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Child & Adolescent Psychiatry Review > CAP4 > Flashcards

CAP4 Flashcards

1
Q

Time out or other forms of isolation may be counterproductive for children with what behaviors?

A

Deviant behaviors

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2
Q

When did the first residential type setting for children emerge?

A

First orphanage in the U.S. was 1729; Program for intellectual disability 1848. The 1850s showed an increase in child care institutions and group foster homes

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3
Q

Baker found what about family contact for children ages 5 to 19 in residential settings?

A

1/3 had no contact with family over the year. 1/2 had 3 or fewer contacts over the year. Driving time and lower SES were a/w less contact.

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4
Q

Even in programs with good resourcdes for discharge planning, what percentage of adolescents are homeless within 5 years of discharge from a residential?

A

1/6 after 1 year, and 1/3 by 5 years. The risks are being in state custody before admission, history of physical abuse and history of drug or alcohol abuse

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5
Q

What is pseudomutuality?

A

A family’s intense need to be unified to the extent that differentiation of personalities is denied

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6
Q

What is pseudohostility?

A

Defensive interactional pattern to ward off intimacy

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7
Q

In family therapy what is projective identification?

A

Describes the projection of unresolved parental conflicts onto a child who assumes an identity based on a historically assigned role

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8
Q

What are the three phases of family therapy?

A
  1. Symptoms of the child are the focus 2. If the child’s symptoms are better, focus on the marital dysfunction or parental psychopathology 3. Higher goal of maturity, creativity. If one focuses prematurely on phase two, there is a bad outcome for the child and parents
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9
Q

In conduct disorder what are coercive family processes?

A

Parents lack management skills –> they are punitive and aggressive but withdraw in the face of strong opposition by the child

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10
Q

What is expressed emotion?

A

Index of family criticism and overinvolvement with the patient

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11
Q

In conduct disorder what are coercive family processes?

A

Parents lack management skills –> punitive and aggressive but withdraw in the face of strong opposition by child

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12
Q

What percentage of families have at least one number who abuses alcohol or drugs?

A

30%

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13
Q

What is a positive of day treatment rather than inpatient regarding staffing?

A

Only one shift = better continuity of care

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14
Q

Measured by successful reintegration into regular school settings, studies show day treatment is effective in what percentage of cases?

A

65-70%. The family plays a key role in post treatment outcome

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15
Q

What might be a focus of intervention with parents of children and adolescents with conduct disorder?

A

Assist in recognizing that neither side possesses sufficient leverage to win the situation, so that compromise can be formed

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16
Q

What is the annual incidence of Caregiver Fabricated Illness?

A

1/200,000 under 16 is estimate

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17
Q

In Caregiver Fabricated Illness, what is the time to onset of diagnosis?

A

15 months

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18
Q

What is the average age of child and adolescent sexual abuse?

A

females 10.4, males 8.6

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19
Q

What percent of child sex abuse victims have no short term symptoms?

A

21 to 35%. The rest can have PTSD, low self esteem, anxiety, fear, depression, SI, somatic complaints, aggression, running away, substance use

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20
Q

What is the most common presentation of Caregiver Fabricated Illness?

A

Bleeding then seizures

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21
Q

Infants as young as how many weeks respond differentially to voice and touch?

A

32 (hence parents can be involved with premature infants)

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22
Q

How do kids with cancer feel socially?

A

Prepubertal shyness, social anxiety. Adoescents social isolation

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23
Q

What percentage of renal transplants that fail in adolescents are due to non-compliance?

A

93% of lost transplants are attributable to non-compliance

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24
Q

What percent of persons are non-compliant with their post-transplant regimen if there is a psychiatric disorder in children and adolescents?

A

50%. 100% if a severe personality disorder is present

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25
Q

What are risk factors for non-adherence to immunosuppressive meds?

A

Females > males, adolescent, personality, no father, lack of community and social supports

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26
Q

What percent of 3 year olds play with their genitals or masturbate?

A

50% (Fitzpatrick 1995, Irish sample)

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27
Q

What is consequence of father absence on boys and girls

A

Worse on boys. Girls do better but have sex earlier and have more partners

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28
Q

What seems to be the concordance rate for homosexuality in monozygotic twins?

A

50%, 20% if DZ (Xq28 is implicated)

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29
Q

What age should one wait for if ambiguous genitalia is present to determine sex?

A

4 to 6 years (earlier if a preference is reliably expressed)

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30
Q

What is the first sign of approaching pubescence?

