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M2 Psychiatry > 8. Childhood Disorders > Flashcards

8. Childhood Disorders Flashcards

1
Q

what is the general rule with child psychiatry?

A

more than 50% chance that there is a second diagnosis (comorbidity = the rule)

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2
Q

what are the most common psychiatric disorders of childhood?

A

Highest to lowest prevalence: anxiety (8-15%), depression (7%), ADHD (4-8%)

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3
Q

what is the MTA study? what did the majority of participants have?

A

Multimodal Treatment Study of Children with ADHD

Majority of kids had at least 1 comorbid condition

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4
Q

rates of depression across the lifespan for men v women?

A

childhood rates are equal. women more likely to be depr in middle of life. equalizes again in 65+.

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5
Q

what is the best treatment for childhood depression?

A

CBT

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6
Q

major depressive disorder in adolescence: how common? associated with what?

A

common: 1 in 20

associated with suicide, long-term impairment

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7
Q

what is the link between SSRIs and suicide?

A

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

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8
Q

a few very general qualities of SSRIs?

A

considered to be broad-spectrum: treat OCD, panic, generalized anxiety d/o, mood volatility, aggression.

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9
Q

why is fluoxetine good for adolescents?

A

long half life in case they miss doses

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10
Q

what is one problem with use of antidepressants?

A

side effects appear more quickly than therapeutic effects: people more likely to discontinue before getting benefit

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11
Q

what are the top 2 antidepressants used for both younger peds population and adolescent popn?

A

sertraline, paroxetine

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12
Q

what works best for treatment of adolescent depression: meds, therapy, combination?

A

combination of meds (fluoxetine) + CBT worked slightly better than meds alone

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13
Q

Epidemiology of anxiety: what % of US children < 18yo have anxiety?

A

10-20%. most common psychiatric disorders, least likely to be diagnosed

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14
Q

given that is is normal to be anxious about a few things, how do we detect pediatric anxiety?

A

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

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15
Q

what are a few specific anxiety disorders?

A

Generalized AD, Separation AD, Social AD, Specific Phobias, Panic, OCD, PTSD

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16
Q

Treatment for anxiety disorders?

A

psychotherapy of different types, pharmacotherapy (classic anxiolytics, broad spectrum), combined psych and pharm

17
Q

combined psych and pharm therapy is best in what type of anxiety

A

Severe anxiety

18
Q

benzodiazepines that are used for anti-anxiety?

A

clonazepam, lorazepam

19
Q

why are TCAs limited in use for anxiety?

A

safety/side effects issues

20
Q

what is the prognosis for childhood anxiety disorders?

A

80% of them remit
1/3 developed new disorders in adulthood
Generalized AD greatest risk

21
Q

what are the 3 types of ADHD?

A

inattentive
hyperactive/impulsive
combined

22
Q

what % of children have ADHD?

A

4-8%

23
Q

male to female ratio of ADHD?

A

4:1 male to female

24
Q

what % of childhood ADHD continues into adulthood?

A

60%

25
Q

what is the evolution of sx from childhood to adulthood in ADHD?

A

motor hyperactivity
aggressiveness
low tolerance of frustration
impulsiveness (distractable, inattentive, bored, impatient, restless)

26
Q

given that there are risks of treatment, is it worth it to treat ADHD?

A

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

27
Q

what is best tx for ADHD?

A

stimulants: methylphenidate, dextro-amphetamine

28
Q

what is a good response for ADHD tx?

A

only 25-50% reduction in sx is a good response.

29
Q

side effects of ADHD meds?

A

relatively benign: insomnia, tics, appetite suppression, decr growth

30
Q

very generally, how does the pharmacology of ADHD tx work?

A

facilitates release or blocks re-uptake of dopamine or NE. so increase amts of dopamine and NE

31
Q

benefits of extended-release stimulants?

A

effective, no school-time dosing, improved compliance and tolerability

32
Q

problems with extended release stimulants?

A

potential for abuse, side effects are insomnia and decr appetite –> height and weight affects.

M2 Psychiatry (24 decks)

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