The document discusses anxiety and depression in children and adolescents. It provides information on different types of anxiety disorders like generalized anxiety disorder, separation anxiety disorder, social anxiety disorder, and obsessive compulsive disorder. It also discusses depression in youth and risk factors. The document aims to help distinguish normal behavior from clinical disorders and offers treatment options like cognitive behavioral therapy and medications.
Historical background
Definition
Age of onset
Signs and Symptoms
DSM V Criteria
Comorbidity
Prevelance and Epidemiology
Etiology and Pathogenesis
Treatment
Conclusion
Historical background
Definition
Age of onset
Signs and Symptoms
DSM V Criteria
Comorbidity
Prevelance and Epidemiology
Etiology and Pathogenesis
Treatment
Conclusion
School phobia is becoming more common in many young school children causing distress and learning difficulties. These slides briefly explain the cause, symptoms and management of school phobia in brief.
Anxiety Disorders in Kids...An Overview for Parents and TeachersStephen Grcevich, MD
This presentation is an overview of how anxiety symptoms manifest in children and teens, and an overview of the two primary treatment modalities (Cognitive-Behavioral therapy and medication). This talk was presented with Dr. Sherri McClurg at Lake Ridge Academy in North Ridgeville, OH, October 6, 2011.
this ppt is used for presentation in public flora as well as for doctors.this is not for commercial purpose. it is only for educating.if any unwarranted mistakes are present please forgive me
Stress and anxiety in teens and young adultsSummit Health
Learn the signs and physiological effects of stress and anxiety. Discover evidence-based approaches, including cognitive behavioral therapy and other techniques that help reduce anxiety and stress. This two-part program will provide a new understanding and awareness of practical skills that can increase your energy and improve daily well-being. Presented by James Korman, PsyD, ACT; Michael Likier, PhD; and Jamie Schwartz, LCSW
Anxiety, defined as dread or apprehension, is not considered pathologic, is seen across the life span, and can be adaptive (e.g. the anxiety one might feel during an automobile crash).
Anxiety becomes disabling.
Interfering with social interactions, development.
Achievement of goals or quality of life.
Can lead to slow self esteem, social withdrawal.
Academic underachievement.
The average age of onset of anxiety disorder is 11 years.
This is the most common psychiatric disorders of childhood.
Occurs in 5-18% of all children and adolescents.
Prevalence rate is comparable to physical disorders such as asthma and diabetes.
One of the most common childhood anxiety disorder.
Prevalence- 3.5-5.4%
Girls ˃ boys
Common in prepubertal children. Average age of onset 7.5 yrs.
It is developmentally normal when it begins about 10 month of age and tapers off by 18 month.
By 3 years of age, most children can accept the temporary absence of their mother or primary caregiver.
SAD is characterised by unrealistic and persistent worries about separation from home or a major attachment figure.
School phobia is becoming more common in many young school children causing distress and learning difficulties. These slides briefly explain the cause, symptoms and management of school phobia in brief.
Anxiety Disorders in Kids...An Overview for Parents and TeachersStephen Grcevich, MD
This presentation is an overview of how anxiety symptoms manifest in children and teens, and an overview of the two primary treatment modalities (Cognitive-Behavioral therapy and medication). This talk was presented with Dr. Sherri McClurg at Lake Ridge Academy in North Ridgeville, OH, October 6, 2011.
this ppt is used for presentation in public flora as well as for doctors.this is not for commercial purpose. it is only for educating.if any unwarranted mistakes are present please forgive me
Stress and anxiety in teens and young adultsSummit Health
Learn the signs and physiological effects of stress and anxiety. Discover evidence-based approaches, including cognitive behavioral therapy and other techniques that help reduce anxiety and stress. This two-part program will provide a new understanding and awareness of practical skills that can increase your energy and improve daily well-being. Presented by James Korman, PsyD, ACT; Michael Likier, PhD; and Jamie Schwartz, LCSW
Anxiety, defined as dread or apprehension, is not considered pathologic, is seen across the life span, and can be adaptive (e.g. the anxiety one might feel during an automobile crash).
