Psychiatry Flashcards
(49 cards)
1
Q
Hospital admission criteria for eating disorders
A
- Significant electrolyte disturbance (K < 3.0)
HR ≤ 50bpm
Postural HR increase ≥ 30bpm
Resting systolic BP ≤ 80mmHg
Postural systolic drop ≥ 20mmHg
Hypothermia < 35.5C
Dehydration
Arrhythmia or prolonged QTc > 0.45s
Weight <75% of their expected body weight or rapid weight loss (>10-15% in 3-6 months is significant)
Out of control ED compensatory behaviours e.g. prolonged fasting/ inability to eat at home/ uncontrolled purging and exercising
Admission may be appropriate in rare circumstances where community management is not effective
2
Q
1st line treatment for anorexia nervosa
A
3
Q
1st line treatment for bulimia nervosa
A
4
Q
Does medication alter the outcome in anorexia nervosa
A
5
Q
Definition of somatisation
A
- Tendency to experience and communicate somatic distress
- Psychological distress manifested in the form for physical symptoms
- Seeks medical help
6
Q
What condition is selective mutism MOST associated with?
A
Social phobia
7
Q
A
8
Q
What style of attachment is the highest risk for developing a psychopathology?
A
- Disorganised attachment highest risk
- Avoidant + resistant attachment are risk factors for psychopathology BUT low predictive value
9
Q
What is the criteria for autism spectrum disorder?
A
- Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays and manifests by ALL 3 of the following:
- Deficits in social-emotional reciprocity
- Deficits in nonverbal communication
- Deficits in developing and maintaining relationships, appropriate to developmental level (beyond those with caregivers)
- Restricted, repetitive patterns of behaviour, interests or activities as manifested by at least 2 of the following:
- Stereotyped or repetitive speech, motor movements, or use of objects
- Excessive adherence to routines, ritualised patterns of verbal or nonverbal behaviour, or excessive resistance to change
- Highly restricted, fixated interests that are abnormal in intensity or focus
- Hyper or hypo reactivitiy to sensory input or unusual interest in sensory aspects of environment
- Symptoms must be present in early childhood (but may not become fully manifest until social demans exceed limited capacities)
- Symptoms together limit and impair everyday functioning
10
Q
What is the average age at diagnosis for autism spectrum disorder?
A
7-8yrs
11
Q
A
10% for each sibling (x50 increased risk)
Monozygotic twin = 60% risk
Serum lead above normal in 44%- related to pica/ oral-motor stage
12
Q
What are co-morbidities in autism spectrum disorder?
A
13
Q
Who get picked up earlier with autism girls or boys?
A
Boys: usually noticed as they get in trouble
Girls: usually are better at masking their symptoms
14
Q
Screening + assessment tools for autism?
A
15
Q
What are the best predictors for outcome in autism?
A
16
Q
What % of patients with autism develop seizures?
A
25% by 11-14yrs
17
Q
What are the diagnostic criteria for ADHD?
A
- Inattention
- Hyperactivity
- Impulsivity
- Symptoms must be before 7yrs of age + in TWO settings or more (e.g. home + school)
- Causes dysfunction
- Subtypes:
- Inattentive
- Hyperactive
- Combined (most common)
18
Q
What is the prevalence of ADHD?
A
19
Q
What are the common comorbidities in ADHD?
A
- ODD / CD 50%
- Learning problems 10-90%
- Anxiety 33%
- Depression 6%
20
Q
What are the risk factors for ADHD?
A
21
Q
What is the treatment for ADHD?
A
- Stimulant medication alone is as good or better than other treatment alone or in combination
- Medications
- Stimulants:
- Methylphenidate
- Dexamphetamine
- Uncommonly used: atomoxetine (takes 1-2 weeks to work, may be more beneficial in families with history of substance use), clonidine (sleep difficult), imipramine, risperidone (used if behavioural concerns)
- Not helpful for ADHD but can be used for comorbid anxiety: SSRI’s
- Stimulants:
- Comorbid disorders may determine other treatment (in addition to stimulants)
- Medication + behavioural treatment for comorbid anxiety
- Parent management training if comorbid ODD/CD
- Tourettes doesn’t preclude stimulants, but avoid high doses
22
Q
A
23
Q
What is the mechanism of action of:
- Methylpenidate
- Amphetamine
- Atomoxetine
A
- Methylpenidate (short acting 3-4hrs), slow release forms available
- Block reuptake of dopamine
- Amphetamine
- Block reuptake of dopamine + increases dopamine release
- Atomoxetine
- Blocks transporter and blocks reuptake of noradrenaline
24
Q
Efficacy of stimulants + positive effects of stimulants in ADHD
A
Efficacy
Improvements in core symptoms range from 50-95%
60-70% of school age children respond to 1st agent, 80% to 2nd
Positive side effects
- Improved sustained attention
- Improved performance on memory, vigilance, attention
- Improved academic productivity
- Improved social interation
- Reduced aggressive behaviour
25
Negative effects of stimulants
Extremely rare: hypersensitivity, SJS, thromobocytopenia, alopecia, toxic psychosis
26
What is the association between stimulant use + growth?
* Associated with reductions in height of 1-2.5cm after 2-3.5 years of treatment
* Weight 0-5kg less than expected
* To overcome this:
* Give medication morning + lunch
* Give large dinner
* Off medication on the weekends + feed
* Height and weight growth rates increase after medication stopped
27
What are the outcomes in ADHD?
