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School Refusal & OCD. Done by: Hisham Al-Hammadi. School Refusal. Refusal to go to or to stay in school, without any attempts to conceal. Often associated with anxiety. Sometimes called school phobia. Prevalence: Around 3% in children with a psychiatric disorder.

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school refusal ocd

School Refusal & OCD

Done by: Hisham Al-Hammadi

school refusal
School Refusal
  • Refusal to go to or to stay in school, without any attempts to conceal.
  • Often associated with anxiety.
  • Sometimes called school phobia.

Prevalence:

  • Around 3% in children with a psychiatric disorder.
  • Around 5% among referrals to CPC
  • Both sexes are equally affected.
  • The incidence peak during three periods of school life:
    • Age 5 and 6.
    • Age 11 and 12.
    • Age 14 to 16.
clinical picture
Clinical picture:
  • High level of anxiety
  • Onset is usually gradual, or may be acute
  • Physical symptoms like: headache, nausea, abdominal pain and palpitations.
  • The symptoms are usually school day linked
  • The child is usually a good student and of average scholastic ability.

Differential diagnosis:

  • Truancy
  • Depressive disorder
  • Conduct disorder
  • Physical illness
aetiology
Aetiology:
  • Individual factors: withdrawal
  • separation anxiety
  • family factors
  • factors specific to school
  • psychiatric disorders: depression, phobic anxiety or other psychiatric conditions.
management
Management:
  • recognition and differentiation from other causes of school non-attendance.
  • attempt should be made for an early return to school.

Outcome:

    • most mild and acute cases resolve rapidly without any further problems.
    • Younger children with a stable family background have the best prognosis.
    • About a third of clinic cases are able to continue their education but will have emotional and social difficulties including relationship problem in adult life and some develop agoraphobia.
    • One third have poor outcome with serious implications on their education.
obsessive compulsive disorder
Obsessive compulsive disorder:
  • These disorders are characterized by obsessions such as thoughts. Ideas or images that are repetitive, intrusive and persistent.
  • Recognized by the person as unreasonable, silly or stupid, but attempts made to resist this are usually associated with increase in anxiety.
  • Compulsions have a similar quality and include repetitive rituals, checking, washing, cleaning, counting etc that are carried out to neutralize or prevent discomfort or anxiety.
  • Are recognized as senseless or excessive, and are often associated with marked distress or impairment in functioning.

Prevalence:

  • Is around 0.3 to 1%.
  • Most cases of adult OCS have an onset in childhood
  • OCD may be secondary to other disorders such as anxiety, depression, schizophrenia.
  • Complications include interference with school achievement and peer relations, and physical sequelae such as dermatitis due to repeated washing rituals.
aetiology7
Aetiology:
  • Genetic factors
  • Psychodynamic theory
  • Learning theory
  • Biochemical theories
  • Organic brain disorders
treatment
Treatment:
  • Behavioral techniques and family involvement
  • Antidepressant drugs
  • Serotonin reuptake inhibitors

Outcome:

  • Symptoms persist into adult life in about a third of cases.
  • A first attack of mild obssessional symptoms have a good outcome, but chronic severe and intractable cases are difficult to treat and have a poor prognosis