Disorders of Childhood and Adolescence Flashcards
(96 cards)
1
Q
What percent of adolescents consider suicide?
A
20%
2
Q
Does depression self resolve?
A
It can
3
Q
True or false: brain structures can change with prolonged depression
A
True
4
Q
Do most schools have suicide prevention programs?
A
Not most, but getting better
5
Q
True or false: irritability as a symptom of depression is much more common in children
A
True
6
Q
True or false: inattentiveness is not a common manifestation of depression in children
A
False–must r/o depression prior to diagnosing ADHD
7
Q
What must always be r/o with suspected depression in children?
A
Substance abuse or medical condition
8
Q
Can schizophrenia appear similar to depression or bipolar mania?
A
Yes
9
Q
What are the criteria for MDD in children? (9)
A
- Fatigue
- Concentration difficulties
- Guilt
- Recurrent thoughts of death
- Anhedonia
- depressed Mood
- Psychomotor agitation
- Appetite changed
- Sleep disturbance
(FC GRAMPAS)
10
Q
How many criteria are needed to diagnose MDD in children? How long must s/sx last?
A
Five symptoms for 2 weeks
11
Q
Which is more common in MDD: weight loss or gain?
A
Weight loss
12
Q
Which is more common in MDD: hypersomnia or hyposomnia
A
Hypersomnia
13
Q
True or false: to meet the criteria for MDD, children can have irritability instead of depressed mood
A
True
14
Q
What are the mood differences from adult MDD?
A
More irritable and labile
15
Q
True or false: anhedonia is not a key marker in childhood MDD
A
False
16
Q
Do children often verbalize feelings of sadness?
A
no
17
Q
True or false: somatic complaints are common in childhood MDD
A
True
18
Q
True or false: kids with MDD have an increased sensitivity to criticism, and poor focus
A
True
19
Q
Why can a learning disability cause MDD?
A
Major part of self-worth at this age
20
Q
What is the average length of depression?
A
7-9 months
21
Q
What percent of childhood MDD remit by 2 years?
A
90%
22
Q
What is the chance of recurrence of MDD in children at 2 and 5 years?
A
40% by 2 years
60-70% by 5 years
23
Q
True or false: depression caught early is usually more treatable
A
False–usually more of a chronic, recurrent issue
24
Q
What percent of children with MDD have one or more comorbid psychiatric conditions?
A
40-70%
25
Substance abuse is preceded by MDD by how many years on average?
5 years
26
What are the major mental health issues with marijuana use?
More anhedonia, apathy
27
What is double depression?
Dysthymia + MDD
28
What is the comorbidity of MDD + dysthymia?
Increased suicidality
| Worse social impact
29
PTSD in the pediatric population often mimics what other psychiatric condition
ADHD
30
What is the common manifestation of trauma in kids?
Reenact the trauma
31
What is the key distinguishing factor for deciding therapy vs medical treatment for MDD?
Severity--psychotherapy first, add drugs if severe
32
What is the MOA of bupropion?
Increased NE and dopamine
33
What are the two SSRIs that are FDA approved in children, and are first line?
Lexapro (escitalopram) and prozac (fluoxetine)
34
Why is it that bupropion is useful for the treatment of ADHD and depression?
Increased NE and dopamine which is similar to amphetamine
35
What doses of SSRIs must be prescribed for OCD (high or lower than for MDD)? How long does this take to take effect for OCD?
Much higher
Takes months to take full effect
36
Neurovegetative s/sx benefit from what particular SSRI?
Fluoxetine
37
What antidepressant has an increased risk of seizures?
Bupropion
38
What is the major adverse effects of SSRIs?
- Disinhibition
| - GI bleed
39
Disinhibition with SSRI use is suspicious for what?
Bipolar disorder
40
Which antidepressant has an increase in DBP?
Effexor (venlafaxine)
41
Which antidepressant has an increased risk of GI bleeding? MAO?
Cymbalta (duloxetine) (SNRI)
42
What are the s/sx of serotonin syndrome? (5)
- Fever
- Rigidity
- Autonomic instability
- Psychosis (visual)
- Myoclonic jerks
43
What are the s/sx of discontinuation of antidepressants?
- Dizziness
- HA
- n/v
- Electric shock sensations
44
What percent of MDD in children has severe suicidal ideation?
60%
45
What is the leading cause of disability in the world?
Depression
46
A child with one depressed parent is how many times more likely to have depression?
2x
47
A child with two depressed parent is how many times more likely to have depression?
4x
48
Why must you disclose the black box warning for SSRIs?
Malpractice o/w
49
What is the issue with the black box warning? What were the results of the study that led to this conclusion?
Correlation vs causation
| 2% with placebo suicide vs 4% with
50
What is the probability of having increased suicidal ideation with meds vs without?
