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Case Discussion

Case Discussion. Effects of trauma in children and adolescents Dr Ayesha Minhas. Issues?. Conversion disorder Depressive illness Trauma. “Pseudo seizures” / “Non epileptic or Psychogenic seizures”. Diagnosis (1) Nothing beats a good History

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Case Discussion

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  1. Case Discussion Effects of trauma in children and adolescents Dr Ayesha Minhas

  2. Issues? • Conversion disorder • Depressive illness • Trauma

  3. “Pseudo seizures”/ “Non epileptic or Psychogenic seizures” • Diagnosis • (1) Nothing beats a good History • (2) Planter response immediately after the fit • (3) video EEG monitoring • (4) measurement of serum prolactin • Included under Conversion disorder

  4. Conversion Disorder • Motor Symptoms: • Weakness or paralysis • Abnormal movements e.g tremor • Gait abnormalities • Sensory Symptoms: • Loss of sensation, vision, hearing • ‘Seizures’ with ‘impaired consciousness’ • Episodes of unresponsiveness like syncope

  5. “The sorrow which has no vent in tears may make other organs weep” Henry Maudsley

  6. Pathophysiology • ‘Repressed emotions’ converted into ‘somatic symptoms’ • Closely related to psychic trauma

  7. Proposed mechanism of Conversion • Traumatic experiences • Repressed from conscious memory • Nervous excitation • Conversion

  8. Trauma in children and adolescents • One in four children experiences a significant traumatic event before reaching adulthood • domestic, community, or school violence • disasters • vehicular or other accidents • medical traumas • war, terrorism • the traumatic death of significant others • child abuse

  9. Single-blow trauma, such as vehicle accident -Memories fully elaborated, ruminate over details • Multiple and repeated traumas, such as covert sexual abuse by a relative -Spotty memories/amnesia with aspects of denial, psychic numbing, dissociation

  10. WHO Definition • “Child maltreatment is the abuse and neglect that occurs to children under 18 years of age. It includes all types of physical and/or emotional ill-treatment, sexual abuse, neglect and commercial exploitation, which results in actual or potential harm to the child’s health, survival, development or dignity”

  11. Childhood trauma effects brain architecture • Childhood Trauma causes disruption in early brain development and immune systems • Limbic irritability • Deficient development of the cerebral cortex and the hippocampus • Deficient left-right hemisphere integration due to underdevelopment of the corpus callosum

  12. Effects of trauma • Increased risk for mental health problems • Post traumatic stress called the “rheumatic fever” of child psychiatry • Conversion/Dissociation • Somatoform disorder • Depression • Panic disorder with agoraphobia • Strongly associated with childhood abuse is Borderline personality disorder • PTSD • 20% of all adolescent suicide attempts due to CSA

  13. Prevention! • Management • Manage Anxiety • Help child gain insight into unconscious conflicts • Discourage illness-related behaviors, and help develop coping mechanisms • Build ‘self-esteem’ and ‘promote assertiveness’ • Family work to improve communication with family

  14. Sometimes adults say, “They're too young to understand” However young children are affected by traumatic events even though they may not understand !

  15. Thank you

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