April 18th lecutre mental health PDF

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Mental health lecture april 18th

FDA just approved the first drug ever to treat TARDIVE dyskinesia: valvenizine. Showed that pts who took 80 mg a day of the active treatment had a significant decrease in the tardive dyskinesia symptoms on the abnormal involuntary movement scale at 6 weeks compared to those who were given a placebo pill….the abnormal involuntary movement scale ATI likes to talk about this Chronic exposure to dopamine receptor blockers, including antipsychotic meds said to cause DD. This effects 500,000 people in the USA. A study looked at 1000 total participants and the continued reductions of the symptoms were observed though 48 weeks of treatment. (This was a good longitudinal study.) Until now one of the few options for managing it was to stop, change or lower the dose potentially jeopardizing their psychiatric stability but it seems that with this medicine, the psychiatric instability didn't occur like the other medications When we look at behavior in children, behaviors of a child at one age may signal behaviors of a child at a different age. For example, tantrums; we don't expect older people to be having tantrums like adolescents or children do so if we see it we know that something we shouldn't be seeing… BUT ANY CHILD WHO IS EVER UNRESPONSIVE TO THEIR ENVIRONMENT IS A MAJOR CONCER FOR US!! We look at things that might not be culturally appropriate, or age appropriate. These things help us to determine whether a child has a problem that we should be concerned about or any deficit in adaptive functioning for that matter. Most children in the united states that have a mental illness go untreated. They said more than 17.1 million kids in the us have a diagnosable mental illness and most of them are untreated. Less than 35% of them ever get help…that's a very big health crisis. Another thing that has come out in relation to being a risk factor for children to develop a mental illness is…  Father over 45 years very often end up having children that have problems. There is a higher risk for autism and adhd and psychosis and bipolar disorder, suicide, substance abuse, failing in grade school. Older fathers seem to present some type of risk. We have known for a long time now that brain imaging shows us that PTSD symptoms are linked to poor hippocampus functioning. This is where we store and retrieve memories when this is compromised by PTSD that is a major concern. Another big concern is that majority of youths who are prescribed anti-psychotic medication do not have a psychiatric diagnosis. Among those that did have a diagnosis many of them were being treated with drugs that were not FDA approved and most of the time the drugs were being prescribed by non-physiatrists people. Most of the drugs that we currently use to treat children are not FDA approved and have never been tested on children. Humpty dumpty article: no child left undiagnosed. By age 21 81% of American kids can be labeled with a psych disorder. The articles main point is that we are turning childhood into a disease. Predatory insurance practices: putting psych patients are risk because our practices are onerous and predatory and dangerous. Psychiatry gets singled out to a different level of scrutiny. Attachment theory: child and caregiver. The need for touch is universally and biologically driven. The baby needs to be touched and cuddled and needs to become securely attached because when there is an insecurity what happens is that the child fears separation from the caregiver and then there is attachment disorganization and that's very serious. When we have detachment disorganization we have a whole series of both behavioral and physiological dysregulations. There was a theorist a while back, named: Stella Chess, who talked about 3 different types of baby temperament. You can see temperament early on in life and you can correlate it with behaviors later.

Mental health lecture april 18th

1. THE EASY temperament: these babies are good, they eat and sleep properly, they adapt to change easily, low emotional intensity. They don't risk psychopathology because these are easy temperament kids. 2. THE DIFFICULT: dysregulated sleeping and eating, really respond negatively to new stimuli, generally they have a negative mood and they are at risk for adjustment problems. If we see these difficult kids like this past the age of 3 there is a correlation to developing some psychopathology. They don't adjust well to change. And if we see kids with this past 3 years 3. SLOW TO WARM UP BABIES: they adapt slowly but they will morph into a positive response. They are saying that peoples’ temperament won’t change but there are environmental changes that can influence a child’s life When we look at the neuro scientific approach to attachment trauma we look at something like the autonomic nervous system. What happens when a child experiences trauma the LEFT BRAIN DOESN'T LET GO OF IT!! Even though they might not be thinking about the trauma its stored there and does create emotional, mental and physical distress. Fear is stored in the amygdala. So what happens is that we get these people when they’re older and at that point if they even talk about it or think about it they get re-traumatized. 

