Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Muscle Disorders

The clinical evaluation can usually distinguish disorders of muscle from those of the central nervous system (CNS) and peripheral nervous system (PNS) ( Table 6.1 ). It can then divide muscle disorders into those of the neuromuscular junction and those of the muscles themselves, myopathies ( Box 6.1 ). Surprisingly, considering their physiologic distance from the brain, several muscle disorders are associated with mental retardation, cognitive…

Peripheral Nerve Disorders

Neurologists generally distinguish peripheral nervous system (PNS) from central nervous system (CNS) disorders on the basis of clinical findings. In PNS disorders, damage to one, a group, or all peripheral nerves causes readily observable patterns of paresis, deep tendon reflex (DTR) loss, and sensory impairments. Some PNS disorders are characteristically associated with encephalopathy, systemic illness, or a fatal outcome. Anatomy The spinal cord’s anterior horn cells…

Cranial Nerve Impairments

Various conditions may strike the cranial nerves individually, in pairs, or in groups. Moreover, when patients appear to have symptoms of a cranial nerve impairment, the underlying problem might not be damage to the cranial nerve itself but rather a cerebral or brainstem lesion, neuromuscular junction or muscle problem, or psychogenic disturbance. Following custom, this chapter reviews the 12 cranial nerves and their disorders according to…

Psychogenic Neurologic Deficits

In classic studies of patients with conversion disorders, when unconscious conflicts were thought to undergo a psychodynamic conversion to expression as a physical symptom, patients only had rudimentary examinations and minimal, if any, laboratory testing. Re-evaluation of the same patients after many years found that specific neurologic conditions, such as movement disorders, multiple sclerosis (MS), or seizures, emerged in as many as 15% of them. Another…

Signs of Central Nervous System Disorders

Disorders of the brain and the spinal cord—the two major components of the central nervous system (CNS)—typically cause readily recognizable combinations of paresis, sensory loss, visual deficits, and neuropsychologic disorders ( Box 2.1 ). Such signs of CNS disorders differ from those of peripheral nervous system (PNS), and both differ from the signs of psychogenic disorders. Neurologists formulate their preliminary diagnosis and often initiate treatment on…

First Encounter With a Patient: Examination and Formulation

Despite the ready availability of sophisticated tests, the neurologic examination remains fundamental to the specialty. Beloved to neurologists, the examination provides a vivid portrayal of both function and illness. When a patient’s history suggests a neurologic illness or dysfunction localized to a particular site in the nervous system, the neurologic examination may unequivocally demonstrate it. Even if psychiatrists themselves do not perform the examination, they should…

Childhood-Onset Schizophrenia

Introduction With symptom onset prior to 13 years of age, Childhood-onset schizophrenia (COS) is an exceptionally rare and devastating psychiatric condition, which clinically and neurobiologically resembles adult-onset schizophrenia (AOS). The etiology of schizophrenia largely remains unknown, but it is widely accepted that it is due to a combination of genetic predisposition and environmental influences. Earlier onset cases are more strongly influenced by genetic factors, less so…

Pediatric Bipolar Disorder

Introduction The recognition, diagnosis, and treatment of pediatric bipolar disorder have undergone a number of changes over the last 30 years in the field of child and adolescent psychiatry. In a review of the history of pediatric bipolar disorder, Glovinsky noted descriptions of mania and melancholy that go all the way back to ancient Greece. However, it was the French in the 1670s who described melancholicus…

Disruptive Mood Dysregulation Disorder

Introduction Irritability is a symptom, which is found in several pediatric psychiatric illnesses, from depression to bipolar disorder (BD) to oppositional defiant disorder (ODD). Until recently, it was not studied outside of these illnesses. However, the description of irritability in these illnesses does not capture the impairment that is caused by severe nonepisodic irritability. The increased incidence and prevalence of BD seems to be in some…

