Difficulty maintaining course of action Histrionic PD Self-dramatization Suggestibility Labile affect Seek attention and excitement Over-concern with physical attractiveness May attempt to impose impractical conditions on treatment Set clear limits Treatment focuses on responding to stressful situations. Medication of little value Anakastic PD Preoccupied with details and rules Inhibited by perfectionism Rigid and stubborn Excessively doubting and cautious Do not respond well to psychotherapy Treatment directed to avoiding situations that increase the pts difficulties and to coping with stressful situations. Avoidant (anxious) PD Tension Feel socially inferior/inadequate Preoccupation with rejection or criticism Avoidance of risk Avoidance of social activity Providing a therapeutic relationship in which they feel valued Be alert to co-morbid depressive disorder. Dependent PD Let others take responsibility for important decisions Unduly compliant with wishes of others Feel unable to care for self and fear having to do so Needs excessive advice to make decisions Problem-solving Should not be seen too frequently to avoid dependence. Avoid meds unless associated depression. Generalized Anxiety Disorder Often present as somatic symptoms: Gastrointestinal (dry mouth, dysphagia, abdo discomfort, wind, diarrhoea) Respiratory (chest tightness, hyperventilation) Cardiovascular (palpitations, chest pain) Genitourinary (frequent/urgent micturation, erectile dysfunction) Neuromuscular (tremor, parathesiae, dizziness, headache) Sleep disturbance (insomnia, night terrors) Psychological (fearfulness, irritability, restlessness, poor concentration)
Hyperkinetic Disorder Also known as ADD, characterised by overactivity Problems with attention and can cause learning difficulty, low and relationship problems. High incidence of familial disharmony. Treatment is by structured daily routine, behavioural therapy and possibly medication (eg amphetamines) Middle Childhood (5-12yrs) Disorder Features Treatment Emotional Most common symptom is anxiety in anticipation of an unpleasant event Associated with tension, physical complaints, bed-wetting and soiling Association with introvert personality Linked to over-protective parenting Stress reduction Improving understanding of anxiety a Enhancing coping mechanisms Conduct More common in boys Antisocial behaviour usually with aggression Lying and disobedience Linked to social deprivation and broken homes Counselling or psychotherapy Behaviour modification through feedback Rarely tranquillisers Psychosomatic Recurrent abdominal pain and headaches are the most common May be due to other physical illness, concern over academic issues and is linked to Joint psychiatric and paediatric management School Refusal More common in single and youngest children who are passive and introvert Usually due to separation anxiety and may be influenced by overprotection Mainly dealt with by parents and teachers. Firmness and encouragement Adolescence (12-16yrs) The common psychiatric problems are: Depressive disorder Suicide and deliberate self-harm Substance Misuse Alcohol Light/Moderate/Heavy Men 21/35/50 Women 14/25/35 Features Acute Intoxication Harmful Use (social / psychiatric / psychological / physical)
Reduce anxiety and at higher doses induce drowsiness (sedatives) and sleep (hypnotics) Prescribed for short periods to avoid tolerance and dependence Gradual withdrawal to prevent withdrawal effects Buspirone Beta-blockers (eg propanolol) Benzodiazepines Antipsychotic Medication Group Examples Unwanted Effects ‘Typical’ Haloperidol Chlorpromazine More ‘Atypical’ Clozapine Olanzepine Less Extrapyramidal side-effects: Acute dystonia (eg tongue protrusion, grimace, ocular spasm) Akathisia (inability to remain still) Parkinsonism (expressionless face, akinesia, rigidity, tremor) Tardive dyskinesia (chewing and sucking, grimacing) Antidepressant Medication Type Examples Unwanted Effects Use Tricyclic Antidepressants (TCAs) Amitriptyline Imipramine Dry mouth Constipation Drowsiness Arrhythmia Moderate/severe depression Selective Serotonin Reuptake Inhibitors (SSRIs) Paroxetine Fluoxetine Fluvoxamine Sertraline GI disturbance Insomnia Agitation Sexual dysfunction Mild/moderate depression Monoamine Oxidase Inhibitors (MAOIs) Phenelzine Isocarboxazid Dry mouth Constipation Headache Tremor Started by specialist TCAs - toxicity in overdose MAOIs - complex interactions with various chemicals and foods Mood Stabilisers Lithium Carbamazepine Sodium valproate