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Child & Adolescent Psychiatry Review > CAP2 > Flashcards

CAP2 Flashcards

1
Q

What are some of the psychological characteristics of patients with anorexai nervosa?

A

Inreased sense of responsibility, obsessional, interpersonal insecurity, minimization of emotional expression, perfectionism, identify confusion, excessive conformity and guilt, rigid control over impulses, low self-esteem, industriousness, competitive, envious

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2
Q

What is the lifetime prevalence of anorexia nervosa?

A

0.1 to 0.7%

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3
Q

What is the general range of onset of anorexia nervosa and what are the bimodal peaks of onset?

A

8 to 30 years of age with peaks at 13 to 14 and 17 to 18

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4
Q

How can families of patients with anorexia nervosa present, according to one set of ideas?

A

Happy, conflict free exterior masking feelings of distrust, lack of intimacy between parents, enmeshment, overprotection, rigidity, and lack of conflict resolution. Over nurturance undermines separation and neglecting behaviors undermine attempts at self expression

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5
Q

What is the mortality rate of anorexia nervosa?

A

0.56% per year, 12 times the general female population. In one study over 10 years, 5 patients of 76 died, or 6%; none by suicide. (The data did not include males.)

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6
Q

What factors predict death in anorexia nervosa?

A

Low albumin, low weight at intake, poor social function, binging and purging type, drugs and alcohol use, and mood disorder

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7
Q

What is key in recovery for anorexia?

A

Therapeutic relationship with professional and positive relationship with family and friends. Individuals relate honestly to the the patient with anorexia; the patient expresses feelings and develops trust

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8
Q

What percentage of women have an eating disorder?

A

3%

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9
Q

Leptin levels are highest in which group, healthy controls, bulimia nervosa, or anorexia nervosa?

A

HC > BN > AN

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10
Q

What peptides are associated with eating disorders?

A

Neuropeptide Y and YY, which are increased in bulimia nervosa

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11
Q

Which chronic medical illness leads to the risk of developing bulimia nervosa?

A

Insulin dependent diabetes (IDDM)

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12
Q

What supplements should be given to prevent osteoporosis in anorexia nervosa?

A

Calcium, phosphorous, and vitamin D

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13
Q

Are SSRIs effective in bulimia nervosa?

A

SSRIs appear to be effective even without depression

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14
Q

What is the crude mortality rate of bulimia nervosa?

A

5% (efffected by mood disorders, drugs and alcohol)

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15
Q

A child with ADHD who is among the brightest in the class is likely to produce little work, true or false?

A

TRUE

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16
Q

Is the Continous Performance Test (CPT) sensitive to drug and dose effect in ADHD?

A

Yes

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17
Q

How is impulsivity defined?

A

Acting without thought of consequences. Unaware of the relationship between cause and effect

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18
Q

What are the four basic categories of conduct disorder?

A

1) Aggression 2) Destruction 3) Deceitfulness 4) Serious violation of rules

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19
Q

What is a useful way of subtyping aggression?

A

Instrumental (purposeful), impulsive, affective

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20
Q

Higher IQ in conduct disorder is associated with what traits?

A

Callousness

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21
Q

How are females thought to more likely to show aggression?

A

Verbal and relational aggression; alienation; and character defamation.

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22
Q

The ability of deviant peer affiliation to predict delinquent outcome is related to what?

A

Amount of parental supervision

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23
Q

What has been found about the reporting of symptoms in their children by mothers with depression?

A

They report higher numbers of symptoms in their children.

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24
Q

What core features of ADHD have remained in present over time in the DSM?

A

Motor hyperactivity, inattention in school, and impulsivity with regard to rule governed behavior

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25
Q

What happens to hyperactivity over time in ADHD?

A

It remits or attenuates. Inattention persists.

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26
Q

What is the prevalence of conduct disorder?

A

1 to 16%

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27
Q

What is the prevalence of ODD?

A

2 to 16%

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28
Q

How is IQ related to conduct disorder?

A

Inversely

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29
Q

Prenatal tobacco exposure is associated with conduct disorder, true or false?

A

TRUE

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30
Q

What three treatment modalities have been found to be helpful for conduct disorder?

A
  1. Functional Family Therapy 2. Multisystemic Therapy (MST)  3. Parent Management Training (PMT)
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31
Q

What has controlled data shown for clonidine in children with ADHD and ODD or CD?

A

Potential efficacy for aggression

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32
Q

Where has propranolol demonstrated effectiveness?

A

Children and adolescents with chronic brain dysfunction and aggression or conduct disorder refractory to other medications

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33
Q

What is the outcome of conduct disorder?

