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Psychiatry > Feb. 26 > Flashcards

Feb. 26 Flashcards

1
Q

Childhood Psychiatric Disturbance

A

-5-15% of children will experience disturbance that is sufficiently severe to require treatment or to impair their functioning during the course of a year

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2
Q

Differences b/w Adult & Child psychiatry

A
  • consideration of developmental level
  • techniques of assessment
  • involvement of family
  • inc. role of non-physicians in the health care team
  • frequent occurrence of psychiatric comorbidity
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3
Q

Intellectual Disability (mental retardation)

A

-significantly sub-average intellectual functioning (IQ) (<70)
-Significant limitations in adaptive functioning:
(communication, self-care, life skills, health & safety skills)

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4
Q

Categories of Intellectual Disability

A
  • Mild ID 55-70
  • Moderate ID 40-55
  • Severe ID 25-40
  • Profound ID under 25
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5
Q

Mild Intellectual DIsability

A
  • 85% of individuals with intellectual disability
  • educable with special education assistance
  • read, write, simple math
  • concrete thinker
  • expect to be able to hold a job, live independently
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6
Q

Moderate Intellectual Disability

A
  • 10% of individuals with Intellectual Disability
  • Talk, recognize name, basic hygiene, do laundry, handle small change
  • minimal academic progress
  • live with family or in supervised group home
  • work in sheltered workshop or supervised activities
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7
Q

Profound & Severe Intellectual Disability

A
  • unable to complete self help

- likely to require care in an institutionalized setting

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8
Q

Intellectual Disability Epidemiology

A
  • affects 1-2% of the population
  • mild 0.37-0.5% of population
  • moderate/severe/profound 0.3-0.4%
  • mild more common in lower SES, moderate/severe/profound are equally common across SES
  • male to female ration 2:1
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9
Q

Intellectual Disability Etiology

A
  • moderate/profound/severe often have identifiable cause
  • mild often does not have an identifiable cause & is likely developed through a combination of genetic & other factors
  • fetal alcohol syndrome most common cause
  • down syndrome most common chromosomal cause
  • fragile X syndrome most common heritable form of mental retardation
  • inborn errors of metabolism (tay-sachs) account for a small percentage of cases
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10
Q

Intellectual Disability Etiology: Prenatal Factors

A
  • substance use/abuse
  • maternal malnutrition & illnesses
  • exposure to mutagens
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11
Q

Intellectual Disability Etiology: Perinatal & Early Postnatal Factors

A
  • traumatic delivery/brain injury
  • infections (toxo, rubella)
  • head injury
  • exposure to toxins
  • malnutrition
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12
Q

Intellectual Disability Comorbidity

A
  • attention deficit/hyperactivity disorder
  • disruptive behavior disorders
  • mood disorders
  • anxiety disorders
  • habit disorders & stereotypies
  • seizure disorder
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13
Q

Child’s Level of Functioning can be impacted by?

A
  • environmental stimulation
  • poverty in environment
  • cultural factors
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14
Q

Intellectual Disability Treatment

A
  • the disability is not treated or cured
  • treat problematic behaviors
  • treat comorbid conditions
  • teach independent living skills
  • provide special education assistance
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15
Q

Learning Disorders

A
  • inability to achieve in a particular academic area at the level predicted by an individual’s cognitive abilities
  • generally borderline IQ or above
  • diagnosis requires standardized IQ & achievement testing
  • disorder is “treated” through special education services
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16
Q

Types of Learning Disorders

A
  • Reading Disorder
  • Math Disorder
  • Disorder of Written Expression (disability can be in 1 or more areas)
  • 2-8% of children
  • male to female 2-4:1
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17
Q

Learning Disorders Comorbidity

A

-ADHD
-Mood disorder
-truancy, school refusal, substance abuse
(these may be associated with frustration due to school difficulty & failure)

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18
Q

Communication Disorders

A

-Expressive Language Disorder
-Mixed Receptive-Expressive Language Disorder
(combine w/language in DSM V)
-Speech Sound Disorder (Phonological disorder)
-Childhood Onset Fluency Disorder (stuttering)
-Communication disorder NOS

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19
Q

Language Disorders

A
  • impairment in the comprehension and/or use of a spoken, written or other verbal symbol system
  • receptive-taking information in
  • expressive - getting info out
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20
Q

Phonological Disorder

A
  • Poor articulation or pronunciation
  • substitution: wight for right, toat for coat, aminal or animal
  • distortions- brlu for blue, crat for cat
  • omissions - oke for joke, ining for signing
  • additions - aluminininum for aluminum
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21
Q