A

Adrenarche at 8 yo. Puberty 8-14 females, 9-14 males. It takes 3 to 4 years to complete.

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31
Q

Stuttering usually begins between what ages?

A

2 and 7 years of age, peaking at 3 and 4. 1/30 kids go through a period of stuttering by adolescence

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32
Q

Does body fat go up or down with age?

A

It increases with the first year of life then decreases until pre-puberty when it increases

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33
Q

What order of kinetics do most psychiatric drugs follow?

A

First order. The amount of drug eliminated is proportional to the amount circulating in the blood stream

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34
Q

Children starting fires account for how many deaths annually?

A

300

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35
Q

Describe fire behaviors

A

Fire interest is common in ages 3 to 5; fire starting in ages 5 to 9. Fires setting is pathologic if there are multiple fires over a 6 month period

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36
Q

What are zero order kinetics?

A

A fixed amount of drug is elminated regardless of plasma level

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37
Q

Criminal fire setting resulting in arrest and recidivism is related to what?

A

Alcohol dependence in males and self-injury and suicide attempts in females

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38
Q

What is the use of cyproheptadine in eating disorders?

A

24 mg/d improves weight and mood

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39
Q

What is the presence of enuresis?

A

10% at 7 years of age. (Risk increases by 7 if the father had it, and by 5 if the mother had it)

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40
Q

What are risk factors for secondary enuresis?

A

Late attainment of initial nocturnal continence and 4 or more stressful events

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41
Q

What does neuroimaging show in youth who are depressed?

A

Decreased ratio of frontal lobe volume to total cerebral volume and increased lateral ventricles to total volume

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42
Q

What is seen in children with depression?

A

Hyposecretion of growth hormone with insulin challenge and hypersecretion of growth hormone during sleep

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43
Q

What are some symptoms or behaviors of pre-school, school age, and adolescent children of depressed adults?

A
  1. Pre-school: perinatal complications, cognitive and emotional delays, inability to separate 2. School age: depression, hyperactivity, school problems, enuresis, rivalry with peers and siblings for attention 3. Adolescents: defiance, rebellion, withdrawal, conflicts with parents. The groups overall have three times the risk of a DSM diagnosis. Symptoms are worse if there is depression in the mother rather than the father
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44
Q

What is the comorbidity of depression in prepubertal children?

A

80% have one other diagnosis, mostly dysthymia (38%), anxiety (33%) and conduct disorder (7%). Another study found 75% anxiety, 50% ODD, 33% CD, 25% Etoh abuse, 25% drug abuse

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45
Q

What percentage of adults have bipolar disorder and what percentage of those recalled the onset between ages 5 and 9?

A

1% approximately; 0.5% of these recalled onset 5-9. 7.5% recalled onset from 10 to 14

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46
Q

What is the concordance rate for mania in monozygotic twins and dizygotic twins?

A

65% MZ, 14% DZ

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47
Q

When tends to be the onset of social anxiety in children?

A

11 to 12 years of age

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48
Q

Do boys or girls of pre-pubertal age more often have GAD?

A

Equal rates

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49
Q

Do adolescent boys or girls more often have GAD?

A

Girls

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50
Q

What is the prevalence of an anxiety disorder in children and adolescents?

A

5 to 18%

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51
Q

What is the prevalence of separation anxiety disorder?

A

3.5 to 5.5%

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52
Q

What is the prevalence of GAD in children and adolescents?

A

2.7 to 4.6%

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53
Q

What are neuroanatomic findings in ADHD?

A

Decreased size and activity of the frontal lobes, especially prefrontal area and corpus callosum and cerebellum. Decreased activitiy of the anterior cingulate. Decreased striatal area activity. Decreased size and activity of the globus pallidus and the caudate

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54
Q

What percentage of adolescents have panic attacks?

A

36 to 63%. 0.6 to 5% have panic disorder

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55
Q

What percengage of youth appear to receive the necessary treatment for the their anxiety disorder?

A

20%

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56
Q

What are neuroanatomic findings in OCD?

A

Ventricular enlargement, decreased mean volumes of the caudate nuclei bilaterally

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57
Q

What are positive-emission tomography (PET) findings for OCD?

A

Increased activity of caudate, especially on right; with treatment, this decreases

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58
Q

What percentage of OCD are secondary to PANDAS?

A

10 to 20% (Autoimmune reaction to basal ganglia; cross reaction of strep)

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59
Q

What percentage of children are physically abused based on documented injury?

A

0.50%

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60
Q

What Act by the U.S. government provided financial incentives to discourage foster care drift?