A

Mild –> improve; severe –> chronic. Aggression in CD: 1/2 had CD at 2 yr follow up. Persistence is a/w antisocial behavior, fire setting, aggression, early onset, family deviance, inattention

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34
Q

What is the most consistently found factor associated with poor outcome in conduct disorder?

A

Early age of onset

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35
Q

What did Werner’s long-term study in Hawaii show about psychosocial circumstances regarding males who develop criminal records?

A
  1. A younger sibling born less than two years after the subject 2. Raised by an unmarried mother 3. No father present during early infancy and childhood 4. Prolonged disruption in family life 5. Having a working mother without suitable caregivers
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36
Q

What did Werner’s long-term study in Hawaii show about high risk, resilient children who did not develop serious behavior disorders?

A

First born child with higher IQ from smaller families with low family discord

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37
Q

Is chumminess protective or not in high risk children?

A

Yes if a child associates with a non-aggressive friend, and no if the friend is aggressive

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38
Q

What percent of arrested juveniles have drugs or alcohol in their blood stream?

A

40 to 60%

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39
Q

What distinguishes pattern of worry in GAD vs. healthy controls?

A

GAD subjects have on average 6 specific worries; HCs average 1. Those with GAD have a higher frequency of the main worry, stronger interference of the main worry, and increased difficulty controlling the worry

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40
Q

What percentage of children with GAD have GAD alone?

A

13%. Most have comorbid depression (62%) or separation anxiety disorder (42%; not present in adolescents usually). Outcome not impacted by comorbidity so much

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41
Q

The Great Smoky Mountains study showed what 3 month prevalence of SAD and GAD?

A

SAD about 3.5% and GAD 2%

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42
Q

What kind of attachment pattern is a risk factor for a child with anxiety disorder?

A

Insecure attachment

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43
Q

For anxiety based school refusal, what percentage of parents have a history of psychiatric illness?

A

81%, mostly anxiety and depression

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44
Q

What life experiences do children with GAD attribute their main worry to?

A

55% report a conditioning experience (e.g. death of grandparent); 33% information pathway (e.g. evening news); 13% modeling experience (e.g. see another worry). None of these are critical to developing GAD

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45
Q

What has been found to be a variable for separation anxiety disorder or separation experiences in children ages 3, 11, and 18

A

The variable most important at age 11 was mother’s fear of going out alone

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46
Q

When should an SSRI be stopped after succes in children?

A

After one year, during a period of low stress (Pine 2002)

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47
Q

Which is more effective, group CBT or individual CBT for children with anxiety?

A

They are equal

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48
Q

Is a family component for CBT in anxious children useful?

A

According to one study, yes at 12 month follow-up, no at 6 year follow-up. It may be most useful to have a family component if the parent is anxious

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49
Q

What is ironic about children with ADHD in physical education?

A

They have trouble modulating their behavior upward

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50
Q

Reading disorder accounts for what percentage of kids with learning disorders

A

80%

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51
Q

What percentage of children seen in psychiatric settings have a language disorder too subtle to be detected without special evaluation?

A

66%

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52
Q

What author clarified the role of physical abuse as an etiology for delinquent behavior?

A

Kempe

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53
Q

What does the assassination of JFK have to do with child psychiatry?

A

Oswald was mentally ill as a child but was never treated. In 1965 the Joint Commission on MH of children was created to study the origins and causes of mental illness in children and adolescents

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54
Q

A 1 month old infant can rembember a mobile for how long?

A

24 hours. By 5 to 6 months of age infants can remember objects seen only a few minutes

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55
Q

What seems to be the upper limit for becoming securely attached after severe deprivation/neglect?

A

24 months

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56
Q

What can centuries of oppression lead to in style of relating?

A

Passive or passive aggressive styles of relating

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57
Q

When did private, employer sponsored health insurance start?

A

1929 Baylor Texas; 1500 teachers; Blue Cross paid hospital costs. Later Blue Shield paid for professional fees. In 1954 the federal government allowed to give health insurance benefits tax free

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58
Q

What are two pictorial assessment methods?

A

1) Dominic R 2) Pictorial Assessment for Children and Adolescents

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59
Q

What does the Beck Hopelessness Scale (BHS) do?

A

Studied in adults but used in teens. Discriminates SI from non-SI adolescents and predicts SAs independent of depression. The HSC (Hopelessness Scale for Children) is a downward extension of the BHS.

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60
Q

What are examples of behaviors that show visuomotor integration

A

Copying a figure or hitting a baseball

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61
Q

What urine finding may be useful in patients with bulimia?

A

Increased ratio of sodium to chloride may predict bulemic behavior

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62
Q

What percentage of parents of children with schizophrenia will have schizophrenia?

