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Module 6: peds & MH > PEDS > Flashcards

PEDS Flashcards

(101 cards)

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1
Q

what is the most commonly dx MH disorder in childhood?

A

ADHD

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2
Q

what are core symptoms of ADHD?

A

inattention, inability to self-regulate, hyperactivity, and impulsivity that do not correspond to chronological age. Education can be severely affected as can social relationships both at home and at school. Self-efficacy and self-esteem issues often ensue. It affects children of a all intellects.

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3
Q

What are the key diagnostic criteria for Attention Deficit Hyperactivity Disorder (ADHD) in children and teens?

A

Symptoms:

Inattention: 6 or more symptoms (5 for teens).
Hyperactivity/Impulsivity: 6 or more symptoms (5 for teens).
Onset: Symptoms present before age 12 and lasting for over 6 months.

Settings: Impairment in more than one setting (e.g., school, home, work).

Significant Impairment: Clinically significant impairment not better explained by another disorder.

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4
Q

what is distractibility?

A

Inability to focus attention for age-appropriate periods of time.

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5
Q

what is Hyperactivity?

A

Excessive activity significantly above the level expected for the setting and the individual’s developmental age

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6
Q

what is impulsivity?

A

Acting without appropriate thought or consideration, often leading to dangerous situations.

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7
Q

What are the indications for starting ADHD medication?

A

egin medication when ADHD symptoms cause significant impairment in daily functioning

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8
Q

what are S/E of stimulants?

A

Common side effects: appetite suppression, sleep disturbances, anxiety, and increased heart rate.

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9
Q

Dextroamphetamine and Amphetamine (Adderall)
Q: What is the indication, half-life, and common side effects?

A

Indication: ADHD
Half-Life: 10 hours
Side Effects: Nervousness, restlessness, difficulty sleeping
Comments: May slow children’s growth or weight gain; may be addictive.

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10
Q

Dextroamphetamine (Dexedrine)
Q: What is the indication, half-life, and common side effects?

A

Indication: ADHD, narcolepsy
Half-Life: 2-3 hours
Side Effects: Nervousness, restlessness, difficulty sleeping
Comments: May be addictive.

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11
Q

Methylphenidate (Ritalin, Concerta)
Q: What is the indication, half-life, and common side effects?

A

Indication: ADHD, narcolepsy
Half-Life: 2-3 hours
Side Effects: Nervousness, restlessness, difficulty sleeping
Comments: May be addictive.

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11
Q

Lisdexamfetamine (Vyvanse)
Q: What is the indication, half-life, and common side effects?

A

Indication: ADHD
Half-Life: 10-13 hours
Side Effects: Decreased appetite, weight loss, trouble sleeping, nervousness
Comments: May be addictive.

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12
Q

Atomoxetine (Strattera)
Q: What is the indication, half-life, and common side effects?

A

Indication: ADHD
Half-Life: 5.2 hours
Side Effects: Nausea, dry mouth, appetite loss, insomnia, fatigue, headache, cough
Comments: A selective norepinephrine reuptake inhibitor (SNRI). No abuse potential.

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13
Q

What is Oppositional Defiant Disorder (ODD)?

A

A conduct disorder characterized by defiance, losing temper, arguing with authority, defying rules, and being resentful or spiteful.

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14
Q

At what age can ODD begin?

A

ODD can begin as early as the preschool years, not after early adolescence. it is more common in males than females.

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15
Q

What are the significant impairments caused by ODD?

A

Impairments in emotional, social, academic, and occupational adjustment.

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16
Q

What are the three main risk factors for developing ODD?

A

1) Personality/temperament with high emotional reactivity and low frustration tolerance.
2) Harsh, inconsistent, or neglectful parenting.
3) Genetics and neurobiology, including abnormalities in the prefrontal cortex and amygdala.

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17
Q

What specific behaviors are associated with ODD?

A

Losing temper, arguing with adults, purposely annoying others, blaming others for mistakes, and being angry or resentful.

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18
Q

What common comorbidity is often associated with ODD?

A

ADHD

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19
Q

What increased risk is associated with ODD, even when controlling for comorbid disorders?

A

Increased risk for suicide attempts.

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20
Q

Why is it important to differentiate ODD from inattention problems?

A

Purposely failing to obey authority must be separated from problems of inattention.