Anxiety becomes disabling.
Interfering with social interactions, development.
Achievement of goals or quality of life.
Can lead to slow self esteem, social withdrawal.
Academic underachievement.
The average age of onset of anxiety disorder is 11 years.
This is the most common psychiatric disorders of childhood.
Occurs in 5-18% of all children and adolescents.
Prevalence rate is comparable to physical disorders such as asthma and diabetes.
One of the most common childhood anxiety disorder.
Prevalence- 3.5-5.4%
Girls ˃ boys
Common in prepubertal children. Average age of onset 7.5 yrs.
It is developmentally normal when it begins about 10 month of age and tapers off by 18 month.
By 3 years of age, most children can accept the temporary absence of their mother or primary caregiver.
SAD is characterised by unrealistic and persistent worries about separation from home or a major attachment figure.
Pediatric Talk: Managing Arthritis During the Holidays - Dr. Marla Guzman - ...Summit Health
While holiday celebrations and activities are great fun, it’s also a disruptor to the daily routine. Our expert will share tips to help you navigate holiday season stressors to minimize your child’s risk of a potential flare-up. This virtual event is hosted by the Arthritis Foundation.
Safety and Success in a Post-Pandemic Society - Daniela Accurso, MD, MPH - 7...Summit Health
The Covid-19 Pandemic has been a health crises that we have been fighting for the last year and a half. Dr. Accurso’s presentation is focused on reviewing how far we have come as a society and to address the questions, health concerns, and important precautions we need to take as we integrate ourselves back into a healthy community.
Melanoma: Prevention, Detection and Treatment - Stephanie Badalamenti, MD - L...Summit Health
Sun safety needs to start at an early age, and continue throughout life, in order to reduce the risk for skin cancer. Learn about prevention and ways to reduce your risk, screening for skin cancer and innovations in treatments.
Melanoma: Prevention, Detection and Treatment - Stephanie Badalamenti, MD - L...Summit Health
Sun safety needs to start at an early age, and continue throughout life, in order to reduce the risk for skin cancer. Learn about prevention and ways to reduce your risk, screening for skin cancer and innovations in treatments.
Shoulder Pain Relief: Common Rotator Cuff Injuries & Treatment Options - And...Summit Health
If you are experiencing shoulder pain, a rotator cuff tear could be the issue. Learn about how, and why, rotator cuff tears happen, how the condition and severity is diagnosed, and the non-surgical and surgical treatment options available.
My Knee Hurts! A Look at Joint Pain in Children - Marla Guzman, MD - 1.12.2021Summit Health
Is your child complaining of joint pain? Learn about concerning symptoms and when to seek medical advice. Our expert discusses the various causes of joint pains in children, how a pediatric rheumatologist evaluates musculoskeletal complaints, and available treatment options.
Mildred “Mitch” Bentler, MA, RD, CSP, CDE, presented a virtual lecture at on diabetes prevention. According to Ms. Bentler,
“A combination of small changes can really make an impact on lowering your blood sugar. Increasing physical activity and adopting healthier eating habits can go a long way to reducing your diabetes risk.”
Why Does My Stomach Ache? - Dennis Han, MD, Gastroenterologist - Morristown &...Summit Health
Do you have stomach issues which are bothering you and you can't figure out why? Learn about conditions that could be causing abdominal pain or discomfort at this virtual program. Our expert will discuss different conditions such as: Irritable Bowel Syndrome; Inflammatory Bowel Disease; Celiac Disease and other conditions that require a gluten-free diet; and GERD (Reflux). He will explain the differences between these various conditions, how they are diagnosed, and treatment options available. Hosted by Morristown & Morris Township Public Library.