So again, you need to have early attachment be reciprocal, you need to have babies learn how to self soothe which is very important. From birth to about to about 18 months old the brain/CNS is really sculpted by the interactions with the mother or care giver.

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The structure of the right brain is involved in autonomic regulation of emotional experiences. It must mature and takes 2 years to do so. During these 2 years, the development of the parent child relationship is critically important. We need reciprocity/ synchrony between the mother and the child to help the brain develop and the child

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What happens to children is very predictive of what can happen to them later on

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When parents themselves have not been the product of secure attachment they wont be able to help the children develop normal secure attachments

National Institute Of Public Health did a study where they look at how chronic stress prematurely ages kids by shortening the telomeres and this is very serious. Telomeres are the part of the DNA at the end of the chromosomes that you don't want to shorten. They looked at kids who came from disadvantaged areas environments and they had the highest genetic sensitivity and they had the shortest telomeres. This shortening of the telomeres is a biomarker for exposure to LIFETIME STRESS. Stress changes the hippocampus which is very important and we don't want any dysregulation here. Kids are at risk for toxic exposure very early on. Can be prenatally or postnatally. When these babies start to crawl around on the floor there is greater exposure to toxins. They’re living and crawling on the floor they’re picking up everything like dirt and the dirt comes from outside from under your shoes. They have early life exposure. Living near power plants you get exposure, pesticides, lead and pcbs and mercury and endocrine disruptions and all of this is either carcinogenic, teratogenic, or mutagenic. Barbeques are CARCINOGENIC- the meat that is cooked at those high temperatures is very serious/bad for you. Eating the meat that is cooked at hose high temperatures is bad. Nonstick pans are bad for people. Anything that is flame retardant is carcinogenic The government doesn't work on a precautionary principle... they don't do anything about anything until it has been proven dangerous and they wait until afterwards when something bad has happened to a large amount of people.

Mental health lecture april 18th

Makeup is toxic: made of so many chemicals that are toxic. We have to be very cautious of where babies are playing at school and at home… use green products 700 chemicals in our body that cross the placenta barrier an article study showed that antipsychotic meds can put kids on a fast track to cardio metabolic changes. takes just weeks to start there are many studies about how changes a child’s diet can impact their personalities. low omega 3 has been linked to cognitive behavioral problems so we want to give them more. adult’s harsh words take a huge toll on kids. There’s an article about the effects of scolding a child. Kids hated to be shouted at and they still believed the parent was mad at them long after the shouting stopped. Children see little difference between physical and verbal violence Most parents/teachers shout at disobedient children both in public and private. They should try to tell the kids how they feel in a normal volume. Its very hard to diagnose children because of diagnostic issues they can’t abstract cognitively

PPDDs: Persistent pervasive developmental disorders: all of them are categorized by sever and persistent impairment in reciprocal social integration. Impairment in Verbal/nonverbal communications skills. Limited number of activities and interests- and when they do have them they tend to be stereotypical. They don't play or relate well to others. They have a lot of significant delay in one or more of the areas listed. WHEN A CHILD IS UNRESPONSIVE TO THEIR ENVIRONMENT HAS A SEVERE EMOTIONAL PROBLEM These kids need a lot of structure. You must be clear and descriptive, break up their tasks into smaller ones so they can handle it. There are many disorders, we will talk about a few… AUTISIM: A BIONEUROLOGICAL DISORDER that effects brain functioning.  We don't know where it comes from. 12 years ago, it was 1 in every10,000 people and now its 1 in 45 kids. We can’t that it is because of better diagnosing… but we don't know exactly why this is the case.  There is evidence that there is a Genetic basis of autism- 27 genes that are linked to autism  We don't recognize it until 18 months to 3 years old…we need to find it early.  The eyes of children with autism from birth to 3 years didn't look at you the same way that regular kids did. Very classic symptom.  Disorganized neurons found in the prefrontal cortex: found by autopsy indicating autism prenatally perhaps brain cell activity has been disrupted during pregnancy  Autism is about 50/50 genetic vs environmental  maternal pre-pregnancy obesity combined with diabetes is linked to an increase in risk for autism, paternal pregnancy and diabetes obesity is also linked to have problems with autism  every 12 mins a kid is diagnosed with autism  mitochondrial dysfunction disease- we need to screen kids for this. Microbes in the gut effect the hippocampus. Kids need to eat healthy food. Early junk food exposure is a risk factor for mental health problems. Poor diet for the mother and the children is a huge risk factor for mental health problems too  BRUNO VETELHIN: used to say autism was caused by cold refrigerator mothers. THIS IS NOT TRUE and has nothing to do with it

