Adolescence mood disorder 2021.

Mood Disorder Among
Adolescence
Dr Wafa Sheikh Consultant
Family Medicine SBFM,
ABFM,MRCGP (int)
Psychiatric clinic at PHC Al Harra AL Sharia
8/23/2021 Mood disorder among Adolescence /DR WAFA SHEIKH 1

Case 1: Severe Anxiety Disorder and Panic Attack
Case 2: Obsessive Compulsive Disorder
Case 3: Social Anxiety Disorder( Social Phobia )
Case 4: Post Traumatic Attack Disorder

Case 2 Generalized Anxiety Disorder and
panic attack
CASE
2
3
8/23/2021 Mood disorder among Adolescence /DR

Generalized Anxiety Disorder and
panic attack

Case 2
17 years old Mada brought by her Aunty with complaint that now a days mada
is highly irritable having aggressive and impulsive behavior and fighting with her
brother and arguing with her parents all the time .She thinks nobody care
about her and understands her feelings and situation . She wants to live alone
as loud noises annoyed her, She has a disturbed sleep and started to have an
episodes of dyspnea palpitation chest pain under stress full situation .
she is always thinking about her childhood and become upset and tense and
worried for future life .
She has conflict with her school teachers and she is unable to concentrate on
her study . In this term her grades was lower than before .
No history of suicidal ideation .
She has three brothers she is eldest one since childhood she responsible to
take care of them .(extra Burdon )
Her mother is having anxiety disorder
last week she had an attack of palpitation and chest pain she went to the
Emergency for the cardiac assessment (MI /Angina) and she was prescribed
with betablocker for her elevated blood pressure and palpitation .
Mood disorder among Adolescence /DR WAFA SHEIKH
8/23/2021

Case Continue …
• She is worried about cardiac symptoms (possible cardiac disease
)and panic attack and her elevated blood pressure (hypertension)
during panic attack .
• Either she continue her drugs or stopped ?
• Examination : BP 110/70 mmHg
• Weight 52 kg pulse 92 /min
• Mini Mental State Examination : Well behaved and well dressed
• looks tense irritable anxious nervous
• Speech tone normal mood not sad but anxious
• Good memory
• Insight positive
• No hallucination or delusion
• Investigations: CBC , Thyroid profile , Vit D (WNL ) ECG Normal

19
19
7
8/23/2021 Mood disorder among Adolescence /DR WAFA SHEIKH

Case continue……
Severe Generalized Anxiety
Disorder and Panic Attack
?
8

The presence of non specific excessive anxiety and worry about a variety of topics,
events, or activities. Worry occurs more often than not for at least six months and
is clearly excessive.
The anxiety and worry are accompanied by at least three of the following physical or
cognitive symptoms (one for children )
• Edginess or restlessness
• Tiring easily; more fatigued than usual
• Impaired concentration or feeling as though the mind goes blank
• Irritability (which may or may not be observable to others)
• Increased muscle aches or soreness
• Difficulty sleeping (due to trouble falling asleep or staying asleep, restlessness at
•
Night or unsatisfying sleep),
DSM- 5 diagnosis of GAD
9

• Chest pain or discomfort
• Chills or hot sensations
• Feeling of choking
• Feeling dizzy, unsteady, lightheaded, or faint
• Fear of dying
• Fear of losing control or going crazy
• Feelings of unreality (derealization) or being detached
from oneself (depersonalization)
• Nausea or abdominal distress
• Numbness or tingling sensations (paresthesia)
• Palpitations, pounding heart, or accelerated heart rate
• Sensations of shortness of breath or smothering
• Sweating
• Trembling or shaking
According to the (DSM-5) A Panic attack is
characterized by a “surge of intense fear or
intense discomfort that reaches a peak within
minutes” and includes four or more of
symptoms.
10
A panic attack is a sudden and intense feeling of terror, fear, or apprehension,
without the presence of actual danger. Symptoms of a panic attack usually
happen suddenly, peak within 10 minutes, and then subside.

