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Case-Based Differential Diagnostic Mental Health Evaluation for Adults
Published in Kunsook S. Bernstein, Robert Kaplan, Psychiatric Mental Health Assessment and Diagnosis of Adults for Advanced Practice Mental Health Nurses, 2023
Kunsook S. Bernstein, Robert Kaplan
The DSM-5 groups together “trauma- and stressor-related disorders” as a category for individuals who have been exposed to a traumatic and/or stressful event, and who exhibit the most prominent clinical characteristics of internalizing anhedonic and dysphoric symptoms and/or externalizing angry and aggressive symptoms, or who exhibit dissociative symptoms. Five disorders are included under this category: (1) reactive attachment disorder; (2) disinhibited social engagement disorder; (3) post-traumatic stress disorder (PTSD); (4) acute stress disorder (ASD); and (5) adjustment disorder (APA, 2013). Due to the complex developmental circumstances of childhood, the DSM-5 indicates that the diagnosis of reactive attachment disorder should be made with caution in children older than 5 years; it further reports that disinhibited social engagement disorder has not been described in adults. Therefore, these two diagnoses are excluded here, as this book solely targets adult populations. Please refer to the DSM-5 for detailed information about them.
Mood and Anxiety Disorders
Published in Tricia L. Chandler, Fredrick Dombrowski, Tara G. Matthews, Co-occurring Mental Illness and Substance Use Disorders, 2022
Tricia L. Chandler, Fredrick Dombrowski
This text is based in research around how trauma can lead to additional psychiatric and substance use disorders. Posttraumatic stress disorder (PTSD) and acute stress disorder are the two most common anxiety disorders in this section. Reactive attachment disorder in young children is due to trauma, abuse, and changes in caregivers. Posttraumatic stress disorder is characterized by directly experiencing, witnessing, learning about, or experiencing extreme exposure to traumatic and life-threatening events (American Psychiatric Association, 2013). These experiences lead to intrusive symptoms of involuntary and recurring distressing memories of the event(s), recurring dreams and nightmares about the event(s), dissociative reactions, intense and prolonged psychological distress at both external and internal triggers that resemble an aspect of the traumatic event being activated, with marked physiological reactions to those cues. The individual persistently avoids external reminders and distressing memories with increasing negative alterations in cognition and mood, along with marked alterations in arousal and reactivity associated with the traumatic event. Symptoms have lasted longer than a month (pp. 271–275). Acute stress disorder is similar to PTSD but is diagnosed if the symptoms occur three days to one month after the trauma occurred (pp. 280–281).
Why services for vulnerable children should be different
Published in Panos Vostanis, Helping Children and Young People Who Experience Trauma, 2021
A distinction, which is nevertheless difficult at times, should be made between behaviours of oppositional nature (as a result of children’s lack of boundaries and discipline); conduct nature (the more severe variation in a social context, usually during adolescence and which may include violence, stealing and other types of offending); and of underlying attachment difficul-ties through the impact of abuse and trauma. Despite the increasing interest and influence of attachment theory on child care and interventions, attachment difficulties (or disorders) do not automatically correspond to the pathological types, and there is not as yet sufficient research evidence and consensus on their use and definitions. On the whole, these refer to a child’s behavioural, emotional, relationship and developmental domains. The more widely used term of reactive attachment disorder encompasses two rather different types. Children with inhibited characteristics cannot initiate or sustain social interactions appropriate for their age. Instead, they respond with aggressive outbursts, ambivalence, avoidance, hyper-vigilance and dysregulated emotions. A child of the disinhibited type cannot differentiate between attachment behaviours and social cues, therefore she or he indiscriminately goes to strangers by misinterpreting cues for comfort and affection. These children can also respond through aggression and emotional dysregulation.
Prolonged injury symptoms and later visits to psychiatric care after mild traumatic brain injury in school-age
Published in Brain Injury, 2021
M Saarinen, N Erkinjuntti, S Koskinen, L Himanen, T Vahlberg, O Tenovuo, T Lähdesmäki
Children with pre-injury diagnosed learning or behavior disorder (14.2%) were diagnosed for ADHD or Tourette’s syndrome (n = 2), mental disability (n = 3), or learning/language development impairment (n = 2). Nine of the children had a pre-injury diagnosis of a psychiatric disorder (conduct disorder, anxiety disorder, reactive attachment disorder). Learning or behavioral problems pre-injury were significantly related to child- or parent-reported post-concussive symptoms at 1–3 months (Table 2). The overall intelligence score (FSIQ) was not a significant predictor for post-concussion symptoms. Due to the significant amount of missing FSIQ values (N = 9) and its high negative correlation with pre-injury learning ability (r = −0.384, p < .001), it was left out from the analyses.
Medical students’ perceptions, awareness, societal attitudes and knowledge of autism spectrum disorder: an exploratory study in Malaysia
Published in International Journal of Developmental Disabilities, 2018
Further, the medical students’ knowledge on ASD might also be affected by their respective cultural beliefs. Past studies with non-Western communities have revealed that members of these communities might not consider social communicative deficits such as the lack of eye contact and limited social interactions as concerns in early childhood development (Freeth et al. 2013). Such beliefs might also be present among the medical students and subsequently affect their recognition of the diagnostic symptoms of ASD. Additionally, different terms might be used in different cultures to refer to the condition of ASD, the meanings of which are varied. For example, Kim (2012) noticed that in Korea, the term reactive attachment disorder (RAD) is used synonymously with ASD because the diagnosis of RAD is more culturally and socially acceptable than that of ASD. Moreover, some Asian cultures might not even have a word to refer to ASD (Dobson et al. 2001). Correspondingly, the variability in the terms used might cause variations in the recognition and interpretation of ASD symptoms in different cultures. Hence, it is important that medical students and medical practitioners are able to disassociate themselves from cultural influences in the recognition of ASD symptoms; but yet be able to realize and acknowledge the presence of these influences for effective communication of diagnosis and treatment with parents (Bernier et al. 2010; Ravindran and Myers 2012).
Pilot study: undetected post-traumatic stress disorder symptoms among intellectually disabled
Published in International Journal of Developmental Disabilities, 2020
A. Borghus, S. Dokkedahl, A. Elklit
Amy underwent psychological assessment and was diagnosed with the following:Hyperkinetic conduct disorder.Mild ID without mention of impairment of behavior.Reactive attachment disorder of childhood.