A

The Adoption and Safe Families Act of 1997

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61
Q

What is Michael Anderson’s theory on IQ

A

“Minimal Cognitive Architecture”. Individuals differ in data processing speed measured as inspection time, reaction time and average evoked potential, and this accounts for differences in IQ. Higher knowledge obtained through thinking is constrained by this ‘lower level’ of function, speed

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62
Q

What percentage of children with asthma have a psychiatric diagnosis?

A

42%, especially anxiety

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63
Q

What classification system in traumatic brain injury is used?

A

It is based on the Glasgow Coma Scale, duration of loss of consciousness (LOC) and post-traumatic amnesia (PTA); mild, mod, severe categories

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64
Q

What is considered a severe traumatic brain injury?

A

Glasgow Coma Scale < 9, loss of consciousness > 24 hours, post-traumatic amnesia > 1 day

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65
Q

What is considered a moderate traumatic brain injury?

A

Glasgow Coma Scale 9-12, loss of consciousness 1 to 24 hours, post-traumatic amnesia 30 minutes to 24 hours

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66
Q

What is considered a mild traumatic brain injury?

A

Glasgow Coma Scale 13-15, loss of consciousness < 30 min, post-traumatic amnesia < 1 hour

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67
Q

How many children a year have a traumatic brain injury?

A

90,000

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68
Q

What did a laboratory classroom study of Concerta show?

A

Concerta was effective for 12 hours with regard to social and task behaviors and academic performance (Pelhman 2001)

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69
Q

What did a one year study of Concerta show with regard to weight, height, blood pressure, pulse, and tics?

A

No effect

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70
Q

The rights of individuals with disabilities were established by Congress in what Act?

A

Civil Rights Act of 1973, Section 504

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71
Q

When a managed care company denies coverage for medical necessity what ethical duties does a physician have?

A
  1. Appeal 2. Discuss with patient; patient can pay out of pocket or appeal 3. Treat patient in an emergency without payment 4. Make alternate treatment plans
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72
Q

What kind of fee for court work is unethical?

A

Contingency

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73
Q

Children who are abused may preferentially set fire to what?

A

Beds or mattresses

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74
Q

When do suicidal gestures and self-injurious behaviors start to occur after initiation of an incestuous relationship?

A

In the months following

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75
Q

What is important to determine in the treatment of sexual abuse?

A

Perception and attribution for the abuse. Help the child reduce self-blame and attribute the responsibility for the abuse to the perpetrator

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76
Q

What are factors that increase likelihood of subsequent psychopathology in the case of sex abuse?

A

Violence, completed intercourse, negative response to disclosure

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77
Q

What number of fatalities yearly occur from maltreatment?

A

1,100

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78
Q

Who first described the ‘battered child syndrome’?

A

Kempe 1962

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79
Q

When were child protective services established?

A

1965 with mandatory reporting laws

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80
Q

What is a profile for a perpetrator of child sexual abuse?

A

May select victims of a similar age and appearance to when they were abused; passive and inadequate in most of life, so like the power and control with children; usually males select females; up to half of female perpetrators can be adolescent babysitters

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81
Q

List some major contributors to family therapy with children

A

Patterson (delinquency); Forehand and McMahon (delinquency); Alexander and Parsons; Zilbach; Scharff and Scharff

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82
Q

What are common fractures in abuse?

A

Less than 2 years of age, rib. Spiral fractures occur in 36% of abuse cases, but also 27% of accidents. Transverse fractures are common, too, but less investigated than spiral

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83
Q

What is the radiologic workup for physical abuse?

A
  1. Radiographic evaluation of possibly abused children < 2 years of age: dedicated skeletal survey, brain CT scan, other studies (e.g., upper GI), as the symptoms may warrant 2. Radiographic evaluation of possibly abused children > 2 years of age address specific symptoms; consider brain CT or MRI scan to evaluate for current or prior head trauma and sequelae
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84
Q

What is one risk of tricyclic antidepressants for enuresis?

A

Child may take whole bottle to stop the enuresis

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85
Q

What is the odds ratio of having a mental health problem if your parent was depressed?

A

In a 20 year follow-up of 101 offspring by Myrna Weissman the OR was 3, with mood 3.3, anxiety 2.9, phobia 4.0, substance use, 2.7, cardiovascular disease 5. Anxiety was present before puberty and depression after

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86
Q

Acute stimulation of 5HT2a in sleep centers does what?

A

Leads to insomnia (SSRI side effect)

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87
Q

Acute stimulation of 5HT2a in basal ganglia does what?