How does anxiety present in adolescence?
Adolescent-specific presentation
National Comorbidity Survey Replication, a nationally representative
epidemiologic study, found that most anxiety disorders have a median age-of-onset
of 11 years.
Primary care providers, as well as adolescents’ parents, friends, and caregivers,
should be aware that anxiety has a unique presentation in children and
adolescents.
First, anxiety disorders are generally more common in adolescent girls than boys.
Additionally, youth may exhibit more behavioral manifestations of anxiety rather
than the cognitive or conscious endorsement by the patient, as is more common in
adults.
Anxiety in adolescents: Update on its diagnosis and treatment for primary care providers

8/23/2021 12
Avoidance behaviors are considered agoraphobia if they greatly impair normal functioning,
such as going to school, visiting the mall, or doing other typical activities.
School avoidance, typically due to social phobia or generalized anxiety, is a particularly
salient form of such oppositional behavior that often accompanies anxiety, specifically in
adolescents.6
Studies have demonstrated that school difficulties, decline in school performance, and even
high school non completion, are associated with anxiety in children and adolescents by some8,9
but not all10 studies.
Social withdrawal from both Peer and Activities .
Panic Disorder in Children and Adolescent:Merck Manual professional version April 2021

Compared with those in adults, panic attacks in children and adolescents are
often more dramatic in presentation (eg, with screaming, weeping, and
hyperventilation). This display can be alarming to parents and others.
Children and Adolescents often have physical complaints or
somatic symptoms of anxiety (ie, stomach or headaches), rather than
recognizing anxiety symptoms as such.
Studies have demonstrated that the most common initial somatic symptoms are
cardiac (chest pain and tachycardia), neurologic (headache, dizziness,
faintness, paresthesia), and gastrointestinal (irritable bowel symptoms and
epigastric pain) ( Katon, 1984 ).
8/23/2021
Mood disorder among Adolescence /DR WAFA SHEIKH 13

Three Stages in the Development of Panic Disorder
Stage 1 Stage 2 Stage 3
Initial acute panic attack
or cluster of attacks➙
Panic attacks increase in
frequency; phobias
develop; anticipatory
anxiety and avoidance
behavior develop;
medical care seeking
dramatically increases for
somatic complaints➙
Agoraphobia; increased
dependence; dramatic
changes in family system;
chronic somatization
develops
8/23/2021
children and younger adolescents usually lack the insight and forethought needed to
develop these features, except they may change behavior to avoid situations they
believe are related to the panic attack.

Relationship between PD and other Anxiety Disorders
8/23/2021
Another common feature of the presentation of
anxiety Disorders is having more than one co-
occurring anxiety disorder simultaneously,
such as having generalized anxiety disorder
and social phobia.
This phenomenon, known as “comorbidity”,
is common in adolescents and adults suffering
.
Anxiety in adolescents from anxiety disorders.
Anxiety and depression are also often
comorbid among adolescents.11

Cardiac symptoms /Panic disorder
The occurrence of cardiac symptoms may especially lead to costly
and potentially dangerous medical tests in patients with panic
disorder. Three studies have documented that nearly 50% of patients
with chest pain and negative angiographic studies suffer from panic
disorder ( Bass and Wade, 1984 ; Beit man et al, 1987 ; Katon et al, 1988 ).
Two studies have documented that one quarter to one third of
primary care patients with palpitations meet the criteria for panic
disorder (Barsky et al, 1995 ; Weber and Kapoor, 1996 ).
8/23/2021

Hypertension and panic attack
Labile hypertension develops in some patients with panic disorder
during an attack. The finding of labile hypertension with associated
chest pain, flushing tachycardia, and shortness of breath often leads
to an aggressive cardiac workup, as well as a potential workup for
Pheochromocytoma and Asthma.
One study demonstrated that approximately 40% of patients evaluated
for Pheochromocytoma suffered from panic disorder, as compared
with less than 5% of hypertensive controls ( Fogarty et al, 1994 ).
8/23/2021

