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Psychiatry for Hunks
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PEDIATRIC
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Autism
‹3 yo, repetitive behavior, marked hearing impairment
Undetected hearing impairment (e.g. hereditary, following repeated ear infections) can produce similar symptoms but detected at older age
Asperger Syndrome
More communicative, appear more socially aware, no language impairments, repetitive behavior
Childhood Disintegrative Disorder
Period of normal development for at least 2 yrs followed by loss of previously acquired skills like expressive or receptive language, social skills, play & motor skills
Attention Deficit Hyperactivity Disorder (ADHD)
Inability to attend to task at hand, ↑ motor activity, impulsivity
Tx: stimulants (Methylphenidate / Dextroamphetamine), psychotherapy / behavioral modification
Enuresis / Bed Wetting
Day & night bladder control usually attained by 5 yo
Causes: UTI, urinary tract abnormalities, developmental delay of bladder, diabetes, stress incontinence, waiting too long to void, medications
Mx: urine analysis (1st step)
Usually self-limited
Tx: non pharmacological → behavioral therapy (bell or buzzer and pad apparatus), ↓ water intake at night, pharmacological → Imipramine, Desmopressin
SLEEPING DISORDERS
Somnambulism (Sleep Walking)
Occurs during stage 4 (Delta sleep)
Tx: Benzodiazepines
Famous Sufferers: heroine in Bellini’s opera ‘La Sonnambula’
Nightmares
Frightening dreams, occur during REM sleep, can be recalled
Night Terrors
Occur during stage 4 NREM (Non-Rapid Eye Movement) sleep, person often unable to fully awaken
Narcolepsy
Sleep attacks, Sleep paralysis / cataplexy (sudden loss of muscle tone), triggered by strong emotions
Hypnopompic, hypnagogic hallucinations
Person falls asleep promptly at night (REM sleep occurs in less than 10 mins)
Excessive daytime somnolence and abnormalities of REM sleep lasting > 3 months
Tx: Amphetamines (Methylphenidrate), Modafinil (non-Amphetamine stimulant), if cataplexy present → Antidepressants
Famous Sufferers: River Phoenix’s character in Gus Van Sant’s 'My Own Private Idaho'
EATING DISORDERS
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Anorexia Nervosa
Control issue is key → pts have lost control over everything else in their life except what they put in their mouth – this gives them a sense of control
Distorted body image (perception problem – even when very thin, pts see themselves as obese)
15-20 % loss of body weight
Complications: osteoporosis (↓ Ca+2, ↓ estrogen), ↑ carotene, ↑ cholesterol, euthyroid sick syndrome, amenorrhea (↓ estrogen), small for gestational age baby, cardiac arrhythmias (hypokalemia), hypomagnesemia
Tx: wt gain with hospitalization if necessary
Re-feeding Syndrome
2nd-3rd wk after initiation of feeding → edema, heart failure
Tx: phosphate supplementation
Bulimia Nervosa
Binge eating with sense of lack of self-control, compensatory behavior to avoid gaining wt (vomiting, laxatives etc)
Pts at or above expected wt
Due to repeated vomiting → dental caries, excoriation on knuckles of hand
Tx: SSRI’s even in non-depressed pts (because Serotonin is ↓)
Prognosis is better than for anorexia
Eating Disorder, Not Otherwise Specified
Features of both anorexia and bulimia, doesn’t meet criteria for specific eating disorder
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