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CCFP 3 > Bad news + Behavioural problems > Flashcards

Bad news + Behavioural problems Flashcards

1
Q

What factors to consider when delivering bad news?

A

Setting - private place, comfortable seating, face patient, have tissues ready, ensure confidentiality, ask if they want someone else present, turn phone to silent, signpost conversation
Perception - check pt perspective, what they already know
Invitation - ask pt what they would like to know
Knowledge - provide info in small chunks
Empathy + compassion
Strategy + summary - arrange FU + treatment plan

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2
Q

Causes of behavioural problems

A

Sensory: hearing or vision impairment
Medical:
Central causes: head trauma, mass
Metabolic: hypo/hyperthyroidism, electrolyte abnormalities, DKA, anemia
Medication
Psych:
Dementia
Depression
Bipolar
Schizophrenia
GAD/ OCD/ PTSD/ ED
Personality disorders
Substance use
Learning disorders
ASD
Conduct disorder
ADHD
Oppositional defiant disorder
Social:
Abuse or neglect
Family chaos: poverty, food insecurity
Peer issues
Parental expectations

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3
Q

Types of bipolar

A

1 = manic/ mixed episode, depression not needed
2 = depression + hypomania
Cyclothymic = several hypomanic + depressive
Rapid cycling = 2-3 days between manic + depressed

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4
Q

Sx of mania

A

GIDDINESS
Grandiosity
Increased goal actibity
Decreased judgement
Distractibility
Irritability
Need for sleep decreased
Euphoria
Speedy thoughts
Speedy talk

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5
Q

Rx for mania, depression, BP1 and BP2 in bipolar

A

Mania
Lithium, quetiapine, divalproex, aripiprazole, paliperidone
Agitation: aripiprazole 9.75mg IM or lorazepam 2mg IM
Depression:
Quetiapine, lithium, lamotrigine
Maintenance meds
BP1:
Lithium, quetiapine, divalproex, lamotrigine
BP2:
Quetiapine, lithium, lamotrigine

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6
Q

Lithium monitoring - measuring serum lithium + what to measure while on lithium

A

12 hrs post dose
5 days after dose change
Cr + TSH + calcium every 3-6 months

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7
Q

AP monitoring

A

BP
FPG + lipids every year

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8
Q

Criteria for ASD and domains

A

ADI-R criteria
2 domains: social communication impairment + restricted, repetitive patterns in behaviours + interests

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9
Q

RF for ASD

A

Genetics
Prenatal (older parents, maternal obesity/ DM/ HTN/ infection, close spacing of pregnancies)
Postnatal (low birth weight, prematurity)

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10
Q

Sx of ASD

A

Parental concerns, developmental regression, loss of social behaviour + communication
6-12 m/o: reduced smiling, limited eye contact, limited sharing of sounds, smiles or expression, decreased babbling or gestures
9-12 mo: repetitive behaviours, unusual play
12-18 mo: no single word, no compensatory gestures like pointing, no pretend play, no joint attention
15-24 mo: diminished or no spontaneous two word phrases
AUTISTICS
Again + again (repetitive behaviour)
Unusual abilities
Talking delay
IQ subnormal
Social development poor
Three years onset
Inherited component
Cognitive impairment
Self injury

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11
Q

Common comorbidities with ASD

A

Seizures, sleep disturbance, GI problems

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12
Q

Screening tools for ASD

A

M-CHAT
Social Responsiveness scale
Autism Spectrum Rating Scale
Screening Tool for Autism in Two y/o (STAT)
Rapid Interactive Screening Test for Autism in Toddlers (RITA-T)

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13
Q

Management of ASD

A

Refer to peds or psych
Behaviour modification with stimulus, response + reward
Pharmologic tx for symptoms
Repetitive behaviour - SSRI, AP, valproic acid
Hyperactivity - stimulant
Aggression - AP, anticonvulsant, SSRI, BB
Sleep dysfunction - melatonin, ramelteon, antihistamine, mirtazapine
Anxiety - SSRI, buproprion, mirtazapine
Depression - SSRI
Bipolar phenotype - lithium, anticonvulsant

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14
Q

Management of ASD

A

Refer to peds or psych
Behaviour modification with stimulus, response + reward
Pharmologic tx for symptoms
Repetitive behaviour - SSRI, AP, valproic acid
Hyperactivity - stimulant
Aggression - AP, anticonvulsant, SSRI, BB
Sleep dysfunction - melatonin, ramelteon, antihistamine, mirtazapine
Anxiety - SSRI, buproprion, mirtazapine
Depression - SSRI
Bipolar phecnotype - lithium, anticonvulsant

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15
Q

What is conduct disorder?

