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m4 psych > 16. Child & Adolescent Psychiatry > Flashcards

16. Child & Adolescent Psychiatry Flashcards

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1
Q

Autism is characterised by

A
  1. Repetitive restricted behaviour
    - restricted interests
    - routines/rituals
  2. Communication difficulty*
    - delayed verbal development
    - conversation cannot be sustained
  3. Impairment in social interaction
    - difficulties demonstrating appropriate behaviour
    - difficulties a/w non-verbal comms used for social interactions
    - difficulties a/w failure to initiate or adapt to social interactions

*refer for hearing test, speech therapist for ix

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2
Q

Clinical features of Autism

A

Attach to odd objects
Unusual mannerism
Thought without creativity
Injury: self biting
Stereotypies (hand flapping, nodding, rocking)
Motor incoordination

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3
Q

Aetiology of Autism

A

Genetics
Chromosome
Congenital infections/diseases

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4
Q

Onset of autism

A

Before the first 3 years of life

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5
Q

Instruments used to evaluate autism

A

Autism Diagnostic Observation Schedule (for patients)
Autism Diagnostic Interview (for parents)
Child behaviour checklist
IQ test (performance IQ > verbal IQ)

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6
Q

Children with ASD with the following features should have a genetic evaluation

A
  1. Micro/macro-cephaly
  2. Positive family history (of a genetic syndrome)
  3. Dysmorphic features
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7
Q

EEG should be considered if any of the following are present

A
  1. Clinical seizures
  2. Sx suggestive of sub-clinical seizures eg. staring spells
  3. Hx of developmental regression
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8
Q

Non-pharmaco management of autism

A
  • Individualised intervention plan
  • Alternative augmentative communication systems
  • Visual strategies
  • Social skills programme
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9
Q

Pharmaco management of autism

A
  • Fluvoxamine: for repetitive thought
  • Risperidone: for irritability, hyperactivity and stereotypic behaviour
  • Methylphenidate
  • Melatonin: for disturbed sleep patterns
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10
Q

Autism vs Asperger’s syndrome (High functioning ASD)

A

Asperger’s syndrome:
- M:F is 9:1
- communication is not affected, normal language development
- Verbal IQ > performance IQ (reverse in autism)

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11
Q

3S treatment for Asperger’s syndrome

A

SSRI
Structured programme orientated treatment
Social skill training

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12
Q

Attention Deficit and Hyperkinetic Disorder

A

Intention and/or impulsivity and hyperactivity
- impair function in more than 2 setting (eg. school and home)

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13
Q

Onset of ADHD

A

Before 12 years old

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14
Q

Symptoms of Inattention

A

SOLID

Starts tasks without finishing through
Organisation of tasks impaired
Lose important things
Instructions not followed
Distraction by external stimuli

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15
Q

Symptoms of hyperactivity and impulsivity

A

WORST FAIL

Waiting for turn causes frustration
On the move most of the time
Restless and jittery
Squirms when seated
Talks excessively without appropriate response to social constraints

Fidgets with hands and feet
Answers blurted out before questions
Interruption of others’ conversations
Loud noises when playing

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16
Q

Screening for parents and teachers to use

A

Connor’s Performance Test
Connor’s Rating Scale

17
Q

Pharmacological treatment for ADHD

A

FIRST LINE: Methylphenidate (stimulant)
- Ritalin
- Concerta (long-acting)

Second line:
Atomoxetine (non-stimulant)

18
Q

MOA of methylphenidate (stimulant)

A

Dopamine reuptake inhibitor and direct release of dopamine

19
Q

S/E of methylphenidate (stimulant)

A

Appetite loss
Growth suppression
HTN, tachy
Tics, anxiety, psychosis symptoms
Headache, insomnia

20
Q

MOA of atomoxetine (non-stimulant)

A

Noradrenaline re-uptake inhibitor

21
Q

Non-pharmacological management of ADHD

A

Training/reeducation programmes
- CBT, social skills training
Behaviour therapy
- positive reinforcement, environmental modification

22
Q

Monitoring of ADHD is done…
What to look out for?

A

every 6 months
Cardiac and growth suppression,
suicide and self harming

23
Q

Management of tics due to stimulant use

A

Monitor for 3 months
Reduce dose of psychostimulant
Substitute with atomoxetine
KIV antipsychotics

24
Q

Oppositional defiant disorder

A

Irritable mood:
- lose temper easily
- annoyed easily
- always angry and resentful

Argumentative behaviour:
- trouble with authority figures
- defiant towards requests made by authority figures
- annoys others
- blames others for his mistakes

Vindictiveness: spiteful or vindictive at least twice within the past 6 months

At least 6 months in duration
4/8 symptoms

25
Q

Conduct disorder

A

Aggression to people and animals
- bullies, threatens, intimidates
- start fights
- use weapons in fights
- forces another person into sexual activity
- commits a crime

Destruction of property
- fire setting to cause damage
- destroyed other’s property

Deceitfulness or theft
- break into someone’s property or car
- lies to obtain favours
- stolen objects of value

Serious violations of rules
- run away from homes
- truants
- staying out at night despite parental prohibitions

26
Q

Risk factors of conduct disorder

A

More common in boys
Lower social economic status
Large family size, overcrowding
School factor
Poor relationship with parents

27
Q

Management for conduct disorder

A

Behaviour therapy
Stimulant medication for hyperactivity
Lithium with outburst

Family therapy
Parent management training
Consistent parenting
Positive reinforcement of positive behavior
Take video to analyze conflict

28
Q

Enuresis

A
  1. Repetitive involuntary or intentional voiding of urine into bed or clothes
  2. At least 2 times a week for the past 3 months
  • functional impairment
  • diagnosis can only be made for children of at least 5 years of age
29
Q

Encopresis

A
  1. Repetitive involuntary or intentional passage of faeces
  2. At least once a month for the past 3 months
  • functional impairment
  • diagnosis can only be made for children of at least 4 years of age
30
Q

Separation Anxiety Disorders of Childhood

A
  • Unrealistic persistent worry (harm befalling on attached figure, anticipatory symptoms)
  • Daytime symptoms (refusal to go school, physical sx)
  • Nighttime symptoms (refusal to sleep, nightmares)

Onset is before 6 years of age, duration is at least 4 weeks

31
Q

Gillick competence

A

Child below 16yo can give consent to treatment without parental agreement provided that the child has achieved sufficient maturity to understand the treatment fully
- child has no right to refuse treatment that is his or her best interest

32
Q

When to use atomoxetine over methylphenidate?

A
  • inability to tolerate the side effects
  • poor response
  • history of substance misuse
33
Q

Pediatric autoimmune neuropsychiatric disorder associated with streptoccocal infections

A
  • affects males > females
  • associated with emotional lability, separation anxiety, cognitive deficits, oppositional behaviours
  • choreiform movements or motor hyperactivity
  • relapsing remitting episodic course
  • prepubertal age of onset
  • neuroimaging shows increased basal ganglia volumes
  • OCD &/or tic disorder
34
Q

Tx for MDD in adolescents

A

Fluoxetine, escitalopram

m4 psych (18 decks)

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