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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

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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

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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
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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
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5
Q

Criteria for inpatient hospitalization in anorexia nervosa

A
  1. <= 75% median BMI for age and sex
  2. dehydration
  3. electrolyte disturbance
  4. EKG abnormality
  5. unstable:
    - bradycardia < 45 bpm onvernight, <50 awake
    - hypotension <90/45
    - hypothermia <35.6
    - orthostatic decrease in BP > 20 SBP, >10DBP
  6. failure of outpatient
    etc
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6
Q

Relative energy deficiency in sport (RED-S) Triad

A
  • oligomenorrhea/amenorrhea
  • low bone mineral density
  • low energy availability
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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
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8
Q

Cannabis physiologic signs

A
  • tachycardia
  • hypertension
  • conjunctival injection
  • dry mouth
  • increased appetite
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9
Q

Cannabis withdrawal signs

A
  • irritability, anger, aggression
  • anxiety, nervousness
  • sleep difficulty
  • restlessness
  • depressed mood
  • somatic sx causing significant discomfort
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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
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11
Q

DDX non-amenorrhea abN uterine bleeding teens

A
  • physiologic adolescent anovulation
  • contraception
  • infection
  • pregnancy related
  • bleeding disorder
  • PCOS
  • thyroid
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12
Q

Heavy menstrual bleeding management (non-acute)

A
  • treat anemia if present
  • Hormonal: combined OCP, progestin only or IUD
  • non-hormonal: NSAID, TXA
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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
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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
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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)
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16
Q

Emergency contraception (order of effectiveness)

A
  1. copper IUD (up to 7 days post)
  2. ullipristal acetate (up to 5 days post)
  3. levonorgestresl (plan B)
  4. Yuzpe method
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17
Q

Reportable STIs

A
  • chlamydia
  • gonorrhea
  • syphilis
  • HIV

Not reportable: trichomonas, HSV, HPV

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18
Q

Chlamydia tx

A

Treat with azithro 1g PO once or doxycycline x 7 d

resistance does not exist!

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19
Q

Gonorrhea tx

A

cefixime + azithro
CTX + azithro
(Combo for resistnace and synergy)

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20
Q

“strawberry cervix” and treatment

A

Trichomonas vaginalis

Tx: metronidazole

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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
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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
Q

Age of consent sexual activity

A
  • 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
Q

Elements of informed consent

A
  • appropriate information
  • capacity
  • voluntariness
27
Q

When to break confidentiality

A
  • 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
Q

ADHD medication algorithm

A
  1. stimulant (try methylphenidate and at least one amphetamine before moving on)
  2. a atomoxetine
  3. b alpha-2 agonists (guanfacine, clonidine) (usually as adjunct)
29
Q

Stimulants response

A
  • 70% respond to any given stimulant

- 85-90% will respond to metyhylphenidate OR amphetamine

30
Q

Atomoxetine (straterra) side effects

A
  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
Q

Adverse effects of alpha-2 agonists e.g. Intuniv

A
  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
Q

ODD diagnosis

A 
Characterized by sx in domains of: 
1. angry/irritable mood
2. argumentative/defiant
3. vindictiveness
(do not need all domains)
33
Q

Conduct disorder diagnosis

A 
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
Q

Treatment approaches for ODD/CD

A
  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
Q

Antipsychotic adverse effects

A
  • wt gain
  • tardive dyskinesia
  • acute EPS
  • diabetes
  • hyperlipidemia
  • neutropenia
  • orthostasis
  • hyperprolactinemia
  • increased QTc interval
  • sedation
  • seizures
36
Q

Treatment approach for anxiety

A
  1. psychoeducation and support (for all)
  2. psychotherapy (for most)
    - primarily CBT
  3. medication (for some)
    - primarily SSRI
37
Q

OCD features

A

Presence of obsessions and/or compulsions that are:

  1. time consuming (>1hr/day) or
  2. cause clinically significant distress or impairment
38
Q

Treatment approach for OCD

A
  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
Q

A child with depression

RFs for bipolar disorder

A
  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
Q

RFs for suicide

A
  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
Q

Treatment approaches for depression

A
  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
Q

SSRI adverse effects

A
  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
Q

SSRIs with QT prolonagation

A
  • citalopram

- escitalopram

44
Q

Symptoms of hypophosphatemia

A
  • weakness
  • rhabdomyolysis
  • neutrophil dysfunction
  • cardioresp failure
  • arrhythmias
  • seizures
  • altered LOC
  • sudden death
45
Q

Duration of sx:

  1. MDE
  2. PTSD
  3. GAD
  4. ODD
  5. CD
  6. brief psychotic d/o
  7. schizoprheniform
  8. schizophrenia
A 
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
Q

Developmentally normal separation anxiety

A

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
Q

ADHD comorbidities

A
  • 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
Q

Nonpharm treatment for ADHD WITH evidence

A
  • psychoeducation
  • parent behaviour training
  • classroom management
  • daily report card
  • FFA supplementation
  • exercise
    Others: organizational skills, behaviour peer interventions)
49
Q

AEs of stimulant meds

A
  • 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
Q

Stimulant medications and growth

A
  • decrease in growth of 2.5cm
  • final height minimally affected
  • may have delay in pubertal growth spurt
51
Q

ASD and ADHD overlap

A

> 50 % of those with ASD meet criteria for ADHD

52
Q

Medication for ADHD sx in ASD and ID

1st line:

A
  • psychostimulants

but more likely to have side effects and less likley to respond

53
Q

Preterm behavioural phenotype

A
  • inattention
  • internalizing disorders
  • social difficulties

(#1 disability = cognitive impariment for ELBW)

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