* 2/3 of ADHD children continue to have one or more initial core symptoms of the syndrome later in life
* 1/3 have full diagnosis at 18 yrs of age
* ADHD + CD kids are at higher risk of antisocial personality disorder
28
What is ODD
Oppositional defiant disorder
* Pattern of negativisitic, hostile and defiant behaviour lasting at least 6 months during which at least 4 of OFTEN;
* Loses temper
* Argues with adults
* Actively defies or refuses to comply with requests/ rules
* Deliberately annoys eople
* Blames others
* Touchy, easily annoyed
* Angry / resentful
* Spiteful/ vindictive
*At risk of developing CD, depression + other psychiatric illnesses*
29
What are effective interventions for ODD in 3-12yr olds?
Parent management training
* Increase positive interactions with your child
* Planned ignoring of unwanted behaviours
* Limit setting
30
Conduct disorder key features
* Childhood onset VS
* Adolescent onset
_Childhood onset_
* One symptom present before 10yrs old
* More likely male, aggressive, disturved peer relationships
* Likely have ODD, ADHD
* Likely develop antisocial personality disorder
_Adolescent onset_
* No symptoms before 10yrs
* F=M
* Less aggression
* Less likely to develop antisocial personality disorder
31
What is the prevalence of conduct disorder?
3-5%
Increase in prevalence after age 12yrs
32
33
What are the anxiety disorders?
* Separation anxiety
* Generalised anxiety disorder
* Specific phobia
* Obsessive compulsive disorder
* Post traumatic stress disorder
* Social phobia
* Panic disorder
34
What is separation anxiety?
Developmentally inappropriate and excessibe anxiety concerning separation from parents and home
* School refusal common
* Often demanding, intrusive and in need of constant attention, especially when anxious
* Often have somatic complaints especially on school days or when facing separation e.g. bed-time
35
Separation anxiety
* Prevalence
* Long term
* Management
* Prevalence 4% of children / young adolescents
* Increased symptoms after a stressor (e.g. death of pet, family member, changing school)
* Long term: most children do not have ongoing anxiety disorders at end of extended follow up. Higher risk if family history of anxiety disorders.
* Family history of anxiety, mood disorders and alcohol abuse common
* Management:
* Behavioural and cognitive strategies
* Relaxation
* Graduated exposure
36
When do you use SSRI's in anxiety?
SSRI's useful if NOT responding to CBT alone
* Fluoxetine (mainstay)
DO NOT use TCA's: high risk in overdose
37
What are the 3 key features of PTSD?
* **Re-experiencing:** flashbacks, dreams, repetitive play
* **Avoidance:** places, activities, people, thoughts
* **Hyper-arousal:** hypervigilance, poor concentration, poor sleep
38
What is the main treatment of PTSD?
* Trauma focussed CBT
* Relaxation + breathing, cognitive reframing
* Traume narrative, mastery via play, talking, drawing
* Group / individual therapy
* Pharmacotherapy
* No RCT evidence for SSRI's clonidine or B blockers
39
What is the definition of OCD?
* **Obsessions**
* ****Persistent ideas, thoughts, images or impulses that are experienced as intrusive and inappropriate and that cause marked anxiety and distress
* **Compusions**
* ****Repetitive behaviours or mental acts (praying, counting) the goal of which is to prevent or reduce the symptoms of anxiety
40
What is the prevalence of OCD?
1%
Generlly gradual onset / progression
Most have a waxing / waning course
15% have progressive deterioration
*Remember to think about PANDAS (Paed autoimmune neuropsychiatric disorder associated with strep infection)* usually quicker onset
41
What are the comorbid conditions in OCD?
80% have another comorbid disorder
* ADHD 35-50%
* Depression 33-40%
* Tics 26%
* ODD 17-51%
* Developmental 24%
* Other anxiety 16%
42
What is the treatment for OCD?
* 1st line = CBT exposure and response prevention
* Medication: SSRI's often require higher doses
43
Social phobia
* Key characteristics
* Outcome
* Treatment
* Marked and persistent fear of social or performance situations leading to avoidance
* May present as school refusal
* May lead to substance abuse
* Treatment: CBT, SSRI's
44
Difference between a panic attack + panic disorder:
45
What sort of tics can you have?
When is the peak onset?
When do you outgrow them usually?
* Motor, vocal or combined
* Peak age of onset - primary school
* Most outgrow them by - high school
46
What are the features of Tourettes disorder?
* Multiple motor tics, and one or more vocal tics
* Occur multiple times / day, through a period of \> 1 year
* Onset BEFORE 18yrs
* Simple tics- muscle twitch like eye blinking
* Complex tics- touching, throwing movement, retracing steps
* Vocal tics- grunts, yelps, snorts, clearing throat
* Coprolalia- uttering obscenitis
47
What are comorbid disorders in Tourette's?
ADHD + OCD
Usually worse when stressed
M:F 3:1
48
What is the treament of Tourette's?
* Psychoeducation, support, family work
* CBT- habit reversal therapy
* Medication: antipsychotics at low doses
* Haloperidol + risperidone
* Clonidine less effective
* MOST patients with ADHD and Tourettes able to take methylphenidate, if problems can trial clonidine +/- antipsychotic
49
What is the most common presentation of conversion disorder in children?
Motor impairment
