随着儿童的成熟和发展解决冲突的技能,侵略倾向于减少。然而,如果儿童受到持续的负面刺激,攻击性会持续存在,如不良的育儿和不良的童年经历(ACE)。此外,侵略在许多精神疾病中很常见,如注意缺陷多动障碍(ADHD)和对立违抗性障碍。这些负面刺激和合并症可能最终阻碍儿童在关键时刻的发展,导致攻击行为恶化,比如犯罪活动。对于患有这些合并症和经历的个人,行为干预是必不可少的。我们的患者是一名11岁的男性,有相关的ADHD病史和多种精神药物的破坏性情绪失调障碍(DMDD),他向急诊科提出杀人意念和自杀倾向的评估。这也发生在攻击行为恶化时,他杀死了家庭宠物,并随后威胁要杀死他的家人。该患者曾因类似的威胁多次急诊就诊,并已被送往许多住院精神病院。目前,病人正在州外的精神病院接受治疗。我们病人的攻击性很可能源于他的多动症和DMDD,受其他因素的影响,例如低社会经济地位,获得心理健康服务的机会有限,生活在医疗服务不足的社区。诸如提高初级保健提供者在管理这些疾病方面的舒适度等因素,特别是在服务不足的社区,那里已经缺乏精神健康提供者,可以帮助解决这个问题。此外,必须筛选其他影响因素,如ACE。此案例还强调了在显示精神药物抵抗的精神病病例中,作为医学检查的一部分进行基因检测的必要性。然而,基因检测在我们州并不容易获得,也不在医疗补助范围内。精神健康状况的早期治疗可以防止以后的社会困难。带着侵略,提供适当的干预措施是防止个人从事有害活动的关键。重要的是筛查ACE,以解决众所周知的加重因素。服务不足的人群还面临着无数的挑战,这些挑战阻碍了他们获得医疗保健服务。造成这种差距的问题很多,从缺乏足够的精神卫生服务到缺乏服务。因此,在服务不足地区执业的初级保健医生和提供者必须接受必要的培训,以识别和治疗精神健康状况。此外,医生应该能够关注导致这些心理健康状况的社会心理压力源,并提供解决这些因素所需的资源。
Aggression tends to decrease as a child matures and develops conflict resolution skills. However, aggression can persist if children are exposed to consistent negative stimuli, such as poor parenting and adverse childhood experiences (ACEs). Furthermore, aggression is commonplace in numerous psychiatric disorders, such as attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder. These negative stimuli and comorbid conditions could ultimately stunt a child\'s development during pivotal moments, leading to worsening aggressive behaviors, such as criminal activity. Behavioral interventions are imperative for individuals with these comorbid conditions and experiences. Our patient is an 11-year-old male with a pertinent past medical history of ADHD and disruptive mood dysregulation disorder (DMDD) on multiple psychotropic medications, who presented to the emergency department for the evaluation of homicidal ideation and suicidality. This also occurred with worsening aggressive behavior, demonstrated by his killing of family pets and subsequent threats to kill his family. The patient has had multiple emergency department visits for similar threats and has been admitted to numerous inpatient psychiatric facilities. Currently, the patient is being treated at an out-of-state inpatient psychiatric facility. Our patient\'s aggression most likely stems from his comorbid ADHD and DMDD, complicated by other factors, such as low socioeconomic status, limited access to mental health services, and living in a medically
underserved community. Factors such as increasing primary care provider comfort in managing these conditions, especially in
underserved communities where there are already shortages of mental health providers, could help address this issue. Furthermore, it is imperative to screen for other contributing factors, such as ACEs. This
case also highlights the need for genetic testing as a part of the medical workup in psychiatric cases that display psychotropic medication resistance. However, genetic testing is something that is not readily available in our state and is not covered by Medicaid. Early treatment of mental health conditions can prevent social difficulties later in life. With aggression, providing appropriate interventions is key to preventing an individual from engaging in harmful activities. It is important to screen for ACEs in order to address well-known aggravating factors.
Underserved populations also face a myriad of challenges that prevent them from accessing healthcare services. There are numerous problems contributing to this disparity, ranging from lack of adequate mental health services to lack of access. Accordingly, it is imperative that primary care physicians and providers practicing in
underserved areas receive the training necessary to recognize and treat mental health conditions. Furthermore, physicians should be able to focus on psychosocial stressors that contribute to these mental health conditions and provide the resources necessary to address these factors.