Stuttering

A
  • repetitions & prolongation of sound, syllables or words, that interrupt the flow of speech
  • occasional secondary characteristics or tics such as stamping the foot or throwing the head out to get the sound out
  • lack fluency & temporal patterning
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22
Q

Assessment issues in speech

A
  • concomitant retardation or learning disability
  • dialect
  • regionalsim
  • facial structure (cleft palate)
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23
Q

Pervasive Developmental Disorders

A
  • autistic disorder
  • rett’s disorder (females, 6 months or normal dev. followed by regression)
  • childhood disintegrative disorder (2 yrs. of normal dev. followed by regression)
  • asperger’s disorder
  • PDD NOS
  • under Autism Spectrum Disorder
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24
Q

Autism Spectrum Disorder

A
  • qualitative impairment in social interaction & social communication
  • restricted repetitive & sterotyped patterns of behavior, interests, & activities
  • symptoms are present in the early developmental period
  • parents may notice problems with social interaction in first few months of life (may not develop normal pattern of smiling or responding to cuddling)
  • failure to develop spoken language often leads parents to seek medical attention (range from complete lack of speech to mildly deviant speech and language patterns)
  • intense & rigid commitment to maintaining specific routines
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25
Q

Autism Spectrum Disorder Data

A
  • 70% show some evidence of mental retardation
  • 25% have comorbid seizure disorder
  • prevalence: 10-15 per 10,000 individuals
  • males: females 3-4:1
  • only 2-3% are able to progress normally through school or live independently
  • etiology unknown
  • no link to childhood immunizations has been proven
  • early diagnosis & early intervention leads to best outcome
  • universal screening at 18 months is recommended
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26
Q

Treatment of Autism Spectrum Disorder

A
  • special ed intervention
  • speech & language therapies (usually done by speech therapies)
  • social skills training
  • sensorimotor therapies (usually done by occupational therapist)
  • Intensive Behavior Therapy (start as early as possible, home-based approach seems best)
  • Pharm: does not alter the natural history & course of autistic disorder, but can be helpful in controlling specific symptoms (aggression, sleep problems), many categories of meds are used, including antipsychotics, SSRIs, stimulants, anticonvulsants, & alpha-adrenergic agonists
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27
Q

Asperger’s Disorder

A
  • often referred to as “mild” “high-functioning” autistic disorder
  • impairment in social interaction
  • no clinically significant delay in language/cognitive development
  • under Autism Spectrum Disorder (level of severity, with/out intellectual/language impairment)
  • if an individual has marked deficits in social communication with no additional criteria of Autism Spectrum Disorder, consider evaluation for Social (pargmatic) Communication Disorder
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28
Q

Attention Deficit and Disruptive Behavior Disorders

A

-Attention-Deficit/Hyperactivity Disorder
(combined type, predominately Inattentive type, predominately hyperactive-impulsive type, ADHD NOS)
-conduct disorder
-Oppositional Defiant Disorder
-Disruptive Behavior Disorder NOS
(conduct disorder & oppositional defiant disorder are in a separate category in DSM-V)

29
Q

Attention-Deficit/Hyperactivity Disorder

A
  • Significant difficulty focusing & maintaining attention
  • sig. hyperactivity & impulsivity
  • symptoms present for at least 6 months
  • onset before age 7 (12 in DSM-V)
  • impairment occurs in at least 2 settings
30
Q

ADHD - Primarily Inattentive

A
  • frequent mistakes/failure to pay close attention
  • difficulty sustaining attention
  • does not listen when spoken to directly
  • fails to finish work/does not follow instructions
  • lacks organizational skills
  • avoids sustained mental effort
  • misplaces items
  • easily distracted
  • forgetful
31
Q

ADHD - Primarily Hyperactive/Impulsive

A
  • often fidgets or squirms
  • leaves seat
  • difficulty being quite in leisure activities
  • on the go, driven by a motor
  • talks excessively
  • shouts answers out of turn
  • runs instead of walks
  • difficulty waiting for turn
  • interrupts or intrudes
32
Q

Executive Functioning Deficits in ADHD

A
  • planning
  • organizing
  • starting & stopping activity
  • managing behavior
  • persisting on tasks
  • problem solving
  • working memory
33
Q

ADHD is NOT due to

A
  • lack of will power
  • inadequate parenting
  • lack of motivation
  • lack on intelligence
  • laziness
34
Q

ADHD Epidemiology

A
  • 3-10% of children
  • male to female 3:1
  • occurs in all cultures
  • at least 1/2 have good outcome (finish school)
  • persistence into adolescence & adulthood (1/3 meet full criteria, 1/3 have some symptoms, 1/3 have complete remission)
35
Q

ADHD is associated with inc. incidence of?