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21
Q

What defines conduct disorders, which are more severe than ODD?

A

A pattern of aggression toward people or animals, destruction of property, or theft/deceit for at least six months.

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22
Q

What are some symptoms of antisocial personality disorder?

A

Disregard for others’ rights, deceitfulness, impulsivity, irritability, aggressiveness, reckless disregard for safety, irresponsibility, and lack of remorse.

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22
Q

What is required for a diagnosis of antisocial personality disorder?

A

The individual must be at least 18 years old and have a history of conduct disorder.

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23
How many symptoms must be present from the specified categories for a diagnosis of ODD?
at least 4
23
What is the minimum duration for the pattern of behaviors to be diagnosed as ODD?
at least 6 months
23
What underlying issues may contribute to ODD and related disorders?
Child abuse, neglect, or sexual abuse.
24
What should be considered when assessing the behaviors for ODD?
Frequency or intensity compared to normative behaviors for the individual's development level, gender, and culture
25
How must the disturbance in behavior impact the individual
It must be associated with distress in the individual or others in their immediate social context or negatively impact important areas of functioning.
25
Diagnostic Criteria from the DSM-5 ODD
A pattern of angry/irritable mood, argumentative/defiant behaviour, or vindictiveness lasting at least 6 months as evidenced by at least four symptoms from any of the following categories, and exhibited during an interaction with at least one individual who is not a sibling. Angry/Irritable Mood Often loses temper Is often touchy or easily annoyed Is often angry and resentful Argumentative/ Defiant Behaviour Often argues with authority figures or, for children and adolescence, with adults. Often actively defies or refuses to comply with requests from authority figures or with rules. Often deliberately annoy others Often blames others for his or her mistakes. Angry/Irritable MoodVindictiveness Has been spiteful or vindictive at least twice in the past 6 months. Note: Consideration must be given as to whether the frequency or intensity of the behaviours are outside the range of what is normative for the individual’s development level, gender and culture. The disturbance in behaviour is associated with distress in the individual or others in his or her immediate social context (e.g., family, peer group, work colleagues), or impacts negatively on social, educational, occupational, or other important areas of functioning. The behaviours do not occur exclusively during a psychotic episode, substance use, depressive or bipolar disorder.
25
What is the treatment for ODD?
Parenting training, and the treatment of any comorbidity like ADHD
26
The main difference between the symptoms of ODD and conduct disorder is ....?
the degree of harm done to others and property
27
How does early childhood trauma affect the risk of developing major depressive disorder (MDD)?
Early childhood trauma or neglect can set the stage for the development of MDD.
27
What familial risk factors increase the likelihood of depression and anxiety in children?
Having relatives with depression, anxiety, or other mood disorders.
28
Which chronic diseases can predispose children and adolescents to MDD?
Epilepsy, Type 1 Diabetes, sleep disorders, eating disorders, metabolic diseases, inflammatory bowel disease, and obesity.
29
How can a parental interview contribute to the screening for depression and anxiety in children?
It provides contextual insights, developmental history, behavioral observations, and understanding of family dynamics.
30
What insights can parents provide regarding a child's emotional state?
They can reveal patterns of behavior at home, changes in mood, sleep patterns, and appetite.
31
What are the key criteria for diagnosing Major Depressive Disorder (MDD) in children?
Anhedonia or depressed mood for at least 2 weeks, a change in previous functioning, and symptoms causing considerable distress and impairment.
31
What additional symptoms may be present in adolescents with MDD?
Impulsivity, fatigue, hopelessness, antisocial behavior, substance use, restlessness, aggression, and problems with family or school.
32
How do symptoms of MDD differ in school-aged children?
They may present with irritability, anger, externalizing behaviors, school avoidance, and internalizing symptoms like social withdrawal or somatic complaints.
33
What are some signs of MDD in toddlers and preschoolers?
Lack of energy, clinginess, poor appetite, sad mood, and developmentally inappropriate separation anxiety.
34
What symptoms indicate potential risk for depression in young children?
