CAP4 Flashcards
(238 cards)
1
Q
Time out or other forms of isolation may be counterproductive for children with what behaviors?
A
Deviant behaviors
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
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.
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
5
Q
What is pseudomutuality?
A
A family’s intense need to be unified to the extent that differentiation of personalities is denied
6
Q
What is pseudohostility?
A
Defensive interactional pattern to ward off intimacy
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
8
Q
What are the three phases of family therapy?
A
- 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
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
10
Q
What is expressed emotion?
A
Index of family criticism and overinvolvement with the patient
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
12
Q
What percentage of families have at least one number who abuses alcohol or drugs?
A
30%
13
Q
What is a positive of day treatment rather than inpatient regarding staffing?
A
Only one shift = better continuity of care
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
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
16
Q
What is the annual incidence of Caregiver Fabricated Illness?
A
1/200,000 under 16 is estimate
17
Q
In Caregiver Fabricated Illness, what is the time to onset of diagnosis?
A
15 months
18
Q
What is the average age of child and adolescent sexual abuse?
A
females 10.4, males 8.6
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
20
Q
What is the most common presentation of Caregiver Fabricated Illness?
A
Bleeding then seizures
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)
22
Q
How do kids with cancer feel socially?
A
Prepubertal shyness, social anxiety. Adoescents social isolation
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
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
25
What are risk factors for non-adherence to immunosuppressive meds?
Females > males, adolescent, personality, no father, lack of community and social supports
26
What percent of 3 year olds play with their genitals or masturbate?
50% (Fitzpatrick 1995, Irish sample)
27
What is consequence of father absence on boys and girls
Worse on boys. Girls do better but have sex earlier and have more partners
28
What seems to be the concordance rate for homosexuality in monozygotic twins?
50%, 20% if DZ (Xq28 is implicated)
29
What age should one wait for if ambiguous genitalia is present to determine sex?
4 to 6 years (earlier if a preference is reliably expressed)
30
What is the first sign of approaching pubescence?
Adrenarche at 8 yo. Puberty 8-14 females, 9-14 males. It takes 3 to 4 years to complete.
31
Stuttering usually begins between what ages?
2 and 7 years of age, peaking at 3 and 4. 1/30 kids go through a period of stuttering by adolescence
32
Does body fat go up or down with age?
It increases with the first year of life then decreases until pre-puberty when it increases
33
What order of kinetics do most psychiatric drugs follow?
First order. The amount of drug eliminated is proportional to the amount circulating in the blood stream
34
Children starting fires account for how many deaths annually?
300
35
Describe fire behaviors
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
36
What are zero order kinetics?
A fixed amount of drug is elminated regardless of plasma level
37
Criminal fire setting resulting in arrest and recidivism is related to what?
Alcohol dependence in males and self-injury and suicide attempts in females
38
What is the use of cyproheptadine in eating disorders?
24 mg/d improves weight and mood
39
What is the presence of enuresis?
10% at 7 years of age. (Risk increases by 7 if the father had it, and by 5 if the mother had it)
40
What are risk factors for secondary enuresis?
Late attainment of initial nocturnal continence and 4 or more stressful events
41
What does neuroimaging show in youth who are depressed?
Decreased ratio of frontal lobe volume to total cerebral volume and increased lateral ventricles to total volume
42
What is seen in children with depression?
Hyposecretion of growth hormone with insulin challenge and hypersecretion of growth hormone during sleep
43
What are some symptoms or behaviors of pre-school, school age, and adolescent children of depressed adults?
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
44
What is the comorbidity of depression in prepubertal children?
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
45
What percentage of adults have bipolar disorder and what percentage of those recalled the onset between ages 5 and 9?
1% approximately; 0.5% of these recalled onset 5-9. 7.5% recalled onset from 10 to 14
46
What is the concordance rate for mania in monozygotic twins and dizygotic twins?
65% MZ, 14% DZ
47
When tends to be the onset of social anxiety in children?
11 to 12 years of age
48
Do boys or girls of pre-pubertal age more often have GAD?
Equal rates
49
Do adolescent boys or girls more often have GAD?
Girls
50
What is the prevalence of an anxiety disorder in children and adolescents?
