Behavioral and Substance use Flashcards by juhee lee

[Behavior/Sleep]

Nightmares occur during ___ sleep
Nght terrors occur during ___ sleep
(REM/non-REM sleep)

Nightmares REM sleep
Night terrors non-REM sleep

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[Behavior/Sleep]

Common Age group for sleep walking?

Between 4 and 8 years of age

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[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

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[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

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[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

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[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

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[Behavior/BHS]

Condition associated with breath-holding spells? (1)

Iron deficiency anemia

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[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

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[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

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[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

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[BehaviorDisruptive]

Neurotransmitter changes in aggressive behaviors?

Decreased __ (3)
Increased __ (2)

Decreased serotonin, oxytocin, GABA
Increased dopamine, vasopressin

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[Behavior/ODD]

Disorders associated with oppositional defiant disorders? (2)

ADHD
Learning disabilities

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[Behavior/ODD]

Psychological treatment for oppositional defiant disorder? (4)

Psychotherapy
Skill training
Cognitive problem-solving training
Parent training
(Rarely medication)

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[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

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[Behavior/ASD]

Medication for autism spectrum and age limit (2)?

Risperidone (Risperdal) ≥ 5 years of age
Aripiprazole (Abilify) ≥ 6 years of age

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[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

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[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

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[Behavior/Tourette]

Disorders associated with Tourette syndrome? (3)

Attention Deficit Hyperactivity ADHD
Oppositional Defiant ODD
Obsessive Compulsive OCD

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[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

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[Behavior/Tic]

Name of disorder?

Tourette syndrome like symptoms but < 12 months

Provisional tic disorder

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[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)

1. Risperidone (Risperdal) 2. Quetiapine (Seroquel) 3. 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)