A

10%

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63
Q

Is IQ increased or decreased in patients with schizophrenia?

A

Decreased by virtue of not making gains

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64
Q

What is a side effect of phenobarbital in children?

A

Hyperactivity

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65
Q

What are behavioral-emotional findings in temporal lobe seizures?

A

Depeened emotions. Changes in sexual function. Aggression. Intensified religion/philosophy. Circumstantiality. Interpersonal viscosity.

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66
Q

Do anti-epileptic drugs effect cognition?

A

The better data suggests no (Mandelbaum and Burack 1997, 12 month prospective study of 43 children; Aldencampl 1998; Bates 1998). Others say decreased attention, concentration, memory, motor and mental speed, and mental processing.

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67
Q

When treating a child with schizophrenia, when should one try to reduce the antipsychotic dose?

A

After one year

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68
Q

What is the data on the effectiveness of clozapine for childhood onset schizophrenia?

A

More effective than haloperidol and other older agents. But 1/2 discontinue because of seizures, hematologic abnormalities, or treatment non-response over time (Kumra 1996)

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69
Q

Is projective testing useful in schizophrenia?

A

Yes and no. A good clinical exam can determine the presence of psychosis and projective testing for diagnosis is not necessary. However, projective testing is useful to determine the severity of the thought disorder

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70
Q

What is the definition of failure to thrive?

A

Marked deceleration in weight and slowing of acquisition of emotional and social developmental milestones. A/w with deceleration in linear and head circumference measures. Malnutrition.

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71
Q

What is benign nutritional dwarfing?

A

Maladaptive eating pattern in children or adolescents without elicited psychiatric or medical problems with a slowing of weight gain for at least a year followed by deceleration of linear growth

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72
Q

In Tourette’s disorder which comes first, phonic or motor tics?

A

Motor tics precede phonic tics by one to two years

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73
Q

What is the adult outcome of seizure disorders?

A

Psychologically intact (if seizure disorder does not remain chronic)

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74
Q

What is psychosocial dwarfism?

A

Deceleration of linear growth in the absence of weight gain deceleration. A/w parental psychopathology

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75
Q

How is intrauterine growth retardation (IUGR) defined?

A

Ht and wt both less than 10% for gestational age

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76
Q

In obesity, is leptin level increased or decreased?

A

Increased

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77
Q

What is the prevalence of PICA?

A

25-33% in children

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78
Q

What is the cutoff in conduct disorder for the childhood onset subtype?

A

10 years of age

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79
Q

On what chromosome is 2D6 located?

A

22

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80
Q

How many varieties of the 2D6 gene are there?

A

70

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81
Q

Patients with which condition are missing a copy of the catecholamine-O-methyltransferase (COMT) gene?

A

Patients with velocardiofacial syndrome. COMT is associated with 3 phenotypes, high activity, intermediate activity, and low activity; low activity is a/w psychosis. Also, those homozygous for the low activity alleles have an increased risk of alcoholism because they experience more euphoria

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82
Q

Besides an IQ of less than 70, what else is considered for a diagnosis of intellectual disability?

A

Adaptive behavior

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83
Q

Can learning disorders co-exist with an intellectual disability?

A

Yes

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84
Q

What percentage of infants have a major anamoly?

A

2 to 4% (60% a/w genetic or in-utero causes)

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85
Q

Are patients with intellectual disability more prone to depressive disorders?

A

Yes

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86
Q

What endocrine disorder should be considered in Down’s Syndrome?

A

Thyroid dysfunction

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87
Q

Anxiety and social avoidance are notable presentations in what genetic disorder?

A

Fragile X

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88
Q

Do children with autism who are overactive often become more active or hypoactive as adults?

A

Hypoactive

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89
Q

What percentage of children with autistic disorder have an IQ > 70?

A

20 to 30% (Several studies have shown that the lower IQ found in autism is not related to test taking motivation)

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90
Q

On the Wechsler Adult Intelligence Scale, what has generally been a/w with an autistic profile?

A

Verbal IQ is lower than performance IQ, with verbal comprehension lower than block design. In high functioning autism this is a more variable finding.

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91
Q

What percentage of patients with autism and intellectual disability have seizures?

A

33%

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92
Q

What are the most common areas of special skills in autism?

A

Musical, mechanical, mathematatical

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93
Q

What seems to be the most common seizure type in autism?

A

Partial

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94
Q

Rett’s disorder involves which mutation?

A

Methyl-CpG-binding protein 2 (MECP2); chromosome Xq28

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95
Q

What are feature’s described originally by Asperger in his observations?

A

Argumentative, condescending, verbally abusive, hit other kids, lash out, knock objects over, and interested in violence

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96
Q

What percentage of children with tuberous sclerosis have autism?