How can clinicians effectively screen adolescents for
anxiety disorders ?
As recommended by The American Academy of Child and Adolescent Psychiatry
in their 2007 practice parameters
Primary care providers should use these tools if concerns about potential anxiety
arise during an office visit, either through self-reported anxiety symptoms,
behavioral concerns that are consistent with anxiety
(eg, school refusal, peer difficulties, somatic symptoms), or parent-reported
concerns.
It is also important when assessing for anxiety disorders to consider a
differential diagnosis of both physical (eg, hyperthyroidism, migraines) and
psychiatric (eg, attention deficit hyperactivity disorder, psychotic
disorders, learning disability) conditions that may share symptoms of
anxiety disorders.

What evidence-based treatments exist for anxiety
disorders in adolescence?
Psychological
treatment
Psychoeducation teaches patients and their parents about
anxiety. It can include information about how common or
what types of anxiety exist, causes of anxiety disorders
(eg, brain changes, genes, environment, and their interaction),
physical manifestations of anxiety (eg, racing heart,
sweaty palms, headaches, and stomach aches), i
Relaxation techniques can also be used in a primary care
setting. The technique involves teaching relaxation strategies,
such as deep breathing, progressive muscle relaxation,
and guided imagery that adolescents can then practice at
home.

Cognitive Behavior Therapy
Cognitive behavior therapy has the best evidence-base for
treatment of anxiety disorders. This therapy was first use with
adults but significant research has now shown that it is also
effective for children and adolescents.
Supportive therapy is another type of treatment in which
the therapist listens to the patient’s concerns and provide empathy and
support through techniques such as active and reflective listening..

Pharmacological treatment
Treatment of anxiety disorders in children and adolescents are the
selective serotonin reuptake inhibitors.
Randomized, placebo-controlled trials have found Fluoxetine,70
Fluvoxamine,71 Paroxetine,72 and Sertraline59 to be superior to
placebo in reducing the severity of anxiety for youth with
generalized anxiety disorder, social phobia, and separation anxiety
disorder.

The Child/Adolescent Anxiety Multimodal Study
8/23/2021
One of the largest randomized, controlled trials in anxious youth, Walkup
et al from the Child/Adolescent Anxiety Multimodal Study of 488
children aged 7–17 years found that the combination of sertraline plus
cognitive behavioral therapy was more effective than either treatment
alone or placebo in reducing severity of anxiety.59
Other selective serotonin reuptake inhibitors, including Escitalopram73
and Citalopram74 have also proven effective in open trials for reducing
anxiety symptoms in youth.

Usually benzodiazepines or selective serotonin reuptake inhibitors (SSRIs) plus behavioral
therapy
Treatment of panic disorder is usually a combination of drug therapy and behavioral
therapy.
In children, it is difficult to even begin behavioral therapy until after the panic attacks have
been controlled by drugs.
Benzodiazepines are the most effective drugs, but SSRIs are often preferred because
benzodiazepines are sedating and may greatly impair learning and memory.
However, SSRIs do not work quickly, and a short course of a benzodiazepine
(eg, lorazepam 0.5 to 2.0 mg orally 3 times a day) may be helpful until the SSRI is effective.
Panic Disorder in Children and Adolescent:Merck Manual professional version April 2021
8/23/2021
Treatment of Panic Disorder in Children and Adolescence

Clinical recommendation for GAD and Panic attack
Psychotherapy is as effective as medication for GAD and PD cognitive behavior
therapy has a best level evidence . A
SSRI are first line of therapy for GAD and PD . B
Physical activity is cost effective for GAD and PD and can reduce symptoms of
GAD and PD. B
Benzodiazepines are effective in reducing anxiety symptoms, but their use is limited
by risk of abuse and adverse effect profiles. B
Medication should be continued for 12 month before tapering to prevent relapse. C
Clinical recommendation for GAD and Panic attack (American Academy of Family Physician))
8/23/2021

