Behavioral and Substance use Flashcards
[Behavior/Sleep]
Nightmares occur during ___ sleep
Nght terrors occur during ___ sleep
(REM/non-REM sleep)
Nightmares REM sleep
Night terrors non-REM sleep
[Behavior/Sleep]
Common Age group for sleep walking?
Between 4 and 8 years of age
[Behavior/Tantrum]
Temper tantrums occurs in nearly all ___ to ___ years old
Normally resolves by ___ years of age
Nearly all 2-4 years of age
Resolves by 5 years of age
[Behavior/BHS]
Breath-holding spells occur between __ months and __ months and resolves by ___ year of age
Between 6 months and 24 months
Resolves by 5 years of age
[Behavior/BHS]
Cyanotic vs pallid breath-holding spells?
- Several shrill cries then prolonged expiratory apnea
- Rapidly lose consciousness and become cyanotic
- Triggered by ‘upset’ events e.g) told no
Cyanotic breath-holding spells
[Behavior/BHS]
Cyanotic vs pallid breath-holding spells?
- Triggered by painful event
- Injury and stops breathing, loses consciousness, pale and hypotonic
Pallid breath-holding spells
[Behavior/BHS]
Condition associated with breath-holding spells? (1)
Iron deficiency anemia
[Behavior/Separation anxiety]
Separation anxiety becomes apparent around ___ months of age, prominent at ___ months of age, resolves by ___ years of age.
Can start at 6 months of age
Apparent around 9-18 months of age
Lessens by 3 years of age
[Behavior/School refusal]
Distinction between school refusal vs school refusal with truancy
School refusal: parents __
Truancy: parents __
(aware vs unaware)
School refusal: parents aware
Truancy: parents unaware
[Behavior/School refusal]
Definition of school absenteeism?
Missing > __% of school days in a year
Often accompanied by __ complaints
Missing > 15% of school days in a year
Often accompanied by somatic complaints
[BehaviorDisruptive]
Neurotransmitter changes in aggressive behaviors?
Decreased __ (3)
Increased __ (2)
Decreased serotonin, oxytocin, GABA
Increased dopamine, vasopressin
[Behavior/ODD]
Disorders associated with oppositional defiant disorders? (2)
ADHD
Learning disabilities
[Behavior/ODD]
Psychological treatment for oppositional defiant disorder? (4)
Psychotherapy
Skill training
Cognitive problem-solving training
Parent training
(Rarely medication)
[Behavior/Conduct]
Conduct disorder vs oppositional defiant disorder?
Conduct disorder with __
Oppositional defiant disorder without __
Conduct disorder with antisocial activities (lying, stealing, physical aggression, sexual assault)
Oppositional defiant disorder without antisocial activities
[Behavior/ASD]
Medication for autism spectrum and age limit (2)?
- Risperidone (Risperdal) ≥ 5 years of age
- Aripiprazole (Abilify) ≥ 6 years of age
[Behavior/Tourette]
Tourette syndrome onset is around ___ years of age, peaks at ____ years of age, and gradually decreases.
Onset around 7 years of age
Severe between 10-12 years of age
[Behavior/Tourette]
DSM-5 criteria for Tourette disorder? (5)
- Tic types
- Duration
- Onset
Multiple motor and vocal tics
Persistent for at least 1 year
No tic free interval for > 3 months
Onset prior to 18 years of age
No underlying medical cause
[Behavior/Tourette]
Disorders associated with Tourette syndrome? (3)
Attention Deficit Hyperactivity ADHD
Oppositional Defiant ODD
Obsessive Compulsive OCD
[Behavior/Tic]
Management for tic disorder?
Behavioral therapy: __
If severely impairing functions: __
Impulse control: __
Tourette and OCD: __
Behavioral therapy: Cognitive behavioral interventions
If severely impairing functions, fluphenazine, pimozide, tetrabenazine
Impulse control: Guanfacine or clonidine
Tourette and OCD: Fluoxetine
[Behavior/Tic]
Name of disorder?
Tourette syndrome like symptoms but < 12 months
Provisional tic disorder
[Behavior/ASD/Drug]
Side effects of Risperidone? (4)
- Increased appetite, weight gain, constipation
- Hyperprolactinemia, resultant galactorrhea
- Liver function abnormalities, insulin resistance
- Somnolence, fatigue, drooling, tremor, dystonia, akathisia
[Behavior/Antipsychotic]
FDA approved 2nd generation antipsychotic drugs for children? (3)
Aripiprazole (abilify)
Risperidone (Risperdal)
Paliperidone (Invega)
[Behavior/Antipsychotic]
Side effects of aripiprazole? (4)
Weight gain
Hypercholesterolemia
Prolactin elevation
QTc prolongation
[Behavior/Depression]
PHQ9 scores, severity, its management
Normal: __
Mild: __
Moderate: __
Moderately severe: __
Severe: __
0-4 normal
5-9 mild: watchful waiting and follow up
10-14 moderate: Review treatment plan
15-19 moderately severe: adjust therapy or consider pharmacotherapy
20-27 severe: focused assessment of safety plan, if emergent, referral for higher level of care
[Behavior/Depression]
Diagnostic criteria of depression? (3)
SIG E CAPS
≥ 5 symptoms,
≥ 2 consecutive weeks with a change of function
At least 1 of depressed mood or lack of interest
Sleep changes
Interest loss
Guilt or feelings of worthlessness
Energy deficit
Concentration problems
Appetite changes
Psychomotor restriction
Suicidality
[Behavior/Depression]
Persistent depressive disorder distinction between major depressive disorder?
