Child Psychiatric Disorders-Ryst Flashcards
T/F A child assessment usu occurs within the context of a family. What is the ideal interview format?
True.
Ideal: lengthy, one interview with child alone & one with child + family
What are things you should ask about during the child assessment?
Behavioral difficulties Functional Impairments Subjective Distress Stressors and Environmental Factors Adverse Impact on Development
What are things that should be asked about in the physical development & medical hx portion of the child assessment?
Height, weight, gross motor development, fine motor development, coordination, hyperactivity, eating, toileting, sleeping, chronic and acute illnesses, seizures, head injuries, allergies, vision/hearing impairment, exposure to lead or toxins, medications, sexual development.
It is important to know about the child’s relationships with others. What are some necessary issues to address within that arena?
school hx emotional development, temperament substance use peer relationships family relationships trauma hx
What are some things to ask about during a family interview?
discipline practices
communication styles
**observe parental attitude toward child, goodness of fit, parental attachment
**look at sociocultural factors
T/F You should never ask about child abuse during a child interview, as it can distress the patient.
False. It is an important issue to address.
T/F A developmental mental status exam should be performed during the child interview.
True.
What are some flexible ways to perform a child interview?
interactive play
projective techniques
direct discussion
What are some possible referrals a child psychiatrist will need to make?
psychological testing medical evaluation educational assessment speech & language evaluation social services referral home environment evaluation
T/F Multimodal treatments are less effective than single modal treatments that are focused and intensive.
False. Multimodal more effective.
T/F You must weigh the benefits & risks of treatment or no treatment for a child.
True.
What are the 4 domains that you should maximize the child’s development in?
home
friends
school
play
If a child needs psychotherapy…what are different types of therapy?
play therapy interpersonal therapy cognitive behavioral therapy parent guidance therapy family therapy
Why is the use of medications for psychological issues in kids a controversial issue?
not approved by FDA often
adverse effects depending on developmental stage
kids metabolize things differently
What are the different tools in the armamentarium?
psychotherapy
medication
advocacy-school intervention etc
What is oppositional defiant disorder?
A recurrent pattern of negativistic, hostile and defiant behavior.
What is the criteria for oppositional defiant disorder?
at least 4 of the following characteristics for at least 6 months
Often loses temper Often argues with adults. Often actively defies or refuses to comply with adults’ requests or rules. Often deliberately annoys people. Often blames others for mistakes or misbehavior. Often touch and easily annoyed. Often angry and resentful Often spiteful and vindictive
What is conduct disorder?
Violation of the rights of others and age-appropriate social norms
What criteria must be met for a diagnosis of conduct disorder?
at least 3 symptoms in the last 12 months & at least 1 in the last 6 months
Bullying or threatening others. Fighting Using a weapon that can cause serious physical harm. Physically cruel to animals. Physically cruel to people. Stealing while confronting a victim. Forcing someone into sexual activity. Fire setting. Destroying property. Breaking into a house, building or car. Frequent lying or “conning.” Stealing without confronting a victim. Staying out late despite parental prohibitions. Running away from home. Being truant from school.
What is a new specifier for conduct disorder?
“with limited prosocial emotions”
may need different treatment
show a lack of empathy
**more severe, greater aggression, less remission
What is the prevalence of oppositional defiant disorder? Which gender is it more common in?
prevalence: 2-16%
Males>Females
What is the prevalence of conduct disorder? Gender?
9% males
2% females
**less than 18yo
T/F Males w/ early onset conduct disorder are less likely to show aggressive symptoms.
False. More likely to show aggressive symptoms
What is the relationship b/w conduct disorder & adhd?
if a child has ADHD, the onset of conduct disorder is earlier
child w/ both disorders has a worse outcome than a child w/ only CD
What is the relationship b/w conduct disorder & oppositional defiant disorder?
ODD symptoms sometimes come before CD diagnosis
T/F All children w/ oppositional defiant disorder go on to develop conduct disorder.
False. BUt some do.
What are some good predictors of onset of conduct disorder?
instance of cruelty to people & weapon use
OR physical fighting + ODD symptoms
Which has a better prognosis….reactive aggression or proactive aggression? overt disruptive behavior or covert disruptive behavior?
reactive aggression
covert disruptive behavior
had better outcomes
In young kids, which behaviors are most predictive of CD diagnosis?
cruelty
running away
breaking into a building
T/F Fighting & cruel behavior are atypical behaviors for young girls. Thus, they are MORE predictive of CD diagnosis.
