Adolescent/psychiatry Flashcards
Most at risk of hip problems
Spastic quadriplegic
GMFS stages
1: mobilise no limits
2: mobilise limits
3: sit and mobilise with device
4: sit need wheelchair
5: severe, no independent mobility
Imaginative play by what age
18m
Drawing development ages
2 a line
3 a circle
4 a person (3 part)
5 a person (6 part)
Drugs causing weight loss
Stimulant
SSRI
toperimate
Methylphenidate short acting most common SE
Insomnia
Tic medication treatment if severe
Clonidine (U.K.)
Risperidone
Suicide highest risk factor
Previous attempts
Most inherited mental illness and Tx
Bipolar Sodium valproate (CMZ, LTG)
Most common conversion disorder
Motor
Diencephalic syndrome/Russell syndrome
Presents as emancipation due to suprasellar tumour
Retinal haemorrhages not part of
SIDS
Striae in adolescence
40% male 70% females
Common teratogen meds
Epileptics
Acei
MTX
Age highest rate HPV infection
20-24
Gardisil
Quadrivalent vaccine 6,11,16,18
Virus like particles
Doesn’t lower cervical cancers rates
Not in pregnancy
Gender dysphoria
Distress associated with mismatch felt if not able to.live as identified gender
Prevalence of autism and sibling
General is 1/150 or 1% 4:1 male ratio
Sibling risk is 20%
Parasomnias o cur in what phase of sleep
Non-R.E.M.
Narcolepsy tetras of symptoms
Sleep attacks
Cataplexy
Sleep paralysis
Hypnagogic/hypnapompic hallucinations
Prevelance ADHD (need dx >6m sx)? Male how much more than female?
5% school age children (almost 7% Australia)
Males 5-10x more than females
OCD comorbidity
80%
ADHD most common 34-51%
(Tics)
Coprolalia in Tourette’s
Uttering obscenities 10%
Management of SS
Benzodiazepines for agitation and stiffness
Cyproheptadine for blocking serotonin production
Stop drug causing syndrome
Fluids by IV
Schizophrenia
1%
2w at least sx
>6m
Psychosis genetic predisposition
1 affected parent 10%
2 parents 45%
Monozygotic twin 50%
What is akathisia
Feeling of inner restlessness and compelling need to b in constant motion
Neuroleptic malignant syndrome compared to serotonin syndrome
Both: Fever, tachy, HTN, sweaty, coma
Differentiated by NMS normal pupils ‘lead pipe’ rigidity, hyporeflexia
10% mortality in NMS with high WCC and CK
Highest mortality rate in which psych d/o
Anorexia
Prevelance AN
2%
10% of cases are makes
Exam findings in anorexia/bulemia
Peripheral cyanosis, peripheral oedema, rough knuckles (Russell sign) enlarged parotid, dental erosions, evidence self harm
Life threatening weight loss in AN
Acute weight loss of 15-20% in 3 months
Total body weight under 75% expected
Treatment AN
Family centred
Food
Support
No role or help with drugs or individual therapy
Bulimia tx
CBT
SSRI
The comorbid diagnosis which is most predictive of poor outcome in AN
OCD
Acquired diffuse hair loss from stress called
Tell Gen effluvium
Strongest predictors outcome in autism
Language and IQ
Adolescent vegan diet risk of deficiency in…
B12
Gonorrhoea treatment
Ceftriaxone 500mg im ( Wth 2ml 1 % lignocaine)
– ( if sensitivity unknown)‐ i.e if dx by SDA (urine)
• (OR Ciprofloxacin 500mg stat
– if known sensitive to this)
Cefotaxime for eye and wash out (presents day 2 of life)
MUST also treat with Azithromycin 1 g stat – To
prevent antibiotic resistance *
• Coinfection chlamydia common‐ up to 40%
Heavy period transenamic acid and NSAIDs reduce blood flow by..
Treatment with NSAIDs can reduce blood flow by 30%
Transhexamic acid can reduce bleeding by 50%
Transgender issues
40% significant depressive symptoms
½ had self harmed in previous 12 months
1 in 5 suicide attempt
Nearly 40% unable to access healthcare
1 in 5 experience bullying at school
More than ½ are afraid
3 in 100 gender dysphoria
In NZ prevelance 1/6000 male 6:1
Autism predictors of outcome (2)
Best predictors of outcome are IQ and speech by 5 years age
Tourette’s management
• Psychoeducation, support, family work
• CBT – habit reversal therapy
• Medication: antipsychotics at low doses
– Haloperidol and risperidone most established
What area is least affected in schizophrenia
Orientation
Erickson stages development
Erikson’s eight stages of psychosocial development include trust vs. mistrust, autonomy vs. shame/doubt, initiative vs. guilt, industry vs. inferiority, identity vs. role confusion, intimacy vs. isolation, generativity vs. stagnation, and integrity vs. despair
Schizophrenia sibling risk and if one parent
10% if sibling
5% if parent
How best to manage temper tantrum toddler
Ignoring
ID levels
Mild under 70
Moderate 40-55
Severe 25-40
Under 25 profound
What is working memory?
Like temporary files or like short term working memory
Comorbidity with ADHD? Name two most common
First is ID (50%)
Second is oppositional defiant disorder (40%)
Sibling risk ADHD?
3O% or 6 x risk
Methylphenidate if have emotional liability when start what do you do?
Persevere
If insomnia or emotional blunting (‘lose spark’) with methylphenidate what do you do?
Insomnia decrease dose
Spark then stop
Atomoxetine mechanism of action
Selective noradrenaline reuptake inhibitor
Benefit and downfall of atomoxetine
Anti anxiety and anti tic
Once daily
Takes up to 8 weeks to work
Mood stabiliser in kids?
Valproate
Not lithium usually
Clonidine is used for ODD and CD and tics - what is its mechanism of action and side effects
Alpha two adrenergic agonist
Sedates
(Irritability)
Taper slow as has rebound HTN
Which one favourite SSRI used for anxiety (OCD and GAD) and bad depression in adolescents?
Fluoxetine (flu like discontinuation syndrome and watch closely first few weeks as some have ‘activation’ with suicidaility increased)
Risperidone works against dopamine (5HTR) and is used for aggression, self injurious behaviour, tics
what is main side effects? (3)
- Weight gain (7%) (and high lipids and insulin resistance)
- High prolactin
- Extrapyridial
- sedation (can try if not responding to melatonin)
Drug to help sleep
Melatonin
Selective mutism associated with what mental health disorder
Anxiety
Anorexia part of brain affected
Insula
