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.
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:

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:

Individual factors: withdrawal

separation anxiety
family factors
factors specific to school
psychiatric disorders: depression, phobic
anxiety or other psychiatric conditions.

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:

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.

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

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