A

Longstanding pattern of violations of rules and antisocial behaviour

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16
Q

RF for conduct disorder

A

Male
Low SES
Familial aggression

17
Q

Sx of conduct disorder

A

Behavioural difficulties
No concern for others
Little guilt about damage caused
Aggression to people + animals
Destruction of property
Deceitfulness and theft
Serious violation of rules

18
Q

Comorbidities with conduct disorder

A

Axis 1 = ADHD, depression, bipolar, anxiety, PTSD, SU, suicide
Axis 2 = BPD, APD, developmental delay
Axis 3 = head trauma, seizures

19
Q

DSM dx of conduct disorder

A

Repetitive + persistent pattern of behaviour in which basic rights of others or rules are violated
3 or more of following criteria:
Aggression to people and animals
Destruction of property
Deceitfulness + theft
Serious violation of rules

20
Q

Management of conduct disorder

A

Parent management training
Individual + family therapy
Aggression: Ritalin, buproprion, dilantin, clonidine, lithium

21
Q

RF for ADHD

A

Fam hx

22
Q

Sx of ADHD

A

poor organisational skills, anger control issues, difficulty maintaining routines, addictions, frequent accidents, difficulty completing assignments, chronic underachievement

23
Q

Dx of ADHD

A

meet criteria for inattentive or hyperactive type, sx present by 12, must impair individual in 2 or more roles (work, school, home), last 6 months, SNAP-IV, Weiss or ASRS

24
Q

Rx for ADHD

A

Parent management training, social skills training, CBT, mindfulness, diet + exercise
No stimulants <6y/o - use behaviour therapy
Screen for sudden cardiac death, measure BP, HR and cardiac exam
Accommodations for school/ work
Adderall - amphetamine
Biphentin - methylphenidate
Concerta - methylphenidate
Vyvanse - lisdexamfetamine

25
Q

Psychostimulants + non-psychostimulants

A

Psychostimulants
methylphenidate, dextroamphetamine, amphetamine mixed salts, lisdexamfetamine
Non-Psychostimulants
selective norepinephrine reuptake inhibitors (atomoxetine)
selective alpha2 adrenergic receptor agonist (guanfacine

26
Q

Adjunct to meds for behavioural issues

A

Time management teaching
Social skills training
Environmental changes
CBT

27
Q

What to monitor in ADHD treatment

A

height + weight

28
Q

Classes of ADHD meds

A

stimulants, SNRI (atomoxetine), alpha adrenergic receptor agonist (Intuniv)

29
Q

Safety risks in ADHD

A

driving MVAs

30
Q

ASD criteria

A

persistent deficits in social communication + interaction, multiple contexts, not etter explained by IDDs

31
Q

Hyperactive sx of ADHD

A

fidgets, leaves seat, constantly on the go, talks excessively, blurts out answers, trouble waiting turn, interrupts others

32
Q

Attention deficit sx of ADHD

A

makes careless mistakes, difficulty holding attention on tasks, doesn’t seem to listen when spoken to, trouble organising tasks, avoids tasks requiring sustained mental effort, loses things, easily distracted, forgetful

33
Q

ASD screening tool

A

M CHAT R/F

34
Q

How to treat behavioural issues

A

refer to psych, counselling, family therapy, melatonin

35
Q

ASD ddx

A

global dev delay, social comm disorder, epilepsy, anxiety, hearing impairment, OCD , add, conduct disorder

36
Q

Conduct disorder sx

A

repetitive, persistent, violation of social norms, running away, rule breaking, violent,

37
Q

Oppositional defiant disorder sx

A

irritable, defiant, vindictive, rx w/ cbt, psychotherapy, fam therapy, social skills training

38
Q

Bedwetting rx

A

bedwetting alarms, desmopressin short term, star chart, involve in cleanup

39
Q

stuttering - who is at higher risk, rx

A

males 4x more, no meds, SLP

CCFP 3 (67 decks)

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