Child Psychiatric Disorders-Ryst Flashcards
(137 cards)
1
Q
T/F A child assessment usu occurs within the context of a family. What is the ideal interview format?
A
True.
Ideal: lengthy, one interview with child alone & one with child + family
2
Q
What are things you should ask about during the child assessment?
A
Behavioral difficulties Functional Impairments Subjective Distress Stressors and Environmental Factors Adverse Impact on Development
3
Q
What are things that should be asked about in the physical development & medical hx portion of the child assessment?
A
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.
4
Q
It is important to know about the child’s relationships with others. What are some necessary issues to address within that arena?
A
school hx emotional development, temperament substance use peer relationships family relationships trauma hx
5
Q
What are some things to ask about during a family interview?
A
discipline practices
communication styles
**observe parental attitude toward child, goodness of fit, parental attachment
**look at sociocultural factors
6
Q
T/F You should never ask about child abuse during a child interview, as it can distress the patient.
A
False. It is an important issue to address.
7
Q
T/F A developmental mental status exam should be performed during the child interview.
A
True.
8
Q
What are some flexible ways to perform a child interview?
A
interactive play
projective techniques
direct discussion
9
Q
What are some possible referrals a child psychiatrist will need to make?
A
psychological testing medical evaluation educational assessment speech & language evaluation social services referral home environment evaluation
10
Q
T/F Multimodal treatments are less effective than single modal treatments that are focused and intensive.
A
False. Multimodal more effective.
11
Q
T/F You must weigh the benefits & risks of treatment or no treatment for a child.
A
True.
12
Q
What are the 4 domains that you should maximize the child’s development in?
A
home
friends
school
play
13
Q
If a child needs psychotherapy…what are different types of therapy?
A
play therapy interpersonal therapy cognitive behavioral therapy parent guidance therapy family therapy
14
Q
Why is the use of medications for psychological issues in kids a controversial issue?
A
not approved by FDA often
adverse effects depending on developmental stage
kids metabolize things differently
15
Q
What are the different tools in the armamentarium?
A
psychotherapy
medication
advocacy-school intervention etc
16
Q
What is oppositional defiant disorder?
A
A recurrent pattern of negativistic, hostile and defiant behavior.
17
Q
What is the criteria for oppositional defiant disorder?
A
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
18
Q
What is conduct disorder?
A
Violation of the rights of others and age-appropriate social norms
19
Q
What criteria must be met for a diagnosis of conduct disorder?
A
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.
20
Q
What is a new specifier for conduct disorder?
A
“with limited prosocial emotions”
may need different treatment
show a lack of empathy
**more severe, greater aggression, less remission
21
Q
What is the prevalence of oppositional defiant disorder? Which gender is it more common in?
A
prevalence: 2-16%
Males>Females
22
Q
What is the prevalence of conduct disorder? Gender?
A
9% males
2% females
**less than 18yo
23
Q
T/F Males w/ early onset conduct disorder are less likely to show aggressive symptoms.
A
False. More likely to show aggressive symptoms
24
Q
What is the relationship b/w conduct disorder & adhd?
A
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
25
What is the relationship b/w conduct disorder & oppositional defiant disorder?
ODD symptoms sometimes come before CD diagnosis
26
T/F All children w/ oppositional defiant disorder go on to develop conduct disorder.
False. BUt some do.
27
What are some good predictors of onset of conduct disorder?
instance of cruelty to people & weapon use
| OR physical fighting + ODD symptoms
28
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
29
In young kids, which behaviors are most predictive of CD diagnosis?
cruelty
running away
breaking into a building
30
T/F Fighting & cruel behavior are atypical behaviors for young girls. Thus, they are MORE predictive of CD diagnosis.
True.
31
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
32
What are some frequent psychiatric comorbidities with disruptive behavior disorders?
```
ADHD
Anxiety
Mood DIsorders
Substance Abuse
Learning Disabilities
```
33
What is the relationship b/w anxiety & disruptive behavior disorders?
youths w/ CD are at increased risk for anxiety disorders
34
What is the relationship b/w mood disorders & disruptive behavior disorders?
if you have both--increased risk for substance abuse & suicide
35
What is the relationship b/w substance abuse & disruptive behavior disorders?
each exacerbates the other
36
Conduct disordered youth have higher rates of which psychiatric conditions in adulthood?
```
anti-social personality disorder
alcohol & drug abuse
anxiety
somatic complaints
psych hospitalization
```
37
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
```
38
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
```
39
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
40
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
41
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
42
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
43
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
44
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.
45
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
46
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
```
47
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
48
Which age group does sometimes experience euphoria, elation, grandiosity during manic episodes of juvenile bipolar disorder?
older children, greater than 9yo
49
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
```
50
According to DSM5, what is a new requirement for a diagnosis of a manic episode?
increased energy & activity
51
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
52
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.
