资源描述
Click to edit the title text format,Click to edit the outline text format,Second Outline Level,Third Outline Level,Fourth Outline Level,Fifth Outline Level,Sixth Outline Level,Seventh Outline Level,Eighth Outline Level,Ninth Outline Level,*,Anxiety Disorders:Separation Anxiety Disorder,Prof.Debbie van der Westhuizen,Head:Child and Adolescent Units,Weskoppies Hospital,Separation anxiety is very normal among preschoolers,especially those who are going to school for the first time,Separation anxiety(SA),SA is a developmentally appropriate response in young children on separation from primary caregivers(normal between 6-30 months;intensifies 13-18months;declines between 3-5 years due to cognitive maturation),Separation anxiety Disorder(SAD),SAD is a developmentally inappropriate 4%of school-aged children,common in 7-8 year olds,Only anxiety disorder in DSM-IV-TR included under disorders:“usually first diagnosed in infancy,childhood or adolescence,SAD:shadowing parents,SAD is a developmentally inappropriate distress(excessive worry/fear)associated with separation from primary caregiver,Anxiety may present prior to,during,and/or in anticipation of separation,Fear that harm may come to themselves or parents-which will result in permanent separation,Difficulty going to places without parents,Specific themes:nightmares of kidnap or being taken away,To avoid separation:complaints of stomach-aches/headaches,Case:Living in her parents shadow,Susan is a 7 year old referred due to concerns regarding anxiety and school refusal,Chief complaint:“Susan is afraid I will forget her at school,her mother stated,History of present illness:For the past 3 months Susan had fears about separating from her parents to go to school,becoming progressively worse,She has extreme distress on Sunday nights,trouble falling asleep with worries about bad things happening to her parents while at school;a burglar will break into their house and kill her mother,History of present complaint,When in time for school,Susan actively resist by hiding under the bed or clinging to her mother while complaining about stomachache,If she is at school,she intermittently appears sad and tearful,tells the teacher she needs to phone home to see if her mother is safe.,She frequently asks to go to the nurses office as she has stomachache or feeling dizzy,Her mom is considering quitting her job;she is shadowing her parents at home and slipping into her parents bed due to bad dreams of monsters capturing them,Past history,Psychiatric:never participated in therapy or been given a prescription for psychotropic medication,Medical history:small for gestational age;prone to illnesses as an infant,Developmental history:as infant and toddler slow to warm up to new people;approached unfamiliar situations with avoidance;separation reactions during preschool years,Social history:She lives with biological parents;no history of abuse and neglect;mother recently returned to work as a retail manager,limited contact with peers outside school,Past history,Family history:Susans mother has a history of a and panic disorder.Her father has recently been diagnosed with recurrent major depressive disorder and being treated with antidepressant medication.Susans older brother has social phobia and dropped out of high school because of impairing fears and avoidance of social and performance situations,Mental status evaluation:Susan was nicely dressed and groomed;appeared her stated age,MSE,She sat on her mothers lap during the evaluation;engaged in minimal eye contact,When asked direct questions-provided limited responses,She refused to separate from her mother and would not allow her mother to leave the interview room without her,Susans mood was described as nervous and irritable at times of separation,MSE,Susans mood was described by her mother as anxious,There was no evidence of psychosis,Her thinking was logical and coherent,Susan stated that she would jump out of her mothers moving car if required to go to school,While at home she constantly shadows her parents;most evenings slips into parents bedroom;afraid she will fall asleep and never wake up,Psychotherapeutic perspective,Susan presented with symptoms suggesting separation anxiety disorder(SAD)and problems with school refusal,She experiences distress upon separation from her parents,worries that harm will befall them,afraid that she will be forgotten at school,refuses to go to school because of her separation concerns,Distressed when at home without her parents;will not sleep alone at night,has nightmares with separation theme;reports stomachache and faintness,Separation concerns present since preschool,Susans symptoms are reported to interfere meaningfully with her academic and social functioning(unable to attend school or peers),Diagnostic formulation,Multi-informant assessment would be helpful(data from Susan,parents,her school teacher),Self-report and teacher measures of anxiety an related emotional concerns,Parent-and teachers-
展开阅读全文