Decreased mood, impaired concentration, irritability, fluctuating moods, and behavioral problems.
34
How is the severity of depression categorized in children?
Mild (daily life affected), moderate (decreased interest), and severe (agitation, psychosis, suicidality).
35
What is a unique symptom that may occur in childhood MDD?
Hallucinations, which can occur in up to 50% of children with MDD but are not indicative of a separate psychotic disorder.
35
What distinguishes severe depression in adolescents?
Having five symptoms, clear suicidality, psychotic features, family history of bipolar disorder, or significant impairment.
36
At what age does separation anxiety become abnormal?
Age 5 onward, with a mean presentation age of 9 years.
37
What comorbidities are associated with Separation Anxiety Disorder?
PTSD, depression, social phobias, and ADHD.
37
What is the typical age range for the presentation of Generalized Anxiety Disorder (GAD)?
Ages 9 to 18 years.
38
What are common symptoms of Separation Anxiety Disorder?
School refusal, somatic complaints, reluctance to sleep alone, nightmares about separation, and social withdrawal.
39
Common symptoms of GAD include:
Worrying about future events, poor sleep, irritability, need for reassurance, restlessness, and somatic complaints.
40
Define Obsessive-Compulsive Disorder (OCD) in children.
Characterized by recurrent, intrusive thoughts (obsessions) and repetitive behaviors (compulsions) that cause significant distress and impairment.
41
What are common obsessions in children with OCD?
Fear of contamination, safety concerns, symmetry, and religious sinfulness.
42
What is PANDAS, and what triggers it?
Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections; triggered by Group B hemolytic streptococcal infection.
43
What are common treatments for mild to moderate OCD?
Cognitive Behavioral Therapy (CBT) is preferred; severe cases may require SSRIs.
44
Which SSRIs are indicated for MDD, anxiety, and OCD in children?
Fluoxetine, escitalopram, fluvoxamine, and sertraline (depending on age).
45
What is the indication for Fluoxetine in children?
Major Depressive Disorder (MDD), anxiety, and Obsessive-Compulsive Disorder (OCD).
46
What age is Escitalopram approved for use in children?
Over age 7.
47
At what age can Sertraline be prescribed to children?
over age 6
47
What are the indications for Fluvoxamine?
MDD and OCD.
48
What is the primary use of Duloxetine in pediatric patients?
MDD and Generalized Anxiety Disorder (GAD). over age 7
49
What age is Venlafaxine approved for use in children?
over age 8
49
What is the first criterion for diagnosing Anorexia Nervosa (AN)?
Restriction of energy intake relative to requirements, leading to significantly low body weight in the context of age, sex, developmental trajectory, and physical health.
50
How is "significantly low weight" defined for diagnosing AN?
A weight that is less than minimally normal, or for children and adolescents, less than minimally expected.
51
What intense fear characterizes Anorexia Nervosa?
An intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight gain despite being at a significantly low weight.
52
What disturbance is present in individuals with Anorexia Nervosa?
Disturbance in the way one's body weight or shape is experienced, with undue influence on self-evaluation or a lack of recognition of the seriousness of the low body weight.
53
What characterizes the restricting type of Anorexia Nervosa?
Dieting through food restriction or fasting, and/or excessive exercise, without using purging behaviors.
54
What are some common risk factors for developing Anorexia Nervosa?
Personality traits of perfectionism, anxiety, obsessional tendencies, and a family history of mental illness.
54
How is the severity of Anorexia Nervosa categorized according to BMI?
Mild: BMI < 17 Moderate: BMI 16 – 16.99 Severe: BMI 15 – 15.99 Extreme: BMI < 15
55
What are common physical examination findings in Anorexia Nervosa?
Amenorrhea, low blood pressure, heart rate, and temperature; lanugo; loss of muscle mass and body fat; and dental erosion.
56
What lab work abnormalities are commonly found in individuals with Anorexia Nervosa?
Mild pancytopenia, high urea, low magnesium, zinc, and phosphate, and metabolic alkalosis from excessive vomiting.
57
What ECG findings might be present in individuals with Anorexia Nervosa?
Sinus bradycardia and occasionally a prolonged QT interval.
58
What characterizes an episode of binge eating in Binge Eating Disorder?
Eating an amount of food larger than most individuals would in a similar time period, along with a sense of lack of control over eating.
59
What are examples of inappropriate compensatory behaviors in Binge Eating Disorder?
Self-induced vomiting, misuse of laxatives or diuretics, fasting, and excessive exercise.
60
Can Binge Eating Disorder occur during episodes of Anorexia Nervosa?