53
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
54
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)
55
should children with disruptive mood dysregulation disorder be prescribed antipsychotics?
NO.
56
Children with disruptive mood dysregulation disorder cannot have a dual diagnosis with certain conditions, but they can with others. Explain.
Can't have a dual diagnosis with: oppositional defiant disorder, intermittent explosive disorder
Can have a dual diagnosis with:
conduct disorder
57
What is the prevalence of depression in preschoolers? Elementary age? Adolescents? Adults?
Preschoolers: 0.3%
Elementary: 1-2%
Adolescents: 5%
Adults: 5-9% women, 2-3% men
58
What is the prevalence of juvenile bipolar disorder in pre-puberty? Adolescents? Adults?
Pre-puberty: 0.5%
Adolescent: 1%, sorta 5.7%
Adult: 0.4-1.6% (bipolar I)
59
T/F It is more common to see juvenile bipolar disorder in male adolescents than females.
False. no gender differences in this age group.
60
T/F Prognosis of childhood mood disorders is very encouraging and positive.
False. difficult progress
61
What is the typical pre-puberty length of a depressive episode?
3-9 months
| some last 2 years
62
What is the recurrence rate of major depression within 5 years for pre-puberty aged children?
70%
| **20-40% of these patients develop bipolar disorder within 5 years
63
Is major depression during puberty isolated or does it continue into adulthood?
continues into adulthood
64
What are the adverse outcomes associated with pre-puberty major depression?
Impairment in school, family, friendships.
Increased risk of suicidal behaviors and suicide.
Tobacco and substance abuse.
Early parenthood.
65
What percentage of children with juvenile bipolar disorder have psychosis? How many weeks on average to recovery?
59% experience psychosis
| 28.6 weeks on average for recovery to happen, some don't recover even after 2 years
66
For those who do recover from juvenile bipolar disorder...what percentage relapse before second year of follow up?
55.2%
67
Which therapy type is as effective as anti-depressant medications?
psychosocial therapies
| CBT (cognitive behavioral therapy) & IPT (interpersonal therapy)
68
What is involved in cognitive behavioral therapy? What was the response of patients?
challenge distorted thinking
behavioral activation
mood monitoring
64% remission rate
69
What is involved in interpersonal therapy? What was the response of patients?
focus on interpersonal conflicts, grief, role disputes, role transitions
75% remission rate
70
What are the anti-depressant medication options?
SSRIs: efficacy 40-70%
Atypical antidepressants
Tricyclic Antidepressants--don't use!
71
What are some meds included in atypical antidepressants?
Bupropion
Mirtazapine
venlafaxine
72
The treatment of adolescent depression study showed which treatment was most effective?
combo therapy of psychotherapy + medication is better than meds alone or therapy alone.
73
What is usu the first line treatment for juvenile bipolar disorder?
medications
Lithium, Valproate, Carbamazepine
Atypical Antipsychotics
74
If a patient is psychotic...which therapy should be used?
mood stabilizer + antipsychotic
75
What are some pediatric anxiety disorders?
```
Generalized Anxiety Disorder
Separation Anxiety Disorder
Selective Mutism
Specific Phobia
OCD
Social Phobia
Panic Disorder
(PTSD)
```
76
What are some common clinical characteristics of pediatric anxiety disorders?
```
Developmentally inappropriate, unrealistic and excessive anxiety.
Subjective distress.
Cognitive– worry, catastrophizing
Physiological—heart, respirations and GI/GU
Anticipatory anxiety
Avoidance
Adult Accomodation
Triggered by exposure
Wax and wane
Highly comorbid
```
77
What are some additional symptoms to look for with pediatric anxiety disorders?
```
somatic complaints
sleep issues
eating issues
avoidance of activities
excessive need for reassurance
inattention & poor performance at school
```
78
What are the 4 categories of anxiety disorders in the DSM5?
Fear-based anxiety disorders
OCD
Trauma-related anxiety disorder
Dissociative disorders
79
What is the criteria for generalized anxiety disorder in children? What is the prevalence & gender differences?
same criteria as for adults, with the requirement of only 1/6 symptoms
3-12% prevalence in childhood, equal in both genders
in adolescence, more girls.
80
What is the most common comorbidity w/ GSD?
major depression
81
What is separation anxiety disorder?
excessive anxiety w/ separation from safety figures
| duration minimum of 4 weeks
82
What is the criteria for separation anxiety disorder?
3 or more:
Distress when separation from home or attachment figures occurs or is anticipated.
Worry about losing, or possible harm befalling attachment figures.
Worry that an untoward event will lead to separation from attachment figure.
Reluctance or refusal to go to school or elsewhere due to separation fear.
