Transcript FINAL with correction-2x

BRANDI J. RUDOLPH- BOLLING, MD
“ERASING THE STIGMA AND REVEALING
THE TRUTH: KNOWING THE DIFFERENCE
BETWEEN MENTAL HEALTH ISSUES AND
MEDICAL PROBLEMS IN YOUTH”
AUGUST 20, 2016
GEAR- UP
Class Schedule by Period
• Homeroom: Roll call (Introduction)
• 1st: Math (The child who adds too much activity- ADHD)
• 2nd: History (The child who always relives the past- PTSD)
• 3rd: Science (The child who practices “chemistry’”- Substance Use Disorders)
• 4th: Social Studies (The child who expresses himself among friends- Social Media)
• 5th: English (The child who cannot write a happy ending- Depression)
• 6th: Elective 1 (The child with an optional course of study- Medical/ Other Diagnoses)
Elective 2 (Developing New Attitudes- Erasing the Mental Health Stigma)
• 7th: Snack Time (Parents’ Diets/ Lifestyles Impact their Ability to Parent their Children)
• 8th: Circle Time (Questions)
Homeroom: (Roll Call)
Who’s Our Teacher?
• Dr. Brandi J. Rudolph- Bolling
• Undergraduate: Vanderbilt University (BS, Neuroscience)
• Medical School: Meharry Medical College (MD)
• Residency:
Pediatrics, Psychiatry, Child and Adolescent Psychiatry
Indiana University
• Work: - Northwest Alabama Mental Health Center, Child & Adolescent
Psychiatrist
- Baptist Medical Center, Geriatric Psychiatry Unit, Psychiatrist
- Rudolph Bolling Psychiatry, PC, Medical Director and C&A Psychiatrist
1st Period: Math (The child who adds too much activity)
Attention deficit- hyperactivity disorder (ADHD)
Case: Kenneth is a 15yo male. In a parent- teacher conference his teacher
mentioned to his mom that he cannot stay seated and always fidgets, blurts
answers in class, rushes to the door as soon as the bell rings, yells often,
invades others’ personal space and hugs them in an unsolicited fashion. He is
also easily distracted, does not respond when he is spoken to, does not
complete his class work, forgets to turn in his homework, fidgets with his pants
and shirt, avoids getting started on his work, and can never keep his backpack
or desk clean. This is his second year in 10th grade but his teachers are
already mentioning making him repeat 10th grade again next year. His mom is
hesitant to believe that anything is wrong and feels that he is just “being a boy.”
She plans to “just pray” about his symptoms.
ADHD: Symptoms of Inattention
• Often fails to give close attention to details or makes careless mistakes
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in schoolwork, work, or during other activities
Often has difficulty sustaining attention in tasks or play activities
Often does not seem to listen when spoken to directly
Often does not follow through on instructions and fails to finish school work,
chores, or duties in the work place
Often has difficulty organizing tasks and activities
Often avoids or is reluctant to engage in tasks that require sustained mental
effort
Often loses things necessary for tasks or activities
Is often easily distracted by extraneous stimuli
Is often forgetful in daily activities
ADHD: Symptoms of Hyperactivity and Impulsivity
• Often fidgets with or taps hands or squirms in seat
• Often leaves seat in situations when remaining seated is expected
• Often runs about or climbs in situations where it is inappropriate
• Is often unable to play or engage in leisure activities quietly
• Is often "on the go" acting as if "driven by a motor"
• Often talks excessively
• Often blurts out answers before questions have been completed
• Often has difficulty awaiting turn
• Often interrupts or intrudes on others
ADHD: Important Notes
• There are three types of ADHD: (1) Predominantly inattentive presentation, (2)
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Predominantly hyperactive-impulsive presentation, and (3) Combined
presentation.
Students must show at least 6 of 9 inattentive and/or hyperactive impulsive
symptoms to have the disorder.
The symptoms must be present for at least 6 months.