Investigation CBC Thyroid Profile and S. vitamin D level is normal
Treatment Non pharmacological
physical activity dec intake tea and coffee
CBT Refer to the CBT Clinic ( Psychiatric Hospital )
Patient education about drug onset duration and efficacy side effect
Safety netting if develop any unusual symptom stop the drug contact to
treating physician or refer to the ER
Pharmacological : Cap Fluoxetine 10 mg po od 1st week
Tab Fluoxetine 20 mg from 2nd week
Tab lorazepam 2mg po od bed time for 2 weeks
Follow up after 1 weeks
Treatment for 12 months to avoid relapse .(aafp)
Case Continue….
25

Continue case …..
About her concern 50% of the patient with the cardiac symptoms have negative test
one quarter to one third of primary care patients with palpitations meet the
criteria for panic disorder. Labile hypertension develops in some patients with
panic disorder during an attack.

These medications are generally well tolerated, especially when following the
typical prescribing advice for children of “start low, go slow”.
Common side effects include abdominal pain, nausea, headaches, and
drowsiness.7
The US Food and Drug Administration issuing of a black box warning on these
medications that focuses on potential for suicidality in October 2004.
Current guidelines suggest that adequate parental and patient consent should be
obtained from any patient potentially being Prescribed serotonergic antidepressants.
This should include a discussion of risks, benefits, and alternatives.
Close monitoring is indicated, especially during the first 3 months of initiating these
agents or during times of dose changes.

Prognosis for panic disorder
Prognosis is good with treatment. Without treatment, adolescents may drop out
of school, withdraw from society, and become reclusive and suicidal.
Panic disorder often waxes and wanes in severity without any discernible
reason. Some patients experience long periods of spontaneous symptom
remission, only to experience a relapse years later.
8/23/2021 28
Panic Disorder in Children and Adolescent: Merck Manual professional version April 2021

Obsessive-Compulsive Disorder (OCD) Adolescents
Mood disorder among Adolescence /DR
8/23/2021 29

Case 3
A 19-year-old female comes to your office as a new patient to
establish care. As you examine her, you notice that the skin on her
hands is quite dry and cracked in places. She says, “I have to wash
them a lot. I can’t stand leaving them dirty.’
After you examine her, you notice that she is becoming increasingly
restless. Suddenly, she stands up from the exam table and moves to
the sink, where she washes her hands. “I’m so sorry … I know this
seems weird, but I really can’t stand having germs on my hands!” As
you begin to question her further, the patient tells you that although
she has always been a “clean freak,” she has recently started
washing her hands countless times per day.
8/23/2021

Obsessive-Compulsive Disorder (OCD) and Related Disorders in
Children and Adolescents
Typically, OCD has a gradual, insidious onset.
Most children initially hide their symptoms and report struggling with symptoms
years before a definitive diagnosis is made.
Obsessions are typically experienced as worries or fears of harm (eg, contracting
a deadly disease, sinning and going to hell, injuring themselves or others).
OCD in Children and Adolescent: Merck Manual professional version April 2021
8/23/2021
31
Symptoms and Signs of OCD and Related Disorders

Compulsions are deliberate volitional acts, usually done to neutralize or offset
obsessional fears; they include checking behaviors; excessive washing, counting, or
arranging; and many more.
Obsessions and compulsions may have some logical connection (eg, hand washing to
avoid disease) or may be illogical and idiosyncratic (eg, counting to 50 over and over to
prevent grandpa from having a heart attack).
If children are prevented from carrying out their compulsions, they become excessively
anxious and concerned
8/23/2021 32

