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psych > psychiatric disorders in children > Flashcards

psychiatric disorders in children Flashcards

1
Q

intellectual disability/MR: dx

A
  • IQ <= 70
  • deficits in adaptive skills
  • onset BEFORE age 18
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2
Q

MR: epidem

A
  • 1-3% of pop
  • 85% of cases are mild
  • males > females
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3
Q

MR subtypes

A
  • profound: IQ <70, 85% of MR
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4
Q

causes of MR

A
  • 50% unidentifiable
  • genetic: Down, Fragile X, PKU, familial, Prader Willi/Angelman, Williams, tuberous sclerosis
  • prenatal: TORCH
  • perinatal: anoxia, prematurity, birth trauma, meningitis, hyperbili
  • postnatal: hypothyroidism, malnutrition, toxins, trauma, psychosocial
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5
Q

prader-willi

A
  • MR
  • obesity
  • hypogonadism
  • almond shaped eyes
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6
Q

fragile X

A
  • FMR1 defect
  • autistic characteristics
  • delayed speech
  • motor delay
  • sensory deficits
  • males: large testicles
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7
Q

learning dos: epidem

A
  • reading: 4-10% of children, boys>girls
  • math: 1% of children, boys=girls
  • written dos: 6% of children
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8
Q

oppositional defiant do: dx

A 
- AT LEATS 6 MOS of negativistic, hostile, defiant behavior
4+ of:
- frequent loss of temper
- arguments with adults
- defying adults' rules
- deliberately annoying people
- easily annoyed
- anger and resentment
- spitefulness
- blaming others for mistakes or misbehaviors
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9
Q

ODD: epidem

A
  • 2-16% prevalence
  • usually observed by age 8
  • onset before puberty more common in boys
  • increased inicdence of comorbid substance abuse, mood dos, ADHD
  • 25% no longer meet criteria later on
  • may progress to conduct do
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10
Q

ODD: tx

A
  • individual psychotherapy

- family involvement: parent management skills training

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11
Q

conduct do: dx

A 
- persistent pattern of behavior in which basic rights of others/social norms are violated during PAST YEAR
3+ behaviors in categories of:
- aggression toward people and animals
- destruction of property
- deceitfulness or theft
-serious violations of rules

boys: fighting, stealing, fire-setting, vandalism more common
girls: lying, running away, sexually acting out more common

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12
Q

conduct do: epidem

A
  • 1-10%
  • boys&raquo_space;> girls
  • risk factors: punitive parenting, psychosocial adversity, hx of abuse, biological predisposition
  • high incidence of comorbid ADHD and learning dos
  • increased risk for mood dos, substance abuse, suicidal gestures/attempts, criminal behavior
  • up to 40% develop antisocial personality do
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13
Q

conduct do: tx

A
  • family and community involvement
  • consistent rules and conequences
  • medications as adjunct if aggression present
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14
Q

ADHD: dx

A
  • 6+ sx of inattentiveness, hyperactivity or both
  • persisted for AT LEAST 6 MOS
  • present at a maladaptive degree
  • onset prior to age 7
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15
Q

ADHD: epidem

A
  • 5-12%
  • boys > girls
  • up to 60% will have sx into adulthood
  • high incidence of mood dos, anxiety dos, personality dos, conduct do, ODD
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16
Q

ADHD: pathophys

A
  • genetics
  • environmental (emotional deprivation, malnutrition, abuse)
  • noradrenergic dysregulation
  • specific EEG patterns
  • toxin exposure, head trauma, prenatal/perinatal factors
17
Q

ADHD: Tx

A
  • 1st line: methylphenidate, dextroamphetamine, amphetamine salts –> significant improvement in 75% of pts
  • atomoxetine: nonstimulant
  • alpha2 agonists (clonidine, guanfacine) if 1st line can’t be used or as adjunct
  • TREAT UNDERLYING MOOD/ANXIETY DO FIRST
  • nonpharm tx
18
Q

pervasive developmental dos

A
  • problems with social skills, language, behaviors
  • notieceable at early age, involves multiple areas of devleopment
  • autism, asperger, rett, childhood disintegrative do
19
Q

autism: dx

A
  • at least 6 sx by age 3
  • 2+ of: problems with social interaction
  • 1+ of impairments in communication OR repetitive/sterotyped patterns
20
Q

autism: epidem

A
  • range of incidence
  • boys&raquo_space;> girls
  • 70% meet criteria for MR
  • assoc with fragile X, tuberous sclerosis, sz
21
Q

autism: pathophys

A
  • prenatal neurological insults
  • genetics
  • immunological, biochemical, increased head size, persistent primitive reflexes, EEG abnormalities
22
Q

autism: tx

A
  • level of intellectual fn and communication skills are most impt prognostic factors
  • remedial education, behavioral tehrapy
  • antipsychotics to help control aggression, hyperactivity, mood lability
  • antidepressants or stimulants if sx warrant
23
Q

asperger

A
  • no clinically significant delay in spoken/receptive language, cognitive development, self-help skills, curiosity about environment
24
Q

Rett

A
  • nl physical and pscyhomotor dvlpmt up to 5 mos
  • 5-30 mos: decreasing rate of head growth, loss of milestones
  • development of stereotyped hand movements
  • girls&raquo_space;> boys
  • MECP2 gene (X-linked)
  • increased risk of sudden death
  • sz common
25
Q

childhood disintegrative disorder

A
  • nl dvlpmt in first two yrs
  • loss of milestones before age 10 in AT LEAST TWO of: language, social skills, bowel/bladder control, play, motor skills
  • loss in AT LEAST TWO of: social interaction, communication, behaviors, interests
  • onset after age 2
  • boys&raquo_space;> girls
  • assoc with many GMCs
26
Q

tourette: dx

A
  • multiple motor AND 1+ vocal tics NOT attributable to CNS dz (motor usually occur long before vocal)
  • onset before age 18
  • many times a day, almost every day for > 1year, no tic free period > 3 months
  • change in location and character of tics over time
27
Q

tourette: epidem

A
  • boys > girls
  • waxing/waning
  • sx peak in severity bw ages 8-12
  • 1/3-1/2 become asymptomatic in adulthood
  • high comorbidity with OCD and ADHD
28
Q

tourette: pathophys

A
  • genetic
  • perinatal
  • impaired DA regulation in caudate nucleus
  • GABHS infection?
  • psychological - exacerbated by stressful life events
29
Q

tourette: tx

A
  • educational and supportive interventions
  • supportive therapy, behavioral therapy
  • atypical neuroleptics, alpha2 agonists when tics are source of impairment
  • typical neuroleptics if severe
30
Q

enuresis: tx

A
  • most spontaneously resolve by age 7
  • psychoeducation, psychotherapy, family therapy, behavioral therapy
  • bell and pad, DDAVP, imipramine
31
Q

selective mutism

A
  • refusal to speak in certain situations for > 1 month
  • onset ~ 2-5 yo
  • tx: psychotherapy, behavior therapy, management of anxiety
32
Q

separation anxiety

A
  • appropriate from 7 mos to 6yo
33
Q

stranger anxiety

A
  • peaks 8-12 mos
34
Q

separation anxiety do

A
  • excessive fear for 4+ weeks of leaving parents/other major figure
  • extreme distress when forced to separate
  • may be preceded by stressful life event
  • up to 4% of children
  • parents often have anxiety dos
  • tx: family tx, CBT, low-dose SSRIs
  • may be risk factor for development of panic disorder

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