A
  • academic failure
  • relationship problems
  • legal difficulties
  • smoking & substance abuse
  • injuries
  • motor vehicle accidents
  • occupational/vocational problems
36
Q

ADHD Etiology

A
  • runs in families (girls have stronger family history than boys, associated w/familial mood disorders, learning disorders, substance abuse, & antisocial personality disorder, genes related to dopamine have been implicated)
  • Nongenetic factors: maternal smoking, alcohol & drug abuse, complications during delivery, exposure to toxins, viral infections, maternal malnutrition)
  • Neuroimaging (not currently being used to diagnose ADHD or to guide treatment selection)
37
Q

ADHD Comorbidity

A
  • oppositional defiant disorder (60%)
  • anxiety disorder
  • depressive disorder
  • learning disability
  • conduct disorder
  • substance use disorder
38
Q

Treatments for ADHD

A
  • behavior modification with child & parents
  • classroom/workplace accommodations
  • medications
39
Q

Classroom Accommodations for ADHD

A
  • preferential seating
  • shorter assignments
  • closer supervision
  • clearer instructions
  • help in getting started on assignments
  • daily report card program
  • allow time for movement
  • extra set of books
  • environment with fewer distractions during tests
40
Q

Medications for ADHD

A
  • stimulants (psychostimulants), generally accepted as most effective (methylphenidate, amphetamine/dextroamphetamine),
  • atomoxetine
  • alpha-adrenergic agonists (clonidine, guanfacine)
  • antidepressants (bupropion, tricyclic antidepressants: imipramine)
  • treatment with stimulant meds has been associated with dec. risk for substance abuse
41
Q

Side Effects of ADHD Meds

A
  • Stimulants: dec. appetite (anorexia) most common

- growth retardation, tics, BBW for abuse potential & serious cardiovascular adverse events & sudden death

42
Q

Oppositional Defiant Disorder

A
  • a pattern of negativistic, hostile, & defiant behavior lasting at least 6 months, during which 4 or more of the following are present:
  • often loses temper
  • often argues with adults
  • often actively defies or refuses to comply with rules/requests
  • often deliberately annoys people
  • often blames others for his mistakes/behavior
  • is often touchy or easily annoyed by others
  • often angry & resentful
  • often spiteful or vindictive
43
Q

Oppositional Defiant Disorder Epidemiology

A
  • 3-15% of kids
  • male to female 3:1
  • commonly comorbid with ADHD
  • usually diagnosed before age 8, almost always before adolescence
44
Q

Conduct Disorder

A
  • a repetitive & persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated
  • 3 or more criteria in the past 12 months, with at least 1 criterion present in the past 6 months
  • childhood-onset type begins prior to age 10
45
Q

Conduct Disorder: Aggression to People & Animals

A
  • often bullies, threatens, or intimidates others
  • often initiates physical fights
  • has used a weapon that can cause serious physical harm to others (bat, brick, knife, bottle, gun)
  • been physically cruel to people/animals
  • has stolen while confronting a victim (mugging, purse snatching, extortion, armed robbery
  • has forced someone into sexual activity
46
Q

Conduct Disorder: Destruction of property, deceitfulness or theft, serious violation of rules

A
  • deliberate fire setting
  • deliberately destroyed others’ property
  • broken into someone else’s house, building, or car
  • often lies to obtain goods or favors or to avoid obligations
  • has stolen without confronting a victim
  • often stays out at night, beginning before at 13 yrs
  • run away from home overnight at least twice
  • often truant from school, beginning b/f age 13
47
Q

Conduct Disorder Epidemiology

A
  • 6-16% boys, 2-9% girls
  • ratio of males to females 3-12:1
    1. 2:1 status offenses
    2. 5:1 minor theft
    4. 5:1 robbery
48
Q

Conduct Disorder Prognosis

A
  • conduct disorder can be a precursor to antisocial personality disorder in adulthood
  • almost 1/2 of kids with CD develop significant APD symptoms
  • # of CD symptoms & early age of onset predict the development of APD
  • conduct disorder may be associated with early death, unemployment, marital status, financial instability, & poor interpersonal relationships in adulthood
49
Q

Conduct Disorder Comorbidity

A
  • Learning Disorders
  • ADHD
  • mood disorder
  • substance abuse
50
Q

Risk Factors for the Disruptive Behavioral Disorders

A
  • inconsistent discipline
  • poor supervision
  • low IQ
  • high family conflict
  • low family warmth & supportiveness
  • low parental acceptance & affection
  • parental criminality, alcoholism, & drug abuse
  • parental psychopathology
51
Q

