Child abuse, obesity, conduct, PTSD, ADHD, Bipolar, Somatic Disorder Flashcards Preview

Applied Behavioral Medicine > Child abuse, obesity, conduct, PTSD, ADHD, Bipolar, Somatic Disorder > Flashcards

Flashcards in Child abuse, obesity, conduct, PTSD, ADHD, Bipolar, Somatic Disorder Deck (90)
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How can you use a non-confrontational approach to assess for and discuss potential abuse with a patient and families

1. open ended questions
2. show empathy, even if you feel strong that abuse is involved (ie. parents fault)
3. strategies if faced w/ resistance
4. give children 12+ choice of who tells the hx
5. Be upfront


Key info a provider needs to know when assessing for abuse

1. History (of injury) must exist and makes sense
2. Timeline of injury: when was the last time your baby was normal / walk me through what happened since then
3. Mechanism of injury
4. Injury characteristics: shape of bruise, etc
5. patient’s view of what happened / why are they concerned / what is their definition of rape
6. hx of abuse in either parent


Be able to determine whether or not a situation requires reporting to social services, the police, etc.

1. Statutory rape: sex below age of consent (laws differ by state)
2. Injury that does not make sense / potential to be non-accidental
3. Note: if ever debating on whether or not to report → REPORT


Recognize the key features of Oppositional Defiant Disorder and the typical age associated with it

6+ months with 4+ sxs:

1. Angry/irritable mood (easily annoyed, angered)
2. Argumentative/Defiant Behavior (defies authority figures, won’t obey rules, purposely annoys others, blames others)
3. Vindictiveness

-Mild (1 setting); Moderate (2 settings); Severe (3+)
-Typical age: young child


Recognize the key features of Conduct Disorder and the typical age associated with it

6+ months, at least 3 of 15 traits:
1. Bullies, threatens others
2. Start physical fights
3. Has used a weapon that could cause serious harm or death
4. Physically cruel to people
5. Physically cruel to animals
6. Has stolen while confronting a victim
7. Forced sexual activity
8. Fire setting to cause damage
9. Deliberate destruction of other’s property
10. Has broken into someone else’s property
11. Lies to obtain goods or favors
12. Has stolen items without confronting a victim (shoplifting)
13. Stays out at night without permission (prior to age 13)
14. Has run away from home
15. Truancy: absence from school w/o good reason (prior to age 13)
*Typical age: teenager (can be younger if fitting traits)


Recognize the key features of Antisocial Personality Disorder and the typical age associated with it

*Same as conduct, just after age 18
*Typical age: over age 18 (common board question)


Traits commonly associated w/ Oppositional Defiant Disorder, conduct, and antisocial personality disorder and NOT w/ behavior disturbances (ADHD, autism, bipolar, depression)

1. Anger, aggression, violence, trouble with authority, disregard rules, blame others
2. callous, unemotional child
3. insensitive to punishment
4. avoid eye contact


Does oppositional defiant disorder always lead to conduct disorder later in life?



Identify events that can trigger the development of PTSD

1. War
2. Fires / tornadoes / traumatic events
3. Medical issues
4. Abuse: physical or mental
5. Parental fighting

Note: not all people react the same to same trauma; some people more vulnerable → women and people who have had previous trauma
*Usually a situation where you feel powerless


List the main categories of criteria in the DSM 5 diagnosis of PTSD

1. Stressor
2. Intrusion re-experiencing trauma (1+: have to have at least 1 of these sxs)
3. Avoidance Symptoms: persistent, effortful avoidance of distressing trauma-related stimuli after the event (1+) → often intrusive symptoms lead to avoidance (can be subconscious)
4. Negative alterations in cognition and mood (2+)
5. Hyperarousal/Reactivity (2+)


give examples of stressors in PTSD

1. death of loved ones, threatened or actual serious injury, sexual violence
2. Direct exposure, witnessing, indirect exposure (close relative, family)
3. Repeated or indirect exposure usually during professional duties (ex: first responders)
*Does NOT include indirect exposure through media, video games, etc.