A

Akathisia and agitation (SSRI side effect)

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88
Q

The brainstem chemoreceptor trigger center can mediate vomiting via what receptors?

A

5HT3 (hence SSRI side effect of nausea)

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89
Q

Projection from the Raphe Nuclei to what area and what receptors may regulate appetite and eating?

A

Hypothalamus, 5HT3 receptors (SSRI side effect)

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90
Q

Projection from Raphe Nuclei to what area and what receptors may be involved in anxiety and panic?

A

Limbic area, 5HT2a and 5HT2c

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91
Q

Projections from Raphe Nuclei to what area and what receptors may help control movement and obessions and compulsions?

A

Basal ganglia, 5HT2a postsynaptic receptors

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92
Q

What presynaptic alpha receptor is located on the cell body of the serotonin neuron?

A

Alpha 1. Stimulation of norepinephrine and alpha 1 receptors leads to increased serotonin release

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93
Q

Serotonin receptors have what heteroreceptors that turn off serotonin release?

A

Alpha 2 (terminal location)

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94
Q

What percentage of maltreatment fatalities are of children less than 3 years of age?

A

75%. Less than a week old, by mother; 1 week to 13 years of age both mother and father; 13+ majority by father

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95
Q

What is the percentage distribution of abuse for neglect, physical abuse, and sexual abuse respectively?

A

60%, 20%, 10%

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96
Q

What did DeAngelis describe about children who are abused?

A

Fearful and docile, no expectation of comfort, wary of physical contact, on alert for danger, attempt to meet parents’ need by role reversal, afraid to go home

97
Q

What does Biederman say about treatment of pediatric mania and ADHD?

A

Treat the mania first (I think it depends)

98
Q

What are signs of neuroleptic malignant syndrome (NMS)?

A

Muscle rigidity, delirium, autonomic instability, creatine phosphokinase (CPK) elevation. Supportive treatment and can use dantrolene and bromocriptine

99
Q

What drug helps with antipsychotic induced hyperprolactinemia?

A

Cabergoline and aripiprazole

100
Q

What did Kolko (1992) find regarding outcome after inpatient stays for children?

A

At 2, 4, 6 month follow-up there was no difference in outcome as a function of the length of the stay or time from discharge. Overall, there were fewer symptoms on follow-up

101
Q

Approximately what percentage of youth with the most severe difficulties use 80 to 90% of available resources?

A

2 to 5%

102
Q

Which autism scales have been tested for their reliability and validity?

A

ABC, ADI-R, ADOS, PL-ADOS, ASQ (aut scr ques), ASDSQ, CHAT, CARS2

103
Q

What are three things to keep in mind to help protect against malpractice

A

Write with risk in mind, check notes for discrepancy, follow-up on diagnoses and investigations

104
Q

What treatment manuals are available for PMT?

A

Cavell 2000, Forehand and McMahon 1981, Forgatch and Patterson 1989, Patterson and Forgatch 1989, Sanders 1993, Kazdin 2008

105
Q

What is a PMT guide for parents?

A

Forehand and Long 1996

106
Q

What is an assessment measure for suicidal behavior in children, adolescents, and adults?

A

Columbia-Suicide Severity Rating Scale (C-SSRS)

107
Q

What are screening instruments for drugs and alcohol use?

A

POSIT (free, available online, Problem Oriented Screening Instrument for Teens–10 domains. TASI (Teen Addiction Severity Index–semi structured). Drug Use Screen Inventory, self report. Personal Experience Screen Questionnaire, self report

108
Q

Sexual abuse is found most commonly in what socioeconomic status?

A

Equally in all, whereas physical abuse and neglect tend to be in lower SES

109
Q

What are some potential characteristics in families with sex father-daughter abuse?

A

Social isolation, enmeshment, role confusion; rigid patriarchal structure and poor marital relationship; father +/- job history, sexually and emotionally rejected by spouse; father pursues daughter as alternative to spouse (and religiosity, ironically, or social inhibition may increase this risk as an extramarital affair is less likely)

110
Q

What percentage of women report retrospectively having been sexually abused?

A

18% (does not include intercourse only). Some studies show higher, from 27% for women and 16% for boys)

111
Q

What is the most common age range for sexual abuse victimization?

A

8 to 9 years old

112
Q

Before the 17th century the age of consent for sex was considered as low as what age?

A

12 (U.S.A)

113
Q

What should a child be told about any abuse they experienced?