Most children have some awareness that their obsessions and compulsions are
abnormal. Many affected children are embarrassed and secretive.
Common symptoms include
Having raw, chapped hands (the presenting symptom in children who compulsively wash)
Spending excessively long periods of time in the bathroom
Doing schoolwork very slowly (because of an obsession about mistakes)
Making many corrections in schoolwork
Engaging in repetitive or odd behaviors such as checking door locks, chewing food a
certain number of times, or avoiding touching certain things
8/23/2021 33

8/23/2021 34

Diagnosis of OCD and Related Disorders
Diagnosis of OCD is by history.
For OCD to be diagnosed, the obsessions and compulsions must cause great
distress and interfere with academic or social functioning.
Children with OCD often have symptoms of other anxiety disorders,
including panic attacks, separation problems, and specific phobias . This
symptom overlap sometimes confuses the diagnosis.
8/23/2021 35

Treatment of OCD and Related Disorders
Cognitive-behavioral therapy is helpful if children are motivated and can carry
out the tasks and should be the first-line treatment.
SSRIs are the most effective drugs and are generally well tolerated all are equally
effective.
For severe OCD, a combination of SSRI and CBT is recommended .
For Treatment-refractory OCD, the following strategies could be considered:
Trial of a different SSRI
Augmentation of the SSRI with an atypical antipsychotic or less often lithium
Trans cranial magnetic stimulation was recently approved for adults by the U.S. Food
and Drug Administration, and testing for use in children is in progress.
8/23/2021 36

Treatment of OCD in Children
SSRIs have been show to be efficacious in numerous studies
Sertraline(Zoloft) has the best safety data in children and adolescents
(studies extend two years)
FDA approval only for OCD:
Fluoxetine (Prozac®) 7 – 17 y/o
Sertraline (Zoloft®) 6 – 17 y/o
Fluvoxamine (Luvox®) 8 – 17 y/o
Clomipramine (Anafranil®) 11 – 17 y/o
Clomipramine may be more effective and have a better response rate
than SSRIs in children but not adults .
Clomipramine may have higher risk of adverse effects, including
anticholinergic and cardiac adverse effects, and seizures.
8/23/2021
37

Case 4
A 15 years old student comes state of anxiety. He feels excessive worrying and
anxiety before attending a social event or excessive preparation for a class
presentation. He has a exam in which 50% of the class grade is based on class
participation and discussion . Although he knows the material well, he is unable to
answer the questions when posed to him by the teacher .
The teacher warn him after the class that if he remains like this behavior “fail the
term” unless he began to participate.
He does not want to go to school he is complaining of headache and some time
stomach .
Even he does not like to go to parties and cant eat and speak in the front of
people .
Basically he is loner and shy child his family has similar trend but nobody get
problem like him .
8/23/2021

What is your Diagnosis ?
8/23/2021 39

Social Anxiety Disorder in Children and Adolescents
(Social Phobia)
8/23/2021 40

Symptoms and Signs of Social Anxiety Disorder
The first symptoms of social anxiety disorder in adolescents may be excessive
worrying before attending a social event or excessive preparation for a class
presentation.
The first symptoms in children may be tantrums, crying, freezing, clinging, or
withdrawing in social situations.
Avoidant behaviors (eg, refusing to go to school, not going to parties, not eating in
front of others) can follow. Complaints often have a somatic focus (eg, “My stomach
hurts,” “I have a headache”).
Some children have a history of many medical appointments and evaluations in
response to these somatic complaints.
Social Anxiety Disorder in Children and Adolescent: Merck Manual professional version April 2021
8/23/2021 41

Diagnosis of Social Anxiety Disorder
For Social Anxiety Disorder to be diagnosed, the anxiety must persist for ≥ 6
months and be consistently present in similar settings (eg, children are
anxious about all classroom presentations rather than only occasional ones
or ones for a specific class). The anxiety must occur in peer settings and not
only during interactions with adults.
8/23/2021 42
Social Anxiety Disorder in Children and Adolescents (Social Phobia) Merck Manual Professional version

