School Refusal & OCD

1. School Refusal & OCD Done by: Hisham Al-Hammadi

2. 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.

3. 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

4. Aetiology: • Individual factors: withdrawal • separation anxiety • family factors • factors specific to school • psychiatric disorders: depression, phobic anxiety or other psychiatric conditions.

5. 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.

6. 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.

7. Aetiology: • Genetic factors • Psychodynamic theory • Learning theory • Biochemical theories • Organic brain disorders

8. 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