Pediatric Inflammatory Brain Disease

Introduction Pediatric inflammatory brain diseases (PIBDs) vary widely in clinical presentation across neuropsychiatric domains. Emergence of psychiatric symptoms may be initial manifestations of PIBDs. Child psychiatrists who are alert for symptoms of PIBDs can hasten their diagnosis, and prompt referral to immunologic treatment can improve outcomes and lead to symptom resolution. In fact, psychiatric symptoms can fully resolve once the underlying inflammatory disease is controlled—if treatment…

Pediatric Catatonia

Introduction Catatonia is a syndrome with characteristic features, involving motor, speech, behavioral, and autonomic dysregulation. It is associated with neurodevelopmental, medical, neurologic, and neuropsychiatric disorders, as well as medication toxicity or withdrawal. Catatonia has similar characteristics and causes in children as in adults, but its recognition has lagged. It is frequently not recognized in the medical and psychiatric pediatric settings. Background In 1874, Karl Kahlbaum used…

Pediatric Delirium

Introduction In everyday parlance, delirium is a familiar term. For example, one might say someone is delirious with grief, or someone else might be described as deliriously happy. Although these forms of delirium may look different (i.e., one is somnolent and sad and the other is frenetically gleeful), these behaviors share a common definition that is encapsulated using the term delirium (i.e., an incoherence of thought…

Concussion in Children and Adolescents

Introduction Of the millions of male and female youth who participate in sports yearly within the United States, approximately 2 million children and adolescents sustain concussions, accounting for over 160,000 emergency room visits and hospitalizations annually. There is increasing evidence of the adverse effects of a single concussion on cognition and postconcussive symptoms, including poor attention, headaches, and fatigue. After a single concussion, a subsequent concussion…

Pediatric Sleep Disorders

Introduction Sleep is one of the most important activities that growing children engage in. By age 3 years, children will have spent more time sleeping than any other activity and will have spent more than half of their lives asleep. As they get older, they continue to require a substantial amount of sleep into their adolescent years. This significant sleep requirement is vital for cognitive, physical,…

Factitious Disorder Imposed on Another

Disclosure Statement Disclosure of any relationship with a commercial company that has a direct financial interest in subject matter or materials discussed in article or with a company making a competing product. Introduction This chapter focuses on a form of psychopathology in a caregiver that can severely, sometimes fatally, affect a child. Given the low prevalence of some of the preceding diagnoses reviewed, it is important…

Childhood Stress and Trauma

Introduction Many children presenting with mental health challenges have or are subject to childhood stress and traumatic (CST) experiences. CST increases the risk of developing a range of issues across the life span that affect functioning. The most common reasons that children and adolescents are referred to treatment are for disruptive behaviors and attention deficit hyperactivity disorder (ADHD) ; in both cases it is highly likely…

Eating Disorders

In this chapter, we will focus on the four primary pediatric eating disorders: anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and avoidant-restrictive food intake disorder (ARFID). Eating disorders are severe psychiatric illnesses that begin in adolescence and have the potential to become chronic if not treated swiftly. Although there are similarities across these four disorders, there are also differences in presentation, treatment, and…

Evolution From Feeding Disorders to Avoidant/Restrictive Food Intake Disorder

Introduction Eating disorders in young children and infants are generally referred to as “feeding disorders,” to emphasize the relationship between caregiver and child that may be strained or dysregulated in these conditions. This term includes a variety of conditions ranging from food refusal and disinterest to food aversions, overeating, undereating, fear of eating, pica (or the eating of nonfood substances), and rumination. Approximately 20%–30% of infants…

Management of ADHD in Youth With Comorbid Epilepsy

Key Summary Points It is important to be vigilant clinically to recognize the presence of epilepsy in patients with attention deficit hyperactivity disorder (ADHD), and vice versa. The longer the duration of seizures or subclinical epileptiform discharges, higher the likelihood of finding ADHD or its symptoms. In cases with subclinical seizures and ADHD, identification of the underlying epilepsy and type will guide treatment. In some cases,…