Phobic disorder
Phobic disorders are classified as agoraphobia, the most pervasive
and severe form, which almost always occurs secondary to the onset
of panic attacks; social phobia; and specific phobia.
A specific phobia involves a persistent irrational fear and
compelling desire to avoid an object or a situation. Common specific
phobias are fears of heights (acrophobia), animals, insects,
airplanes, and closed-in spaces (claustrophobia).
The term Generalized social phobia is used when the fears are
related to most social situations (e.g., initiating conversations, dating,
participating in small groups, attending parties).
8/23/2021

(Social Anxiety Disorder) Social phobia / Psychiatric
Comorbidity
Patients with social phobia have high lifetime psychiatric
comorbidity
(80% with one or more other psychiatric disorders),
especially major depression (37%),
other anxiety disorders (57%),
and alcohol or substance abuse (40%) ( Magee et al, 1996 ).
Social phobia has marked effects on patients functioning
and social and work achievement.
8/23/2021

Social Anxiety Disorder (Social phobia) treatment
Behavioral therapy is the cornerstone of treatment for social anxiety
disorder.
Children should not be allowed to miss school. Absence serves only to
make them even more reluctant to attend school.
If children and adolescents are not sufficiently motivated to participate in
behavioral therapy or do not respond adequately to it,
Then Treatment with an SSRI may reduce anxiety enough to facilitate
children’s participation in behavioral therapy.
Pharmacologic: The drug class of choice is the SSRIs.(Fluvoxamine and
Sertraline)
8/23/2021
Social Anxiety Disorderin Children and Adolescent: Merck Manual professional version April 2021

Phobic Disorders
(Specific Phobias, Agoraphobia, Social Phobias)
SSRIs such as paroxetine have been found to be effective in
randomized placebo-controlled trials in treating Social Anxiety
disorder ( Stein et al, 1998) .
Clonazepam was also shown to be effective in randomized trials at dosages
effective for treating panic disorder ( Davidson et al, 1993 ).
Finally, Phenelzine (a monoamine oxidase inhibitor), was demonstrated to be
effective in treating Social Anxiety Disorder in a randomized controlled trial (
Liebowitz et al, 1992 ).
Exposure-based treatments such as cognitive-behavioral therapy have also
been shown to be effective ( Alstrom et al, 1984 ) for generalized social phobia.
8/23/2021

Post Traumatic Stress Disorder(PTSD)
8/23/2021

Case 5
A 14-year-old female comes to your office with complaint of difficulty
trusting people, irritability, low mood, and recurrent nightmares. Her
symptoms started when she following the death of her parents in a
house fire.
She was rescued by firefighters but has never been able to forgive
herself for surviving when her parents died. She has not been able to
form close relationships, and she is seeking help because of
renewed nightmares.
They were common in the first 2 years following the incident but had
faded away until recently.
8/23/2021

Case continue….
Continuing news reports of terrorist activities and bombings have
brought all of this back to the forefront again. She sometimes wakes
up in a fright after dreaming that her own house is on fire.
She is afraid to go near any bright lights or fireworks displays. When
she is forced to be in the presence of fires, she frequently notices
palpitations, dyspnea, and a sense of doom.
8/23/2021

What is the diagnosis ?
8/23/2021 50

Posttraumatic stress disorder (PTSD) in children
and adolescents
Posttraumatic stress disorder (PTSD) in children and adolescents is a severe, often
chronic, and impairing mental disorder.
PTSD is characterized by intrusive thoughts and reminders of the traumatic
experience(s), avoidance of trauma reminders, negative mood and cognitions
related to the traumatic experience(s), and physiological hyper arousal that lead to
significant social, school, and interpersonal problems.
The consequences of PTSD include elevated risk for other mental disorders and
suicide, substantial impairment in role functioning, reduced social and economic
opportunity, and earlier onset of chronic diseases, particularly cardiovascular
disease.
Uptodate 2021 Post Traumatic Disorder among children and Adolescence
8/23/2021
51

