Exam 4 - Lec 65-66 Pediatric Psych Ott

Question 1

T or F: Kids have lower risk of significant adverse effects from medications than adults

Answer 1

F (higher risk)

Question 2

two criteria for Tourette’s

Answer 2

-tics may wax and wane in freq, but have been present for > 1 year
-onset before age 18

Question 3

what % of pts with tic disorders also have ADHD and OCD?

Answer 3

~75% also have ADHD
~50% also have OCD

Question 4

what is the “Rule of Thirds” for tic disorders?

Answer 4

1/3 resolve, 1/3 improve, 1/3 stay the same - ~10% have persistent symptoms as adult

Question 5

first line drugs for tics (not bolded)

Answer 5

alpha 2 agonists

Question 6

antipsychotic drug FDA-approved for tics in ages 6-17

Answer 6

aripiprazole

Question 7

which of the following is FALSE about stimulant use in Tourette’s?

a. ADHD is a common co-morbidity in Tourette’s
b. use of amphetamine-based stimulants can relieve motor and vocal tic sx
c. when treating ADHD and tourette’s, we can give a trial of atomoxetine or a TCA instead of an amphetamine-based stimulant
d. if ADHD sx are not well-controlled, can resume amphetamine-based stim and adjust dose of antipsychotic

Answer 7

b. use of amphetamine-based stimulants can relieve motor and vocal tic sx

(it exacerbates sx)

Question 8

3 classes of conduct disorder

Answer 8

-childhood-onset type: < 10 yo
-adolescent-onset type: > 10 yo (no sx under 10)
-unspecified onset

Question 9

which of the following is FALSE about the tx of oppositional defiant disorder and conduct disorder?

a. pharmacotherapy is considered adjunctive, palliative, non-curative and should only be used in certain cases
b. treat underlying conditions such as ADHD
c. stimulants and clonidine/guanfacine are first line before using atypical antipsychotics
d. typical antipsychotics may be used to treat severe sx
e. we often see combo stimulant/alpha agonist tx if ADHD with impulsivity or need for sedation for sleep

Answer 9

d. typical antipsychotics may be used to treat severe sx

(atypical)

Question 10

first line combo tx for separation anxiety disorder

Answer 10

CBT plus med

Question 11

what drug class is first line for separation anxiety disorder?

Answer 11

SSRIs

Question 12

T or F: we should treat co-morbidities such as depression, ADHD, etc in pts with separation anxiety disorder

Answer 12

T

Question 13

look at slide 15-16 for DSM-5 Autism Spectrum Disorder criteria and signs/sx

Answer 13

Ok

Question 14

T or F: SSRIs have shown efficacy in treating the core Autism Spectrum Disorder sx

Answer 14

F (no meds have shown efficacy)

Question 15

T or F: up to 30% of ASD pts have at least one seizure by age 20

Answer 15

T

Question 16

associated medical problems for ASD include _____ disorder and _____ disorders

Answer 16

seizure; GI

Question 17

first line tx for disruptive behaviors in ASD

Answer 17

behavioral interventions (applied behavioral analysis)

Question 18

two FDA approved-drugs for mgmt of irritability/aggression for disruptive behaviors of ASD

Answer 18

-aripiprazole (ages 6-17)
-risperidone (ages 5-16)

Question 19

what two seizure meds have shown no significant effect on irritability in ASD?

Answer 19

lamotrigine/levetiracetam

Question 20

tx of repetitive behaviors in ASD (3 drugs)

Answer 20

haloperidol
risperidone
aripiprazole

Question 21

what is the preferred stimulant for pts with ASD and ADHD?

Answer 21

methylphenidate

Question 22

T or F: clonidine/guanfacine have a modest effect on irritability and explosive behavior in ASD pts with ADHD

Answer 22

T

Question 23

what drug reduces sleep latency and inc time asleep in pts with ASD and sleep problems?

Answer 23

melatonin 1-6 mg nightly

Question 24

what disorder is described?

-Severe recurrent temper outbursts that are out of proportion with the intensity/duration of the situation
-Present in at least two of three settings (home, school, with peers) and are severe in at least one of these
-diagnosis should not be made before age 6 or after age 18

a. ODD
b. CD
c. ASD
d. DMDD
e. PTSD

Answer 24

d. DMDD

(disruptive mood dysregulation disorder)

Question 25

what two drug classes are first line for DMDD?