Several inattentive or hyperactive-impulsive symptoms have to be present in
two or more settings.
There needs to be clear evidence that the symptoms interfere with, or reduce
the quality of, social, academic, or occupational functioning.
ADHD: Treatment Options- Psychostimulants
• Methylphenidates
• Amphetamines and
- Concerta
derivatives
- Adderall
- Vyvanse
- Daytrana
- Focalin
- Methylin
- Quillivant
- Ritalin
ADHD: Treatment OptionsNon-stimulants
• Strattera
• Tenex
• Intuniv
• Clonidine
• Kapvay
ADHD: Treatment OptionsNon- medication
• Behavioral modifications
- Calendars
- Telephone reminders
- Alarms
- Post- It® Notes
2nd Period: History (The child who always relives the past)
PTSD (Post-traumatic Stress Disorder)
Case: Sidney is a 13yo male. His mother and father recently separated, but
before that his mom was constantly physical towards his dad and cursed him.
One night his mom beat his dad so badly that the police were called. However,
his dad did not press charges. In addition to this domestic violence at home,
Sidney is teased by his classmates because his hair is not always neatly cut,
his shoes are “run over,” and his pants stop three inches above his ankle. At
the point that he thought he could handle his parents’ violence, he returned
home to find that his dad has shot his mom.
PTSD Symptoms (1)
A. Exposure to actual or threatened death, serious injury, or sexual violence in
one (or more) of the following ways:
• 1. Directly experiencing the traumatic event(s).
• 2. Witnessing, in person, the event(s) as it occurred to others.
• 3. Learning that the traumatic event(s) occurred to a close family member
or close friend. In cases of actual or threatened death of family member or
friend, the event(s) must have been violent or accidental.
• 4. Experiencing repeated or extreme exposure to aversive details of the
traumatic event(s) (e.g., first responders collecting human remains; police
officers repeatedly exposed to details of child abuse).
PTSD Symptoms (2)
B. Presence of one (or more) of the following intrusion symptoms associated with the
traumatic event(s), beginning after the traumatic event(s) occurred:
• 1. Recurrent, involuntary, and intrusive distressing memories of the traumatic
event(s).
• 2. Recurrent distressing dreams in which the content and/or affect of the dream are
related to the traumatic event(s).
• 3. Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if
the traumatic event(s) were recurring. (Such reactions may occur on a continuum,
with the most extreme expression being a complete loss of awareness of present
surroundings.)
• 4. Intense or prolonged psychological distress at exposure to internal or external cues
that symbolize or resemble an aspect of the traumatic event(s).
• 5. Marked psychological reactions to internal or external cues that symbolize or
resemble an aspect of the traumatic event(s).
PTSD Symptoms (3)
C. Persistent avoidance of stimuli associated with the traumatic event(s),
beginning after the traumatic event(s) occurred, as evidenced by one or both of
the following:
• 1. Avoidance of or efforts to avoid distressing memories, thoughts, or feelings
about or closely associated with the traumatic event(s).
• 2. Avoidance of or efforts to avoid external reminders (people, places,
conversations, activities, objects, situations) that arouse distressing memories,
thoughts, or feelings about or closely associated with the traumatic event(s).
PTSD Symptoms (4)
D. Negative alterations in cognitions and mood associated with the traumatic
event(s), beginning or worsening after the traumatic event(s) occurred, as
evidenced by two (or more) of the following:
• 1. Inability to remember an important aspect of the traumatic event(s) (typically due to
dissociative amnesia and not to other factors such as head injury, alcohol, or drugs).
• 2. Persistent and exaggerated negative beliefs or expectations about oneself, others,
or the world (e.g., “I am bad,” “No one can be trusted,” “The world is completely
dangerous,” “My whole nervous system is permanently ruined”).
• 3. Persistent, distorted cognitions about the cause or consequences of the traumatic
event(s) that lead the individual to blame himself/herself or others.
