Psych Flashcards
1
Q
Breathholding spells
- ____ is more prevalent in children with BHS
- 2 types: 1) Cyanotic (commonly preceded by cries, lose consciousness, become cyanotic) 2) Pale//pallid form (vasovagal scope, turn pale)
- Tx: Reassurance. Prevent situations that induce attack and iron supplementation.
A
Breathholding spells
- Iron deficiency anemia is more prevalent in children with BHS
- 2 types: 1) Cyanotic (commonly preceded by cries, lose consciousness, become cyanotic) 2) Pale//pallid form (vasovagal scope, turn pale)
- Tx: Reassurance. Prevent situations that induce attack and iron supplementation.
2
Q
Thumb sucking
- __yo: refer for dental evaluation
A
Thumb sucking
- <4yo: reassure parents as most will self resolve with no consequences
- > 4yo: refer for dental evaluation
3
Q
Sleepwalking:
- ___ sleep.
- Tx: ___
A
Sleepwalking:
- Non-REM sleep.
- Tx: Gently lead back to bed. Preemptive awakening
4
Q
Sleep/Night Terrors:
- ___ stages, during ___ 3rd of night.
- Strong ___ predisposition.
- Pt does not remember the incidence later
- Tx: ____
A
Sleep/Night Terrors:
- Non-REM stages, during 1st 3rd of night.
- Strong genetic predisposition.
- Pt does not remember the incidence later
- Tx: Observe WITHOUT attempting to awaken. A preemptive awakening before usual time can break cycle
5
Q
Nightmares
- Peak age 3-5yo
- ___ 1/3 of night during REM, muscle tone is inhibited.
- Child remembers the dream
- Tx___
A
Nightmares
- Peak age 3-5yo
- Last 1/3 of night during REM, muscle tone is inhibited.
- Child remembers the dream
- Tx: Reassure child that dream is over. Good sleep hygiene.
6
Q
Narcolepsy
- ___ sleep disorder due to a deficiency in neuropeptide ___
- 4 clinical features for at least 3 mo: ____, _____, _____, _____
- Dx: Polysomnography followed by multiple sleep latency testing (MSLT)
- Tx: ____
A
Narcolepsy
- REM sleep disorder due to a deficiency in neuropeptide hypocretin-1
- 4 clinical features for at least 3 mo: Excessive daytime sleepiness (cardinal feature), cataplexy (sudden paralysis), hypnagogic hallucinations (hallucinations during sleep onset), sleep paralysis
- Dx: Polysomnography followed by multiple sleep latency testing (MSLT)
- Tx: Pharm: Stimulants/methylphenidate. Lifestyle modifications.
7
Q
Obstructive sleep apnea (OSA)
- If left untreated, long-term sequelae of frequent episodes of intermittent hypoxia and sleep arousals: HTN, pulmonary HTN, cardiovascular disease, arrhythmias, heart failure, metabolic disorders, obesity, neuropsychiatric and developmental issues.
- Dx: Polysomnography (PSG) to confirm significant obstruction
- Mild OSA: AHI 1-4.9
- Moderate OSA: AHI 5-9.9
- Severe OSA: >__
- Tx: In those with adenotonsillar hypertrophy, ENT referral for tonsil and adenoidectomy (also known as adenotonsillectomy) is recommended as the 1st line tx.
A
Obstructive sleep apnea (OSA)
- If left untreated, long-term sequelae of frequent episodes of intermittent hypoxia and sleep arousals: HTN, pulmonary HTN, cardiovascular disease, arrhythmias, heart failure, metabolic disorders, obesity, neuropsychiatric and developmental issues.
- Dx: Polysomnography (PSG) to confirm significant obstruction
- Mild OSA: AHI 1-4.9
- Moderate OSA: AHI 5-9.9
- Severe OSA: >10
- Tx: In those with adenotonsillar hypertrophy, ENT referral for tonsil and adenoidectomy (also known as adenotonsillectomy) is recommended as the 1st line tx.
8
Q
Restless Legs Syndrome
- Path: ______
- Supportive features of RLS
- Sleep disturbance for age (eg sleep onset/maintenance insomnia)
- A biologic parent or sibling with definite RLS
- The child has documented PLMS index of >5/hour
- Tx and management
- Measure serum ferritin, TIBC, serum iron.