5 to 18%
51
What is the prevalence of separation anxiety disorder?
3.5 to 5.5%
52
What is the prevalence of GAD in children and adolescents?
2.7 to 4.6%
53
What are neuroanatomic findings in ADHD?
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
54
What percentage of adolescents have panic attacks?
36 to 63%. 0.6 to 5% have panic disorder
55
What percengage of youth appear to receive the necessary treatment for the their anxiety disorder?
20%
56
What are neuroanatomic findings in OCD?
Ventricular enlargement, decreased mean volumes of the caudate nuclei bilaterally
57
What are positive-emission tomography (PET) findings for OCD?
Increased activity of caudate, especially on right; with treatment, this decreases
58
What percentage of OCD are secondary to PANDAS?
10 to 20% (Autoimmune reaction to basal ganglia; cross reaction of strep)
59
What percentage of children are physically abused based on documented injury?
0.50%
60
What Act by the U.S. government provided financial incentives to discourage foster care drift?
The Adoption and Safe Families Act of 1997
61
What is Michael Anderson's theory on IQ
"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
62
What percentage of children with asthma have a psychiatric diagnosis?
42%, especially anxiety
63
What classification system in traumatic brain injury is used?
It is based on the Glasgow Coma Scale, duration of loss of consciousness (LOC) and post-traumatic amnesia (PTA); mild, mod, severe categories
64
What is considered a severe traumatic brain injury?
Glasgow Coma Scale < 9, loss of consciousness > 24 hours, post-traumatic amnesia > 1 day
65
What is considered a moderate traumatic brain injury?
Glasgow Coma Scale 9-12, loss of consciousness 1 to 24 hours, post-traumatic amnesia 30 minutes to 24 hours
66
What is considered a mild traumatic brain injury?
Glasgow Coma Scale 13-15, loss of consciousness < 30 min, post-traumatic amnesia < 1 hour
67
How many children a year have a traumatic brain injury?
90,000
68
What did a laboratory classroom study of Concerta show?
Concerta was effective for 12 hours with regard to social and task behaviors and academic performance (Pelhman 2001)
69
What did a one year study of Concerta show with regard to weight, height, blood pressure, pulse, and tics?
No effect
70
The rights of individuals with disabilities were established by Congress in what Act?
Civil Rights Act of 1973, Section 504
71
When a managed care company denies coverage for medical necessity what ethical duties does a physician have?
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
72
What kind of fee for court work is unethical?
Contingency
73
Children who are abused may preferentially set fire to what?
Beds or mattresses
74
When do suicidal gestures and self-injurious behaviors start to occur after initiation of an incestuous relationship?
In the months following
75
What is important to determine in the treatment of sexual abuse?
Perception and attribution for the abuse. Help the child reduce self-blame and attribute the responsibility for the abuse to the perpetrator
76
What are factors that increase likelihood of subsequent psychopathology in the case of sex abuse?
Violence, completed intercourse, negative response to disclosure
77
What number of fatalities yearly occur from maltreatment?
1,100
78
Who first described the 'battered child syndrome'?
Kempe 1962
79
When were child protective services established?
1965 with mandatory reporting laws
80
What is a profile for a perpetrator of child sexual abuse?
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
81
List some major contributors to family therapy with children
Patterson (delinquency); Forehand and McMahon (delinquency); Alexander and Parsons; Zilbach; Scharff and Scharff
82
What are common fractures in abuse?
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
83
What is the radiologic workup for physical abuse?
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
84
What is one risk of tricyclic antidepressants for enuresis?
Child may take whole bottle to stop the enuresis
85
What is the odds ratio of having a mental health problem if your parent was depressed?
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
86
Acute stimulation of 5HT2a in sleep centers does what?
Leads to insomnia (SSRI side effect)
87
Acute stimulation of 5HT2a in basal ganglia does what?
Akathisia and agitation (SSRI side effect)
88
The brainstem chemoreceptor trigger center can mediate vomiting via what receptors?
5HT3 (hence SSRI side effect of nausea)
89
Projection from the Raphe Nuclei to what area and what receptors may regulate appetite and eating?