• 4. Persistent negative emotion state (e.g., fear, horror, anger, guilt, or shame).
• 5. Markedly diminished interest or participation in significant activities.
• 6. Feelings of detachment or estrangement from others.
• 7. Persistent inability to experience positive emotions (e.g., inability to experience
happiness, satisfaction, or loving feelings).
PTSD Symptoms (5)
E. Marked alterations in arousal and reactivity associated with the
traumatic event(s), beginning or worsening after the traumatic event(s)
occurred, as evidence by two (or more) of the following:
• 1. Irritable behavior and angry outbursts (with little or no provocation) typically
expressed as verbal or physical aggression toward people or objects.
• 2. Reckless or self-destructive behavior.
• 3. Hypervigilance.
• 4. Exaggerated startle response.
• 5. Problems with concentration.
• 6. Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).
F. Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month.
3rd Period: Science (The child who practices “chemistry”)
Substance Use Disorders
Case: Calvin is a 13yo boy. He has played football with the local park since he
was 5yo. However, this year he did not want to play. His mom did not think
much of it since most of his teammates opted to play with their middle schools.
She has noticed recently, though, that he isolates to his room. He is irritable
towards his 12yo brother, with whom he has always enjoyed playing. One
winter night he had a cold and she noticed that he had blood shot eyes. He
was sleeping a lot around that time but maintained an excessive appetite.
Recently he has a new group of friends and this once-all-A-student is now
making failing grades. His mother feels that he just does not care about
anything at all.
Substance Use Disorders- Things to watch for
• Drug and alcohol paraphernalia
• Slurred speech
• Poor academic performance
• Signs of hangover (bloodshot eyes, changes in pupils)
• Changes in eating habits
• Tremors or impaired coordination
• High risk behaviors
• Poor school attendance
• Appears fearful, anxious, or paranoid
• Sudden mood swings
• Aggressive behavior
• Unexplained hyperactivity
• Lack of motivation
Substance Use Disorders
Parents, remember that the only question your child cannot answer is the one you do not ask, so
Talk to your children!!!
More to come from Ms. Pamela Butler
4th Period: Social Studies (The child who expresses himself among friends)
Adolescents and Social Media
Case: Jamal is a 12yo male. He lives with his mother and father, who are both
professional workers and spend a great deal of time at work. His parents
bought him a high-dollar popular phone to make sure he gets to and from
school. But in order to use this phone to the fullest a media package had to be
purchased. Because Jamal’s parents work a lot they are not as attentive and
did not know that Facebook and Twitter were already installed on the phone.
The principal has called the parents in for a meeting because of something
Jamal has posted on line.
Adolescents and Social Media
Parents, remember that the only question your child cannot answer is the one you do not ask, so
Talk to your children!!!
And look at their phones if
you have to!!!
More to come from Dr. Jarralynne Agee
5th Period: English (The Child Who Cannot Write A Happy Ending)
Major Depressive Disorder (Depression)
Case: Samuel is a 12yo male. Last year he was held back in 6th grade. As the
new school year starts he feels that his friends have moved on and do not want
to be around him. Additionally, he is not making friends in his new class. When
he comes home he isolates in his room, has low energy, sleeps a lot, and
fluctuates between eating too much and not eating at all. He has gained about
15 pounds in the last 3 weeks. Last year he struggled to understand his school
work, and this year he is having a hard time concentrating, and therefore is not
doing well academically again. He no longer wants to play football, something
he has done and excelled at since he was in kindergarten. A once loving child,
he now screams at his 2yo sister, whom he has always enjoyed being around.
He told his mom “I just want it to all be over” a few days ago.
Major Depressive Disorder (Depression) Symptoms (1)
A.
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3.
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6.
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9.