Mental health lecture april 18th

Parents tell us all the same thing: my kid was growing normally but at 18 months they don't play the way other kids do they started growing slower, they went into a world of their own  effects boys more than girls 5 to 1. These kids have a very limited ability to relate to peers, kids or parents. They don't really enjoy any spontaneous play. They don't really have any social skills, they have very impaired social interaction. They don't really like to play with other kids or toys… if they do play with toys its more about lining them up and organizing them. sometimes in therapy treating these kids we use multi-sensory toys. There speech is idiosyncratic and they use A LOT OF ECCHOLALIA!!! They have a lot of repetitive and self-soothing behaviors that we call “Stimmi behaviors”: including finger posturing, hand flapping, rocking, body twisting, bite themselves, they bang their heads, walk on their toes. They have a lot of sensory behaviors they may sniff at a non-smelling object, mouthing objects, they don't like certain textures. They do not sleep well, they wake frequently, sometimes because they have seizures. The parents have trouble getting good sleep too because of this The M-CHAT is a pretty good diagnostic tool where parents report what they see or don't see in their child. It's a bunch of yes or no questions. If they say no to 2 or more things on this list they need to get a work up on the child

CONCERNING BEHAVIORS red flags:  6 months old and not reciprocally smiling back at you this is a concern- most babies are at 4 months  no smiles or warm joyful expressions  not babbling by a year old  no back and forth gestures such as pointing showing or reaching objects  they should be waving bye bye or saying mama or dada  by 16 months should be saying words  by 2 they should be putting meaningful phrases together the goal of the treatments is to reduce the behavioral symptoms, promote their learning- especially their language skills, behavioral therapy as been helpful in reducing some of their unnecessary behaviors. they very often give them Rispiradol (can cause gynecomastia (ATI chapt 23)) or Zyprexa to reduce the temper tantrums. Kids with autism seem to respond to activities where they don't have to talk- animals & music are huge! They can relate to them in a way that they cant relate to humans, or music because they don't really have to talk. Some of the weaknesses found in autism can translate to strengths in areas that involve specific tasks that would bore most people who aren’t autistic Kids with autism need a MEDIA FREE bedroom- no television, you don't want computers either to prevent sleep disturbances. 80% of people have intellectual disabilities and will require significant care all the way through adulthood the best outcome we can hope for is that they can establish trust with at least one caregiver. It can be so difficult to deal with these kids and live with them at home. Yoga improves the lives of kids with autism on long island ASPERGER’S SYNDROME: more boys than girls. diagnosed around preschool or school age because that when the deficits become noticeable. You might have same stereotypical behaviors as autism but you won’t find the same degree of cognitive or intelligence delays. They have normal language

