and fantasies

therapeutic holding

nonpunitive in nature, or helmets to protect a patient during head banging can be used

Bipolar Spectrum Disorders (BSDs)

Conditions that include bipolar disorder and other types of mental conditions that can involve depression or mood swings

• Chronic, recurrent, and life-threatening illnesses

• They include a range of symptoms on a continuum.

  • Mania

  • Depressive symptoms

  • Mixed

• Behavior, speech patterned, thought process

  • Paranoid delusions

  • Grandiosity

  • Sensory perceptions

  • Pressured speech

  • Flight of idea

  • Circumstantial speech

  • Rate and rhythm of speech can be rapid, and verbose

  • The content of the speech is often sexually explicit

  • Clang associations

  • 1/3 of BD patients display significant cognitive difficulties

Bipolar I disorder

DSM5

Lasts at least 7 consecutive days, most of the day, nearly every day.

3 or more symptoms/4 or more if mood is only irritable:

• Inflated self-esteem or grandiosity

• Decreased need for sleep (e.g., feeling rested after only 2–3 hours)

• Unusually talkative or pressure to keep talking (fast speech)

• Flight of ideas or subjective feeling that thoughts are racing

• High distractibility

• Increase in goal-directed activity or physical restlessness

• Excessive involvement in high-risk or impulsive activities (e.g., spending sprees, reckless driving, or risky business investments) [1, 2, 3]

What we see:

1. Manic Episodes (The "Highs")
Manic phases involve abnormally elevated, irritable, or energized states that heavily impair daily functioning. Key signs include: [1, 2]

• Decreased need for sleep: Feeling fully rested after only a few hours.

• Grandiosity: An inflated sense of self-worth, power, or holding unrealistic, magical plans.

• Racing thoughts: Rapid, pressured speech that is difficult to interrupt.

• Impulsive behaviors: High-risk activities like reckless spending, substance misuse, or risky sexual encounters.

• Psychosis: In severe cases, a detachment from reality with delusions or hallucinations. [1, 2, 3]

2. Depressive Episodes (The "Lows")
Following mania, moods can crash into deep, persistent depression. Symptoms include: [1]

• Profound sadness, hopelessness, or emptiness.

• Complete loss of interest in once-enjoyed activities.

• Fatigue, lack of motivation, and sleep disturbances (insomnia or hypersomnia).

• Feelings of excessive guilt or worthlessness.

• Recurrent thoughts of death or suicide. [1, 2]

Bipolar II disorder

DSM 5:

1. Hypomanic Episode
A distinct period of persistently elevated, expansive, or irritable mood and abnormally increased energy or activity.

• Duration: Lasts at least 4 consecutive days.

• Symptoms Required: Must exhibit more than 3 of the following or more than 4 if mood is only irritable):

  • Inflated self-esteem or grandiosity

  • Decreased need for sleep

  • Being more talkative than usual

  • Racing thoughts or flight of ideas

  • High distractibility

  • Increase in goal-directed activity or non-goal-directed psychomotor agitation

  • Excessive engagement in high-risk activities (e.g., shopping sprees, reckless investments) [1, 2, 3]

2. Major Depressive Episode
A period of severe, sustained low mood or loss of interest that causes significant distress or impairment in daily life. [1, 2]

• Duration: Lasts at least 2 weeks. [1]

• Symptoms Required: Must exhibit more than 5 of the following, including at least one of the first two:

  • Depressed or sad mood

  • Markedly diminished interest or pleasure in activities (anhedonia)

  • Significant weight or appetite changes

  • Insomnia or hypersomnia

  • Fatigue or loss of energy

  • Feelings of worthlessness or excessive guilt

  • Diminished ability to think, concentrate, or make decisions

  • Recurrent thoughts of death or suicidal ideation [1, 2, 3, 4]

Cyclothymic disorder

• Duration: Numerous periods of hypomanic symptoms and depressive symptoms for at least 2 years (1 year for children and adolescents). [1]

• Symptom Presence: The alternating mood swings must be present for at least half of the time during the 2-year period, and the individual must not go symptom-free for more than 2 consecutive months. [1]

• Threshold Limitation: The symptoms cause significant distress or impairment but never quite fulfill the full diagnostic criteria for a hypomanic, manic, or major depressive episode. [1]

• Exclusion: The symptoms are not better explained by another mental health disorder, substance use, or an underlying medical condition

Rapid-cycling bipolar disorder

• Episode Count: \(\ge 4\) separate episodes in a 12-month period.

• Episode Types: These can include major depressive episodes, manic episodes, or hypomanic episodes.

• Separation: The episodes must be separated by at least 2 months of full/partial remission, or a switch to the opposite polarity (e.g., a depressive episode switching directly into a manic episode).

Unipolar depression

• Affects women more than men and appears later in life

• Sleep disturbances, loss of appetite

• Depression may be agitated

• Physical symptoms can be seen

Delirious mania

Rapid onset of delirium, plus mania, and may include psychosis

Mania

• Hyperactivity may range from mild to frenetic, wild activity

• Individuals can be manipulative, profane, fault finding, and adept at exploiting others’ vulnerabilities

• All persons experiencing mania sleep less

• Nonstop physical activity and the lack of sleep and food can lead to physical exhaustion and even death

Hypomania

Individuals show signs and symptoms similar to mania, just not as extreme.

clang associations

inking words together by their sound, rhyming, or rhythm rather than by their actual meaning - usually during mania

Phases

1. Acute mania: The acute phase involves managing severe, full-blown manic (or mixed) episodes characterized by high energy, agitation, psychosis, or impaired judgment

   1. Safety is a priority

2. Continuation phase: immediately after acute symptoms resolve and clinical improvement is achieved. This period lasts for about 2 to 6 months

3. Maintenance phase: the long-term management strategy that begins once the patient has fully stabilized, extending for months to years, and often indefinitely

flight of ideas

shifting, loosely connected thoughts that manifest as hurried, pressured speech - usually during mania

pressured speech

It is characterized by rapid, loud, and compulsive talking driven by racing thoughts - usually during mania