A

It is not their fault and they are not to be blamed; also explore issues of betrayal, overexcitement, sense of personal responsibility; also, ambivalence over any arousal feelings

114
Q

What are treatment elements to selective mutism?

A

Contingency management, exposure-based techniques, self-modeling

115
Q

What percentage of 5 year olds have enuresis?

A

15%

116
Q

Is enuresis associated with a particular sleep stage?

A

No

117
Q

What is the remission rate with DDAVP for enuresis?

A

30%

118
Q

What percentage of chidlren with encopresis have anismus?

A

75% (lack of relaxation of the external sphincter). Uncertain if precedes or emerges after the encorpresis

119
Q

What percentage of high school seniors report having used marijuana in the previous year?

A

46%, 26% in the last month. 7% of 9th to 12th graders have tried at least once before age 13 (YRBSS 2017)

120
Q

What is the lifetime use of steroids for high school students?

A

3%

121
Q

What step of 12 step programs is not useful for teenagers?

A

Step 1, surrending to a higher power. This goes against the developmental stage adolescents are in

122
Q

What is autosynephilia?

A

Male’s propensity to be sexually aroused by the thought of himself as female. Transvestic adolesdcents with autosynephilia are those who most commonly request sex re-assignment surgery

123
Q

In adults transvestic fetishism involves what sexual orientation, homosexual or heterosexual?

A

heterosexual

124
Q

What percentage of males with gender dysphoria (who do not like their male gender) are sexually attracted to males?

A

50% are attracted to males, and 50% to females

125
Q

What is the risk of major depressive disorder in relatives of suicide victims?

A

Three times the rate for siblings, mothers, and friends

126
Q

How do tricyclic antidepressants cause cardiovascular problems and seizures?

A

They block sodium channels in the heart and brain leading to cardiac arrhythmias and arrest in overdose

127
Q

What are the dynamic issues involved in elopement or self-injurious behaviors in treatment settings?

A
  1. Fear of improvement that leads to discomfort 2. Lack of insight leading to non-compliance with treatment and discouragement 3. Ambivalence about attachment to or dependence on others 4. Fear that external control is lacking when opportunities for more independent function are offered 5. Projection of internal conflicts on the milieu 6. Perception that the milieu doe not allow for individual emotional growth
128
Q

What is a feeling often overlooked with adolescents in treatment?

A

Shame (as a result they may attack self, attack others, and show shame avoidance)

129
Q

Who wrote about shame?

A

Donald Nathanson

130
Q

How did tricyclic antidepressants come about?

A

They were first considered for schizophrenia, given their 3 ring structure which is similar to other agents with 3 ring structures meant for schizophrenia

131
Q

What is the tripartite model?

A

Id, ego, superego

132
Q

What is drive in psychodynamics?

A

Stimulus arising within an individual that arouses the mind and incites mental activity

133
Q

Is the rigidiity of the superego proportional to the parents’ severity?

A

No. More related to the intensity of aggressive wishes and relative weakness and immaturity of an individual’s ego and defenses

134
Q

What is a representation?

A

Enduring organization or schema constructed from a multitude of images, each derived from a multitude of experiential impressions

135
Q

What is ‘observing ego’

A

Self observation

136
Q

What is ‘objective’ countertransference?

A

Anyone would find the behavior provocative. The word ‘counterreaction’ has also been used here.

137
Q

Who said that there is no evidence that personal psychotherapy is not an important part of training?

A

Marks 1982

138
Q

In which Piagetian stage do children find it hard to have two feelings at once?

A

Pre-operational

139
Q

What is negative reinforcement?

A

The removal of an aversive stimulus after a positive behavior has occurred.

140
Q

What are examples of punishment?

A

Time out, response cost (e.g. agree upon reward–car use–upon completing desired behavior–coming in for curfew); overcorrection (e.g. deface poster, make money to replace it and do favor for the roommate)

141
Q

How should one proceed with dosing of tricyclic antidepressants?

A

EKG. 10 - 25 mg dose and increase by 20 to 30% every 4 to 5 days; at 3.0 mg/kg (1.5 mg/kg for nortriptyline) check EKG and at steady state levels. Typical dose range is 2 to 5 mg/ kg, half for nortriptyline

142
Q

Is methylphenidate psychosis similar to schizophrenia?

A

No, more of a toxic psychosis with visual hallucinations, etc.

143
Q

What is a manual based treatment of anxiety in autism spectrum disorders?