A

20-25% or more

97
Q

What is Landau-Klefner Syndrome?

A

Onset at 3 to 5 years with loss of language and seziures. Social interaction and non-verbal skills are preserved

98
Q

Which gender has a greater rate of seizures in autism?

A

females

99
Q

What percentage of siblings of a proband have autism?

A

2-7%

100
Q

What percentage of children with autism will have neurological abnormalities?

A

30 to 50%

101
Q

What percentage of those with autistic disorder will have increased serotonin levels?

A

33%

102
Q

What are birth factors associated with autism?

A

Mixed findings. Wing found 1/2 had a history of pre, peri, and post natal complications, such as anoxia at birth. Other studies have found no difference with controls. (Ghaziuddin 1995; Szatmari 1989)

103
Q

Do you have to be female to have Rett’s disorder?

A

No. It is not part of the criteria in DSM, and the latter is based on the International Rett Syndrome Association-CDC. It is overwhelmingly found in females.

104
Q

What percentage of those with Rett have the MECP2 mutation?

A

80%

105
Q

What are behaviors that distinguish autism from Rett’s disorder?

A

In autism, grossly stated, tendency to play with hard obects, dislike to be disturbed in activity, pleased when left alone, rejection of tenderness, hyperactivity, excessive attachment to objects, rotation of small objects, stereotyped play.

106
Q

What is the prevalence of Rett’s disorder?

A

1-4/20,000

107
Q

What percentile is the ht and wt in Rett’s disorder?

A

Less than 2.5%

108
Q

What is the outcome of Rett’s disorder?

A

Death by 40’s

109
Q

What percentage of children have a mathematics disorder?

A

1 to 6%; females > males

110
Q

What percentage of children have a disorder of written expression?

A

2 to 8%

111
Q

When there is a diagnosis of a learning disorder, when is it appropriate to use a nonverbal IQ test?

A

When reading is a concern. One can use the Leiter International Performance Scale

112
Q

What should one first verify when there is concern for a learning disorder, either by exam or medical records?

A

Vision and hearing

113
Q

What is the most common neurocognitive impairment in reading disorder?

A

Deficit in phonological processing

114
Q

For developmental coordination disorder, what history should be obtained?

A

Developmental motor milestones, including sucking, swallowing, crying, tracking, grasping, toiletting, feeding, dressing, drawing, and others. DCD can be diagnosed with intellectual disability

115
Q

What are Mahler’s stages of development?

A

Symbiosis 0-5 months; differentiation 5-10 months (stranger anxiety); practicing 10-15 months; rapprochement 18-24 months; object constancy (consolidation) 24-36 months

116
Q

In the Isle of Wright Study, what percentage of 9 to 11 year olds with an intellectual disability had other psychiatric illness?

A

30 to 42%

117
Q

When does babbling begin?

A

6 weeks

118
Q

When does a whole smile begin?

A

4 to 6 weeks

119
Q

What explains hand flapping?

A

Hand flapping is related to motor problems and is seen when children with motor problems become excited or overloaded.

120
Q

What do we know about leptin and neuropeptide Y in eating disorders?

A

Bulimia has an increase in leptin and neuropeptide Y. Anorexia has decreased levels of both

121
Q

Where is the serotonin transporter gene located?

A

Long arm of 17q12 (There are 2 polymorphisms, the long and short forms of the gene)

122
Q

What are two neuropsychological theories of autism?

A
  1. Cortical dysfunction with disorder of hemispheric lateralization. 2. Brainstem dysfunction
123
Q

Who coined the term shaken baby syndrome?

A

John Caffey

124
Q

What is the prognosis of shaken baby syndrome?

A

1/3 are fine, 1/3 with physical or mental disability, 1/3 die of their injuries

125
Q

Which atypical antipsychotic have some data for use in tics?

A

Risperidone, olanzapine, ziprasidone

126
Q

Parasomnias tend to occur how long after falling asleep?

A

90 to 120 minutes

127
Q

What can happen hormonally if non-REM stage 4 sleep is disturbed in young children?

A

Ostensibly, mild growth retardation because GH secretion usually occurs during NREM stage 4 sleep

128
Q

What is a theory for parasomnias?

A

Normally, REM after NREM stage 4 sleep may arouse a subject from deep sleep. In children with a parasomnia the mechanism that triggers the transition is immature or dysfunctional. As a result there is a failure to properly enter REM, and this leads to parasomnias (talk, walk, night terrors)

129
Q

Which gender is more likely to have a parasomnia?

A

Male

130
Q

What is the prevalence of narcolepsy?

