Lecture 10: Pediatric Psychiatry Flashcards
(81 cards)
1
Q
Goals of psychiatric interview-overall (3)
A
- Come to a diagnostic formulation
- Provide a therapeutic intervention
- Create a foundation for treatment
2
Q
Parental Interview Goal (3)
A
- Form an alliance
- Obtain a formal hx
- Obtain info about
- relationships
- family dynamics
- values
- communication
3
Q
Infant Interview Goals (4)
A
- Determine causes of disturbances
- in regulation
- social
- psychophysiologic
- developmental delays
4
Q
Child Interview Goals (6)
A
- How the child feels
- What the child thinks the purpose is
- Correct misunderstandings
- Assess development
- Gauge coping skills
- Establish alliance
5
Q
Adolescent Interview Goals (3)
A
- Establish possible diagnosis
- build rapport
- build a foundation for treatment
6
Q
Family Interview Goals (5)
A
- Gather comprehensive history
- Observe and assess family interactions
- Formulate family diagnosis and treatment plan
- Educate and motivate for treatment
- Build therapeutic relationship
7
Q
Interviewing Parents (2)
A
- intake questionnaires and checklists
2. Work through the domains of a psychiatric evaluation
8
Q
Interviewing Infants (3)
A
- interview the parents
- observe parent-child interactions
- standardized testing (developmental level scales)
9
Q
Interviewing Children (4)
A
- Interview structure depends on the child
- Unstructured vs. semi-structured vs. structured
- Help them relax; toys, no white coats, no notebooks
- little ones are concrete-ask pointed questions
10
Q
Interviewing Adolescents (5)
A
- listen
- don’t be too formal
- start with easier topics
- ask about SI
- discuss confidentiality
11
Q
Family Interview (2)
A
- Identify problems
2. Observe family interactions
12
Q
Mental Status Exam (2)
A
- organized observations and assessments of behavior during the assessment
- helpful in refining diagnosis and knowing where to look further
**OBJECTIVE
13
Q
Treatment Planning (5)
A
- safety first
- identify goals of treatment
- look at all factors
- treat -> monitor -> revise
- consider risks and benefits
14
Q
Intellectual Disability Dx
A
- not a single d/o
- Onset before age 18
- Impairment in intellectual and adaptive functioning
- varying levels of severity
15
Q
Mild MR
A
IQ 50-55 to 70
*verbal skills lack below 50 typical
16
Q
Moderate MR
A
IQ 35-40 to 50-55
*verbal skills lack below 50 typical
17
Q
Severe MR
A
IQ 20-25 to 35-40
18
Q
Profound MR
A
IQ 20-25
19
Q
Intellectual Disability Epidemiology (5)
A
- 0.7%-1% prevalence
- 2/3 of cases are mild
- increased rx for comorbidities
- multitude of cases: prenatal/perinatal/postnatal
- can be genetic or external
20
Q
Diagnostic Testing for Intellectual Disability (7)
A
- psychological testing**
- genetic testing
- metabolic screening
- EEG
- hearing acuity evaluation
- ophthalmologic assessment
- neuroimagining
21
Q
DDX for intellectual disability (5)
A
- dementia
- PDD -austism
- learning d/o
- communication d/o
- other mental d/o
22
Q
Treatment intellectual disability (5)
A
- treatment and education based on strengths and weaknesses
- behavioral management programs
- early intervention services
- psychopharmacologic bass on specific symptoms
- other: OT, PT, ortho, GI, etc.