Hypothalamus, 5HT3 receptors (SSRI side effect)
90
Projection from Raphe Nuclei to what area and what receptors may be involved in anxiety and panic?
Limbic area, 5HT2a and 5HT2c
91
Projections from Raphe Nuclei to what area and what receptors may help control movement and obessions and compulsions?
Basal ganglia, 5HT2a postsynaptic receptors
92
What presynaptic alpha receptor is located on the cell body of the serotonin neuron?
Alpha 1. Stimulation of norepinephrine and alpha 1 receptors leads to increased serotonin release
93
Serotonin receptors have what heteroreceptors that turn off serotonin release?
Alpha 2 (terminal location)
94
What percentage of maltreatment fatalities are of children less than 3 years of age?
75%. Less than a week old, by mother; 1 week to 13 years of age both mother and father; 13+ majority by father
95
What is the percentage distribution of abuse for neglect, physical abuse, and sexual abuse respectively?
60%, 20%, 10%
96
What did DeAngelis describe about children who are abused?
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
What does Biederman say about treatment of pediatric mania and ADHD?
Treat the mania first (I think it depends)
98
What are signs of neuroleptic malignant syndrome (NMS)?
Muscle rigidity, delirium, autonomic instability, creatine phosphokinase (CPK) elevation. Supportive treatment and can use dantrolene and bromocriptine
99
What drug helps with antipsychotic induced hyperprolactinemia?
Cabergoline and aripiprazole
100
What did Kolko (1992) find regarding outcome after inpatient stays for children?
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
Approximately what percentage of youth with the most severe difficulties use 80 to 90% of available resources?
2 to 5%
102
Which autism scales have been tested for their reliability and validity?
ABC, ADI-R, ADOS, PL-ADOS, ASQ (aut scr ques), ASDSQ, CHAT, CARS2
103
What are three things to keep in mind to help protect against malpractice
Write with risk in mind, check notes for discrepancy, follow-up on diagnoses and investigations
104
What treatment manuals are available for PMT?
Cavell 2000, Forehand and McMahon 1981, Forgatch and Patterson 1989, Patterson and Forgatch 1989, Sanders 1993, Kazdin 2008
105
What is a PMT guide for parents?
Forehand and Long 1996
106
What is an assessment measure for suicidal behavior in children, adolescents, and adults?
Columbia-Suicide Severity Rating Scale (C-SSRS)
107
What are screening instruments for drugs and alcohol use?
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
Sexual abuse is found most commonly in what socioeconomic status?
Equally in all, whereas physical abuse and neglect tend to be in lower SES
109
What are some potential characteristics in families with sex father-daughter abuse?
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
What percentage of women report retrospectively having been sexually abused?
18% (does not include intercourse only). Some studies show higher, from 27% for women and 16% for boys)
111
What is the most common age range for sexual abuse victimization?
8 to 9 years old
112
Before the 17th century the age of consent for sex was considered as low as what age?
12 (U.S.A)
113
What should a child be told about any abuse they experienced?
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
What are treatment elements to selective mutism?
Contingency management, exposure-based techniques, self-modeling
115
What percentage of 5 year olds have enuresis?
15%
116
Is enuresis associated with a particular sleep stage?
No
117
What is the remission rate with DDAVP for enuresis?
30%
118
What percentage of chidlren with encopresis have anismus?
75% (lack of relaxation of the external sphincter). Uncertain if precedes or emerges after the encorpresis
119
What percentage of high school seniors report having used marijuana in the previous year?
46%, 26% in the last month. 7% of 9th to 12th graders have tried at least once before age 13 (YRBSS 2017)
120
What is the lifetime use of steroids for high school students?
3%
121
What step of 12 step programs is not useful for teenagers?
Step 1, surrending to a higher power. This goes against the developmental stage adolescents are in
122
What is autosynephilia?
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
In adults transvestic fetishism involves what sexual orientation, homosexual or heterosexual?
heterosexual
124
What percentage of males with gender dysphoria (who do not like their male gender) are sexually attracted to males?
50% are attracted to males, and 50% to females
125
What is the risk of major depressive disorder in relatives of suicide victims?
Three times the rate for siblings, mothers, and friends
126
How do tricyclic antidepressants cause cardiovascular problems and seizures?