A

0.04 to 0.07%. More common in HLA-DQB1*0602 and HLA-DR2. 85% of patients with narcolepsy are positive for these compared with up to 40% of the general population

131
Q

What is the mechanism of action of modafinil?

A

Activates orexin containing neurons

132
Q

What do sleep studies show about ADHD and sleep?

A

ADHD has no impact on the sleep-wake state organization

133
Q

What does a careful taking of a sleep history consist of?

A

Regularity of sleep habits, amount of sleep, disruption of sleep, behaviors a/w going to bed

134
Q

What is the mechanism of action of lamotrigine?

A

Inhibits sodium and glutamate channels

135
Q

Which SSRI has serotonin and dopamine inhibition?

A

Sertraline has weak dopamine inhibition

136
Q

Describe the mesocortical pathway

A

Ventral tegmental area to the Cortex (limbic). Cell bodies are located in the ventral tegmental area of brainstem and project to the cerebral cortex, especially the limbic cortex. Negative symptoms are a/w deficit in dopamine especially in the DPFC

137
Q

Theoretically what should a 5HT1D antagonist do?

A

Rapidly disinhibit serotonin release

138
Q

What is a serotonin-dopamine hypothesis of OCD?

A

There is decreased tonic inhibition of dopamine by 5HT resulting in increased dopamine function.

139
Q

Why do zaleplon and zolpidem have fewer cognitive, motor, and memory side effects than benzodiazepines do?

A

These agents act selectivley at omega 1 and not omega 2; the latter are concentrated in brain areas that affect those functions

140
Q

What is the mechanism of action of benzodiazepines?

A

They allosterically modulate GABA resulting in increased conductance of chloride through the channel

141
Q

What is pindolol?

A

A beta blocker and an antagonist and very partial agonist at 5HT1A receptors. Midbrain raphe 5-HT(1A) autoreceptors control the activity of ascending 5-HT-mediated pathways

142
Q

What is congenital adrenal hyperplasia?

A

An autorecessive disorder that results in increased adrenal steroid biosynthesis resulting in masculinization of external genitalia

143
Q

What can be prescribed to facilitate presenting as the opposite sex?

A

Depot leuprolide or depot triptorelin (puberty blocking luteinizing hormone releasing agonists). Both males and females do not develop secondary sex charecteristics.

144
Q

What happens to bleeding time in hemophilia with emotional arousal?

A

It increases

145
Q

Cancer increases which interleukin that is a/w depression?

A

Interleukin 6 (IL-6)

146
Q

Which families demonstrate better glycemic control in preadolescents with diabetes? Those with warmth and support or those that are restrictive

A

Warmth and support.

147
Q

In a child who is chronically ill, what is important regarding psychological symptoms and their history?

A

The chronology between physical symptoms and emotional, stressful periods

148
Q

What is the best intervention to modify the psychosomatic component of an illness?

A

Education about the illness

149
Q

What is the lifetime prevalence of OCD in adolescence?

A

3%

150
Q

What are 5 clinical characteristics of PANDAS?

A

Tic disorder or OCD or both. Prepubertal onset. Dramatic onset and acute exacerbation with episodic course of symptom severity. GABHS. Neurologic abnormalities

151
Q

What is Syndenham’s chorea?

A

Autoimmune response to in the basal ganglia caused by misdirected antibodies from a streptococcal infection. OCD symptoms can be present

152
Q

What is the prognosis of OCD in pediatric patients?

A

Berg 1989 followed 16 adolescents: 31% still had OCD at 2 years; 25% had subclinical symptoms. Another study found that 50% of pediatric OCD patients were symptomatic as adults. In 54 patients, 80% improved c/w baseline, 43% met diagnostic criteria

153
Q

Adolescents with social phobia are at increased risk for what in particular?

A

Alcohol abuse

154
Q

After 6 years old, enuresis is more common in which gender?

A

Males. From the age of 4 to 6 years of age it is equal in males and females

155
Q

What is the treatment for encopresis?

A

Laxatives or enema; diet high in fiber and H2O; use of gastro-ilieal reflex by sitting for 10 minutes, 20 minutes after a meal; reinforce with tangible rewards; expectation for cleaning soiled clothes

156
Q

What are the two subtypes of encopresis?

A

With or without constipation and overflow incontinence

157
Q

Secondary encopresis (encopresis starting after a year of continence) accounts for what percentage of encopresis?

A

50 to 60%

158
Q

What are characteristics of histrionic personality disorder in a child?

A

Outgoing, engaging, charming, but soon perceived as irritating, intrusive, selfish, impulsive. Craves attention, hyperemotional, in superficial way. Capricious. Loses friends as quickly as gained.

159
Q

What are characteristics of borderline personality disorder in a child?