Treatment for the Disruptive Behavior Disorders

A
  • behavior management training for parents & child
  • social skills training
  • problem solving skills
  • conflict management
  • multisystemic therapy
52
Q

Pica

A

-persistent eating of nonnutritive substances for a period of at least 1 month

53
Q

Rumination Disorder

A

-repeated regurgitation & rechewing of food for a period of at least 1 month following a period of normal functioning

54
Q

Tourett’s Disorder

A
  • Tic
  • both motor & vocal
  • both multiple motor & one or more vocal tics occur during the illness, but not necessarily concurrently
  • tics occur many times a day nearly every day or intermittently throughout a period of more than 1 year, and during this period there was never a tic-free period of more than 3 consecutive months
  • onset before 18 yrs
  • not due to direct physiological effects of a substance (stimulants) or a general medical conditions (Huntington’s disease or postviral encephalitis)
55
Q

Chronic Motor or Vocal Tic Disorder

A

-doesn’t meet criteria for Tourette’s because either motor or vocal tics are present, but not both

56
Q

Transient Tic Disorder

A

-doesn’t meet criteria for Tourette’s b/c hasn’t lasted long enough

57
Q

Tic

A

-sudden, rapid, recurrent, nonrhythmic, sterotyped motor movement or vocalization

58
Q

Tourette’s Disorder Epidemiology

A
  • Affects from 1 to 10 school children per 10,000 b/w the ages of 6 to 17
  • up to 20% of children experience transient simple tics
  • male to female ration 3:1
  • motor tics typically begin b/w the ages of 3 & 8, several yrs. b/f the appearance of vocal tics
  • symptoms peak in adolescence
  • 20% of people have a remission of symptoms in their 20’s
59
Q

Tourette’s Disorder Treatments

A
  • alpha-adrenergic agents: clonidine, guanfacine

- neuroleptics: haloperidol, pimozide

60
Q

Enuresis

A
  • Elimination Disorders
  • chronological age of at least 5 years, behavioral treatments (enuresis alarms: most effective treatment)
  • medications: deamino-8-D-arginine vasopressing (DDAVP) or desmopressin
  • imipramine
61
Q

Encopresis

A
  • elimination disorders
  • chronological age of at least 4 years
  • treatment is more complex
62
Q

Other Disorders of Infancy, Childhood, or Adolescence

A
  • separation anxiety disorder
  • selective mutism
  • reactive attachement disorder
  • stereotypic movement disorder
  • disorder of infancy, childhood or adolescence NOS
63
Q

Separation Anxiety Disorder

A

-separation anxiety is a normal maturational experience - develops at 9 months
-separation anxiety disorder is a level of anxiety beyond that expected for child’s developmental level
(causes impairment) (lasta at least 4 weeks)
-most common anxiety disorder in children

64
Q

Separation Anxiety Disorder Criteria

A
  • 3 or more:
  • excessive distress when separation from home or major attachment figures occurs or is anticipated
  • worry about losing, or possible harm befalling, major attachment figure (kidnapping)
  • reluctance or refusal to go to school or elsewhere b/c of fear of separation
  • fearful of being alone or w/out major attachment figures
  • reluctance or refusal to go to sleep without being near a major attachment figure or to sleep away from home
  • repeated nightmares involving the theme of separation
  • physical symptoms when separation is anticipated or occurs
65
Q

Separation Anxiety Disorder Prevalence

A
  • prevalence 4% of school children
  • onset may be as early as preschool; adolescent onset uncommon
  • may develop after some life stress
66
Q

Selective Mutism

A

-consistent failure to speak in specific social situations, where there is an expectation for speaking, despite speaking in other situations
(children with Selective Mutism often will speak at home but nowhere else)
-prevalence: <1%

67
Q

Reactive Attachement Disorder of Infancy or Early Childhood

A
  • disturbed & developmentally inappropriate social relatedness that begins before age 5
  • associated with grossly pathological care
  • Inhibited: child fails to initiate & respond to social interactions in a developmentally appropriate way
  • Disinhibited: child exhibits indiscriminate sociability or a lack of selectivity in the choice of attachment figures
68
Q

Sterotypic Movement Disorder

A
  • motor behavior that is repetitive, seemingly driven & nonfunctional
  • Interferes with normal activities or results in self-inflicted bodily injury that requires medical treatment
  • most commonly associated with Intellectual Disability
69
Q

Developmental Coordination Disorder

A

-delayed developmental milestones such as sitting, crawling, standing, & walking, clumsiness, accident proneness, & poor fine motor skills

Psychiatry (7 decks)

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