DSM-5 Criteria for PTSD
To meet the criteria for diagnosis, patients must have been exposed directly or indirectly to a
traumatic event and have symptoms from each of the following categories for a period ≥ 1 month.
Intrusion symptoms (≥ 1 of the following):
Having recurrent, involuntary, intrusive, disturbing memories
Having recurrent disturbing dreams (eg, nightmares) of the event
Acting or feeling as if the event were happening again, ranging from having flashbacks to
completely losing awareness of the present surroundings
Feeling intense psychological or physiologic distress when reminded of the event (eg, by its
anniversary, by sounds similar to those heard during the event)
Avoidance symptoms (≥ 1 of the following):
Avoiding thoughts, feelings, or memories associated with the event
Avoiding activities, places, conversations, or people that trigger memories of the event
8/23/2021 52

Negative effects on cognition and mood (≥ 2 of the following):
Memory loss for significant parts of the event (dissociative amnesia)
Persistent and exaggerated negative beliefs or expectations about oneself, others, or the
world
Persistent distorted thoughts about the cause or consequences of the trauma that lead to
blaming self or others
Persistent negative emotional state (eg, fear, horror, anger, guilt, shame)
Markedly diminished interest or participation in significant activities
A feeling of detachment or estrangement from others
Persistent inability to experience positive emotions (eg, happiness, satisfaction, loving
feelings)
Post Traumatic Stress Disorder in Children and Adolescent: Merck Manual professional version April 2021
8/23/2021 53

Altered arousal and reactivity (≥ 2 of the following):
•Difficulty sleeping
•Irritability or angry outbursts
•Reckless or self-destructive behavior
•Problems with concentration
•Increased startle response
•Hyper vigilance
In addition, manifestations must cause significant distress or significantly impair
social or occupational functioning and not be attributable to the physiologic
effects of a substance use or another medical disorder.
Post Traumatic Stress Disorder in Children and Adolescent: Merck Manual professional version April
2021
8/23/2021 54

Acute stress disorder (ASD) and posttraumatic stress disorder
(PTSD) in Children and Adolescents
Acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) are
reactions to traumatic events.
The reactions involve intrusive thoughts or dreams, avoidance of reminders of
the event, and negative effects on mood, cognition, arousal, and reactivity.
ASD typically begins immediately after the trauma and lasts from 3 days to 1
month. PTSD can be a continuation of ASD or may manifest up to 6 months
after the trauma and lasts for >1 month.
Diagnosis is by clinical criteria. Treatment is with behavioral therapy and
sometimes with selective serotonin reuptake inhibitors or antiadrenergic drugs.
8/23/2021
55

Key Points
ASD typically begins immediately after the trauma and lasts from 3 days to 1
month; PTSD lasts for > 1 month and can be a continuation of ASD or may
manifest up to 6 months after the trauma.
Stress disorders may start after children directly experience a traumatic event, if
they witness one, or learn that one happened to a close family member.
Symptoms of ASD and PTSD are similar and usually involve a combination of
intrusion symptoms (eg, re-experiencing the event), avoidance symptoms,
negative effects on cognition and/or mood (eg, emotional numbing), altered
arousal and/or reactivity, and dissociative symptoms.
Treat with trauma-based psychotherapy and, in children with comorbid anxiety,
depression and/or sleep difficulties, SSRIs; sometimes antiadrenergic drugs may
be helpful.
8/23/2021 56

Screening question…..?
How ever experienced a panic attack? (Panic)
Do you consider yourself a worrier? (GAD)
Have you ever had anything happen that still haunts you? (PTSD)
Do you get thoughts stuck in your head that really bother you or
need to do things over and over like washing your hands, checking
things or count? (OCD)
When you are in a situation where people can observe you do you
feel nervous and worry that they will judge you? (SAD)
8/23/2021

8/23/2021
Thank you

Adolescence mood disorder 2021.

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