A

Relates to mother or father to the exclusion of the other parent; no empathy for others; other children as props; cannot tolerate separation from mother; inability to express a wide range of modulated feelings; not able to maintain a sense of sex and role identity; does not enjoy peer interaction or increased independence from parent; no emancipation from the family; AVH if do not express aggression (because cannot contain affect)

160
Q

Can a personality disorder be diagnosed in children?

A

Yes. It is discouraged because other disorders, such as depression, can lead to behaviors suggestive of a personality disorder, and because aspects of developmental norms can appear PD-like, especially under stress; but nonetheless some children are best captured by a PD diagnosis and are better served with an accurate diagnosis around which to organize care.

161
Q

Homicide, suicide, and injuries account for 80% of adolescent deaths. What percent of these are associated with alcohol?

A

50%. (Therefore 40% of deaths in teens are a/w alcohol)

162
Q

What prevention programs for drug and alcohol use are most successful?

A

Those that enhance social skills and drug refusal skills; those programs with an informational or affective component have little effect

163
Q

What is a poor prognosis for encopresis?

A

Non-chalant attitude; soil at night; conduct problems; soil as aggression

164
Q

What percentage of youths in high school have reported a lifetime use of inhalants?

A

Nationwide, 6.2% of students had sniffed glue, breathed the contents of aerosol spray cans, or inhaled any paints or sprays to get high one or more times during their life

165
Q

Who first showed immune reactivity could be conditioned?

A

Ader 1974. Rats were given cyclophosphamide and saccharine solution –> when just given saccharine solution –> led to immune suppression

166
Q

What is the age of onset of Tourette’s disorder?

A

5 to 8 years of age

167
Q

Children with separation anxiety disorder have an increased risk of what?

A

Panic disorder

168
Q

What percent of probands have a first degree relative with OCD?

A

30%

169
Q

What recombination fraction indicates complete linkage?

A

0.0; 0.5 = independent assortment

170
Q

What is the monozygotic concordance rate for autism?

A

90%. Risk for non MZ siblings is 3 to 8%

171
Q

Cocaine can be measured as far back as the first trimester in an infant. How?

A

By hair or meconium samples

172
Q

What is rate of fetal alcohol syndrome in children of mother’s with alcoholism?

A

2.5 to 10%

173
Q

What are some findings for infants exposed to prenatal opiates?

A

Decreased birth weight and head circumference. Increased risk of sudden death. At the age of 1, more active, less attentive and decreased motor coordination

174
Q

What are the effects of prenatal THC exposure?

A

Tremor and increased startle response the first one to two weeks of life.

175
Q

What are the effects of prenatal cocaine exposure?

A

Increased arousal, inattention, reactivity to stress; effect on the developing mono-amine system. Increased risk of IUGR by 4. However, Bayley Scales are okay

176
Q

What can be features of mother-child interactions in substance using mothers?

A

Impoverished use of language; restriction of exploration (seen as ‘getting into things’); decreased response of mother to infant social bids

177
Q

What percent of widows are depressed after the death of a spouse?

A

16% at 1 year (42% immediately)

178
Q

What percent of children are born to unmarried mothers?

A

25%

179
Q

What percent of preschoolers are cared for by their father when mother is at work?

A

23%

180
Q

What percent of mothers who were abused abuse their own children?

A

20%

181
Q

What is failure to thrive (FTT)?

A

Wt and Ht less than 5% or deviation off growth curve over time > 2 major percentiles

182
Q

What has MRI shown in anorexia nervosa?

A

Enlarged lateral ventricles and cortical sulci a/w degree of weight loss

183
Q

By adulthood what percent of those with Tourette’s have OCD?

A

40%

184
Q

Is ADHD genetic or environmental?

A

Some say two subtypes

185
Q

What are anatomic findings of the brain in ADHD?

A

Loss of assymetry of the caudate and changes in the corpus callosum

186
Q

Paterson (1982) found what two symptom clusters in conduct disorder?

A

Problem of aggression and problem of theft

187
Q

Wolf (1971) found what two symptom clusters for conduct disorder?

A

The aggressive-overactive and the antisocial

188
Q

In a longitudinal study by Cloninger what traits were risk factors for juvenile delinquency?

A

High impulsivity, low anxiety, and low reward dependence (Definition: individuals high in reward dependence are tender-hearted, sensitive, socially dependent, and sociable; Individuals low in reward dependence are practical, tough-minded, cold, socially insensitive, irresolute, and indifferent if alone)

189
Q

What are family factors in conduct disorder?

A

A large family size with the child most at risk a middle child separated by several years from an older brother. Absence of bio-father is not mitigated by presence of stepfather or socio-economic class

190
Q

Family risk factors for juvenile violence are?