Mental health lecture april 18th

development…but sometimes they speak robotically. They can’t read social cues, or facial gestures, they doesn’t understand humor in conversations. Issues in these 4 areas 1. SPEECH- very robotic type- not always 2. SOCIALIZATION- they can’t read social cues. they get bullied 3. SLEEP- no sound sleep 4. SENSITIVITY to feelings/or materials There is no cure, there is no lab work to diagnose it Supplements, sensory therapy, CBT, OT AND PT, and language therapy are good treatments RETS disorder: Primarily in females because the boys usually die at birth. It’s very rare. We don't know what causes it, we do see seizure disorders and severe/profound mental disorders. This child seems to progress normally and then all the sudden they lose their gross motor skills, can’t walk, move or talk or reason. They have a very stiff gait if they do walk. Some make it to adult hood but a lot die. The most classic sign:They do a lot of wringing of the hands- almost all of them do this. THIS IS MOST PHYSICALLY IMPAIRING OF ALL THESE TYPES OF DISORDERS. Similarly treated in the same ways as autism EXCEPT THERE’S A MUTATION IN ONLY ONE GENE HERE ADHA: ATTENTION DEFICIT HYPERACTIVITY DISORDER. NEURO BIOLOGICAL DISORDER: Boys more than girls 3:1. Diagnosed in preschool or school age. These kids didn't eat or sleep well, they were very fussy, hard to manage- says the mothers who tell us. We don't know where this comes from- many different theories. A lot more prevalent in western cultures.  Prenatal exposure to tobacco and alcohol and lead and severe malnutrition are risk factors. These kids love to eat high fat food so a lot of them are obese.  There is a brand-new medicine, its chewable methylfenedate but there very high risk for dependence and abuse… supposed to calm them down and make them more manageable and less hyperactive/ impulsive.  If we don't catch it before adolescence they usually end up doing high risk behaviors. High rates of drug and alcohol abuse  They do a lot with sugar control and mega vitamin therapy and educational and psychosocial interventions.  Mostly they use psychostimulants –methylfenedate: RITALIN, or Adderall which is an amphetamines mixture. Daytrana the transdermal patch- put it on in the morning, take it off after 9 hours and alternate the hip it’s on every day. They all have potential of abuse and there are a lot of growth problems associated with these. Sometimes there are vivid hallucinations. One non-stimulant med- Stretera NRI norepinephrine reuptake inhibitor: give these meds to them in the morning because we want them to pay attention and focus at school but unfortunately, they diminish the child’s appetite but we can’t give these at night because it will disturb their sleep so it is kind of a Catch-22 medicine. not that many side effects but its very hepatotoxic and requires many liver function tests  These people often become substance abusers chasing the dopamine high  Theres a link between adha and premature death. 2 million people over 32 years.  Small study showed: A 20 min walk may help with concentration in kids with adhd. ASK/ NATIONAL ASK day- this is a new movement about making sure you children’s friend’s home doesn't have a gun before any playdates ODD: OPPOSITION DEFIANT DISORDER: 1 in 55 kids have it. a recurrent pattern of reoccurring negativistic disobedient hostile uncooperative defiant behaviors towards authority without carrying out any antisocial violations/ or behaviors . They may be aggressive but they aren’t impulsive. They lose their temper, they don't comply with anything, they defy rules, they never accept blame, they complete go against authority figures- parents or peers or anything. Not with in the realm of anything we consider to be developmentally normal, seen more in males before puberty and then females catch up. Is this a strong-willed child or do they have ODD… is they symptoms have lasted for over 6 months and are disrupting family and

Mental health lecture april 18th

school life and there is violence we figure it odd. It does seem to run in the family. 3x more likely to develop this ODD is the family have alcohol issues or trouble with the law. Usually co morbid with ADHA…… IF WE DON'T TREAT IT WILL GO ON TO BE A CONDUCT DISORDER: A REPTATIVE AND EPERSISTANT PATTERN OF BEHAVIOR IN WHICH THE BACIS RIGHTS OF OTHERS OR MAJOR SOCIETAL RULES ARE VIOLATED. This is so much worse than ODD the biggest difference that there is a HUGE issue of safety. Odd is annoying but its not dangerous and they don't violate the rights of others but the conduct disorder does. The most serious of all the childhood social disorders. Most go on to have bipolar disorder  Physically aggressive to people and animal they are cruel,  They destroy property  They’re deceitful, they steal they lie, they'll hurt you. They'll break into you house or car or anything.  Serious violation of any type of parental rules: They don't feel any remorse or guilt, they have no empathy. Everything is there’s and they'll beat the hell out of you to talk it. They'll kill you, they don't care. They end up in the criminal justice system.  They set fires a lot.  There’s a paradox when you have this at adolescent onset they seem to be less aggressive and more normal and it’s a lot less severe, they don't have the anti-social personality.  SUICIDAL ideation in common.  Some parents say it would be better off if their child was dead because they can’t handle it and its extremely unsafe. We really don't have a lot of help for conduct disorder  Person in need of supervision court ordered treatment TURRETS: neurological disorder, involuntary and very distressful/embarrassing; ticks, vocal utterances, grimacing, cursing, movements. These ticks do change frequency or severity. They do have periods of remission; the symptoms diminish sometimes for longer periods of time than others. 1 in 100 people. First born, inade...