A

Manual-based cognitive-behavioral treatment program to target anxiety symptoms as well as social skill deficits in adolescents with ASD (Multimodal Anxiety and Social Skills Intervention: MASSI)

144
Q

What are the active enantiomers of methylphenidate

A

D-threo > L-threo

145
Q

In family treatment, Stierling proposed ‘binding, delegating, expulsion’. What are they?

A

Three ways to overcome fear of prolonged fusion. 1. Binding: forces suicidal or psychotic thinking for the child and adolescent to get out 2. Delegating: family lets child out on long leash to share vicariously in the exploits 3. Expulsion: a child is rejected to free from the unit

146
Q

What percentage of child patients never complete treatment to the satisfaction of therapists?

A

50%

147
Q

What do outcome studies of residential treatment centers show?

A

Depends more on ecologic and post discharge factors than the RTC itself. An RTC at times serves as a secure base.

148
Q

What receptors does ziprasidone effect?

A

Inhibits 5HT2c, 5HT1d, norepinephrine, and serotonin reuptake. Stimulates 5HT1a

149
Q

What placebo-controlled discontinuation trial showed nortriptyline to be effective for ADHD?

A

Prince et al. 1999. Useful for enuresis in the context of ADHD or if other agents are not effective for ADHD

150
Q

What circuit is involved in Tourette’s?

A

cortico-striato-thalamo-corical

151
Q

What are the two monoamine oxidase neurotransmitter subtypes and what neurotransmitters do they metabolize?

A

A and B, serotonin and norepinephrine

152
Q

What were the first anti-depressants?

A

MAOIs (anti-tubercular)

153
Q

What are two benzodiazepine substrates of P450 3A4?

A

Alprazolam and triazolam

154
Q

What are two SSRI inhibitors of P450 3A4?

A

fluoxetine, fluvoxamine

155
Q

Fluvoxamine inhibits what CYP?

A

1A2

156
Q

Which cytochrome does nicotine induce?

A

1A2

157
Q

Tricylics antidepressantss are substrates for what cytochrome?

A

2D6 (hydroxylates and therefore inactivates the TCA)

158
Q

Cytochrome 1A2 does what with certain Tricyclic antidepressants?

A

Demethylates them but does not inactivate them. Clomipramine–> desmethylclomipramine, imipramine–>desipramine

159
Q

What is the family, subtype, gene in cytochrome nomenclature?

A

E.g. 2D6: 2 = family, D = subtype, 6 = gene product

160
Q

What is the explanation for the development of tolerance to acute side effects of antidepressants?

A

Densisitization of postsynaptic receptors

161
Q

What is a candidate mechanism as the site of possible flaw in signal transduction from monoamine receptors?

A

The target gene for brain derived neurotrophic factor (BDNF)

162
Q

What does brain derived neurotrophic factor (BDNF) do?

A

Normally BDNF sustains the viability of brain neurons but under stress the gene for BDNF is repressed, leading to the atrophy and possible apoptosis of vulnerable neurons when their BDNF is cut off. Theory: anti-depressants cause genes for neurotrophic factors to be activated

163
Q

What is the monoamine theory of depression?

A

Pseudomonoamine deficiency due to a defiency in signal transduction from the monoamine neurotransmitter to its postsynaptic neuron in the presence of normal amounts of neurotransmitter and receptor (second messenger system could be a site of dysfunction)

164
Q

Acute stimulation of what receptors results in GI cramps and diarrhea?

A

5HT3 and 5HT4 in the gut

165
Q

Acute stimulation of what receptor leads to nausea of vomiting?

A

5HT3 in the brainstem vomit center

166
Q

Acute stimulation of what results in sexual dysfunction?

A

5HT2A in the spinal cord

167
Q

Explicit memory is mediated by what structures?

A

Medial temporal lobe and hippocampus and related structures that enable verbal representations

168
Q

Are traumatic memories processed like ordinary memories?

A

No. This results in failure to organize the traumatic event into coherent verbally represented narrative. There are repetitious and non-consecutive memory chunks

169
Q

What is the condom use of adolesents?

A

Those who had casual sex partners tended to use condoms more than those with just a main partner (47% versus 37%) but because they reported more sex, the mean number of unprotected sex acts was not significantly different (Lescano 2006)

170
Q

Is the risk of tardive dyskinesia (TD) and extrapyramidal symptoms (EPS) the same across conventional antipsychotics?

A

The risk for acute EPS varies but there is not difference in risk for TD

171
Q

What is a strength-based paradigm after exposure to trauma rather than posttraumatic stress?