Answer 25

SSRIs and stimulants

Question 26

for DMDD, we need to differentiate from _______ disorder, both for using antidepressants as well as evaluating need for mood stabilizers

Answer 26

bipolar

Question 27

T or F: DMDD is more similar to bipolar disorder than to depression, ADHD, or anxiety

Answer 27

F (more similar to depression, ADHD, or anxiety; in same chapter in DSM-5)

Question 28

look at slide 21 for things to know about pediatric depression

Answer 28

sure

Question 29

only antidepressant FDA-approved for kids down to 8 yrs old

a. sertraline
b. fluoxetine
c. duloxetine
d. escitalopram
e. paroxetine

Answer 29

b. fluoxetine

Question 30

which of the following is FALSE about pediatric depression tx?

a. non-pharm is first line
b. CBT leads to remission rates of 70%
c. antidepressants have black box warning for suicidality, with the highest risk in the first 3 months
d. fluoxetine is FDA-approved for ages 12-17

Answer 30

d. fluoxetine is FDA-approved for ages 12-17

(this is escitalopram, fluoxetine is for ages 8 and up)

Question 31

what antidepressant should be avoided in kids with pediatric depression?

a. paroxetine
b. fluoxetine
c. duloxetine
d. escitalopram
e. sertaline

Answer 31

a. paroxetine

(1st antidepressant with suicidal thinking warning)

Question 32

_______ is first drug option for pediatric bipolar, mixed or manic, with or w/o psychosis

Answer 32

lithium

Question 33

look at slide 23 for drug tx of pediatric bipolar disorder

Answer 33

You got it boss

Question 34

first line tx (not drugs) for pediatric PTSD

Answer 34

trauma-focused psychotherapy

Question 35

first line drug class for tx of pediatric PTSD

Answer 35

SSRIs

Question 36

which of the following is FALSE about childhoood-onset schizophrenia?

a. use adult diagnositic criteria
b. hallucinations/delusions are not explained by substance use or PDD/autism
c. visual hallucinations are less common than in adults
d. onset of sx before age 13
e. rare in children, adolescent prevalence reaches adult prev of 0.5-1.0%

Answer 36

c. visual hallucinations are less common than in adults (more common)

Question 37

which atypical antipsychotic is FDA-approved for irritability with autism in pediatrics? SELECT ALL THAT APPLY

a. aripiprazole
b. asenapine
c. brexpiprazole
d. lurasidone
e. olanzapine
f. olanzapine/fluoxetine
g. paliperidone
h. quetiapine
i. risperidone

Answer 37

a. aripiprazole
i. risperidone

Question 38

which atypical antipsychotics are NOT FDA-approved for pediatric schizophrenia? SELECT ALL THAT APPLY

a. aripiprazole
b. asenapine
c. brexpiprazole
d. lurasidone
e. olanzapine
f. olanzapine/fluoxetine
g. paliperidone
h. quetiapine
i. risperidone

Answer 38

b. asenapine
f. olanzapine/fluoxetine

Question 39

FDA-approved indication for brexpiprazole and paliperidone in pediatrics

a. bipolar disorder
b. schizophrenia
c. irritability w/ autism
d. tourette’s
e. bipolar depression

Answer 39

b. schizophrenia

Question 40

FDA-approved indication for olanzapine/fluoxetine in pediatrics

a. bipolar disorder
b. schizophrenia
c. irritability w/ autism
d. tourette’s
e. bipolar I depression

Answer 40

e. bipolar I depression

Question 41

paliperidone FDA-approved indication in pediatrics

a. bipolar disorder
b. schizophrenia
c. irritability w/ autism
d. tourette’s
e. bipolar depression

Answer 41

b. schizophrenia

Question 42

asenapine FDA-approved indication in pediatrics

a. bipolar disorder
b. schizophrenia
c. irritability w/ autism
d. tourette’s
e. bipolar depression

Answer 42

a. bipolar disorder

Question 43

look at slide 26 for full chart about atypical antipsychotics in pediatrics

Answer 43

will do