Know Your Numbers and What They Mean for Your Overall Health - Madison Public...Summit Health
What does your blood pressure, BMI, cholesterol, blood sugar and vitamin levels tell you about your health? Our expert will discuss how these numbers tell a story, and why it’s important to understand what that story means to your overall health. Dr. Im-Imamura will also share tips for helping you get these numbers where they should be, and how increasing physical activity and improving nutrition are key factors that can impact those numbers in a good way.
Presented as part of the Madison Public Library Virtual Seminar Series.
Understanding Knee Arthritis and Cartilage Disorders - Maurice M. Pine Free P...Summit Health
Many people suffer from pain, swelling, stiffness, and loss of knee function as a result of knee arthritis. Our expert will discuss the causes, symptoms, and nonsurgical and surgical treatment options available. Hosted by Maurice M. Pine Free Public Library.
Pulmonologist, Jenny Kim, MD, FCCP of our Sleep Disorders Center partnered with the Livingston Health Department to present, Can’t Sleep? The ABCs of Your ZZZs to the community. During the session, Dr. Kim discussed tips for improving sleep and treatment options for common sleep disorders.
Christina Lavner, RDN, Nutrition Services, presented Healthy Eating for Cancer Survivorship, as the second session of our Now What? A Cancer Survivorship Speaker Series for patients wanting to learn more about nutrition that will benefit them during and after treatment. Be sure to check out upcoming presenters in this series and pass the word on to any patients you think would be interested in the information. The next presentation in this series is November 16, Coping with Treatment Side Effects, presented by Constance Gore, RN-APN
Guide to Eating an Anti-Inflammatory Diet Virtual Lecture - Christina Lavner,...Summit Health
An anti-inflammatory diet, along with exercise, can yield many health benefits, such as improved symptoms of many chronic conditions, reduced cancer risk, and a lower risk of obesity, heart disease, and diabetes. Learn more about this healthy way of eating and how to get started.
While most common in teens, the onset of acne can be troubling at any age. Depending on its severity, acne can cause emotional distress and scar the skin. The earlier you start treatment, the lower your risk of such problems. Learn about the causes of acne and effective treatment options for adolescents and adults.
Living a Heart Healthy Life - Liliana Cohen - West Orange Public Library - 2....Summit Health
Learn how to make healthy choices that impact heart health, the typical mistakes to avoid, and how to recognize the signs and symptoms of a heart attack.
Heart of the Matter - Ali Ahmad, MD, FACC - Livingston Library - 1.6.2020Summit Health
Heart disease is the leading killer of adults nationwide and it carries a significant morbidity for the population at risk. Learn about traditional and non-traditional risk factors associated with coronary artery disease, and how to modify your risk and prevent heart disease. Also, learn about how heart disease affects different ethnic backgrounds, particularly the high-risk groups, such as South Asians.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Empower Yourself! Child Anxiety and Depression - Dr. Leibu - 10.10.19
1. Empower Yourself!
Anxiety and Depression in Children
and Adolescents: When it is More
than Temper Tantrums
Presented by:
Dora Leibu-Lerman, D.O., MBA
Nancy Moran, LCSW, ACT
October 10, 2018
2. Lecture Objectives
• Inform and educate about various types of anxiety in children
and adolescents
• Inform and educate about various types of depression in
children and adolescents
• Risk factors predisposing children and adolescents to having
anxiety and depression
• Help with distinguishing normal behavior patterns and reactions
to stressors to true anxiety and depression disorders
• Offer insight into possible therapy options
• Offer parents/caregivers tools to recognize “red flags” in their
children
• Dispel common misconceptions about mental in health in
children and adolescents
4. Anxiety Disorders in Children &
Adolescents
• Normal reactions to stressors aka NOT
anxiety disorders
• Types of anxiety disorders
Generalized Anxiety Disorder
Separation Anxiety Disorder
Social and Specific Phobias
Panic Disorder
Obsessive Compulsive Disorder
5. Common & Appropriate
Fears in Children
• Infants (up to the age of 10 months)- loud noises,
being startled, strangers
• Toddlers (1-6 y/o)- imaginary creatures (monsters),
dark, separation anxiety
• School Aged children- worrying about injuries to
themselves and loved ones, natural events (storms,
floods etc.)
