Citation

Romanowicz M, McKean AJ, Vande Voort J. BMC Psychiatry 2017; 17(1): e330.

Affiliation

Mayo Clinic, Department of Psychiatry and Psychology, 200 1st SW, Rochester, MN, 55901, USA.

Copyright

(Copyright © 2017, Holtzbrinck Springer Nature Publishing Group - BMC)

DOI

10.1186/s12888-017-1492-y

PMID

28893219

Abstract

BACKGROUND: Long-term effects of neglect in early life are still widely unknown. Diversity of outcomes can be explained by differences in genetic risk, epigenetics, prenatal factors, exposure to stress and/or substances, and parent-child interactions. Very common sub-threshold presentations of children with history of early trauma are challenging not only to diagnose but also in treatment. CASE PRESENTATION: A Caucasian 4-year-old, adopted at 8 months, male patient with early history of neglect presented to pediatrician with symptoms of behavioral dyscontrol, emotional dysregulation, anxiety, hyperactivity and inattention, obsessions with food, and attachment issues. He was subsequently seen by two different child psychiatrists. Pharmacotherapy treatment attempted included guanfacine, fluoxetine and amphetamine salts as well as quetiapine, aripiprazole and thioridazine without much improvement. Risperidone initiated by primary care seemed to help with his symptoms of dyscontrol initially but later the dose had to be escalated to 6 mg total for the same result. After an episode of significant aggression, the patient was admitted to inpatient child psychiatric unit for stabilization and taper of the medicine.

CONCLUSIONS: The case illustrates difficulties in management of children with early history of neglect. A particular danger in this patient population is polypharmacy, which is often used to manage transdiagnostic symptoms that significantly impacts functioning with long term consequences.

Language: en

Keywords

Adoption; Case report; Disinhibited social engagement disorder; Neglect; Polypharmacy