8. Childhood Disorders Flashcards
what is the general rule with child psychiatry?
more than 50% chance that there is a second diagnosis (comorbidity = the rule)
what are the most common psychiatric disorders of childhood?
Highest to lowest prevalence: anxiety (8-15%), depression (7%), ADHD (4-8%)
what is the MTA study? what did the majority of participants have?
Multimodal Treatment Study of Children with ADHD
Majority of kids had at least 1 comorbid condition
rates of depression across the lifespan for men v women?
childhood rates are equal. women more likely to be depr in middle of life. equalizes again in 65+.
what is the best treatment for childhood depression?
CBT
major depressive disorder in adolescence: how common? associated with what?
common: 1 in 20
associated with suicide, long-term impairment
what is the link between SSRIs and suicide?
black box warning on SSRIs, but we don’t know if they incr suicide. SSRIs can make people edgy, but does this lead to depression? it may increase suicidal thoughts but not attempts
a few very general qualities of SSRIs?
considered to be broad-spectrum: treat OCD, panic, generalized anxiety d/o, mood volatility, aggression.
why is fluoxetine good for adolescents?
long half life in case they miss doses
what is one problem with use of antidepressants?
side effects appear more quickly than therapeutic effects: people more likely to discontinue before getting benefit
what are the top 2 antidepressants used for both younger peds population and adolescent popn?
sertraline, paroxetine
what works best for treatment of adolescent depression: meds, therapy, combination?
combination of meds (fluoxetine) + CBT worked slightly better than meds alone
Epidemiology of anxiety: what % of US children < 18yo have anxiety?
10-20%. most common psychiatric disorders, least likely to be diagnosed
given that is is normal to be anxious about a few things, how do we detect pediatric anxiety?
the content of fears is less impt than frequency, themes. get multiple informants.
characterize pathology by pervasiveness, intensity, how time consuming, whether it is debilitating
what are a few specific anxiety disorders?
Generalized AD, Separation AD, Social AD, Specific Phobias, Panic, OCD, PTSD
Treatment for anxiety disorders?
psychotherapy of different types, pharmacotherapy (classic anxiolytics, broad spectrum), combined psych and pharm
combined psych and pharm therapy is best in what type of anxiety
Severe anxiety
benzodiazepines that are used for anti-anxiety?
clonazepam, lorazepam
why are TCAs limited in use for anxiety?
safety/side effects issues
what is the prognosis for childhood anxiety disorders?
80% of them remit
1/3 developed new disorders in adulthood
Generalized AD greatest risk
what are the 3 types of ADHD?
inattentive
hyperactive/impulsive
combined
what % of children have ADHD?
4-8%
male to female ratio of ADHD?
4:1 male to female
what % of childhood ADHD continues into adulthood?
60%
what is the evolution of sx from childhood to adulthood in ADHD?
motor hyperactivity
aggressiveness
low tolerance of frustration
impulsiveness (distractable, inattentive, bored, impatient, restless)
given that there are risks of treatment, is it worth it to treat ADHD?
yes, there are addl risks for adolescents with ADHD that should be understood. kids with untreated ADD are 4x more likely to develop substance problems. ADD tx has a protective function against later addiction
what is best tx for ADHD?
stimulants: methylphenidate, dextro-amphetamine
what is a good response for ADHD tx?
only 25-50% reduction in sx is a good response.
side effects of ADHD meds?
relatively benign: insomnia, tics, appetite suppression, decr growth
very generally, how does the pharmacology of ADHD tx work?
facilitates release or blocks re-uptake of dopamine or NE. so increase amts of dopamine and NE
benefits of extended-release stimulants?
effective, no school-time dosing, improved compliance and tolerability
problems with extended release stimulants?
potential for abuse, side effects are insomnia and decr appetite –> height and weight affects.