A

Resilience

172
Q

What did Teicher et al. find regarding maltreatment and ‘limbic irritability’?

A

Verbal abuse is more detrimental than non-familial sex abuse; domestic and verbal abuse is = to familial sexual abuse (AJP 2006)

173
Q

In enuresis, who are those that are more likely to have urinary tract incontience?

A

Those with daytime wetting

174
Q

What is the success rate of the alarm clock method for enuresis?

A

77% if the alarm is set when the bladder may be reaching maximal capacity (alarm clock and not bell and pad method here)

175
Q

What is the success rate of the bell and pad method?

A

75%

176
Q

Are children with enuresis at increased risk of psychopathology?

A

No

177
Q

What findings are there in children with enuresis?

A

General developmental delays, lower functional bladder volume, lag in maturity for age (suggests maturational delay of CNS)

178
Q

Enuresis at night occurs in what stage of sleep?

A

Each stage, according to the proportion of time spent in that stage

179
Q

What is secondary enuresis?

A

Enuresis that occurs after first having maintained continence for one year

180
Q

What is the concordance rate for anorexia nervosa in monozygotic and dizygotic twins?

A

66% MZ, 0 % DZ,; according to Treasure and Holland 1989

181
Q

Does the data suggest that patients with an eating disorder have a higher rate of experiencing sexual abuse?

A

Not more than other clinic based populations

182
Q

What is the incidence and prevalence of anorexia nervosa?

A

8.1/100,000 per year and 0.28%. The prevalence for bulimia nervosa is 1%

183
Q

What is the male to female ratio of anorexia nervosa?

A

1 to 10-20

184
Q

Who first described cases of anorexia nervosa?

A

John Reynolds in 1669 and Richard Morton 1689

185
Q

Who first described and named bulimia nervosa?

A

Gerald Russell 1979. Descriptions of bulimia existed and it was thought to be a part of anorexia. Russell first described it as a separate disorder

186
Q

What are some observations in children who fireset?

A

Decreased achievement, conduct disordered behaviors, stressors, do not call for help after the fire is started

187
Q

What is process trauma?

A

Trauma related to secondary events of trauma (e.g. a disaster can be traumatic and then the move because it also disrupts life)

188
Q

Is the blood brain barrier permeable in children?

A

More permeable than adults

189
Q

1 in 200 white persons are slow metabolizers for what 2 CYPs together?

A

2D6 and 2C19.

190
Q

What percent of whites have a genetic deficiency of 2D6

A

7% to 10% of whites have a genetic deficiency of CYP 2D6 and are less efficient in metabolizing 2D6 substrates,

191
Q

How do lamotrigine and valproate interact?

A

VPA increases lamotrigine by inhibiting glucuronidation by which lamotrigine is metabolized alone

192
Q

Post-synaptic cells have which two types of receptors?

A

Fast acting class I (inotropic) receptors and slow acting classs II (g-protein coupled) receptors

193
Q

How is dopamine degraded?

A

Catechol-o-methyltransferase (COMT)

194
Q

What does glutamate potentiate?

A

Glutamate neurons and NMDA receptors are involved in long-term potentiation, a crucial component of memory

195
Q

What is psychic determinism?

A

The principle that nothing in the mind happens by chance or in a random way

196
Q

What important areas of the limbic system are associated with aggression?

A

Hypothalamus, septal area, amygdala

197
Q

Are the cerebral volumes of children who have been abused increased or decreased?

A

Decreased by 7% (De Bellis et al. 1999)

198
Q

What is the juvenile arrest rate for violent crimes per 1000 juveniles?

A

4

199
Q

Dementia can be diagnosed by what age?

A

4 to 6 years of age, after the IQ is stable

200
Q

Pain travels by what fibers?

A

Unmyelinated C, smaller and slower. Thinly myelinated A-delta, larger and faster

201
Q

What projection mediates the effect of norepinephrine on attention?

A

Locus coeruleus to prefrontal cortex

202
Q

What projection is thought to be responsible for norepinephrine’s regulation of mood?

A

Locus coeruleus to the fontal cortex

203
Q

Where are the presynaptic 5HT autoreceptors located?

A

5HT1a = somatodendritic autoreceptor (decreases neuron impulse flow). 5HT1D (axon terminal autoreceptor inhibits release)

204
Q

What are the key postsynaptic serotonin receptors?

A

5HT1a, 5HT1d, 5HT2a, 5HT2c, 5HT3, 5HT4

205
Q

What are the two key serotonin presynaptic receptors?