A

Parental criminality; physical discipline, poor supervision, low attachment; child maltreatment; parental conflict; large family size; family poverty

191
Q

What are the rates for fears, worries, and scary dreams in healthy kids?

A

76% have fears; 68% worries; 81% scary dreams

192
Q

What does the literature show about custody regarding boys and girls about whether they are with their mother or father?

A

Females fair less well with father custody. Boys are less well adjusted with mother custody but this is improved with father contact

193
Q

What communication difficulties are present in patients with schizophrenia?

A

Pragmatics, prosody, auditory processing and abstract language

194
Q

What percent of patients refractory to other antipsychotics are responsive to clozapine?

A

30%

195
Q

What percent of child and adolescent patients with bipolar disorder have anxiety?

A

Child 33%; Adolescent 12%

196
Q

What is the lifetime risk of major depressive disorder in children if parents have depression?

A

15 to 45%

197
Q

Do stressful life events influence depression in children?

A

Unclear. It appears remarriage of parent for male and death of parent for female does. Lewisohn found that death of parent or having less than 2 parents did not specifically correlate with MDD

198
Q

What are symptoms of toxoplasmosis?

A

Chorioretinitis, neurologic deficits at birth or later in infancy and childhood. 90% of children effected have an intellectual disability and 80% have seizures. It is acquired from the oocysts of cats or uncooked meat

199
Q

What are cytomegalo symptoms?

A

Jaundice, hepatosplenomegaly, anemia, neuro abnormalities. Most newborns however are asymptomatic; some can also have delayed sequelae such as school difficulties

200
Q

When is the greatest risk of maternal transmission of rubella during pregnancy

A

Majority first 12 weeks; then 13-14 weeks; then end of 2nd trimester. Results in deafness, cataracts, chorioretinitis, severe intellectual disability (25%), spasticity

201
Q

What happens to school achievement in HIV infected kids?

A

67% normal at 9.5 years. Have difficulties in visual spatial, time orientation, speech and language delays

202
Q

What predicts psychopathology after a traumatic brain injury?

A

Persistent neurologic abnormalities 2.5 years out is the biggest predictor. Other factors are pre-injury behavior, family adversity. Younger children suffer from more cognitive difficulties although age is not a factor in psychopathology. 

203
Q

What is the twin concordance rate for OCD?

A

80% MZ, 25% DZ

204
Q

For children who were exposed to heroin in utero, what percent are living with their bio mother?

A

12% are with bio M; 60% with family or friends; 25% adopted. At the age of 1 yo half live away from their bio mother

205
Q

In Werner’s study of children in Hawaii what infant temperaments were associated with resiliency?

A

Active, affectionate, cuddly, good natured, easy to deal with

206
Q

What are some classifications by Zeanah for attachment?

A

Disorder of non-attachment, secure base distortions, disrupted attachment disorder. Boris and Zeanah use the term “disorder of attachment” to indicate a situation in which a young child has no preferred adult caregiver. Such children may be indiscriminately sociable and approach all adults, whether familiar or not; alternatively, they may be emotionally withdrawn and fail to seek comfort from anyone. Boris and Zeanah also describe a condition they term “secure base distortion”. In this situation, the child has a preferred familiar caregiver, but the relationship is such that the child cannot use the adult for safety while gradually exploring the environment. Such children may endanger themselves, may cling to the adult, may be excessively compliant, or may show role reversals in which they care for or punish the adult. The third type of disorder discussed by Boris and Zeanah is termed “disrupted attachment”. This type of problem, which is not covered under other approaches to disordered attachment, results from an abrupt separation or loss of a familiar caregiver to whom attachment has developed. The young child’s reaction to such a loss is parallel to the grief reaction of an older person, with progressive changes from protest (crying and searching) to despair, sadness, and withdrawal from communication or play, and finally detachment from the original relationship and recovery of social and play activities.

207
Q

What percent of children will lose a parent to any death by age 15?

A

4% (7,000 to 12,000 kids lose a parent to suicide every year)

208
Q

After the death of a parent when do behavioral problems appear to show up?

A

Two years later; this is impacted by childcare. 37% of prepubertal children meet criteria for depression at 1 month

209
Q

In anorexia what is the reason for amenorrhea?

A

Hypothalamic hypogonadism

210
Q

What happens to FSH and LH in anorexia?

A

decreases to levels typical of puberty

211
Q

In anorexia, does amenorrhea cease with weight gain

A

+/-

212
Q

Exogenous administration of GnRH (gonadotropin releasing hormone) in anorexia does what to FSH and LH levels?

A

Increases them, indicating the pituitary is intact and the problem is at the level of the hypothalamus

213
Q

Describe the actions or phase of gonadotropin secretion in children and adolescents?

