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PSYCHO-TRAUMAS IN THE HISTORY OF PSYCHIATRIC DISORDERS IN CHILDREN AND ADOLESCENTS

Autor: Roxana Toma
Distribuie pe:

This paper aims to identify the correlations between the psychotraumas from the early childhood and further development of mental illness in teenagers.This is a retrospective study conducted inside the Child & Adolescent Psychiatric Clinics in Cluj-Napoca. 83 subjects that are presented in this study were exposed to different psychotrauma , also the pathology developed after this was closely watched. Subjects were aged between 5 and 17 years. There were subjects excluded from this study, those who presented different forms of psychiatric comorbidity at the diagnosis of PTSD. All data presented in this study was performed using SPSS 20. Based on this , we observed that the most common psychiatric disorders that occurred in adolescents with psychotrauma history are the anxiety and depressive disorders.

Introduction

Posttraumatic Stress Disorder ( PTSD ) is a severe condition that may develop when a person is exposed to one or more traumatic events. While, in DSM- IV, this disorder was included in anxiety disorders, in DSM -V it is included in a new chapter called Disorders caused by trauma and stress. (“Diagnostic and Statistical Manual of Mental Disorders“). The exposure should result in one or more of the following scenarios, where the individual:

  • experiences the traumatic event directly;
  • is witness to a traumatic event;
  • a close person has been exposed to a traumatic event;
  • suffers repeated exposure or exposure to aversive details of the traumatic event (not media images)

Unlike DSM –IV, diagnostic criteria in DSM-V establish a clear demarcation of the traumatic event. DSM -V pays more attention to behavioural symptoms that accompany PTSD and proposes four different diagnostic groups instead of three: re – experiencing, avoidance, negative changes in cognition and mood, increased arousal.

Re – experiencing the traumatic event includes spontaneous memories, recurring dreams about it, flashbacks or other intense and prolonged distress.

Avoidance refers to unpleasant memories, thoughts, feelings related to the traumatic event.

Negative changes in cognitions refer to the ideas of self-blame, social withdrawal, decreased interest in activities, and the inability to remember key aspects of the traumatic event.

Increased arousal is characterized by aggression, self-destructive behaviour, sleep disorders, relationship problems. (Iuliana Dobrescu, MD., PhD; Kaplan & Sadock).

DSM-V only requires that a disruption should continue for more than a month to eliminate the distinction between acute and chronic phases of PTSD. DSM -V includes the addition of two subtypes: PTSD in children less than 6 years old and PTSD with predominantly dissociative symptoms (feelings of detachment from self or feelings where the world seems unreal or distorted, like in a dream).

 

Objectives

This study aims to identify the relationship between the presence of posttraumatic stress disorder and subsequent occurrence of psychiatric disorders in children and adolescents, in order to improve the methods of treatment of PTSD, and to prove the need for sustained, multidisciplinary therapy, in such cases.

 

Method

The study is a retrospective one, performed in the archives of Clinic of Paediatric Psychiatry from Cluj- Napoca. The group consisted of 83 subjects (47 girls, 36 boys), aged 5-17 years. We followed all psychiatric assessments and admissions to Clinic of Paediatric Psychiatry of those subjects in the interval January 1993 – December 2008 (15 years). The criterion for inclusion was the fact that patients had a first PTSD and subsequently new diagnoses occurring during the interval mentioned above were pursued. Patients who had a history of psychiatric pathology before the diagnosis of posttraumatic stress disorder were excluded from the study.

 

Results

The patients included in our study were from both urban (62 subjects – 74 % ) and in rural areas (21 subjects – 26% , background conditions being poor for 61 subjects (73.4%).

The age distribution of the group at the time of diagnosis of posttraumatic stress disorder:

 

Age (years) 4 5 7 8 9 10 11 12 13 14 15 16
Number of patients 1 2 8 6 7 5 8 9 11 13 10 3

 

 

The age distribution of the consignment upon occurrence of other psychiatric disorders:

 

Age (years) 5 6 7 8 9 10 11 12 13 14 15 16 17
Number of patients 2 2 5 5 6 3 4 6 5 13 13 12 7

 

 

In 46 of the tested subjects, positive psychiatric family history positive was identified and in 28 of the subjects problems at birth were detected (prematurity , birth dystocia, prolonged labour).

Although 37 of the subjects came from families organized by marriage, 33 of these families had increased conflictuality with strained relationships within the family, with multiple episodes of marital conflict and domestic aggression towards the mother and children. 36 of the subjects were from dysfunctional families through divorce. Seven subjects were institutionalized.