23
Q
Special consideration intellectual disability (5)
A
When using medication in this population
- rule out all other causes for behaviors
- use least intrusive medication at the lowest effective dose
- avoid poly pharmacy if possible
- monitor closely
- goal is maximizing quality go life not eliminating challenging behaviors
24
Q
Learning D/O diagnosis
A
- Significant difficulties in learning and using skills such as listening, speaking, writing, reasoning or math
- achievement well below average on standardized testing and interferes with achievement or daily activities
25
DSM 3 types learning d/o
1. reading d/o
2. math d/o
3. written expression d/p
26
Epidemology learning d/o (2)
1. estimated 2%-8% of school aged children
| 2. can be intrinsic or environmentally influenced
27
Dx and Tx learning d/o (4)
1. Psych testing (WISC-III)
2. Remedial Approach- improve specific skills
3. Compensatory approach- work about deficit
4. interventions for related social/emotional issues
28
Motor D/o Dx (4)
1. performance in daily motor functioning is far below expected
2. disturbance interferes with academic achievement or ADLs
3. Not due to general medical condition or PDD
4. if MR is present, motor difficulties are more than expected
29
Motor Disorders (6)
1. clumsiness
2. Adventitious movements
3. Dyspraxia
4. material-specific dyspraxia
5. neurologic soft signs
6. pathologic handedness
30
Clumsiness
Motor D/O
inefficiency in performance of fine motor movements
31
Adventitious Movements
Motor D/O
synkinesis, chorea, tremor, tics
32
Dyspraxia
Motor D/O
inability to learn or perform serial voluntary movements to complete skilled acts
33
Material-Specific Dyspraxia
Motor D/O
motor execution below expected age with regard to writing (dysgraphia), drawing (constructional dyspraxia), or speech (verbal dyspraxia)
34
Neurologic Soft Signs
Motor D/O
non normative performance on motor or sensory neurologic tests in the absence of localizable neurologic disease or defect
35
Pathologic Handedness
Motor d/o
left-handedness assoc with left-hemispheric defect and paresis of the right hand
36
Epidemiology Motor d/o (3)
1. 6% school aged children
2. genetic cause, possibly "minimal brain damage"
3. typically improved throughout development
37
Diagnostic Testing (5)
1. development hx (questions about motor performance)
2. neuro exam
3. specific assessment procedures based on sx
4. psych testing
5. neuroimaging
38
DDX Motor d/o (4)
1. neuroleptic/anticonvulsant toxicity
2. neuromuscular d/o
3. upper motor neuron d/o
4. other d/o involving motor issues
39
Motor d/o tx
1. pysiotherapy and occupational therapy for remediation of motor handicaps
40
Communication D/O
1. must be severe enough to interfere with patient's
- school
- occupational achievement
- social communication
2. must exceed expectations for age/IQ/Dialect
41
Communication D/o types (4)
1. expressive language d/o
2. mixed expressive-receptive language d/o
3. phonological d/o
4. stuttering
42
Signs/Sx Expressive Language D/O (4)
Communication D/O
1. limited vocabulary
2. errors in grammar
3. difficulties with word recall
4. difficulties with sentence production
43
Signs/Sx Mixed Expressive-Receptive Language D/O
Communication D/O
1. same as expressive language d/o
- difficulties processing or understanding spoken words/sentences
44
Phonological D/O signs/symptoms
Communication D/O
1. developmentally inappropriate difficulties with sounds (production, use, organization)
45
Suttering D/O signs and sx
Communication D/O
1. disturbance in normal fluency and patterning of speech
46
Epidemiology Communication d/o (5)
1. 2-7%
2. elevated rate psych comorbidity
3. occurs more frequently in families with hx of language d/o
4. 4x more likely in boys than girls
5. genetic or acquired
47
DDX Communication D/O (3)
1. autism
2. PDD
3. ADHD
48
Diagnosis Communication D/O
1. psych testing
2. audiological testing
3. neuroimaging if neuro exam abnormal
49
Tx Communication D/o
Therapeutic services
50
Autism Signs/Sx (6)
1. Wide range sx and severity
2. Difficulties with social interactions
3. abnormal eye contact
4. delays/abnormalities in language
5. lack of interest ing environment
6. repetitive behaviors/ difficulties with change in routine
51
Autism Dx (4)
1. qualitative impairment in social interactions (at least 2)
2. Qualitative impairment on communication (at least 1)
3. Restricted, repetitive, and stereotyped patterns of behavior, interests, and acitivites (at least 1)
4. 6 total items from diagnostic list
52
Epidemiology Autism (5)
1. 4.5-9 per 10,000
2. boys 3-4x more likely than girls
3. high rates seizure d/o, persistence of primitive reflexes, "soft" neurological signs
