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Psychiatric Disorders in Children Flashcards

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1
Q

What are the 4 sources to consult in child psychiatry?

What kind of information do they report?

A
  • The child
    • Report info in concrete terms
    • Give accurate details about emotional states
  • Parents
    • More reliable for info about conduct, school performance, problems w/ law
    • Child’s developmental hx & issues w/ other family members (medical/psychiatric conditions, problems in family function, etc)
  • Teachers
    • Child’s conduct, academic performance, peer relationships
  • Child welfare/juvenile justice
    • If applicable
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2
Q

What are 4 other methods of gathering information?

A
  • Play, stories, drawing
    • Help to assess conceptualization, internal states, experiences, etc.
  • Kaufman Assessment Battery for Children (K-ABC)
    • Intelligence for ages 2.5 to 12
  • Weschler Intelligence Scale for Children-Revised (WISC-R)
    • Determines intelligence quotient (IQ) for ages 6 to 16
  • Peabody Individual Achievement Test (PIAT)
    • Tests academic achievement
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3
Q

What is the DSM-IV criteria for mental retardation?

A
  • Significantly subaverage intellectual functioning w/ an IQ of 70 or below
  • Deficits in adaptive skills appropriate for the age group
  • Onset must be before the age of 18
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4
Q

Mental Retardation

  • Prevalence: ___%
  • Mild vs. Severe
  • Men vs. Women
A
  • Prevalence: 2.5%
  • 85% mild cases
  • Males 2x affected as females
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5
Q

What are the 4 subclassifications of mental retardation?

A
  • Profound
    • IQ <25
    • 1-2% of MR
  • Severe
    • IQ 25-40
    • 3-4% of MR
  • Moderate
    • IQ 40-50
    • 10% of MR
  • Mild
    • IQ 50-70
    • 80% of MR
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6
Q

What are 4 causes of mental retardation?

A
  • Genetic
  • Prenatal: infection & toxins (TORCH)
  • Perinatal
  • Postnatal
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7
Q

What are genetic causes of mental retardation?

A
  • Down’s syndrome
    • Trisomy 21 (1/700 live births)
  • Fragile X syndrome
    • 2nd most common cause of retardation
    • Involves mutation of X chromosome
    • Males >> females
  • Many others
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8
Q

What are prenatal causes of mental retardation?

A

TORCH

  • Toxoplasmosis
  • Other (syphilis, AIDS, alcohol/illicit drugs)
  • Rubella (German measles)
  • Cytomegalovirus (CMV)
  • Herpes simplex
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9
Q

What are perinatal causes of mental retardation?

A
  • Anoxia
  • Prematurity
  • Birth trauma
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10
Q

What are postnatal causes of mental retardation?

A
  • Hypothyroidism
  • Malnutrition
  • Toxin exposure
  • Trauma
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11
Q

Always rule out __________ in the workup before diagnosing learning disorders.

A

hearing or visual deficit

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12
Q

What is the DSM-IV criteria for a learning disorder?

A
  • Achievement in reading, mathematics, or written expression that is significantly lower than expected for chronological age, level of education & level of intelligence
  • Affect academic achievement or daily activities
  • Cannot be explained by sensory deficits, poor teaching, or cultural factors
  • Often due to deficits in cognitive processing (abnormal attention, memory, visual perception, etc.)
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13
Q

What are the 4 types of learning disorders?

A
  • Reading disorder
  • Mathematics disorder
  • Disorder of written expression
  • Learning disorder not otherwise specified (NOS)
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14
Q

Reading Disorder

  • ___% of school-age children
  • Boys vs. girls
A
  • 4% of school age children
  • Boys 3-4x as often as girls
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15
Q

Mathematics Disorder

  • ___% of school-age children
  • Boys vs. girls
A
  • 5% of school-age children
  • May be more common in girls
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16
Q

Disorder of Written Expression

  • ___% of school-age children
  • Boys vs. girls
A
  • 3-10% of school-age children
  • Male to female ratio unknown
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17
Q

What is the etiology and treatment of learning disorders?

A
  • Etiology
    • Genetic factors, abnormal development, perinatal injury, neurological or medical conditions
  • Treatment
    • Remedial education tailored to child’s specific needs
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18
Q

What are the disruptive behavioral disorders?

A
  • Conduct disorder
  • Oppositional defiant disorder
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19
Q

What is the DSM-IV criteria for conduct disorder?