Not meeting major depressive disorder criteria,
Chronically depressed mood for most of each day > 1 year
[Behavior/Depression]
FDA approved SSRI for depression in children (2)?
Fluoxetine (Prozac) ≥ 8 years of age
Escitalopram (Lexapro) ≥ 12 years of age
[Behavior/Bipolar]
Bipolar type 1 and 2 distinction?
Bipolar 1: classic manic-depressive
Bipolar 2: depressive without classic manic (hypomania)
[Behavior/Bipolar]
Treatment options for bipolar in children? (3)
- Risperidone (Risperdal)
- Quetiapine (Seroquel)
- Lithium
[Behavior/Anxiety]
Treatment options for anxiety disorder? (2)
Cognitive behavioral therapy
SSRI for severe or non-responsive to CBT
[Behavior/PTSD]
Treatment options for PTSD in children?
Trauma-focused psychotherapy (>6 years of age)
Child-parent psychotherapy (≤ 6 years of age)
[Behavior/OCD]
Treatment options for OCD in children (3)?
Expressive and supportive psychotherapy
Behavioral therapy
And/or SSRI (flouxetine, sertraline)
[Behavior/ADHD]
Side effects for Stimulant medication for ADHD? (4)
Appetite suppression, Insomnia
Headache, abdominal pain
Hypertension, increased heart rate
Potential exacerbation of tic disorder
[Behavior/ADHD]
Other medical treatment options for ADHD other than methylphenidate (3)?
Atomoxetine (Strattera) for not tolerating stimulant
Guanfacine (Intuniv) for aggressive or hyperaroused behavior
Clonidine (Kapvay) for aggressive or hyperaroused behavior
[Behavior/ADHD]
Side effect of clonidine? (3)
Sedation
Bradycardia
Hypotension
[Substance/Basic]
Urinary toxicology positive time frame?
Majority last ___ hours
Phencyclidine (PCP, angel dust) detected up to ____ days
Chronic marijuana user up to ___ weeks
Majority last 24 - 72 hours
PCP detected up to 8-14 days
Chronic marijuana user up to 4-6 weeks
[Substance/cannabinoid]
Treatment options for cannabinoid hyperemesis syndrome (3)?
Hot showers
Antiemetics, IV fluid
Benzodiazepines
[Substance/Psychoactive]
Psychoactive drugs
____ and ____ often used in date rapes, causes retrograde amnesia
GHB (gamma-hydroxybutyrate, G, Liquid X)
Flunitrazepam (Rohypnol, Roofies, Roach)
[Substance/Psychoactive]
Which substance abuse/intoxication?
Often used in parties
Hyperthermia, rhabdomyolysis, electrolytes imbalance
NMDA
[Substance/Psychoactive]
Which substance abuse/intoxication?
Tachycardia, dysrhythmias, ventricular irritability, hypertension
Hyperpyrexia, Seizures
Tooth decay
Methamphetamine
[Substance]
Which chronic substance abuse?
Perioral/perinasal rashes
Nosebleeds
Chronic lower respiratory symptoms
Inhalants
[Substance/Inhalant]
Which substance acute intoxication?
Euphoria, hallucinations,
Hypotension, cutaneous flushing followed by vasoconstriction, Tachycardia
Dizziness, nystagmus, excessive salivation
EKG: ST depression and inverted T waves
Inhalants
[Substance/Inhalant]
Which inhalation result in methemoglobinemia
Amyl nitrate (popper)
[Substance/intoxication]
Which substance intoxication?
Hallucinations, hypertension, tachycardia, dizziness, nausea, vomiting, diarrhea
Hallucinogens: LSD (lysergic acid diethylamide) mescaline, psilocybin (magic mushroom),
[Substance/intoxication]
Which intoxication?
Over the counter cough syrup
Euphoria, hallucination, mydriasis, diaphoresis
Dextromethorphan
[Substance/intoxication]
Which substance intoxication?
Euphoria, increased appetite, anxiety, paranoia
Conjunctival injection, dry moith, tachycardia
Marijuana
[Substance/withdrawal]
Which substance withdrawal?
Anxiety, irritability, decreased appetite, insomnia, depression, somatic pain (abdominal pain)
Cannabis withdrawal
[Substance/Basic]
Neonatal urine toxicology test detects up to ___
Neonatal meconium test detects around ___ time
Urine hours to days
Meconium 2nd and 3rd trimester
[Substance/Basic]
False positive drug test with ibuprofen use < 24 hr (3)
PCP
Cannabis
Barbiturates or Benzodiazepines
[Substance/Basic]
False positive drug test with proton pump inhibitors use (1)
Cannabis
[Behavioral/antipsychotics]
Which stimulant medication potential side effects of suicidal ideation?
Atomoxetine
[Behavior/ASD]
M-CHAT-R score and management?
Normal: 0-2
2nd stage question: 3-7
Immediate referral: >8 (total 20)