4. 2%-10% in siblings
5. work being done on genetic factors, obstetrical risk, environmental factors
53
Diagnostic testing autism (5)
1. psych testing
- strengths in nonverbal tasks, but deficiencient in verbal cognitive abilities
3. most function in MR range
4. savant skils
5. EEG abnormalities may be seen (not diagnostic)
54
DDX Autism (4)
1. other developmental d.o including PDD
2. sensory impairment
3. MR
4. Language d/o
55
Treatment Autism (6)
1. Education and behavioral interventions
2. antipsychotics
3. SSRIs
4. mood stabilizers
5. psychodynamic therapy
6. 20% + able to become independently functioning adults
56
Pervasive Developmental D/O
1. Aspbergers
2. Childhood Disintegrative D/O
4. Rett D/o
5. Pervasive Developmental D/O NOS: Autism Spectrum
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Asperger's
PDD
Social disability with good verbal skills
58
childhood disintegrative d/o
PDD
rare condition in which a condition life autism develops after a time of normal development
59
Rett D/O
PDD
Neurodegenerative D/O
60
Pervasive Developmental D/O NOS
PDD
Autism Spectrum D/O
61
Attention Deficit D/O Signs and sx (6)
1. inattentive
2. distractible
3. impulsive
4. hyperactive
5. poor organization
6. daydreaming
7. frequently changing activities
8. poor time management '
9. low frustration tolerance
62
ADHD Dx (5)
1. 6+ sx of inattention OR
2. 6 + or more sx of hyperactivity
3. some impairment of these symptoms in 2+ settings
4. Evidence of significant impairment in social/academic/occupational functioning
5. sx are not only during the course of another d/o
63
Epidemiology ADHD (6)
1. Most common emotional/cognitive/bx d/o treatment in youth
2. 4-7% children
- combined= 50-70%
- inattentive= 20-30%
- hyperactive/impulsive= <15%
3. Girls more commonly have inattentive type
4. biologic adversity rx
5. psychosocial adversity rx
6. highly genetic, 77%
64
Diagnostic Testing ADHD
1. Diagnosis made by careful hx
2. rating scales for screening
3. psych testing (not necessary but can be beneficial)
65
DDX AHDH (6)
1. ODD and conduct d/o
2. mood d/o (mania)
3. anxiety d/o
4. learning disability
5. Tics
6. substance use d/o
66
Tx ADHD (6)
1. Psychostimulants
2. Strattera (SNRI)
3. Antidepressants (TCAs, Wellbutrin)
4. Alpha agnoists
5. Modafinil
6. psychotherapeutic interventions
67
Opposotional Defiant D/O
Signs/Sx (10)
1. Oppositional
2. Tests Limits
3. disruptive behaviors
4. moddy
5. irritable
6. often in conflict
7. argumentative
8. angry
9. easily loses temper
10. spiteful
68
ODD Dx (5)
1. Pattern of negative, hostile, and defiant d/o
2. lasts at least 6 month
3. disturbances causes impairment in social/ academic/occupational functioning
4. symptoms not exclusive to another psych d/o
5. criteria not met for conduct d/o
69
Epidemiology ODD (6)
1. 5.7-9.9%
2. average onset 6 years
3. 4:1 M:F
4. low heritability
5. increased rx with infants with disorganized attachments, highly stressed families
6. related to failure to provide adequate praise, attention, and consistent limits
70
DDX ODD (6)
1. normal developmental testing
2. ADHD
3. Conduct D/O
4. Pre-morbid schisophrenia
5. oppositionality with MR
6. parental psychopathology
71
Dx and treatment ODD (4)
1. Psych testing (behavioral check list)
2. under 12: treatment through parents
3. adolescents: family therapy approach
4. Problem solving communication training (PSCT)
72
Conduct Disorder Diagnosis (3)
1. Repetitive violation of social norms/rules
2. Behaviors cause impairment in social, academic or occupational functioning
```
3. Disruptive or dangerous behaviors
3+
-Agression to people or animals
-property destruction
-deceitfulness of theft
-seroius violations of rules
```
73
Epidemiology Conduct Disorder
1. 0.9-8.7%
2. Multiple etiologic theories
- genetic
- physiological
- acquired
74
DDX Conduct D/O
1. Mania
2. Dysthymia/ MDD
3. Likely to coexist with
- ODD
- ADHD
- Substance use
- Learning d/o
- Depression
- PTSD
- Anxiety
75
Dx Conduct D/O (2)
1. comprehensive biopsychosocial evaluation
| 2. psych testing can provide insight
76
Tx of Conduct D/O (3)
1. psychosocial intervention
2. ecological intervention
3. biological intervention s
77
Pharmacological tx conduct d/o
1. methylphenidate
2. Depakote
3. Lithim
78
Methyphenidate Tx in conduct d/o
reduce defiance, oppositionality, aggression
79
Depakote tx in conduct d/o
reduce hyperarousal, anger, agression
80
Lithium tx in conduct d/o
reduce agression
81
Prognosis ODD
ODD -> Conduct D/O -> antisocial PD
Additional Pathways:
1. substance use
2. covert/nonaggressive
3. aggressive/versatile
4. authority conflict
