18. Child Psychiatry Flashcards
(35 cards)
1
Q
Define: Temperament (2)
A
- a child’s innate psycho-physiological and behavioural characteristics (i.e. emotionality, activity, and sociability)
- spectrum from “difficult” to “slow-to-warm-up” to “easy temperament”
2
Q
Define: Parental fit (1)
A
the congruence between parenting style (authoritative, permissive) and child’s temperament
3
Q
Define: Attachment (2)
A
- special relationship between child and primary caretaker(s)
- develops during first year, the caretaker’s attachment style is the best predictor of their child’s attachment style
4
Q
Define: Separation anxiety (2)
A
- normal between 10-18 mo
- where separation from attachment figure results in distress
5
Q
Name attachment models (4)
A
- Secure
- Insecure (avoidant)
- Insecure (ambivalent/resistant)
- Disorganized
6
Q
Define this attachment type: Secure (6)
A
- Parent/Caregiver:
- Loving
- consistently available
- sensitive
- receptive
- Features in Child:
- Freely explores and engages with strangers well (as long as mother in close proximity)
- upset with caregiver’s departure, happy with return
7
Q
Define this attachment type: Insecure (avoidant) (6)
A
- Parent/Caregiver:
- Rejecting
- unavailable psychologically
- insensitive responses
- Features in Child:
- Ignores caregiver
- shows little emotion with arrival or departure
- little exploration
8
Q
Define this attachment type: Insecure (ambivalent/resistant) (6)
A
- Parent/Caregiver:
- Inconsistent
- insensitive responses
- role reversal
- Features in Child:
- Clingy but inconsolable
- often displays anger or helplessness
- little exploration
9
Q
Define this attachment type: Disorganized (3)
A
- Parent/Caregiver:
- Frightening, dissociated, sexualized, or atypical
- Often history of trauma or loss
- Features in Child:
- Simultaneous approach/avoidance and stress related straining behaviour
10
Q
Describe epidemiology in child psychiatry: Major Depressive Disorder (2)
A
- lifetime prevalence for pre-pubertal 1-2% (F:M = 1:1)
- adolescents 8-18% (F:M = 2:1)
11
Q
Describe clinical features in child psychiatry: Major Depressive Disorder (3)
A
- only difference in diagnostic criteria is that irritable mood may replace depressed mood
- physical features:
- insomnia (children)
- hypersomnia (adolescents)
- somatic complaints
- substance abuse
- decreased hygiene
- psychological features:
- irritability
- boredom
- anhedonia
- low self-esteem
- deterioration in academic performance
- social withdrawal
- lack of motivation
- listlessness
12
Q
In Major Depressive Disorder in child psychiatry, name common comorbid diagnoses (5)
A
- anxiety
- ADHD
- ODD
- conduct disorder
- and eating disorders
13
Q
Describe treatment in child psychiatry: Major Depressive Disorder (3)
A
- majority never seek treatment
- individual (CBT, IPT), family therapy and education, modified school program
- SSRIs
- in severe depression, best evidence for combined pharmacotherapy and psychotherapy
- ECT: only in adolescents who have severe illness, psychotic features, catatonic features, persistently suicidal
- internet based psychotherapy, light therapy, self-help books and applications
14
Q
Describe SSRIs for Major Depressive Disorder in child psychiatry (2)
A
- 1st line fluoxetine
- 2nd line escitalopram, sertraline
15
Q
Describe prognosis in child psychiatry: Major Depressive Disorder (3)
A
- prolonged episodes, up to 1-2 yr = poor prognosis
- adolescent onset predicts chronic mood disorder; up to 2/3 will have another depressive episode within 5 yr
- complications:
- negative impact on family and peer relationships
- school failure
- significantly increased risk of suicide attempt (10%) or completion (however, suicide risk low for pre-pubertal children)
- substance abuse
16
Q
Describe clinical features: Disruptive mood dysregulation disorder (6)
A
- severe, developmentally inappropriate, recurrent verbal or behavioural temper outbursts at least 3x/wk with persistently irritable mood in between
- symptom onset before age 10, occurring for ≥ 12 mo, in ≥ 2 settings, with no more than 3 consecutive mo free from symptoms
- diagnosis should be made between 6 and 18 years of age
- criteria not met for intermittent explosive disorder, bipolar disorder (no mania/hypomania)
- supersedes diagnosis of ODD if criteria for both are met
- common comorbidities: ADHD, anxiety disorders, depressive disorders
17
Q
Describe clinical features: Bipolar Disorder (4)
A
- mixed presentation and psychotic symptoms (hallucinations and delusions) more common in adolescent population than adult population
- unipolar depression may be an early sign of adult bipolar disorder
- ~30% of psychotic depressed adolescents receive a bipolar diagnosis within 2 yr of presentation
- associated with rapid onset of depression, psychomotor retardation, mood-congruent psychosis, affective illness in family, and pharmacologically-induced mania
18
Q
Describe treatment: Bipolar Disorder (2)
A
- pharmacotherapy:
- mood stabilizers (lithium, anticonvulsants) and/or antipsychotics (risperidone, olanzapine, quetiapine, aripiprazole)
