Adolescent and psych Flashcards
1
Q
Early adolescence vs. middle adolescence vs. late adolescence
A
Early: 12-14 yrs, preoccupation with changing body
Middle: 15-16 yrs, peak of conflict
Late: 17-19+, future oriented, begin to perceive consequences
2
Q
Anorexia nervosa
DSM 5 criteria simplified (A,B,C)
A
A. low body weight secondary to nutritional restriction
B. fear of gaining weight
C. distortion of body image
3
Q
Bulimia nervosa DSM 5 simplified
A
- binge eating and purging at least once weekly x 3 months
- body weight is normal or increased
- self evaluation closely linked to body image
4
Q
Refeeding syndrome risk factors
A
- rapid wt loss
- extremely low body wt (<70%)
- low baseline phosphate, potassium, magnesium
- little or no intake for 5-10 days prior to refeeding
5
Q
Criteria for inpatient hospitalization in anorexia nervosa
A
- <= 75% median BMI for age and sex
- dehydration
- electrolyte disturbance
- EKG abnormality
- unstable:
- bradycardia < 45 bpm onvernight, <50 awake
- hypotension <90/45
- hypothermia <35.6
- orthostatic decrease in BP > 20 SBP, >10DBP - failure of outpatient
etc
6
Q
Relative energy deficiency in sport (RED-S) Triad
A
- oligomenorrhea/amenorrhea
- low bone mineral density
- low energy availability
7
Q
CRAFFT substance use disorder`
A
- driven in a car
- use to relax
- use while alone
- forget about things you did
- family or friends
- trouble
8
Q
Cannabis physiologic signs
A
- tachycardia
- hypertension
- conjunctival injection
- dry mouth
- increased appetite
9
Q
Cannabis withdrawal signs
A
- irritability, anger, aggression
- anxiety, nervousness
- sleep difficulty
- restlessness
- depressed mood
- somatic sx causing significant discomfort
10
Q
Investigations non-amenorrhea abnormal uterine bleeding
A
- hx and physical
- CBC + ferritin
depending on picture: - pregnancy test
- coags
- thyroid screen
- PCOS investigations
- STI investigations
11
Q
DDX non-amenorrhea abN uterine bleeding teens
A
- physiologic adolescent anovulation
- contraception
- infection
- pregnancy related
- bleeding disorder
- PCOS
- thyroid
12
Q
Heavy menstrual bleeding management (non-acute)
A
- treat anemia if present
- Hormonal: combined OCP, progestin only or IUD
- non-hormonal: NSAID, TXA
13
Q
Risks of estrogen containing contraception
A
- irregular bleeding
- breast tenderness
- nausea
- headaches
- venous thromboembolism 2-4x increased risk
- stroke 1.5-2x increased risk
14
Q
ABSOLUTE contraindications to estrogen
A
- < 6 weeks postpartum
- hypertension > 160/100
- current or past hx of VTE or cerebrovascular accident
- migraine with focal neuro sx
- breast cancer (current)
- severe cirrhosis
- liver tumor
- SLE with positive or unknonw antiphospholipid antibody
- complivated valvular heart disease
15
Q
Contraindications to intrauterine contraception
A
- pregnancy
- purulent cervicitis
- distortion of uterine cavity
- pelvic TB
- abnormal uterine bleeding that has not been adequately evaluated
- Wilson disease (copper IUD)
16
Q
Emergency contraception (order of effectiveness)
A
- copper IUD (up to 7 days post)
- ullipristal acetate (up to 5 days post)
- levonorgestresl (plan B)
- Yuzpe method
17
Q
Reportable STIs
A
- chlamydia
- gonorrhea
- syphilis
- HIV
Not reportable: trichomonas, HSV, HPV
18
Q
Chlamydia tx
A
Treat with azithro 1g PO once or doxycycline x 7 d
resistance does not exist!
19
Q
Gonorrhea tx
A
cefixime + azithro
CTX + azithro
(Combo for resistnace and synergy)
20
Q
“strawberry cervix” and treatment
A
Trichomonas vaginalis
Tx: metronidazole
21
Q
Indication for hospitalization with PID
A
- severe clinical illness
- tuboovarian abscess
- alternative dx needs to be ruled out
- pregnancy
- inability to tolerate oral meds
- lack of response to oral meds
- concern for nonadherence
22
Q
Tx PID
A
cefoxitin + doxycycline
23
Q
Complications PID
A
- abscess
- chronic pelvic pain
- ectopic pregnancy
- infertility
24
Q
Transition of youth principles
A
- adolescent involved in management of condition
- adolescent understanding the condition
- understanding personal potential for activity, recreation, education, vocation
- completion of adolescent developmental tasks
- attainment of self-esteem and self-confidence
25
Age of consent sexual activity
- 11yrs and below: canNOT consent
- 12+13 yrs - 2yr close age exception
- 14+15 - 5 yr close age exception
- 16+ can consent to anyone but not in a position of trust/authority
26
Elements of informed consent
- appropriate information
- capacity
- voluntariness
27
When to break confidentiality
- risk of serious harm to self
- risk of serious harm to others
- abuse of any child under the age protected by child welfare agency
- reportable illnesses
28
ADHD medication algorithm
1. stimulant (try methylphenidate and at least one amphetamine before moving on)
2. a atomoxetine
2. b alpha-2 agonists (guanfacine, clonidine) (usually as adjunct)
29
Stimulants response
- 70% respond to any given stimulant
| - 85-90% will respond to metyhylphenidate OR amphetamine
30
Atomoxetine (straterra) side effects
1. sedation
2. GI upset
- other: sleep, mood sx, dizziness, increase in HR/BP, dry mouth, constipation, urinary sx, dysmenorrhea, sexual dysfunction, small increase in psychotic sx, suicide-related events, rare cases of severe liver, priapism, sudden death
31
Adverse effects of alpha-2 agonists e.g. Intuniv
1. sedation
2. bradycardia
3. hypotension
other: dizziness, dry mouth, rebound tachy and HTN, HA, emotional, GI sx, modest increase in QT (guanfacine), ecg abN, suicide
32
ODD diagnosis
```
Characterized by sx in domains of:
1. angry/irritable mood
2. argumentative/defiant
3. vindictiveness
(do not need all domains)
```
33
Conduct disorder diagnosis
```
Characterized by sx in domains of:
1. aggression
2. destruction of property
3. deceitfulness or theft
4. serious violations of rules
(do not need all domains)
```
34
Treatment approaches for ODD/CD
1. psychoeducation and support (for all)
2. psychoscial intervention (for all) e.g. parent management training etc.