give examples of intrusion sx in PTSD

*re-experiencing trauma (1+: have to have at least 1 of these sxs)
1. Intrusive memories
2. Traumatic nightmares (people do not want to sleep)
3. Flashbacks (brief loss of consciousness) – uncontrollably re-living situation
4. Intense distress after exposure to traumatic reminders
5. High physiologic reactivity after exposure to trauma-related stimuli


give examples of avoidance sx in PTSD

*persistent, effortful avoidance of distressing trauma-related stimuli after the event (1+) → often intrusive symptoms lead to avoidance (can be subconscious)

1. Trauma related thoughts or feelings
2. Trauma related reminders (people, places, activities, etc.)


give examples of negative alterations in cognition and mood in PTSD

(need 2+)
1. Inability to recall event details (dissociative amnesia – not recalling trauma)
2. Persistent negative beliefs about self and world (bad, unsafe, scary)
3. Persistent distorted blame of self or others for event and consequences (guilt, blame)
4. Lack of interest in pre-trauma activities (anhedonia)
5. Feelings of alienation (detachment)
6. Flat or negative affect


give examples of hyperarousal/reactivity in PTSD

1. Irritability/aggressiveness
2. Self-destructive/reckless behavior
3. Hyper-vigilance
4. Exaggerated startle response
5. Problems concentrating / problems sleeping


What is the difference between acute stress disorder and PTSD

acute stress disorder (<1 month)

PTSD (>1 month)


___ is called the “great imitator”



Explain how PTSD can affect functioning in key parts of the brain

1. Reptilian Brain: homeostasis, endocrine system (brainstem – keeping things going; no thought processes)
2. Mammalian System (limbic system; amygdala): emotional and memory regulation (primitive)
3. Emotional Brain: combo of the above, purpose is to look out for welfare, use hormones to communicate, initiate fight/flight/freeze
4. Neocortex (prefrontal cortex): logic, planning, understanding, choice, empathy (large and unique to humans – thinking part of brain)
5. Thalamus (“cook”): messenger b/t neocortex and mammalian; which processes what is happening and sends appropriate messages to the amygdala and frontal cortex


In PTSD, the __ and __ goes up (no rational thinking behind initial emotions) and __ and __ go down

Mammalian and emotional brain

Neocortex and thalamus


Explain several ways in which an fMRI can look abnormal when a person is asked to recount a traumatic event

1. During flashback (husband): right-side of brain is active (related to emotion and intuition); amygdala very active
*pre-frontal cortex (logic, speech) is inactive
2. During flashback (wife): decreased activity in all area of brain (vital signs did not change) – frozen
-Completely dissociated → freeze response; depersonalization; cut self off from these emotions (but also from normal, happy emotions)
-Have little emotion when they talk about the experience (often trauma in past)


what is the number 1 preventative measure and tx for PTSD



What meds can be used for PTSD

1. SSRI's
2. Prazosin (alpha-adrenergic blocker (antihypertensive) – watch for hypotension)
3. beta-blockers: calm physicologic reactivity
4. Benzos
5. Atypicals (many SE, not recommended typically)


What are ways to treat PTSD

#1 preventative measure and treatment for PTSD is support

1. Meds
2. EMDR (eye movement desensitization and reprocessing)
3. Psychotherapy
4.Mindfulness, body therapy (Message), animal therapy


How can Prazosin help PTSD

1. Used specifically for nightmares
2. Dosing: begin with 1-2 mg at night, some studies suggest up to 25 mg effective


How can BB help PTSD

1. calm physiologic reactivity


How can Benzos help PTSD

possibly if use can be prn for specific trigger

*use cautiously


How can EMDR help PTSD

1. non-medication; worth a try
2. Simulates eye mov’t that happens during REM sleep (natural healing process); asked questions during this mov’t about stressors or traumatic event
3. 1-12 sessions depending on seriousness of condition


How can Mindfulness, body therapy (message), and animal therapy help PTSD

1. People with PTSD usually over or under react → often leads to turning things off completely
2. Animal therapy: involves communicating with animals as well as therapeutic riding (horses)


Describe the core symptom of ADHD in pediatrics

1. Irritability,
2. impulsivity,
3.mood swings
4. inattention, hyperactivity


ADHD is impairment in __, ___, and __

attention, impulse control, hyperactivity