• Adolescents (>13 y/o)- school performance, social
competence, health issues (body imaging, sexual
and physical development)
7. Common Anxiety Pattern in
Children and Adolescents
• Child enters difficult situation
• Child becomes fearful
• Fear escalates to anxiety and child gets stuck
• Child avoids the situation or is asking for help
• Child continues to think the situation is
dangerous/harmful and feels helpless against
it
8. Separation Anxiety Disorder
• A universal human developmental
phenomenon starting <1 y/o
• Peaks between 9 months to 18 months and
may persist until 2.5 y/o
• Seen in 15% of children
• Can later develop into another form of an
anxiety disorder
• Usually seen in shy and introverted children
9. Separation Anxiety Disorder
• Fear regarding being separated from
caregiver that is beyond developmental
expectations
• Excessive worry that harm might come to the
caregiver that leads to extreme distress and
nightmares
• Must go on for at least 1 month
• Manifests as refusal to go to school, physical
complaints and distress upon separation
10. Generalized Anxiety Disorder
• Extreme disruption in activities of daily living due to
any perceived danger in many areas such as school,
family and social settings
• Child often feels fearful in multiple settings and
almost always expects negative outcomes when
faced with various challenges
• Affected children are often perfectionists and seek
contact reassurance
• May experience physical issues such as headaches,
abdominal pain, N/V, palpitations, chest tightness,
dizziness and sweating
11. Specific Phobias
• Fear of a particular object/situation
which is either avoid or endured with
great distress to the child
• Children often do not see it as
unreasonable fear, while adolescents
and adults do
• Avoidance from the particular stressor
12. Social Anxiety Disorder
• Intense fear in one social setting or another
• Often impaired by their fear of scrutiny/humiliation by
their peers in social situations
• May manifest as excessive crying, tantrums, freezing,
mutism and avoidance
• Symptoms stop when away from the social situation
• Child/adolescent must be observed to be
anxious/fearful in presence of their peers
13. Social Anxiety Disorder –
Why is it important?
• Decreased level of satisfaction in leisure
activities
• Increased rate of school drop out
• Decreased productivity at the workplace in
adulthood
• Increased rates of remaining single
• About 50% with this Dx do not receive proper
treatment
14. Obsessive Compulsive Disorder
• Recurrent, intrusive thoughts associated with fear
and/or repetitive, purposeful mental/behavioral
actions that are aimed at reducing the tensions
caused by obsessions
• Up to 25% of cases are seen by the age of 14 y/o
• Manifestations are similar to that of adults, however,
children and adolescents often do not see it as
irrational
• Likelihood increases with age
• Children with first degree relatives are 10 times more
at risk of developing it themselves
• Presence of chemical imbalance
15. Obsessive Compulsive Disorder-
cont.
• Extreme fears of contamination- exposure to germs, dirt or
disease followed by worries related to harm befalling
themselves or their loved ones
• Obsessive need for symmetry, exactness, excessive religious or
moral concerns
• Typical rituals include: cleaning, checking, counting, repetitive
behavior patterns or item arrangement
• Often get very anxious when unable to perform the rituals above
• Often referred to professionals when their rituals interfere with
ADL’s
16. Panic Disorder
• Recurrent unexpected surge of intense fear/discomfort that
reaches a peak within minutes during which 4 of the following
may occur
Palpitations
Sweating
Shaking
Shortness of breath
Choking feeling
Chest pain/tightness
Abdominal pain, GI discomfort
Numbness and tingling
Fear of losing control or “going crazy”
Fear of dying
Depersonalization (detached from oneself)
17. Panic Disorder- cont.
• Peak onset 15-19 y/o
• Generally last for 20-30 minutes (rarely >60 min.)