Fearful or reluctant to be alone at home or without significant adults in other settings.
Reluctance to got to sleep without being near an attachment figure or sleep away from home.
Repeated nightmares about separation.
Repeated physical complaints when separation occurs or is anticipated
Duration minimum 4 weeks.
83
What is the prevalence of separation anxiety disorder? Gender?
3.5-4.5%
| more common in girls
84
At what age is separation anxiety considered normal?
18-30 months
85
What are the comorbidities w/ separation anxiety disorder?
MDD
generalized anxiety disorder
ADHD
86
Symptoms of separation anxiety disorder can be prompted by which medications?
haldol
inderal
pimozide
87
What is selective mutism?
consistent failure to speak in selective social situations
interferes w/ educational achievement & social communication
duration: at least 1 month
not due to language problems
88
What is the prevalence of selective mutism?
less than 1%
associated w/ excessive shyness, fear of social embarrassment
usu diagnosed with social phobia or another anxiety disorder
89
What is the criteria for a diagnosis of a specific phobia? How does it differ from adult criteria?
Same except:
Children’s anxiety response may be expressed as crying, tantrums, freezing and clinging.
Children don’t have to realize that fear is excessive or unreasonable.
Duration at least 6 months.
70% have another anxiety disorder
90
How does the criteria for OCD in children differ from adults?
children don't have to realize that obsession & compulsions are excessive
pre-puberty: sometimes see compulsions w/o obsessions
91
What is the prevalence of OCD? ARe OCD symptoms ever normal?
1-4%
| Sometimes transient symptoms are a normal part of development, ex: bedtime rituals
92
HOw does the criteria for social anxiety disorder in children differ from that in adults?
Child most show evidence of capacity for age-appropriate relationships with familiar people, and the symptoms must occur with peers as well as adults.
Children can express anxiety as crying, tantrums, freezing or shrinking.
Children don’t have to realize that it’s unreasonable.
Duration at least six months.
93
What is the prevalence of social anxiety disorder? What is the average age of onset?
5-15%
| 11-12 yo
94
What are comorbid anxiety disorders w/ social anxiety disorder?
ADHD
depression
other anxiety disorders
substance abuse
95
WHat is a panic disorder?
panic attacks prompted often by episodes of depression or separation anxiety
**rare in children, more common in adolescents
96
Which criteria has been added and which has been eliminated for PTSD?
added: stressor criterion
Eliminated: subjective reaction
97
What are the 4 symptom clusters for PTSD?
Intrusion symptoms
avoidance symptoms
numbing/negative alterations in mood & cognition
alterations in arousal or reactivity
98
Although children less than 6 yo can experience PTSD...what is the difficulty with diagnosing them?
they can't describe their cognitions & internal experiences as easily
99
RAD has been separated into 2 separate disorders. Describe them both.
Reactive attachment disorder: similar to depression, difficulty forming attachments to people
Disinhibited Social Engagement DIsorder: similar to ADHD, can have secure or insecure attachments
100
What are the medications used to treat pediatric anxiety disorders?
SSRIs
101
What are some psychosocial therapy approaches to treating anxiety?
CBT
| Coping Cat
102
HOw is OCD treated?
clomipramine & SSRIs
| exposure with response prevention
103
How is specific phobia treated?
graduated in vivo exposure to fear w/ management
| meds not effective
104
How is a social phobia disorder treated?
CBT
105
What is a medication sometimes used to treat selective mutism?
prozac
106
How common is early onset schizophrenia?
very rare
less than age 15: 14/100K
less than puberty age: 1.6/100K
107
Why is it difficult to diagnose psychosis in children?
```
Overactive imaginations
Developmental delays
Language problems
Postraumatic phenomena
Misperceptions of questions asked.
```
108
What are the first line meds for early onset schizophrenia? Second line? IF they are resistant?
```
First line: atypical antipsychotics
Second line: Typical antipsychotics
Considered for treatment-resistant cases
Clozapine
ECT
```
109
What are some psychosocial interventions used for early onset schizophrenia?
Psychoeducation
Behaviorally-based family therapy (Goldstein and Miklowitz)
Cognitive-behavioral therapy (Rector and Beck)
Weight management
SPED/vocational training
110
HOw common are pediatric sleep problems? What are some useful assessment tools?
```
20-30% common!
sleep diaries
ask about sleep behaviors
sleep-related breathing problems
daytime alertness
look for sleep apnea
```
111
What are some medical problems that can cause pediatric sleep problems?
```
Allergies/eczema
Asthma
GERD
Migraine headaches
Neuromuscular Disorders
Arnold-Chiari Malformation
Chronic Renal Failure
Seizure Disorders
Ear Infections
Diabetes Mellitus
Pain Syndromes
Iron deficiency anemia
Hyperthyroidism
Hypothyroidism
Substances/Medications
```
112
What are some psychiatric problems that can cause sleep disorders?