3. medication (for some)
- to treat ADHD, anxiety/mood sx
- cautious use of antipsychotics for aggression
35
Antipsychotic adverse effects
- wt gain
- tardive dyskinesia
- acute EPS
- diabetes
- hyperlipidemia
- neutropenia
- orthostasis
- hyperprolactinemia
- increased QTc interval
- sedation
- seizures
36
Treatment approach for anxiety
1. psychoeducation and support (for all)
2. psychotherapy (for most)
- primarily CBT
3. medication (for some)
- primarily SSRI
37
OCD features
Presence of obsessions and/or compulsions that are:
1. time consuming (>1hr/day) or
2. cause clinically significant distress or impairment
38
Treatment approach for OCD
1. psychoeducation and support (for all)
2. psychotherapy (for most)
- CBT with emphasis on exposure and response prevention (ERP)
3. medication (for some)
- SSRIs
- clomipramine and augmentation with an antipsychotic in refractory cases
39
A child with depression
| RFs for bipolar disorder
1. depressive episode that is rapid onset, psychomotor retardation, psychotic features
2. family hx of bipolar disorder
3. hx of mania/hypomania after antidepressant treatment
40
RFs for suicide
1. older age
2. male sex
3. MDD or other psychopathology
4. hx of suicde attempts
5. presence of suicdial plan/intent
6. stressful life events
7. exposure to abuse/violence
8. access to lethal means
9. family history
41
Treatment approaches for depression
1. risk assessment and safety planning (for all)
2. psychoeducation and support (for all)
3. psychotherapy (for most)
- CBT and interpersonal therapy for adolescents
4. Medication (for some)
- SSRIs most evidence for fluoxetine
42
SSRI adverse effects
1. GI upset
2. headaches
3. dizziness
4. activation (esp in younger children)
irritability, insomnia/somnolence, appetite change, akathisia, diaphoresis, sexual dysfunction, hyperprolactin, manic sx in predisposed pts, serotonin syndrome, flu like sx during discontinuation
43
SSRIs with QT prolonagation
- citalopram
| - escitalopram
44
Symptoms of hypophosphatemia
- weakness
- rhabdomyolysis
- neutrophil dysfunction
- cardioresp failure
- arrhythmias
- seizures
- altered LOC
- sudden death
45
Duration of sx:
1. MDE
2. PTSD
3. GAD
4. ODD
5. CD
6. brief psychotic d/o
7. schizoprheniform
8. schizophrenia
```
MDE: 2 weeks
PTSD: 1 month
GAD: 6 months
ODD: 6 months
Conduct disorder: 12 months
Brief psychotic disorder < 1 mo
Schizophreniform < 6 mo
Schizophrenia > 6 mo
```
46
Developmentally normal separation anxiety
Developmentally normal when it begins at about 10 months of age and taper off by 18 months
By 3 yrs, most children can accept temporary absence of primary caregiver
47
ADHD comorbidities
- ODD + CD
- anxiety disorder and OCD (anxiety in 30% of ADHD)
- mood disorders
- substance use
- tic disorders
- developmental coordination disorder
- ASD
- learning disorder (MOST common comorbidity)
- eating disorder
48
Nonpharm treatment for ADHD WITH evidence
- psychoeducation
- parent behaviour training
- classroom management
- daily report card
- FFA supplementation
- exercise
Others: organizational skills, behaviour peer interventions)
49
AEs of stimulant meds
- low appetite
- sleep difficulties
- moodiness
- irritabilities
- tics
- peripheral vasculopathic sx
- rarely: psychosis, priapism
- slight increase in HR and BP (measure BP at appropriate intervals)
50
Stimulant medications and growth
- decrease in growth of 2.5cm
- final height minimally affected
- may have delay in pubertal growth spurt
51
ASD and ADHD overlap
> 50 % of those with ASD meet criteria for ADHD
52
Medication for ADHD sx in ASD and ID
| 1st line:
- psychostimulants
| but more likely to have side effects and less likley to respond
53
Preterm behavioural phenotype
- inattention
- internalizing disorders
- social difficulties
(#1 disability = cognitive impariment for ELBW)
