Psychiatry-Childhood Disorders Flashcards Preview

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Flashcards in Psychiatry-Childhood Disorders Deck (35):
1

Bobby is always late turning in his assignments. He needs to be told things repeatedly and he has poor grades. His parents say that they have to sit next to him to help him complete his homework. What is your diagnosis? What are the criteria for this diagnosis?

ADHD: inattentiveness, impulsivity and hyperactivity for at least 6 months, before age 12 and affects child in 2 separate settings.

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ADHD specifiers

Combined symptoms of inattentiveness and impulsivity or stronger one way or the other

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ADHD risk factors

Low birth weight, smoking and being male

4

Things to rule out when considering ADHD

Medications, thyroid disorder, malnutrition, abuse, environmental (lead), hunger, constipation etc.

5

ADHD DDx

Bipolar, oppositional defiant, conduct and learning disorders. Psychosocial considerations.

6

ADHD Tx

Environmental changes, Stimulants (DA agonists), behavioral changes

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Why it is necessary to treat ADHD in childhood

30%, resolve by adulthood, 30% residual, 30% worsen.

8

Poor prognosis for ADHD

Early presentation, co-morbid conduct disorder and worsening symptoms in adolescence

9

12-year-old boy set fires at school, beat up the neighbors kid and killed the class pet. Nothing has changed despite 200 hours of community service. What is your diagnosis?

Conduct disorder: characterized by aggression, destruction of property, deceitfulness, theft and serious violation of rules before age 13. Kid must be < 18 years old and have 12 months of symptoms.

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Types of conduct disorders

Childhood onset (1 criterion b/f age 10), Adolescent onset (no criterion b/f age 10) and Unspecified onset. They are also characterized as mild, moderate and severe.

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Conduct disorder specifiers

Limited pro-social emotions: lack of remorse, calloused and unconcerned about others.

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Conduct disorder prognosis

40% go on to antisocial personality, high co-morbidity with ADHD. Worse prognosis w/early onset and greater frequency of events.

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Conduct disorder Tx

Psychotherapy and drugs (mood stabilizers, beta-blockers and neuroleptics)

14

Charlie is rude, disobedient and cheeky. He throws tantrums and breaks things when confronted. He swears at his teachers and has been suspended from school. What is your diagnosis?

Oppositional defiant disorder. Must be < 18 yrs old, with six months of angry mood, defiant behavior and vindictiveness

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Etiologies of oppositional defiant disorder

Inconsistent parenting, family history

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Tx of oppositional defiant disorder

Similar to conduct disorder

17

Tim makes noises like barking and clearing his throat. What is your diagnosis?

Tic Disorder (can be motor or vocal). This is characterized by rapid recurrent movements or vocalizations preceded by an urge to do the tic. Note that functional impairment is not required to make this diagnosis.

18

Criteria for Tourette’s disorder

Motor and vocal tic. Occurs many times a day. > 1 year duration without > 3 months tic free. Onset b/f 18 years old. Not due to other disorder (Huntington, postviral encephalitis, stimulants)

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Transient tic disorders

4 weeks – 12 months.

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Prognosis of Tourette’s disorder

1/3 recover by adolescence, 1/3 improve by adulthood, 1/3 stay the same or get worse

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Tic Tx

Psychoeducation, drugs if bad (alpha-1 agonists, neuroleptics are the drug of choice)

22

Kid poops on mom’s pillow all the time

Encopresis: > 4 years old passage of feces into inappropriate places for at least 3 months

23

Kid wets the bed all the time

Enuresis: 2x/week for 3 consecutive months older than 5 years old.

24

Tx for elimination disorders

“Bell” sleeping pad that rings whenever it gets wet. Encopresis is treated w/behavioral modification.

25

Kid is overly concerned about mom’s safety

Separation anxiety disorder

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8 year old girl talks to friends and family, but refuses to talk at school

Selective mutism

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Risk factor that goes with separation anxiety disorder?

Future anxiety disorders

28

5-year-old kid doesn’t play with other kids. Likes to line up his toys methodically and only wears clothes with no tags, laces or belts. What is your diagnosis?

Autism Spectrum Disorder: deficits in social communication, restrictive repetitive behavior, early in development.

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Autism spectrum disorder specifiers

With or w/o intellectual impairment. With or w/o language impairment. Genetic association. Other disorder association. With catatonia.

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Autism spectrum disorder children with highest need

Level 3

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Typical age of presentation of autism spectrum disorder

Age 2

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Risk factors for autism

Advanced paternal age, family history and low birthweight

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Autism spectrum disorder poor prognosis

Intellectual disability, additional mental health disorders and epilepsy. Language by age 5 is a good prognosis.

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Common comorbidities w/autism spectrum disorder

Other psychiatric disorder, anxiety disorder, intellectual impairment, ADHD and depression

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Autism disorder Tx

Speech pathologist, PT, behavioral therapy, sleep specialist and treat with drugs when kids are aggressive (neuroleptics)