• At least 1 of the attacks has been followed by more
than 1 month or more of one of the following
Persistent concern about additional attacks
Changes in behavior to avoid the attacks
• Attacks cannot be explained by medical (organic)
condition and NOT due to substance use
• Attacks cannot be explained by other mental
disorders
18. What is NOT considered an
Anxiety Disorder?
• Attention deficit hyperactive disorder- usually see
worsening of anxiety with onset of treatment
• Asperger’s syndrome
• Learning disabilities
• Depression
• Psychosis
• Medication/substance induced anxiety
• Medical conditions- thyroid dysfunction, anemia,
vitamin deficiencies
19. Red Flags
• Avoidance- school truancy, avoiding parties, camp,
self isolation
• Changes in eating habits- under or overeating
• Inattention and decline in concentration- seen as
poor academic performance
• Sleep changes- insomnia or hypersomnia (over
sleeping), frequent visits to parents’ room
• Excessive need for reassurance by parents, peers
• Risky behavior such as substance abuse
• Impairment in ADL
• Physical complaints
20. Physical Complaints and Anxiety
Disorders
• Children (toddlers, pre-school) cannot express their feelings
(anxiety, depression etc.) so as caretakers, parents and
teachers we will perceive physical complaints first such as:
Headaches
GI upset- abdominal pain, N/V, changes in BM
Changes in sleep
Chest pain/tightness
Tight neck/back
Fatigue, exhaustion
Easily irritable
Increased vulnerability to common viruses
21. Treatment Options
• Parent/caregiver- child interactions,
family intervention
• Classroom interventions and
accommodations
• Primary care, pediatricians interventions
• Cognitive behavioral therapy
• Medications
22. What Not to Do
• Do not try and convince them it will be alright
• Do not minimize their experiences
• Do not tell them to fight the anxiety
• Do not physically force them to face the
situation
• Do not verbally bully them into the situation
• Do not be afraid to share your concerns with
educators, primary health care providers
23. What to Do
• Accept/acknowledge their feelings
• Demonstrate understanding
• Cooperate with them and respond to their
needs rather than react
• Catch your breath
• Accept negative feelings
• Label emotions
• Implement/teach problem solving skills and
coping mechanisms
24. Cognitive Behavioral Therapy
• Understanding the connection between
thoughts, emotions, actions and
physiology.
• Increasing awareness of unhelpful
behavioral responses or irrational
thought patterns
25. Cognitive Behavioral Therapy-
cont.
• There are 3 primary
components-
Cognitive
Emotional/physiological
Behavioral
Thought
processes
FeelingsBehavior
26. Cognitive Behavioral Therapy-
cont.Unhealthy
Process
Healthy
Process
Thought processes Distorted thinking, overly
negative, self critical,
selective and biased
More positive,
acknowledging success,
balanced thinking and
recognition of personal
strengths
Feelings Unpleasant, anxious,
depressed, angry,
frustrated
Pleasant, relaxed,
happy, calm, confident
Behavior Avoidant, quick to give
up, irritable,
inappropriate
Confident to try new
things, ready to tackle
problems, appropriate
27. Depression in Children &
Adolescents
• Normal sadness vs. Depression
• Define major depression in children and
adolescents
• Risk factors predisposing to depression
• Screening and diagnostic tools
• Treatment Modalities
• Resources
28. Is it Depression?
• Severity- the more severe it is, the less likely
it is a passing mood; “red flags” include:
changes in appetite, substance use, isolation
from family and friends and hobbies, feelings
of hopelessness and apathy
• Duration- usually 2 weeks or longer without
disruption
• Domain- encompasses school, family, home
lives
29. Major Depressive Disorder
• Must consist of at least 5 manifestations that
last at least 2 weeks or longer-
Depressed/irritable mood
Loss of interest/pleasure
Appetite fluctuations leading to changes in weight (>5% of
weight change in a month)