True.
Some of these types of behaviors could eventually fall into the category of antisocial personality or psychopathy-related symptoms (egocentricity, callousness, manipulative). If they do…it could be predictive of which disorder?
anti-social personality disorder
What are some frequent psychiatric comorbidities with disruptive behavior disorders?
ADHD Anxiety Mood DIsorders Substance Abuse Learning Disabilities
What is the relationship b/w anxiety & disruptive behavior disorders?
youths w/ CD are at increased risk for anxiety disorders
What is the relationship b/w mood disorders & disruptive behavior disorders?
if you have both–increased risk for substance abuse & suicide
What is the relationship b/w substance abuse & disruptive behavior disorders?
each exacerbates the other
Conduct disordered youth have higher rates of which psychiatric conditions in adulthood?
anti-social personality disorder alcohol & drug abuse anxiety somatic complaints psych hospitalization
What are other behaviors that are more likely for adults w/ a hx of conduct disorder in their youth?
driving while intoxicated criminal behavior unemployment less education trouble w/ marriage fewer relationships higher mortality rate
Once again, what is the most successful intervention model? What will it include?
address multiple needs from multiple domains & involve the parents parent-direct component social-cognitive skills training academic skills training proactive classroom management teacher training
What’s the deal with medications for disruptive behavior disorders?
no FDA approved meds
mood stabilizers, atypical antipsychotics, clonidine, stimulants–>can help decrease aggression, reduce emotional reactivity
What is a validated treatment for oppositional defiant disorder in younger children?
parent management training-parent interacts with child in a way that promotes pro-social behavior, focus on antecedents & reinforcements
PCIT: parent child interaction training
Describe the 2 phases of PCIT.
Phase 1: parents trained in non directive play skills to alter interactions
Phase 2: parents taught to give clear instructions, praise for compliance, time out for noncompliance
What is multi systemic therapy (MST)?
intensive treatment
addresses therapeutic barriers–parental substance abuse, parental psychopathology, marital conflict, delinquent peers, school performance, problem solving skills
Why have childhood mood disorders been misdiagnosed in the past?
- *thought it was child’s inability to express emotions verbally-present with somatic complaints
- *parents & teachers only notice external symptoms
- *bipolar has overlap in symptoms w/ ADHD
What is the DSM5 criteria for childhood depression?
same as for adults except
can have irritable mood, rather than depressed mood
failure to make weight gains that are expected is considered equivalent to weight loss
Persistent Depressive Disorder: can just be irritable (rather than depressed), duration must be 1 year, instead of 2.
What are some signs to look out for in children to signal possible depression?
somatic complaints-psychomotor agitation, hallucinations
separation anxiety, phobias, behavioral problems
developmental deviations-school performance, interest in activities & peers
What are some signs to look out for in adolescents to signal possible depression?
antisocial behavior substance abuse restlessness grouchiness aggression withdrawal school or family problems wanting to leave home feelings of being misunderstood or unloved
How does juvenile bipolar disorder usu present?
different manic states
more mixed states
rapid cycling, but chronic
usu irritable w/ emotional issues, rather than euphoric
Which age group does sometimes experience euphoria, elation, grandiosity during manic episodes of juvenile bipolar disorder?
older children, greater than 9yo
Give some associated symptoms for juvenile bipolar disorder?
Decreased need for sleep Rapid speech, talkativeness Distractibility, racing thoughts, tangentiality Hypersexuality Increased goal-directed activity Impulsivity Abnormal thought content, paranoia
According to DSM5, what is a new requirement for a diagnosis of a manic episode?
increased energy & activity
According to DSM5, children with manic, hypomanic, or major depressive episodes that are mixed are called what?
with mixed features
not mixed episodes
**includes sub threshold mixed states
HOw does the DSM5 treat accompanying anxiety in children with other disorders?
can tack onto a diagnosis, “with anxious distress” to bipolar or depressive disorders
anxiety symptoms often co-occur with these conditions.
How has the DSM5 changed the bereavement exclusion?
it eliminated it
this way you don’t have to wait 2 months before prescribing SSRIs for a grieving depressed person
What is the disruptive mood dysregulation disorder?
this is a new disorder added to the DSM5
it is basically a disorder that acts like bipolar disorder but with consistent irritability (not associated with a manic episode)