Following the school situation of the patients, we observed that 37 of them (44.5 %) had poor school performance, 27 of the subjects had failed, 17 were repeating the school grade, 24 had school absenteeism, and 12 of them had low marks in behaviour. It has to be noted that there had been a progressive decrease in school performance since the psycho-trauma moment.

The main symptoms for which patients came for evaluation were represented by: hypoprosexia (78 %), irritability, and irascibility (84 %), low frustration tolerance (91 %), disruptive behaviour (74 %), decreased school performance (92 %), negativity (88 %), insomnia (96 %), emotional lability (98 %), depressed mood (78 %).

The most common psycho-traumas in the study group, were represented by physical abuse (27 subjects – 32.5 %), emotional abuse (23 subjects – 27.7 %), death of a parent or a close relative (19 subjects – 23%), parental divorce (18 subjects – 21%). Other forms were registered, too: sexual abuse (7 subjects – 8%), severe somatic disorders (3 subjects – 3%), road accident (2 subjects – 2%).

The interval between the presence of psycho-trauma and the occurrence of secondary psychiatric diagnoses:

 

Time interval 2 mo. 3 mo. 4 mo. 5 mo. 6 mo. 1 yr. 2 yrs. 3 yrs. 4 yrs. Over 4 yrs.
Number of patients 3 6 5 5 16 12 12 12 6 6

 

 

Main subsequent psychiatric diagnoses were represented by: inorganic sleep disorder (61 subjects – 73.5%), conduct disorder (33 subjects – 40 %), anxiety disorder (25 subjects – 30 %), depressive disorder (21 subjects – 25 %), elimination disorders (10 subjects – 125), autolytic attempts (8 subjects – 10%), somatisation disorder (5 subjects – 6%),
tics (4 subjects – 4%) , abnormal sexual relating (3 subjects – 3%).

 

Statistics Analytical

I watched the existence of possible correlations between the type psychotrauma and secondary psychiatric diagnoses, and after application of statistical tests (Fisher test, chi test), we observed the following results with statistical significance (p < 0.05):

  1. patients who were physically abused (27 subjects), have subsequently frequently conduct disorder (20 subjects), sleep disorders (17 subjects) and anxiety disorders (13 subjects).
    anxiety disorders p=0.0207
    sleep disorders p=0.0001
    conduct disorder p=0.0001
  2. patients who had the psychotrauma death of a parent or a close relative (19 subjects), have subsequently commonly depressive disorders (13 subjects) and anxiety disorders (10 subjects)
    depressive disorder p=0.0001
    anxiety disorders p=0.0224
  3. posttraumatic stress disorder caused by parental divorce later led to the emergence of a higher frequency in the study group, sleep disorders (7 patients), elimination disorders (5 subjects).
    sleep disorders p=0.007
    elimination disorders p=0.038
  4. patients with emotional abuse were mainly developed for anxiety disorders (13 subjects) and elimination disorders (6 subjects )
    anxiety disorders p=0.0026
    elimination disorders p=0.0241
  5. sexually abused patients developed after a certain time anxiety disorders (5 subjects), depressive disorder (4 subjects), autolytic attempts (4 subjects), sleep disturbances (7 subjects), abnormal sexual relating (3 subjects) and disorder somatisation ( 3 subjects ).
    anxiety disorder p=0.023
    depressive disorder p= 0.046
    autolytic attempts p=0.0012
    sleep disturbances p=0.0035
    disorders of sexual networking p=0.0004

 

Conclusions and discussion

In the study group there was a positive correlation between the type psychotrauma and psychiatric disorders subsequent to , the following:

  • Most common were anxiety disorders, in children abused physically, emotionally, sexually, and in children who have been through the loss of a close relative
  • Conduct disorders occurred predominantly in children physically abused, with a higher frequency among boys
  • Sleep disorders manifested by nightmares, deambulări nocturnal sleep occurred mainly after sexual abuse and physical ( Kovachy B1, O’Hara R , Hawkins N, Gershon A, Primeau MM, Madej J , Carrion V. Lev – Wiesel R1, Markus L.)
  • Autolytic attempts were found mostly in girls multidrug ingestion after sexual abuse (O’Brien BS , Sher L. , Browne , Angela , Finkelhor , David Wherry JN1 , Baldwin S , Junco K , Floyd B.) .

In agreement with previous studies that demonstrate the negative impact of abuse, neglect or any child psychotrauma proves the need for prompt therapeutic approaches, multimodal and continuous tracking of children who suffered post-traumatic stress disorder (Cyr C, Michel G, M. Dumais, David M. Benedek).

 

Limitations of the study:

  • Inconsistent addressability of patients has led to the development gaps – incomplete
  • In the future, prospective, comparative

 

Bibliography

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