Behavioral and

Psychiatric
Disorders
Ignace Claire Gamallo, M.D
 .
 Mood Disorders
 Major and Other Depressive Disorders
 Bipolar and Related Disorders

 Suicide and Attempted Suicide

 Eating Disorder
 Disruptive, Impulse-Control and Conduct
Disorders
 Age Specific Behavioral Disturbances
 Autism Spectrum Disorder
 Definition of terms:
 Manic Episode
 Hypomanic Episode
Mood Disorders
 Interrelatedsets of psychiatric
symptoms characterized by a core
deficit in emotional self regulation
Depressive Disorders
 Major Depressive Disorders
 Persistent Depressive Disorders
 Disruptive Mood Dysregulation
 Others
 Male : female ratio
 1:1 (childhood)
 1:1.5-3 (adolescence)
 Comorbidity
 Anxiety disorder
 40-90% depressive Do + other psychiatric
Do
 50% has 2 or more comorbid diagnosis
Etiology and Risk Factors
 2-4x increase in risk 1st degree relatives
Differential Diagnoses
 BipolarDisorder
 Autism Spectrum disorder
Sequelae
 30% - suicide
Screening/Case Finding
 PediatricSymptom Checklist
 Strengths and Difficulties Questionnaire,
 Vanderbilt ADHD Diagnostic Rating
Scales
Management
 Stepped Approach
 Guided Self Help
 Manualized Psychotherapies
 Antidepressant Medication
 Fluoxetine
 Escitalopram
Bipolar and Related Disorders
 Bipolar I
 Bipolar II
 Cyclothymic
 Other
 Definition of terms:
 Manic Episode
 Hypomanic Episode
 Bipolar I
 (+)manic episode
 (+)Hypomanic episode
 (+)major depressive episode

 Bipolar II
 (+)Hypomanic episode
 (+)major depressive episode
 Cyclothymic Disorder
 (+) Hypomanic symtoms
 (+)depressive symptoms
Epidemiology
 1-3% prevalence rate
 1.1:1 ratio male to female ratio
 Comorbity
 Sequelae
 Etiology/risk factors
 60% heritability
Prevention
 Family focused treatment
Treatment
 Bipolar I : Lithium
 Bipolar II : Lamotrigine
Suicide and Attempted Suicide
 3rdleading cause of death in the US
 Globally:
 4th leading cause in males
 3rd leading cause of death in females.
Epidemiology
 1completed suicide: 200 suicide
attempts
 Suicide attempts:
 Ingestion of medication – most common
 15-19 yo
 4:1 female to male ratio
Epidemiology
 Completed suicide:
 Male: Female
 3:1 children
 4:1 15-24 yo
 Firearms
Protective Factors
 sense of family responsibility
 life satisfaction
 social support
 coping and problem-solving skills
 religious faith
 intact reality testing
 solid therapeutic relationships
Assessment and Intervention
 Ask Suicide Screening Questionnaire
(1)Inthe past few weeks, have you felt that
you or your family would be better off if
you were dead?
(2) In the past few weeks, have you wished
you were dead?
(3) In the past weeks, have you been
having thoughts about killing yourself?
(4) Have you ever tried to kill yourself?
Fig 27.3
Prevention
Eating Disorders
 arecharacterized by body
dissatisfaction related to overvaluation
of a thin body ideal associated with
dysfunctional patterns of cognition and
weight-control behaviors that result in
significant biologic, psychological, and
social complications.
 Anorexia Nervosa
 Bulimia Nervosa
 Avoidant/Restrictive Food Intake
Disorder
 Anorexia Nervosa
 Restrictive
 Binge-Purge
 Bulimia Nervosa
 AvoidantRestrictive Food Intake
Disorder (ARFID)
Epidemiology
Pathology and Pathogenesis
 Central role of development
 (+)History Sexual Trauma:difficult
recovery
Clinical Manifestations
 Overestimation of body size, shape or
parts
 Severe restriction of caloric intake
 Compulsive exercising
 Purging
 Vomiting
 Taking laxatives
Differential Diagnosis
 Malignancy
 ChronicInfection
 Malabsorption
Complications
 RefeedingSyndrome
 Hypothalamic Dysfunction
 Thermoregulation
 Satiety
 Sleep
 Cardioregulatory imbalance
 Endocrine function
Treatment
 Nurturant-authoritative approach using the
biopsychosocial model
 Nutrition and Physical Activity
 Primary Care Treatment
 Referral to Mental Health Services
 Medication
 Cognitive-behavioral Therapy
 Dialectical behavioral therapy
 Group Therapy
 Referral To Interdisciplinary Eating Dosorder Team
 Supportive Care
Prognosis
 AN : 80% recover
 BN: not well established
Prevention
 difficult
Disruptive, Impulse-Control
and Conduct Disorders
 oppositional defiant
 intermittent explosive, conduct,
 other specified/ unspecified disruptive, impulse
control, and conduct, and antisocial personality
disorders
 Pyromania
 kleptomania
Oppositional Defiant Disorder
Intermittent Explosive Disorder
Conduct Disorder
Epidemiology
 ODD : 3%
 1.4:1 (male:female)
 IED: 3%
 CD : 4%
Differential Diagnosis
Comorbidity
 ODD – ADHD
 IED - depressive, anxiety, and substance
use disorders
 ADHD and ODD - CD
Sequelae
 Suicide
 Injury
 Delinquency
 Criminality
 Substance use
 Social instability
 Marital failure
 Underachievement
Etiology and Risk Factors
 Neurobiologic factors
 Natal insults
 Impairements
 Ineffective parenting
 Peer influence
Prevention
 FAST TRACK
 SEATTLE SOCIAL DEVELOPMENT
PROJECT
Screening and Case Finding
 `Stepped Approach
Treatment
 EarlyIntervention
 Guided Self Help
 Mental Health Setting
 Medications
Age Specific Behavioral
Disturbances
 Infancy and Toddlerhood
 Temper Tantrums
 Breath-Holding Spells
 Timeout
 Head banging – refer
 Lying
 Childhood and Adolescence
 Lying
 Confront
 Set Limits
 Stealing
 Truancy and running away
 Fire Setting
 Aggression and Bullying
 Cutting anf Self Injurious Behavior
Autism Spectrum Disorder
 Social Communication & Interction
Deficits
 Restricted and repetitive patterns
Epidemiology
 Prevalence rate : 0.7/10000 to
72.6/10000
 Femur: male (4:1)
Etiology and Risk Factors
 Genetic
 Recurrence rate : 2-19%
 Familial factors
 Closer spacing of pregnancies, advanced
maternal or paternal age,
 extremely premature birth
 family members (+)

 Neuro Factors
Clinical Course
 delayed language
 lack of social interest or odd play
patterns
 odd and repetitive behaviors
 absence of typical play
Differential Diagnosis
 Social Communication Disorder
 Intellectual Disability
 reactive attachment disorder
 OCD
Comorbidities
 Epilepsy
 sleep dysfunction
 motor delay
 Dyspraxia
 Incoordination
 Gait disturbances
Sequelae
 Better prognosis
 Higher intelligence
 Functional speech
 Less-bizarre symptoms and behavior
Screening and Case Finding
Assessment
 physical examination
 hearing screen
 genetic testing
 psychological assessments
Treatment
 Psychosocial Interventions
 Applied Behavioral Analysis
 Early Intensive Behavioral Intervention
 Individualized Educational Plan
 Pharmacotherapy
 Risperidone (5-16yo)
 Aripiprazole (6-17)