A
  • Pattern of behavior that involves violation of the basic rights of others or of social norms & rules, with at least 3 acts w/i the following categories during the past year:
    • Aggression toward people & animals
    • Destruction of property
    • Deceitfulness
    • Serious violations of rules
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20
Q

_______ is the most common diagnosis in outpatient child psychiatry clinics.

A

Conduct disorder

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21
Q

Conduct Disorder

  • Prevalence: ___%
  • Etiology involves…?
  • ___% risk of developing antisocial personality disorder in adulthood
A
  • Prevalence
    • 6-16% boys
    • 2-9% girls
  • Etiology involves genetic & psychosocial factors
  • Up to 40% risk of developing antisocial personality disorder in adulthood
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22
Q

If a child has conduct disorder, they have increased incidence of what disorders/behavior?

A
  • Comorbid ADHD & learning disorders
  • Comorbid mood disorders, substance abuse, criminal behavior in adulthood
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23
Q

How is conduct disorder treated?

A
  • Multimodal treatment approach most effective
  • Structure child’s environment w/ firm rules that are consistently enforced
  • Individual psychotherapy that focuses on behavior modification & problem-solving skills
  • Adjunctive pharmacotherapy
    • Antipsychotics or lithium for aggression
    • SSRIs for impulsivity, irritability, mood lability
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24
Q

What is the DSM-IV criteria for Oppositional Defiant Disorder (ODD)?

A

At least 6 mo of negativistic, hostile & defiant behavior during which at least 4 of the following have been present:

  • Frequent loss of temper
  • Arguments w/ adults
  • Defying adults’ rules
  • Deliberately annoying people
  • Easily annoyed
  • Anger & resentment
  • Spiteful
  • Blaming others for mistakes or misbehaviors
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25
**Oppositional Defiant Disorder** * Prevalence: \_\_\_% * Age of onset * Boys vs. girls
* Prevalence: 16-22% in children \>6 yo * Begins by age 8 * Onset before puberty: boys \>\> girls * Onset after puberty: boys = girls
26
If a child has oppositional defiant disorder, they have **increased** **incidence** of what disorders/behavior? How many children have remissions?
* Increased incidence of comorbid substance abuse, mood disorders, ADHD * Remits in 25% of children * May progress to conduct disorder
27
How is ODD treated?
* Individual psychotherapy that focuses on: * Behavior modification * Problem-solving skills * Parental skills training
28
2/3 of children with _____ also have conduct disorder or oppositional defiant disorder.
ADHD
29
What are the 3 subcategories of ADHD?
* Predominantly inattentive type * Predominantly hyperactive-impulsive type * Combined type
30
What is the DSM-IV criteria for ADHD?
* At least 6 symptoms involving inattentiveness, hyperactivity or both that have persisted for at least 6 months * **Inattention** - problems listening, concentrating, paying attention to details or organizing tasks; easily distracted, often forgetful * **Hyperactivity-impulsivity** - blurting out, interrupting, fidgeting, leaving seat, talking excessively, etc. * Onset before age 7 * Behavior inconsistent w/ age & development
31
The etiology of ADHD is multifactorial, including....
* **Genetic factors** * Monozygotic twins \> dizygotic twins * **Prenatal trauma/toxin exposure** * Fetal alcohol syndrome * Lead poisoning * **Neurochemical factors** * Dysregulation of peripheral & central noradrenergic systems * **Neurophysiological factors** * Abnormal EEG patterns * Positron-emission tomography scans * **Psychosocial factors** * Emotional deprivation
32
How is ADHD treated?
* Pharmacotherapy * Individual psychotherapy * Behavior modification techniques * Parental counseling * Education & parental skills training * Group therapy * Help pt improve social skills, self-esteem
33
What specific pharmacotherapy is used to treat ADHD?
* **CNS stimulants** * First line: Methylphenidate (Ritalin) * Dextroamphetamine (Dexedrine) * Pemoline (Cylert) * **SSRIs/TCAs** * Adjunctive therapy
34
What are pervasive developmental disorders (PDD)?
* Group of conditions that involve problems with social skills, language & behaviors * Impairement noticeable at early age of life * Involves multiple areas of development
35
What are examples of pervasive developmental disorders (PDD)?
* Autistic disorder * Asperger's disorder * Rett's disorder * Childhood distintegrative disorder
36
What is the DSM-IV criteria for Autistic Disorder?
* **Problems with social interaction (at least 2)** * Impairement in nonverbal behaviors (facial expression, gestures, etc) * Failure to develop peer relationships * Failure to seek sharing of interests or enjoyment with others * Lack of social/emotional reciprocity * **Impairments in communication (at least 1)** * Lack of or delayed speech * Repetitive use of language * Lack of varied, spontaneous play, and so on * **Repetitive & stereotyped patterns of behavior & activites (at least one)** * Inflexible rituals * Preoccupation w/ parts of objects, and so on
37
**Autistic Disorder** * Prevalence: \_\_\_% * Boys vs. Girls * Inheritence?
* 0.02-0.05% in children under age 12 * Boys 3-5x higher incidence than girls * Some familial inheritance
38
What conditions are autistic disorder association with?
* Fragile X syndrome * Tuberous sclerosis * Mental retardation * Seizures
39
What is the age of onset for autism? What percent of autistic pts have mental retardation?
* May be apparent at an early age due to delayed developmental milestones (social smile, facial expression) * **Almost always begins before age 3** * 70% of pts are mentally retarded (IQ \<70) * 1-2% can function completely independently as adults
40
What is the etiology of autism?
* **Prenatal neurological insults** (infections, drugs) * **Genetic factors** * 36% concordance rate in monozygotic twins * **Immunological & biochemical factors**
41
How is autistic disorder treated?
* Remedial education * Behavioral therapy * Neuroleptics * Help control aggression, hyperactivity, mood lability * SSRIs * Adjunctive therapy to help control stereotyped & repetitive behaviors * Some children benefit from stimulants
42
What is the DSM-IV criteria for Asperger's Disorder?
* **Impaired social interaction (at least 2)** * Failure to develop peer relationships * Impaired use of nonverbal behaviors (facial expression, gestures, etc.) * Lack of seeking to share enjoyment or interests w/ others * Lack of social/emotional reciprocity * **Restricted or stereotyped behaviors, interests or activities** (inflexible routines, repetitive movements, preoccupations, etc.)
43
Unlike autistic disorder, children with Asperger's disorder have normal ________ & \_\_\_\_\_\_\_\_.
language cognitive development
44
**Asperger's disorder** * What is the incidence? * Boys vs. Girls
* Incidence unknown * Boys \> girls
45
What is the etiology of Asperger's disorder?
* Unknown etiology * May involve genetic, infectious or perinatal factors
46
How is Asperger's disorder treated?
* Supportive treatment * Similar to autistic disorder * Social skills training & behavior modification techniques may be useful
47
What is the typical patient population of **Rett's disorder**? What is the time course for cognitive development?
* Seen only in girls * Early development appears normal * Diminished head circumference & stereotyped hand movements eventually ensue * Cognitive development never progresses beyond that of the first year of life
48
What are the 9 things Rett's disorder is characterized by?
* Normal prenatal & perinatal development * Normal psychomotor development during the first 5 mo after birth * Normal head circumference at birth, but decreasing rate of head growth btwn ages of 5 & 48 months * Loss of previously learned purposeful hand skills btwn ages 5 & 30 months, followed by development of stereotyped hand movements (hand wringing, hand washing, etc.) * Early loss of social interaction, usually followed by subsequent improvement * Problems w/ gait or trunk movements * Severely impaired language & psychomotor development * Seizures * Cyanotic spells
49
**Rett's disorder** * Age of onset * Boys vs. Girls * Prevalence * Genetic testing?
* Onset btwn age 5-48 months * Girls predominantly * Boys have variable phenotype * Developmental delay * Many die in utero * Rare * Genetic testing available