A

5HT1a and 5HT1d

206
Q

Where is the serotonin transporter pump located on the synapse?

A

Presynaptically

207
Q

Where are presynaptic alpha 2 receptors located?

A

Axon terminal (autoreceptors)

208
Q

At what age are the greatest number of synapses present?

A

6 years. 50% of connections are removed over time. 100 trillion synapses are present with 10,000 synapses for some neurons

209
Q

The brain makes its own ‘morphine’. What is it called?

A

Beta endorphin

210
Q

What is anandamide?

A

An endogenous cannibinoid receptor

211
Q

Where are neuropeptides made?

A

Cell body

212
Q

Where does monoamine synthesis occur?

A

Axon terminal (pieces are gathered in the cell body and sent to axon terminal for synthesis and synaptic vesicle packaging)

213
Q

In what way are children at birth more at risk with morphine?

A

The blood brain barrier is immature at birth and more permeable to morphine

214
Q

Is feminine behavior in boys related to homosexuality?

A

Its persistence rather than its mere presence

215
Q

What are the typical ages for firesetting?

A

Child 8 years of age; adolescent 13 years of age

216
Q

What is the treatment of encopresis?

A
  1. Initial bowel catharsis 2. Daily laxative or mineral oil 3. Daily timed timed interval on toilet with reward for success. 80% success rate with this
217
Q

In encopresis what percentage of children have abnormal contractions of the external anal sphincter?

A

About half

218
Q

What is the workup for encopresis?

A

A rectal exam usually reveals retention. If not one can check an abdominal x-ray

219
Q

What is the prevalence of encopresis?

A

1.5% of 7 to 8 year olds. The male to female ratio is 3:1

220
Q

What does increased maternal cortisol associate with postnatally?

A

Increased aggression postnatally

221
Q

By what age do infants alternate their vocalizations?

A

3 months

222
Q

What percentage of children with ADHD no longer have hyperactivity as adolescents?

A

20 to 30% (same with impulsivity); attentional problems persist. In adults, 40% no longer have hyperactivity

223
Q

What percentage of children with hyperactivity have a hyperactive parent?

A

20%

224
Q

What does clonidine do?

A

Agonist for alpha 2 leading to reduced norepinephrine (autoreceptor signal to decrease)

225
Q

What is the risk of tardive dyskinesia?

A

5% per year for conventional antipsychotics

226
Q

Which antipsychotics are associated with 1A2?

A

Clozapine, olanzapine

227
Q

Which antipsychotics are associated with 2D6?

A

Risperidone, clozapine, olanzapine

228
Q

Which antipsychotics are associated with 3A4?

A

Clozapine, quetiapine, olanzapine

229
Q

What do anticonvulsants generally block?

A

Sodium channels

230
Q

What is the likely mechanism of action of ECT?

A

Probable mobilization of neurotransmitters caused by the seizure

231
Q

At what age do numerical ratings start to work for pain?

A

> 8 years old

232
Q

How does the mesolimbic dopamine pathway project?

A

Dopamine cell bodies in the ventral tegmental area project to to axon terminals in the limbic areas, such as the nucleus accumbens (which leads to positive symptoms)

233
Q

Bupropion blocks reuptake of what neurotransmitters?

A

Weak dopamine and weaker norepinephrine. Bupropion is a prodrug metabolized to an active metabolite that is a more powerful inhibitor of norepinephrine reuptake than bupropion and is also concentrated in the brain (hydroxylated active metabolite)

234
Q

Which of the following are fast acting: GABA, glutamate, norepinephrine, or serotonin?

A

GABA and glutamate

235
Q

Which of the following are slow acting: GABA, glutamate, norepinephrine, or serotonin?

A

Norepinephrine and serotonin

236
Q

What is the principal function of the locus coeruleus?

A

To determine wether attention is being focused on the environment or the internal milieu of the body

237
Q

How does alpha 2 antagonism work in regard to norephinephrine?

A

Normally, norepinephrine (NE) lands on the presynaptic alpha 2 receptor, and the system ‘thinks’ there is plenty of NE, so this leads to decreased NE. An alpha 2 antagonist blocks NE so the system thinks there is not enough NE, and NE increases.

238
Q

How does alpha 2 antagonism work in regard to serotonin type neurons which have presynaptic alpha 2 receptors on them (i.e. heteroreceptors)?

A

Normally NE lands on the alpha 2 site leading the system to decrease serotonin release. When an alpha 2 antagonist lands on the site it leads to increased serotonin release

Child & Adolescent Psychiatry Review (6 decks)

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