- Tx when the serum ferritin falls <50ng/mL. The goal of therapy is ferritin level of 80-100ng/mL
- Use of cognitive and physical countermeasures for RLS symptoms - physical relaxation techniques, warm baths, and cognitive restructuring
- Avoid activators of RLS-sleep deprivation and certain drugs and medications (caffeine, nicotine, SSRIs, TCAs, antiemetics, and antihistamines)
A
Restless Legs Syndrome
- Path: Iron deficiency
- Supportive features of RLS
- Sleep disturbance for age (eg sleep onset/maintenance insomnia)
- A biologic parent or sibling with definite RLS
- The child has documented PLMS index of >5/hour
- Tx and management
- Measure serum ferritin, TIBC, serum iron.
- Tx when the serum ferritin falls <50ng/mL. The goal of therapy is ferritin level of 80-100ng/mL
- Use of cognitive and physical countermeasures for RLS symptoms - physical relaxation techniques, warm baths, and cognitive restructuring
- Avoid activators of RLS-sleep deprivation and certain drugs and medications (caffeine, nicotine, SSRIs, TCAs, antiemetics, and antihistamines)
9
Q
Anorexia Nervosa
- Euthyroid hyperthyroxinemia (euthyroid sick syndrome) is typically seen. Characterized by normal free thyroxine T4 and TSH and low serum total T4 and T3 concentrations - all in the absence of signs or symptoms of thyroid dysfunction.
- Dx: 1. Persistent restriction of energy, 2. Intense fear of gaining weight, 3. Severe body image distortion with denial of seriousness of illness
- Reasons for admission:
- Marked cachexia: less than 75% ideal body weight or failure of outpatient tx with ongoing weight loss despite intensive management
- Refusal to eat or uncontrolled binging and purging; dehydration
- EKG rhythm disturbances other than sinus bradycardia
- HR less than ___ in daytime, less than __ at night
- Acute medical complications of malnutrition (eg cardiac failure, liver failure, pancreatitis, hypoglycemia)
- Hypotension: less than __/___ mmHg
- Orthostatic changes >20bpm increase in HR or a decrease in bp (>20 mmHg systolic or >10mmHg diastolic)
- Syncope
- Temp less than ____
- Severe electrolyte disturbances
- Seizures
- Comorbidity that prevents adequate outpatient care
- Suicidal ideation or other psychiatric emergency
A
Anorexia Nervosa
- Euthyroid hyperthyroxinemia (euthyroid sick syndrome) is typically seen. Characterized by normal free thyroxine T4 and TSH and low serum total T4 and T3 concentrations - all in the absence of signs or symptoms of thyroid dysfunction.
- Dx: 1. Persistent restriction of energy, 2. Intense fear of gaining weight, 3. Severe body image distortion with denial of seriousness of illness
- Reasons for admission:
- Marked cachexia: <75% ideal body weight or failure of outpatient tx with ongoing weight loss despite intensive management
- Refusal to eat or uncontrolled binging and purging; dehydration
- EKG rhythm disturbances other than sinus bradycardia
- HR <50 in daytime, <45 at night
- Acute medical complications of malnutrition (eg cardiac failure, liver failure, pancreatitis, hypoglycemia)
- Hypotension: <90/45 mmHg
- Orthostatic changes >20bpm increase in HR or a decrease in bp (>20 mmHg systolic or >10mmHg diastolic)
- Syncope
- Temp <96 / 35.6
- Severe electrolyte disturbances
- Seizures
- Comorbidity that prevents adequate outpatient care
- Suicidal ideation or other psychiatric emergency
10
Q
Bulimia
- Dx:
- 1) Recurrent episodes of binge eating characterized by:
- Rapid intake of food in a short period of time
- Sense of lack of control over eating during the episode
- 2) Recurrent inappropriate compensatory mechanisms to prevent weight gain (purging) such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise
- 3) The binge eating and inappropriate compensatory behaviors both occur, on average, at least 1x/week for 3 months
- 4) Self-evaluation is unduly influenced by body shape and weight
- 5) The binge eating does not occur exclusively during episodes of inappropriately compensatory behavior.
- 1) Recurrent episodes of binge eating characterized by:
- Tx: ______ are more effective in BN than in AN. ____ approved.