Five or more of the following symptoms have been present and documented during the
same two-week period and represent a change from previous functioning; at least one of
the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
Depressed mood most of the day, nearly every day, as indicated by either subjective report
Markedly diminished interest or pleasure in all, or almost all, activities most of the day,
nearly every day (as indicated by either subjective account or observation)
Significant weight loss when not dieting or weight gain or decrease or increase in appetite
nearly every day
Insomnia or hypersomnia nearly every day
Psychomotor agitation or retardation nearly every day
Fatigue or loss of energy nearly every day
Feelings of worthlessness or excessive or inappropriate guilt nearly every day
Diminished ability to think or concentrate, or indecisiveness, nearly every day
Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a
specific plan, or a suicide attempt or a specific plan for committing suicide
Major Depressive Disorder (Depression) Symptoms (2)
B. The symptoms do not meet criteria for a mixed episode.
C. The episode is not attributable to the physiological effects of a substance or to another
medical condition.
• Note: Criteria A-C represent a major depressive episode.
• Note: Responses to a significant loss (e.g., bereavement, financial ruin, losses from a natural
disaster, a serious medical illness or disability) may include feelings of intense sadness,
rumination about the loss, insomnia, poor appetite and weight loss noted in Criterion A, which
may resemble a depressive episode. Although such symptoms may be understandable or
considered appropriate to the loss, the presence of a major depressive episode in addition to
the normal response to a significant loss should also be carefully considered. This decision
inevitably requires the exercise of clinical judgment based on the individual's history of and the
cultural norms for the expression of distress in the context of loss.
D. The occurrence of the major depressive episode is not better explained by schizoaffective
disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and
unspecified schizophrenia spectrum and other psychotic disorders.
E. There has never been a manic episode or a hypomanic episode.
6th Period: Elective 1 (The child with the optional course of study)
Medical and other mental diagnoses
Case: Cassie is a 14yo girl. She moves about in the classroom and never
seems to be still. She does well in her classwork, but her teacher notices that
she does best when she sits in the front of the class or when she has
worksheets to work on at her desk. She can complete her work uninterrupted
and does not seem easily distracted. She usually finishes her work quickly and
perfectly and, once she does, moves about in the classroom. She constantly
complains of upset stomach and sometimes needs to put her head on her desk
because of headaches. Her mom told the teacher yesterday that she and dad
have recently separated and will be going through a divorce soon.
Medical and other mental diagnoses: Possible options
• Medical Problems to Consider
- Vision problems
- Constipation
- Headaches
- Abdominal pain
• Other Mental Health Problems to Consider
- Learning disorders (Special Education)
- Advanced learning needs (Special Education)
- Anxiety
- Depression
- Poor sleep
6th Period: Elective 2
Erasing the Mental Health Stigma
8 Reasons Why People Don’t Get Mental Health Treatment
1. Fear and shame
2. Lack of insight
3. Limited awareness
4. Feelings of inadequacy
5. Distrust
6. Hopelessness
7. Unavailability
8. Practical barriers
7th Period: Snack Time
Parents’ Diets and Lifestyles Impact their Ability to Parent
Parents, make sure you take care of yourselves!
Your children need you to be healthy and happy.
Happy, healthy parents can foster happy, healthy
children!
More to come from Mr. Jacques Austin, LPC-S, NCC
8th Period: Circle time
QUESTIONS
BRANDI J. RUDOLPH-BOLLING, MD
201 Beacon Parkway, West, Suite 201
Birmingham, Alabama 35209
Office (205) 948-7129
Nurse (205) 948-7139
Fax (844) 270-4926
www.rbpsychiatry.com
We are accepting new patients and we take most insurance,
including Medicaid and AllKids!!!
Keep up with your tickets!!!
You could be the winner of a Walmart or Subway gift card,
or the Grand Prize, a
32” TV,
all donated by Rudolph Bolling Psychiatry, PC and
Bolling Law Firm, LLC
Reference
• Diagnostic and Statistical Manual, 5th edition
• 8 Reasons Why People Don’t Get Mental Health Treatment
June 11, 2015July 10, 2016 by David Susman