1. Repetition lecture Child and adolescent psychiatry II D 14.05.12 Dagrun Breirem-de Beer RBUP/NTNU/St. Olav Dagrun Breirem-de Beer

2. Factors Biological factors Psychological factors Socio-cultural factors (economical) Dagrun Breirem-de Beer

3. Neuropsychiatry General, pervasive, specific developemental disorders ADHD Tourettes syndrome Autism spectrum/Asperger OCD Dagrun Breirem-de Beer

4. Neuropsychiatry ADHD 1,5-8 % Etiology: Dopamine- Serotonin related neurochemical deviation of function in the brain- stem, mesencephalon and frontal cortex Living in the present, without past or future (Barkley) Frontal lobe, executive functions, working memory Dagrun Breirem-de Beer

5. Neuropsychiatry ADHD Clinical diagnosis Hyperactive (3:5), impulsiveness (1:4), attention (6:9) DSM-IV criteria After the assessment you review the findings, observations and test results. Then you weigh for and against a ADHD diagnosis, and exclude or confirm possible differential diagnosis or co- morbid conditions Final diagnosis is set by the specialists, but the primary doctor is to do a thorough basic work up in co-operation with the first line services and follow up the patient (NB chronic condition) Dagrun Breirem-de Beer

6. Neuropsychiatry ADHD Treatment: – Parent guidance – School guidance – Pharmacological treatment (metyfenidate, atomoxetin) – Individual therapy Dagrun Breirem-de Beer

7. Affective disorders Unipolar depression, bipolar depression 3 main criteria: Depressive mood, Interest – anhedonia, Reduced energy – reduced activity 8 other symptoms: Concentration problems, Reduced self-esteem, Guilt and self- deprecation, Psychomotoric changes, Thoughts of death or suicidal attempts, Sleep Disturbances, Apetite changes Dagrun Breirem-de Beer

8. Affective disorders Depression (ICD- 10) Depressiv episode – severe : All main criteria + at least 5 of the other 7 (i.e. 8 of 10). Daily – At least 2 weeks Depressiv episode – moderate : 2 main criteria + 4 of the others (i.e. 6 of 10) Depressiv episode – mild : 2 main criteria + 2 of the others (i.e. 4 of 10) Dysthymia = chronic depression – less symptoms: Two years (DSM-IV one year) Dagrun Breirem-de Beer

9. Affective disorders Unipolar depression Etiology: heridity, environment, brain Assesment: MFQ (humøret ditt), Treatment – Biological: medication, aktivity, sleep/rest – Psychological: individual, group, family CBT + medication (fontex) or medication alone most rapid improvement Dagrun Breirem-de Beer

10. Questions from the students Feel free to ask! Dagrun Breirem-de Beer