Sleep changes- too much or too little
Psychomotor agitation/retardation
Daily fatigue
Feeling worthless/ inappropriate guilt
Inability to concentrate at tasks at hand
Recurrent thoughts of death
30. Major Depressive Disorder- cont.
• Most common mental health disorder in children and
adolescents
• Only 50% of adolescents with depression are
diagnosed before reaching adulthood
• In primary care setting- 2 out of 3 youths are not
identified by their physician and thus do not receive
treatment
• When identified only ½ receive treatment
• Severe shortage in mental health providers, primary
care physicians are the main resource to raising
awareness and starting treatment
32. Risk Factors for
Developing Depression
• Low birth weight
• Family Medical History of depression (first degree relative- x2,
both parents- x4)
• Family dysfunction
• Exposure to early adversity
• Psychosocial stressors
• Gender dysphoria
• Traumatic brain injuries
• Chronic illness
• Other existing mental health issues- anxiety, ADHD, substance
abuse, learning disabilities, ODD
33. Screening Tools &
Diagnostic Tools
• Starts at home and continues in the classroom
• At the doctor’s office- questionnaire (PHQ-9A) and discussing
with the adolescent alone (>12 y/o) every year
• Discuss limits of confidentiality
• Emphasize healthy habits
• Multiple sources of intervention have shown most promise
• Safety Planning
Restrict access to controlled substances, weapons, medications
Emergency plan
34. How to Determine
Who is at Risk?
• Family members (past/present) who
were diagnosed with depression, bipolar
D/O, substance abuse or suicide
attempts
• Substance abuse involved
• Prior Suicide Attempts
• Is there a plan in place?
35. Treatment Modalities
• Mild Depression- active support by family,
school and peers with healthcare provider
involved (1-2 months)
• Moderate to severe depression - counseling
with mental health specialist with or without
medication regimen
Psychotherapy - CBT, IPT-A, PCIT-ED
Medications - SSRI’s
36. Treatment Modalities - cont.
• CBT- cognitive behavioral therapy
• IPRT-A: interpersonal psychotherapy that focuses on
ways in which depression interferes with
interpersonal relationships with emphasis on a
separation from parents, authority figures, peer
pressures and dyadic relationships
• PCIT-ED: Parent child interaction therapy emotion
development; modules that strengthen parent-childs
relationship by coaching parents in positive play
techniques, giving effective directives to the child and
teaching parents to respond to disruptive behavior in
a firm but not punitive manner
38. Resources for Parents
• Teachers and educators - get to know them
• Family physicians, pediatricians
• Parents’ medication guide:
http://www.parentsmedguide.org/
• SPARX: https://www.sparx.org.nz/about
• Pediatric Psychiatry Collaborative in NJ:
http://njaap.org/programs/mental-health/ppc/
Editor's Notes
This lecture is NOT:
Meant to shame parents/ caregivers’ child rearing methods but to raise awareness to certain phenomena
Meant to prescribe treatment plans but to offer options and possible approaches to dealing
This lecture was meant to bring mental health to the forefront of children's wellbeing and normal development
I will discuss the various types of anxiety disorders, their manifestations, risk factors, epidemiology and treatment options
Anxiety and fear can be used interchangeably;
fear of strangers or being separated from our parents and loved ones helps protect us from harm
Fear of failure (in any domain) propels us to do better in school, sports and allowing us to be better versions of our former selves
Fear prevents us from engaging in risky behaviors that may lead to our demise
It is a universal human developmental phenomenon that starts <1 y/o and marks the child’s awareness of separation between them and their caregiver- it is used to protect the child from danger (evolution), to solidify the bond between the child and their caregiver
Normally peaks between 9 months and 18 months and diminishes by 2.5 years old
Seen in 15% of children
Can later develop into another form of an anxiety D/O
Usually seen in shy and introverted
Explain the first paragraph
PCP and Peds interventions usually warranted by significant interference in child’s ADL’s or on a recommendation made by teachers or concerned parents/caregivers or family members