```
Anxiety Disorders
Mood Disorders
Disruptive Behavior Disorders
Posttraumatic Stress Disorder
Pervasive Developmental Disorder
Psychotic Disorders
Substance use disorders
Reactive Attachment Disorder
Obsessive Compulsive Disorder
```
113
What are some psychosocial issues that can cause sleep disorders in children?
```
Abuse
Chaotic Home Life
TV/computer in bedroom
Parental sleep disorder
Inappropriate sleep-onset associations
Marital conflict
New infant in home
```
114
What is sleep onset association disorder? What is its prevalence?
sleep initiation requires parental involvement
25-50% of 6-12 mo
15-20% of 1-3 yo
treatment: behavioral interventions
115
What are parasomnias?
disorders of arousal
child looks awake, but is asleep
sleep terrors
116
What age is usu affected by sleep terrors? What is the prevalence? What is the presentation?
toddlers & school age children
3% prevalence
happens in first 1/3 of night
autonomic arousal w/ tachycarida, tachypnea, sweating, inconsolable screaming, amnesia of event
117
What is the treatment for night terrors?
parental reassurance
avoid sleep deprivation
benzodiazepines
118
Which age group experiences sleep walking? Prevalence? Treatment?
4-8 yo
15-40% have 1 episode
3-4% have weekly or monthly episodes
treatment: reassurance, safety measures, benzodiazepines if severe
119
Characterize sleep walking.
```
1-2 hours after sleep onset
walk for up to a half hour
confused
incoherent
difficult to awaken
amnesia of event
```
120
What % of children experience sleep apnea? How do you diagnose it?
1-2%
habitual snoring, noisy breathing, pauses in breathing, nocturnal sweating, mouth breathing
diagnose w/ sleep study
121
What is the treatment for childhood obstructive sleep apnea?
adenotonsillectomy or CPAP
122
What is delayed sleep phase syndrome?
```
common in adolescents
delayed onset sleep 3-4 hours
difficulty waking up
impaired relationships & academic functioning
sleep normally if on their own schedule
```
123
What is the treatment for delayed sleep phase syndrome?
light therapy
behavioral interventions
melatonin
124
When does narcolepsy begin? What is its prevalence? HOw is it characterized?
begins in adolescence
0.05% prevalence
cataplexy, hypnogogic hallucinations, sleep paralysis, sleep attacks
125
HOw do you diagnose & treat narcolepsy?
diagnose: polysomnogram, multiple sleep latency test, hypocretin deficiency in CSF
treatment: modafinil or stimulants for daytime sleepiness, SSRIs or TCAs for cataplexy
schedule in naps!
126
What are some good guidelines for sleep hygiene?
Schedule bedtime and wake-up
Synchronize the sleep-wake rhythm with the circadian clock using light in am at scheduled wake time.
Exercise during the day
Hot bath few hours before bed.
Avoid daytime naps, excessive temperature, noise, light, alcohol and caffeine
Time in bed: only for sleep.
127
What is encopresis?
repeated passage of feces into inappropriate places-intentional or not
once per month for at least 3 mo
sometimes related to constipation
128
What is the prevalence of encopresis? What are some organic causes?
```
1% of 5 yo
Hirshsprung's disease
Crohn's disease
Irritable Bowel Syndrome
use of laxatives
```
129
What are some causes of encopresis?
```
psychosocial stressors
anger, ODD
chronic constipation (fear of toilet training)
fecal retention
weak anal sphincter
decreased sensation in rectum
maternal ambivalence
```
130
What is the treatment for encopresis?
```
medical management of constipation
10 minute toilet seatings after meals
behavioral incentive programs
consequences for soiling
psychotherapy
```
131
What is enuresis?
repeating voiding of urine into bed or clothes
2X/week for 3 months
not due to a medical condition
132
What are 3 forms of enuresis?
nocturnal only, diurnal only, nocturnal & diurnal
133
What percentage of 5 yo have nocturnal enuresis?
15%
134
What are some medical conditions that could cause enuresis?
```
diabetes mellitus
diabetes insipidus
psychogenic polydipsia
UTI
seizure disorders
renal insufficiency
neurogenic bladder conditions
neuroleptic-induced enuresis
urinary tract anomalies
```
135
What are some treatments for enuresis?
DDAVP
Imipramine
behavioral stuff
enuresis alarm
136
What is avoidant/restrictive food intake disorder?
feeding disorder of infancy or early childhood
137
What is the prevalence of anorexia nervosa? What are some covert signs of eating disorders?
```
Anorexia Nervosa: 0.1-0.7%
wearing oversized clothing
obsession w/ food & cooking
frequent trips to the bathroom
food preferences
```