```
With= 4%
Without = 15%
```
51
When in the course of the depression is the risk of suicidal ideation greatest post antidepressant prescription?
First four weeks
52
The black box warning goes up to what age?
24
53
What has happened to rates of suicide since the black box warning? What about the number of prescriptions?
Suicides have Gone up 20%
Number of prescriptions down 20%
54
What are the five questions that should be asked with suicidal ideation?
1. Plan
2. Means / access
3. Intent
4. Homicidal
5. Previous attempts
55
What is the issue with contracts for safety?
Still liable for anything that happens
56
What is the role of family history of suicide in determining the risk for suicide?
Risk factor
57
What is a major warning sign for suicidality?
Getting significantly better in a short period of time--may point to suicidal ideation
58
True or false: childhood bipolar disorders tend to be less severe than adult onset
False--more severe
59
What are the characteristics of childhood bipolar disorders as compared to adults? (2)
- Non-episodic course
| - Mixed with *rapid* cycling
60
What is the usual initial episode of bipolar disorder in children: depression or mania?
Depression
61
What is the prevalence of bipolar disorder in adolescents?
1%
62
What is a rapid cycler for bipolar adults vs kids?
```
Adults = 4 times / year
Children = 4 times / day
```
63
What is the MOA of aripiprazole?
Atypical antipsychotic and mood stabilizer
64
What is the treatment for bipolar disorder?
antipsychotics (mood stabilizers)
65
What are the common side effects with antipsychotics? (3)
- Weight gain
- Tardive dyskinesia
- Increased prolactin
66
What are the two antipsychotics that cause weight gain? Are these typical or atypical antipsychotics?
-Olanzapine
-Clozapine
(both atypical antipsychotics)
67
Where is the weight gain located with antipsychotics?
Centrally
68
What is the major side effect of risperidone? MOA?
Increase prolactin
| Atypical antipsychotic
69
What is akathisia? What is this commonly caused by?
Need to move
| Bipolar
70
What is the major benefit of quetiapine over other psychotics?
Less EPS
71
What are the two antipsychotics that cause less weight gain?
Aripiprazole
| Ziprasidone
72
What is the MOA of antipsychotics?
Reduce the dopamine in mesolimbic area of the brain
73
What are the typical antipsychotics? (4)
Chlorpromazine
Thioridazine
Fluphenazine
Haloperidol
74
What are the atypical antipsychotics? (6)
```
Clozapine (Clozaril)
Olanzapine (Zyprexa)
Risperidone (Risperdal)
Aripiprazole (Abilify)
Quetiapine (Seroquel)
Ziprasidone (Geodon)
```
("Old Quietly Risper from A to Z")
75
What are the major side effects of antipsychotics? (4)
- Sedation
- Akathisia
- Parkinsonian s/sx
- Orthostatic Hypotension
76
What is the treatment for dystonia use with antipsychotics?
Antihistamine
77
What is neuroleptics malignant syndrome? S/sx? Lab change?
- Adverse reaction to antipsychotics, and dopamine blockade
- presenting with fever, autonomic instability, and delirium.
- Increased CK
78
What is the treatment for neuroleptic malignant syndrome?
- Stop med
- Treat hyperthermia
- Dantrolene for muscle rigidity, and bromocriptine
79
What labs must be monitored with Li use? (3)
- TSH (hypothyroidism)
- Cr
- CBC
80
What must be monitored with Depakote (valproic acid) use? (3)
- LFTs
- CBC
- pCO
81
What is the major side effect of lamotrigine?
Steve-Johnson syndrome
82
What are the major side effect of tegretol (carbamazepine)?
Aplastic anemia
83
What is the major issue with Li?
Chronic renal insufficiency, and narrow therapeutic index
84
What are the only two drugs that have been proven to decrease suicidality?
Clozapine
| Li
85
What are the skin side effects of Li?
Acne
86
What are the endocrine problems with Li?
Hypothyroidism
87
What happens to the tremor with Li?
Increase from fine to coarse as increased dose
88
What is the major cardiac issue with Li?
Cardiac arrhythmia
89
What is the only OTC analgesic that is appropriate with Li intake?
Acetaminophen
90
What is the major adverse reaction to (clozapine)?
Agranulocytosis
91
What is the major issue in benzos with children?
- cognitive clouding
| - paradoxical excitation
92
What is the reversal agent for benzos?
Flumazenil
93
Is separation anxiety a symptom of depression in kids?
Can be
94
What type of hallucinations are seen with serotonin syndrome: visual or auditory?
Visual
95
What happens to bipolar kids or other psychotic kids when you put them on a stimulant for suspected ADHD?
-Worsens symptoms, and may cause hallucinations
96
What is the treatment for serotonin syndrome?
Cyproheptadine