A

2 to 4 year olds, increased gonadotropin secretion; juvenile phase of quiet activity; adolescent phase of increased amplitude and duration of GnRH

214
Q

What cytokines are associated with psychosocial findings?

A

IL-1, IL-6, and TNF-alpha. Lead to social withdrawal, decreased energy, increased sleep, poor appetite. IL-6 specifically leads to decreased mood and appetite. Anxiety has been a/w with decreased IL-2 production; PTSD with decreased natural killer cells and T-lymphocytes

215
Q

What are characteristics of psychosocial dwarfism?

A

Growth failure and developmental delay with hyposecretion of growth hormone; delayed bone age without malnutrition; decreased basal secretion of GH; onset 2-3 years; parents have psychiatric disturbance; blunted GH response (to challengers); separation from mother leads to increased sensitivity of HPA axis

216
Q

Amygdala growth is greater in boys or girls?

A

Boys (there are more androgen receptors in the amygdala)

217
Q

Hippocampal growth is greater in boys or girls?

A

Girls (there are more estrogen receptors in the hippocampus)

218
Q

The peak differentiation of neurons and formation of synapses occurs at what age?

A

The second year postnatally (i.e. one to two)

219
Q

What is Wilson’s disease?

A

An error of copper metabolism. There is degeneration of the basal ganglia; liver cirrhosis; presents as hepatitis and/or dystonia and gait disturbance in mid childhood; other findings include intellectual changes, affective lability, anxiety, psychotic symptoms, tremor, dysarthria, ataxia, choreoathetosis. There is partial recovery with oral chelation agents

220
Q

When is the onset of multiple sclerosis and what is its etiology?

A

Most cases occur after puberty. The etiology is autoimmune

221
Q

What does the thalamus do?

A

It is the ‘Grand Central Station’ of the sensations. There is decreased verbal fluency with central lesions; decreased pattern recognition with right lesions

222
Q

What age defines precocious puberty?

A

Less than 8 years old

223
Q

What are the three classifications of precocious puberty?

A

Peripheral, central and combined. This leads to premature epiphyseal closure

224
Q

What is peripheral precocious puberty?

A

Excessive production of adrenal/gonadal steroids or exogenous ingestion

225
Q

What is central precocious puberty?

A

Premature activation of HPG axis by GnRH or gonadotropins

226
Q

Lesion of the paraventricular nucleus leads to what?

A

Hyperphagia and hypothalamic obesity

227
Q

Is the activity of the hypothalamic pituitary axis increased or decreased in anorexia nervosa?

A

Increased

228
Q

Is growth hormone increased or decreased in anorexia nervosa?

A

Increased

229
Q

What happens to T3 in anorexia nervosa?

A

Decreased but T4 and TSH are the same

230
Q

A larger number of depressed patients than healthy controls have increased antibodies to what?

A

The thyroid. Antimicrosomal and antithyroglobulin antibodies

231
Q

Is oxytocin increased or decreased in autism?

A

Oxytocin is decreased in autism (1/2 of typical controls)

232
Q

The hypothalamic and amygdala mediated responses in shy children are hyperactive or hypoactive?

A

Hyperactive

233
Q

What is the function of the basal ganglia?

A

Modulate motor and some autonomic function. Maintain attention, regulate motor, and information flows to and from the cortex

234
Q

The sexually dimorphic nuclei are involved in what?

A

Sexual orientation and gender identity. It is found in the pre-optic area of the hypothalamus. It is increased in men (decreased in transexual men)

235
Q

How does increased HPA activation damage the hippocampus?

A

Increased HPA leads to increased corticosteroids which indirectly damage neurons via NMDA. Loss of neurons leads to cognitive and memory impairments, stress and anxiety disorder

236
Q

Frontal lobe activation on the left leads to depression or happiness?

A

Happiness. Decreased activation of the left frontal lobe leads to depression

237
Q

Describe the synthetic pathway of serotonin?

A

Tryptophan–tryptophan hydroxylase–> 5HTP(phan) –L-aromatic decarboxylase –> 5HT (5-hydroxytryptamine) –MAO–> 5-HIAA 5-Hydroxyindoleacetic acid

238
Q

Describe the synthesis and catabolism of norepinephrine and dopamine?

A

Tyrosine + tyrosine hydroxylase–> DOPA + L-Aromatic AA decarboxylase–>Dopamine. Dopamine + Dopamine betahydroxylase–> Norepinephrine –> Epinephrine. Dopamine + MAO or COMT –> homovanillic acid Norepinephrine + MAO or COMT–> MHPG –> Vanillylmandelic acid

Child & Adolescent Psychiatry Review (6 decks)

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