Adolescent/psychiatry Flashcards by Emily W

Most at risk of hip problems

Spastic quadriplegic

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GMFS stages

1: mobilise no limits
2: mobilise limits
3: sit and mobilise with device
4: sit need wheelchair
5: severe, no independent mobility

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Imaginative play by what age

18m

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Drawing development ages

2 a line
3 a circle
4 a person (3 part)
5 a person (6 part)

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Drugs causing weight loss

Stimulant
SSRI
toperimate

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Methylphenidate short acting most common SE

Insomnia

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Tic medication treatment if severe

Clonidine (U.K.)

Risperidone

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Suicide highest risk factor

Previous attempts

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Most inherited mental illness and Tx

Bipolar 
Sodium valproate (CMZ, LTG)

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Most common conversion disorder

Motor

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Diencephalic syndrome/Russell syndrome

Presents as emancipation due to suprasellar tumour

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Retinal haemorrhages not part of

SIDS

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Striae in adolescence

40% male 70% females

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Common teratogen meds

Epileptics
Acei
MTX

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Age highest rate HPV infection

20-24

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Gardisil

Quadrivalent vaccine 6,11,16,18
Virus like particles
Doesn’t lower cervical cancers rates
Not in pregnancy

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Gender dysphoria

Distress associated with mismatch felt if not able to.live as identified gender

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Prevalence of autism and sibling

General is 1/150 or 1% 4:1 male ratio

Sibling risk is 20%

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Parasomnias o cur in what phase of sleep

Non-R.E.M.

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Narcolepsy tetras of symptoms

Sleep attacks
Cataplexy
Sleep paralysis
Hypnagogic/hypnapompic hallucinations

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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

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OCD comorbidity

80%
ADHD most common 34-51%
(Tics)

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Coprolalia in Tourette’s

Uttering obscenities 10%

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Management of SS

Benzodiazepines for agitation and stiffness
Cyproheptadine for blocking serotonin production
Stop drug causing syndrome
Fluids by IV

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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)

1. Weight gain (7%) (and high lipids and insulin resistance) 2. High prolactin 3. Extrapyridial 4. 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