- psychotherapy: CBT, Family Focused Therapy
19
Q
Describe epidemiology of anxiety disorders in child psychiatry (2)
A
- lifetime prevalence 10-20%
- F:M = 2:1
20
Q
Describe clinical features of anxiety disorders (10)
A
- children and adolescents rarely vocalize their anxiety but instead exhibit behavioural manifestations
- associated with
- school problems
- recurrent physical symptoms (abdominal pain, headaches) especially in mornings
- social and relationship problems
- social withdrawal and isolation
- family conflict
- difficulty with sleep initiation
- temper tantrums
- irritability and mood symptoms
- alcohol and drug use in adolescents
21
Q
Name DDX of anxiety disorders (4)
A
- depressive disorders, ODD, truancy
- persistence and impairment to daily functioning differentiates anxiety disorder from normal anxiety
- for school avoidance, differentiate fear of general performance and humiliation
- consider anxiety about separation, and rule out bullying and school refusal due to learning disorder
22
Q
Describe course and prognosis of anxiety disorders (2)
A
- better prognosis with later age of onset, fewer co-morbidities, early initiation of treatment, ability to maintain school attendance and peer relationships, and absence of social anxiety disorder
- with treatment, up to 80% of children will not meet criteria for their anxiety disorder at 3 yr follow-up, but up to 30% will meet criteria for another psychiatric disorder
23
Q
Describe the treatment of anxiety disorders (4)
A
- similar principles for most childhood anxiety disorders due to overlapping symptomatology and frequent comorbidity
- family psychotherapy, predictive, and supportive environment
- CBT: child and parental education, relaxation techniques (i.e. deep breathing), exposure/desensitization, recognizing and correcting anxious thoughts
- pharmacotherapy: SSRIs (i.e. sertraline, fluoxetine)
24
Q
A
25
Describe: Separation anxiety disorder (3)
* excessive and developmentally inappropriate anxiety on real, threatened, or imagined separation from attachment figures or home, with physical or emotional distress for at least 4 wk
* persistent worry about losing attachment figures or experiencing an untoward event to self; reluctance to go places, be alone, or sleep alone; nightmares involving separation; physical symptoms when separated
* school refusal (75%) and comorbid major depression common (2/3)
26
Describe: Social anxiety disorder (social phobia) (5)
* anxiety, fear, and/or avoidance provoked by situations where child feels under the scrutiny of others
* must distinguish between shy child, child with issues functioning socially (i.e. autism), and child with social anxiety
* diagnosis only if anxiety interferes significantly with daily routine, social life, academic functioning, or if markedly distressed. Must occur in settings with peers, not just adults
* features: crying, tantrums, freezing, clinging behaviour, mutism, excessively timid, stays on periphery, refuses to be involved in group play
* significant implication for future quality of life if untreated; lower levels of satisfaction in leisure activities, higher rates of school dropout, poor workplace performance, increased rates of remaining single
27
Describe: Selective mutism (3)
* consistent failure to speak in specific social situations where speaking is expected, despite speaking in other situations for ≥ 1 mo
* the disturbance interferes with educational or occupational achievement or with social communication
* not due to lack of knowledge of language or communication disorder
28
Describe: Generalized anxiety disorder (3)
* diagnostic criteria same as adults (note: only 1 item is required in children for Criteria C)
* often redo tasks, show dissatisfaction with their work, and tend to be perfectionistic
* often fearful in multiple settings and expect more negative outcomes when faced with academic or social challenges, and require reassurance and support to take on new tasks
29
30
Name common phobias in childhood (8)
* fear of heights
* small animals
* doctors
* dentists
* darkness
* loud noises
* thunder
* lightning
31
Describe OCD (2)
* diagnostic criteria same as adults
* note: young children may not be able to articulate the aims of these behaviours or mental acts, i.e. compulsions
32
Describe: HEEADSSS Interview (7)
* **H**ome environment
* **E**ducation/**E**mployment
* **A**ctivities
* **D**rugs/**D**iet
* **S**ex
* **S**afety
* **S**uicide/depression
33
Attachment type can be assessed in infants 10-18 mo of age using what? (1)
the **Strange Situation test**, in which the child is stressed by the caregiver being removed from the situation and the stranger staying. Attachment style is measured by the child’s behaviour during the reunion with the caregiver
34
Attachment problems may present as what? (5)
a child who is
* difficult to soothe
* has difficulty sleeping
* problems feeding
* tantrums
* or behavioural problems
35
Describe: Shy Child (1)
The shy child is quiet and reluctant to participate but slowly ‘warms up’