- Admission reasons:
- Syncope
- K less than ___
- Cl less than __
- Esophageal tears
- Cardiac arrhythmias, prolonged QTc
- Hypothermia
- Suicide risk
- Intractable ____
- Hematemesis
- Failure to respond to outpatient management
A
Bulimia
- Dx:
- 1) Recurrent episodes of binge eating characterized by:
- Rapid intake of food in a short period of time
- Sense of lack of control over eating during the episode
- 2) Recurrent inappropriate compensatory mechanisms to prevent weight gain (purging) such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise
- 3) The binge eating and inappropriate compensatory behaviors both occur, on average, at least 1x/week for 3 months
- 4) Self-evaluation is unduly influenced by body shape and weight
- 5) The binge eating does not occur exclusively during episodes of inappropriately compensatory behavior.
- 1) Recurrent episodes of binge eating characterized by:
- Tx: SSRIs are more effective in BN than in AN. Fluoxetine approved.
- Admission reasons:
- Syncope
- K <3.2
- Cl < 88
- Esophageal tears
- Cardiac arrhythmias, prolonged QTc
- Hypothermia
- Suicide risk
- Intractable vomiting
- Hematemesis
- Failure to respond to outpatient management
11
Q
Refeeding syndrome
- Pt: ___, ____, ____
- Delirium, chest pain, heart failure
A
Refeeding syndrome
- Pt: Hypophosphatemia, hypokalemia, hypomagnesemia
- Delirium, chest pain, heart failure
12
Q
Tics
- ____ medications sometimes unmasks a tic disorder. Discontinuation only if tic is worse than ADHD.
- Tx: Supportive with education. Comprehensive behavioral intervention for tics.
- 2 meds: ___ and ___. Many try ____
A
Tics
- Stimulant medications sometimes unmasks a tic disorder. Discontinuation of stimulant only if tic is worse than ADHD.
- Tx: Supportive with education. Comprehensive behavioral intervention for tics.
- 2 meds: Haloperidol and pimozide. Many try alpha2-adrenergic agonist such as clonidine or guanfacine.
13
Q
Tourette syndrome
- ___
- Dx: Tics for at least 1 year with presence of both vocal and motor tics, no tic-free interval for >3mo, onset prior to 18yo, and no underlying medical cause
- Tx: Supportive with education. _____ is FDA approved for tx.
A
Tourette syndrome
- AD
- Dx: Tics for at least 1 year with presence of both vocal and motor tics, no tic-free interval for >3mo, onset prior to 18yo, and no underlying medical cause
- Tx: Supportive with education. Haloperidol is FDA approved for tx.
14
Q
Rett syndrome
- ____ mutation. Most patients are girls
- Pt:
- Earliest sign is _____.
- Psychomotor development is normal in first 6-18mo after birth, followed by _______ in language and motor skills (intellectual disability)
- Autistic-like behaviors
- Hand-wringing and repetitive, stereotypic hand movements
A
Rett syndrome
- XLD mutation. Most patients are girls
- Pt:
- Earliest sign is a decline in head growth.
- Psychomotor development is normal in first 6-18mo after birth, followed by developmental regression in language and motor skills (intellectual disability)
- Autistic-like behaviors
- Hand-wringing and repetitive, stereotypic hand movements
15
Q
Depression
- FDA has approved 2 SSRIs- ___ for children >8yo and adolescent depression, and ____ for adolescent depression
- In 2004, the FDA issued a black box warning for the risk of increased suicidal ideation and behaviors (but not completed suicides).
- ____ is 1st line for tx both depression and tobacco cessation.
- Medication trial should last at least 6-12 weeks.
- Once an effective SSRI has been identified and symptoms have resolved, treatment with the SSRI should be continued for an additional 6-12 months.
A
Depression
- FDA has approved 2 SSRIs- fluoxetine for children >8yo and adolescent depression, and escitalopram for adolescent depression
- In 2004, the FDA issued a black box warning for the risk of increased suicidal ideation and behaviors (but not completed suicides).
- Bupropion is 1st line for tx both depression and tobacco cessation.
- Medication trial should last at least 6-12 weeks.
- Once an effective SSRI has been identified and symptoms have resolved, treatment with the SSRI should be continued for an additional 6-12 months.
