1. “I guess what I miss most is being drunk.”

2. SUD Assessment l Parental values l Genetics l Culture l Individual characteristics l Peer group

3. Suicide l Epidemiology l Impulse control risk factors l Biopsychosocial etiology l Gender differences

4. Tic Disorders l Sudden, rapid, recurrent non- rhythmic, stereotyped, motor movement or vocalization l Tourette’s Disorder l motor before vocal l autosomal dominant

5. Eating Disorders l Anorexia Nervosa l Bulimia Nervosa l Pica

6. Symptoms of Depression in Young People l Irritability l Low self-esteem l Denial of depression l Somatic Complaints l Depressed appearance

7. Diagnosis of Dysthymia l Depressed or irritable mood lasting a year or longer l Never symptom free for longer than 2 months

8. Diagnosis of Dysthymia ( Cont’d. ) l Symptoms –pessimism –social withdrawal –decreased energy –low self-esteem –poor concentration –hopelessness –sleep and appetite changes

9. Risk Factors for MDD and Dysthymia l Stressful life events l Parental dysfunction and loss l Boys - neonatal health problems l Girls - perceived unpopularity, anxiety

10. Early Onset Bipolar Disorder l Changes in mood, sleep pattern and energy l Hyperactivity and irritability l Distractibility l Pressured speech

11. Early Onset Bipolar Disorder ( Cont’d. ) l Affective symptomatology l Visual hallucinations l Unreasonable irritability and anger

12. Epidemiology of Depression l Incidence increasing l 4.7% MDD among adolescents l Mean age of onset 11 years l 0.7% bipolar among adolescents

13. “Son, it’s important to remember that its O.K. to be depressed.”

14. Depression Biologic Etiology l Genetic influences l Structural and functional changes l Serotonin and norepinepherine l Cortisol and growth hormone l Attachment experience

15. Depression Psychosocial Etiology l Developmental dynamics l Life stress l Family dysfunction l Cultural support

16. Depression DDX and Co-mobidity l Bipolar Disorder l Anxiety and PTSD l ADHD Medical causes

17. Separation Anxiety Disorder l Differential Diagnosis PhobiaLD Conduct Disorder Depression l Excessive anxiety about separation from the home or from significant others

18. Selective Mutism l Failure to speak in specific social situations despite speaking in other situations.

19. Reactive Attachment Disorder of Infancy or EarlyChildhood Reactive Attachment Disorder of Infancy or Early Childhood l Developmentally inappropriate social relatedness beginning before age 5 associated with pathological care. l Inhibited and Disinhibited Type

20. Generalized Anxiety Disorder l Excessive anxiety and worry for at least 6 months l Worry about performance at school and sports l DSM IV criteria less stringent

21. Phobias l Most common disorder in childhood l Fears and anxieties decrease with age. About 2 - 3% of adolescents have significant fears.

22. Phobias ( Cont’d. ) l Fear of loud noises, the dark, animals, or imaginary creatures are common in younger children. In older children, fears are more focused on health, social and school problems.

23. Obsessive-Compulsive Disorder l High incidence in Tourettes l Age of onset younger in males l Basal ganglia disorders (PANDAS)

24. PTSD l Fear of separation, withdrawal, reenactment, sleep disturbance, regression, impulsivity l Anxiety, psychosis l Physical symptoms, nightmares

25. Response to Traumatic Events l The effect of trauma depends on the mediating processes –developmental level –biology of the trauma experience –social context –coping skills, protective factors, resilience

26. Childhood Trauma l Type I –full detailed memories –“omens” and misperceptions l Type II –denial and numbing –self-hypnosis, dissociation, rage

27. Dissociative experiences both during the trauma and afterward is related to the later development of PTSD

28. Biologic Response to Stress l Genetics l Fight or flight l Norepinepherine linked to immediate and prolonged response l Serotonin linked to anxiety and panic in PTSD

29. Biologic Response to Stress (Cont’d.) l Brain regions involved include locus coeruleus, ventral tegmental region, and amygdala l Increase glucocorticoid release results in loss of neurons and decreased dendritic branching in hippocampus and cognitive dysfunction.

30. The Child Interview (Pynoos) l Stage 2 –relive experience –coping themes –closure, recapitulation, courage/strengths l Stage I –focus and traumatic reference

31. Associated Problems l Co-morbid psychiatric disorders l Substance abuse l Sexual/intimacy problems