50
What is the etiology & treatment of Rett's Disorder?
* MECP2 gene mutation on X chromosome * Supportive treatment
51
What is the DSM-IV criteria for Childhood Disintegrative Disorder?
* Normal development in the first 2 yrs of life * **Loss of previously acquired skills in at least 2 of the following areas:** * Language * Social skills * Bowel or bladder control * Play * Motor skills * **At least 2 of the following** * Impaired social interaction * Impaired use of language * Restricted, repetitive & stereotyped behaviors & interests
52
**Childhood Disintegrative Disorder** * Age of onset * Boys vs. Girls * Incidence
* Onset age 2-10 * Boys 4-8x higher than girls * Rare
53
What is the etiology & treatment of Childhood Disintegrative Disorder?
* Etiology unknown * Treatment supportive (similar to autistic disorder)
54
What are tics? What tics are Tourette's disorder characterized by?
* Tics: involuntary movements or vocalizations * Tourette's disorder * Most severe tic disorder * Multiple daily motor/vocal tics w/ onset before age 18 * Vocal tics may appear yrs after motor tics
55
What are some examples of motor tics & vocal tics?
* Motor tics * Involved the face & head * Example: blinking of the eyes * Vocal tics * **Copralalia**: repetitive speaking of obscene words (uncommon in children) * **Echolalia**: exact repetition of words
56
**True or False** Both motor & vocal tics must be present to diagnose Tourette's disorder
True The presence of exclusive motor or vocal tics suggests a diagnosis of motor tic disorder or vocal tic disorder
57
What is the DSM-IV criteria for Tourette's Disorder?
* Multiple motor & vocal tics (both must be present) * Tics occur many times a day, almost every day for \>1 year (no tic-free period \>3 mo) * Onset prior to age 18 * Distress or impairment in social/occupational functioning
58
**Tourette's Disorder** * Prevalence: \_\_\_% * Boys vs. Girls * Age of onset * High co-morbidity with what conditions?
* 0.05% of children * Boys 3x more than girls * Onset btwn ages 7-8 * High co-morbidity w/ OCD & ADHD
59
What is the etiology of Tourette's Disorder?
* **Genetic factors** * 50% concordance rate in monozygotic vs. 8% in dizygotic twins * **Neurochemical factors** * Impaired regulation of dopamine in the caudate nucleus (possibly impaired recognition of endogenous opiates & the noradrenergic system)
60
How is Tourette's Disorder treated?
* Pharmacotherapy * Dopamine receptor antagonists * Haloperidol * Pimozide * Supportive psychotherapy
61
The great majority of cases of enuresis spontaneously remit by age \_\_\_.
7
62
What is enuresis? What should be ruled out before diagnosis?
* Urinary continence established before age 4 * Enuresis: involuntary voiding of urine * Rule out medical conditions * Urethritis * Diabetes * Seizures
63
What are the 4 types of enuresis?
* **Primary** * Child never established urinary continence * **Secondary** * Manifestation occurs after a period of urinary continence, most commonly btwn ages 5-8 * **Diurnal** * Includes daytime episodes * **Nocturnal** * Includes nighttime episodes
64
What is the DSM-IV criteria for Enuresis?
* Involuntary voiding after age 5 * Occurs at least 2x/wk for 3 mo or with marked impairment
65
What is the prevalence of Enuresis?
7% of 5-year-olds prevalence decreases w/ age
66
What is the etiology of enuresis?
* Genetic predisposition * Small bladder or low nocturnal levels of antidiuretic hormone * Psychological stress
67
How is Enuresis treated?
* Behavior modification * Example: buzzer that wakes child up when sensor detects wetness * Pharmacotherapy * Antidiuretics (DDAVP) * TCAs (imipramine)
68
What is Encopresis? What should be ruled out before diagnosis?
* Bowel control normally achieved by age 4 * Bowel incontinence can result in rejection by peers & impairement of social development * Rule out * Metabolic abnormalities (hypothyroid) * Lower GI problems (anal fissure, IBD) * Dietary factors
69
What is the DSM-IV criteria for Encopresis?
* Involuntary or intentional passage of feces in inappropriate palces * Must be at least 4 yo * Has occured at least 1x/mo for 3 mo
70
**Encopresis** * Prevalence: \_\_\_% * (increases/decreases) w/ age * Associated w/ what psychiatric conditions
* 1% of 5-year-old children * Incidence decreases w/ age * Associated w/ conduct disorder & ADHD
71
What is the etiology of encopresis?
* Psychosocial stressors * Lack of sphincter control * Constipation w/ overflow incontinence
72
How is encopresis treated?
* Psychotherapy, family therapy, behavioral therapy * Stool softeners (if etiology is constipation)
73
What is selective mutism? What is the epidemiology? How is it treated?
* Rare condition, girls \>\> boys * Not speaking in certain situations (like school) * Onset age 5-6 * May be preceded by a stressful life event * Treatment * Supportive psychotherapy * Behavior therapy * Family therapy
74
What is the clinical presentation of separation anxiety disorder?
* **Excessive fear of leaving one's parents or other major attachment figures** * Children may... * Refuse to go to school or sleep alone * Complain of physical symptoms * When forced to separate, they become extremely distressed & may worry excessively about losing their parents forever
75
**Separation Anxiety Disorder** * Prevalence: \_\_\_% * Age of onset * How do parents react? * Treatment
* Up to 4% of school-age children * Boys = girls * Onset around age 7, may be preceded by stressful life event * Parents often afflicted w/ anxiety disorders & may ex
76
What does child abuse include? What should doctors do when they know abuse is occuring?
* Physical abuse, emotional abuse, sexual abuse, neglect * Doctors are *legally required* to report all cases of suspected child abuse to appropriate social service agencies * Children may be admitted to the hospital w/o parental consent in order to protect them
77
Adults who were abused as children have an increased risk of developing.....
* Anxiety disorders * Depressive disorders * Dissociative disorders * Substance abuse disorders * Posttraumatic stress disorder * Increased risk of abusing their own children
78
Who does child sexual abuse most commonly involve? What is the most common age? What is the prevalence?
* Male who knows the child * Existence of true pedophilia in abuser rare * Most common btwn ages 9-12 * Report being sexually abused as children * Women 25% * Men 12%
79
What is evidence of sexual abuse in a child?
* Sexually transmitted diseases * Anal or genital trauma * Knowledge about specific sexual acts (inappropriate for age) * Initiation of sexual activity w/ others * Sexualy play with dolls (inappropriate for age)

Psychiatry (18 decks)

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