what disorder would this be?

[meghan91]

hey guys my friend i go to school with is doing a project for school she is a psych major and she was having some issues trying to decide what disorder this case would be and she asked me about it yesterday but i wasnt sure .

A 12 year old child who is very defiant, hyper, mood difficulties, frustrated easily, temper outbursts,impulsive,impatient,always wants to sleep, aggressive, triggered by loud noises or other kids, requires many prompts, and gets mad and upset about them. Yells, screams, and curses. Gets agitated upon not getting his own way, extreme mood lability; his moods rapidly alternate between happiness, sadness and anger which are accompanied by an exaggerated intense expression of these emotions(screaming,yelling,cursing, crying, punching,kicking,breaking objects,leaving class) gets nervous easily, cries over little things, sleeps and wakes up hungry,poor self esteem,and had suicidal ideations at the age of 4.

i was wondering if anyone had any idea what this would be since she doesnt know and wont know until she gets her grade back thursday. (this isnt for me or for her homework her project is already handed in for grading Im just wondering since she asked me about it yesterday)

thanks everyone

[UTHSC_Bound, BSN]

Saw a really interesting bit on PBS about this the other day:

The Medicated Child | FRONTLINE | PBS

[Tait, MSN, RN]

Saw a really interesting bit on PBS about this the other day:

The Medicated Child | FRONTLINE | PBS

Watching this now.

[netglow, ASN, RN]

It's the suicidal ideations that tipped it and made me suggest schizophrenia as something to consider. At 4? An age where there may be no discussion as to how/who came up with the idea of killing - voices? who? No way to put it into words and explain when you are 4 most likely. They will try to control it to avoid the negative attention it all brings and they are fearful too, so it's a real fight as they get older. The quick turns in mood here are described as very quick as in the moment - which is not so characteristic of Bipolar mania/depression - no euphoria conquer the world feelings it seems with this kid noted.

Schizo often comes as one part of a cluster of psych dx and that makes it hard to figure out.

[UTHSC_Bound, BSN]

It's the suicidal ideations that tipped it and made me suggest schizophrenia as something to consider. At 4? An age where there may be no discussion as to how/who came up with the idea of killing - voices? who? No way to put it into words and explain when you are 4 most likely. They will try to control it to avoid the negative attention it all brings and they are fearful too, so it's a real fight as they get older. The quick turns in mood here are described as very quick as in the moment - which is not so characteristic of Bipolar mania/depression - no euphoria conquer the world feelings it seems with this kid noted.

Schizo often comes as one part of a cluster of psych dx and that makes it hard to figure out.

my mother died when i was two. It was overwhelming and confusing. My father told me by 4 I was rocking myself to sleep saying 'i wish i were dead'. There weren't any 'voices'. I was just overwhelmingly sad and there was no escape because didn't yet have the tools to navigate that water.

i think in general there is a lack of credit given to children's mental acuity to their environment. Too often they are labeled without looking at environmental and historical data.

[jadelpn, LPN, EMT-B]

Schizophrenia. PTSD with Borderline Traits. Could be anything, but per TOS no medical advice. And here's hoping that this is not your child--if so, hugs, and bring the kid to the doctor about this!!

Specifically as a project, as nurses, our job is to assess and suggest a consult. So be careful that this is not a trick question--it should be written as what one finds in assessing not diagnosing (

It is interesing because one has to look at what forum one is assessing in--did the nurse witness any of these behaviors? Or is this a parental subjective assessment? All in all, be careful that as a nurse your friend doesn't diagnose, but does an objective assessment and observes for those behaviors in a hospital setting. If it were an office setting, maybe an alternate level of care is needed to get to the root of the childs' issues.

[lilaclover6984]

Conduct disorder

[netglow, ASN, RN]

"hey guys my friend i go to school with is doing a project for school she is a psych major and she was having some issues trying to decide what disorder this case would be and she asked me about it yesterday but i wasnt sure . "

My psych classes involved discussion of diagnosis. Remember AN is a discussion forum and there is nothing that prevents nurses from discussing :) an interesting topic. Nobody asked for medical advice, an nobody is "at work" here.

[SoldierNurse22, BSN, RN]

It's the suicidal ideations that tipped it and made me suggest schizophrenia as something to consider. At 4? An age where there may be no discussion as to how/who came up with the idea of killing - voices? who? No way to put it into words and explain when you are 4 most likely. They will try to control it to avoid the negative attention it all brings and they are fearful too, so it's a real fight as they get older. The quick turns in mood here are described as very quick as in the moment - which is not so characteristic of Bipolar mania/depression - no euphoria conquer the world feelings it seems with this kid noted.

Schizo often comes as one part of a cluster of psych dx and that makes it hard to figure out.

Interesting point. I suppose the suicidal ideations would make sense with schizo, but with Bipolar, suidical ideations could occur in the depressive phase as well. I suppose I was assuming that the kid's out of control anger could be a manifestation of mania, but that's just a guess.

[MrChicagoRN, RN]

Umm, why is she asking you and not going to her faculty for assistance? If she is studying psych as an undergraduate she isn't responsible for diagnosing anyway. If this is a hypothetical, she can do an "if this, then that" sort of paper. If it's a real child, then she needs to ask caregivers, treating team members, and others...not some random other undergrad.

Great points

I personally find it disturbing To be asked to diagnose a child based on 2nd or 3rd hand information coming from an undergrad with no known expertise.

I'd say, tell her to get a DSM-V and get a sense of the complexity of diagnosing a mental or brain illness.

[Esme12, ASN, BSN, RN]

moved to student forum for best result.

I would have your friend join so they can do their own work....but it is difficult to advise without more information

[donk]

Sounds like one of my boys... He's been diagnosed as borderline personality disorder.