No, the disturbance does not occur exclusively during episodes of Anorexia Nervosa.
60
How often must binge eating and inappropriate compensatory behaviors occur to meet the criteria for Binge Eating Disorder?
At least once a week for 3 months.
61
What is the specification for remission in Binge Eating Disorder?
Behaviors of the disorder have abated, and normal patterns have resumed for a specified period of time.
62
How is the severity of Binge Eating Disorder determined?
Based on the frequency of inappropriate compensatory behaviors (ICB), particularly purging-type behaviors.
63
What defines mild severity in Binge Eating Disorder?
An average of 1-3 episodes of inappropriate compensatory behaviors per week.
64
What defines moderate severity in Binge Eating Disorder?
An average of 4-7 episodes of inappropriate compensatory behaviors per week.
65
What defines severe severity in Binge Eating Disorder?
An average of 8-13 episodes of inappropriate compensatory behaviors per week.
66
What defines extreme severity in Binge Eating Disorder?
An average of 14 or more episodes of inappropriate compensatory behaviors per week.
66
What types of treatment are typically recommended for Binge Eating Disorder?
Cognitive-behavioral therapy (CBT), interpersonal therapy, and sometimes medications like SSRIs
67
67
ow does the DSM-5 differentiate between different severity levels of Binge Eating Disorder?
Severity is based on the frequency of inappropriate compensatory behaviors rather than the frequency of binge eating episodes.
67
What is a common characteristic that makes Bulimia Nervosa difficult to recognize?
Eating is often done in secret, and individuals typically maintain a stable, normal weight or are overweight.
68
What is the main difference between Binge-Eating Disorder (BED) and Bulimia Nervosa (BN)?
BED does not involve purging behaviors, whereas BN includes inappropriate compensatory behaviors to prevent weight gain.
68
hat triggers binge eating episodes in individuals with BN?
Negative affect, interpersonal stressors, dietary restraint, negative feelings about body weight or shape, and boredom.
69
What are some risk factors for developing Bulimia Nervosa?
Low self-esteem, depressive symptoms, social anxiety, history of abuse, stressful life events, and internalization of a thin-body ideal.
69
What are common comorbidities associated with Bulimia Nervosa?
Depression, anxiety disorders, and borderline personality disorder.
70
What is Diabulimia?
Diabulimia is a term used for individuals with Type 1 Diabetes who manipulate their insulin doses to lose weight, often by skipping doses or underdosing.
70
What physical signs may indicate purging behaviors in individuals with BN?
Russell's sign (scars or calluses on the knuckles), evidence of excessive exercise, and signs of gastrointestinal complications.
70
Why do individuals with Diabulimia lose weight
They lose weight because their body's cells are starved of glucose due to insufficient insulin, leading to hyperglycemia and potentially diabetic ketoacidosis (DKA).
70
How can primary care providers monitor for Diabulimia?
By regularly monitoring the weight of adolescents with Type 1 diabetes and conducting A1c tests to detect irregularities.
70
What are the potential dangers of Diabulimia?
It can result in serious health issues, including hyperglycemia, diabetic ketoacidosis, coma, and can be fatal.
71
What is EDNOS?
Eating Disorder Not Otherwise Specified (EDNOS) is a lay term for the DSM-5 diagnosis called Other Specified Feeding or Eating Disorder.
72
What is a Purging Disorder?
Purging behaviors (e.g., vomiting, excessive exercise) without binge eating, aimed at modifying weight or shape.
72
What is an example of Atypical Anorexia Nervosa?
Meeting all criteria for Anorexia Nervosa while having a body weight that is within or above the normal range.
73
What behavioral signs may indicate a higher suicide risk in children?
Acting out feelings destructively, temper problems, aggression, and social isolation.
74
What is a critical practice point regarding suicide risk?
Suicide risk is cumulative; the more risk factors present, the greater the risk.
75
when is suicide risk the greatest?
during the first 4 weeks of a depressive episode, and or when starting an anti-depressant.
76
When assessing a child or teen for suicidal ideation, the Canadian Pediatric Society recommends exploring questions such as:
Have you had thoughts about wanting to hurt yourself or end your life? Do you have a plan for how you would do it? Do you have the means to carry out your plan? What led you to feel this way? How are you coping with your feelings? Are there people in your life you feel you can talk to about your feelings? These questions help gauge the severity of the ideation and the immediate risk of action.

Module 6: peds & MH (1 decks)

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