They block sodium channels in the heart and brain leading to cardiac arrhythmias and arrest in overdose
127
What are the dynamic issues involved in elopement or self-injurious behaviors in treatment settings?
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
What is a feeling often overlooked with adolescents in treatment?
Shame (as a result they may attack self, attack others, and show shame avoidance)
129
Who wrote about shame?
Donald Nathanson
130
How did tricyclic antidepressants come about?
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
What is the tripartite model?
Id, ego, superego
132
What is drive in psychodynamics?
Stimulus arising within an individual that arouses the mind and incites mental activity
133
Is the rigidiity of the superego proportional to the parents' severity?
No. More related to the intensity of aggressive wishes and relative weakness and immaturity of an individual's ego and defenses
134
What is a representation?
Enduring organization or schema constructed from a multitude of images, each derived from a multitude of experiential impressions
135
What is 'observing ego'
Self observation
136
What is 'objective' countertransference?
Anyone would find the behavior provocative. The word 'counterreaction' has also been used here.
137
Who said that there is no evidence that personal psychotherapy is not an important part of training?
Marks 1982
138
In which Piagetian stage do children find it hard to have two feelings at once?
Pre-operational
139
What is negative reinforcement?
The removal of an aversive stimulus after a positive behavior has occurred.
140
What are examples of punishment?
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
How should one proceed with dosing of tricyclic antidepressants?
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
Is methylphenidate psychosis similar to schizophrenia?
No, more of a toxic psychosis with visual hallucinations, etc.
143
What is a manual based treatment of anxiety in autism spectrum disorders?
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
What are the active enantiomers of methylphenidate
D-threo > L-threo
145
In family treatment, Stierling proposed 'binding, delegating, expulsion'. What are they?
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
What percentage of child patients never complete treatment to the satisfaction of therapists?
50%
147
What do outcome studies of residential treatment centers show?
Depends more on ecologic and post discharge factors than the RTC itself. An RTC at times serves as a secure base.
148
What receptors does ziprasidone effect?
Inhibits 5HT2c, 5HT1d, norepinephrine, and serotonin reuptake. Stimulates 5HT1a
149
What placebo-controlled discontinuation trial showed nortriptyline to be effective for ADHD?
Prince et al. 1999. Useful for enuresis in the context of ADHD or if other agents are not effective for ADHD
150
What circuit is involved in Tourette's?
cortico-striato-thalamo-corical
151
What are the two monoamine oxidase neurotransmitter subtypes and what neurotransmitters do they metabolize?
A and B, serotonin and norepinephrine
152
What were the first anti-depressants?
MAOIs (anti-tubercular)
153
What are two benzodiazepine substrates of P450 3A4?
Alprazolam and triazolam
154
What are two SSRI inhibitors of P450 3A4?
fluoxetine, fluvoxamine
155
Fluvoxamine inhibits what CYP?
1A2
156
Which cytochrome does nicotine induce?
1A2
157
Tricylics antidepressantss are substrates for what cytochrome?
2D6 (hydroxylates and therefore inactivates the TCA)
158
Cytochrome 1A2 does what with certain Tricyclic antidepressants?
Demethylates them but does not inactivate them. Clomipramine--> desmethylclomipramine, imipramine-->desipramine
159
What is the family, subtype, gene in cytochrome nomenclature?
E.g. 2D6: 2 = family, D = subtype, 6 = gene product
160
What is the explanation for the development of tolerance to acute side effects of antidepressants?
Densisitization of postsynaptic receptors
161
What is a candidate mechanism as the site of possible flaw in signal transduction from monoamine receptors?
The target gene for brain derived neurotrophic factor (BDNF)
162
What does brain derived neurotrophic factor (BDNF) do?
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
What is the monoamine theory of depression?
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
Acute stimulation of what receptors results in GI cramps and diarrhea?
5HT3 and 5HT4 in the gut
165
Acute stimulation of what receptor leads to nausea of vomiting?
5HT3 in the brainstem vomit center
166
Acute stimulation of what results in sexual dysfunction?
5HT2A in the spinal cord
167
Explicit memory is mediated by what structures?
Medial temporal lobe and hippocampus and related structures that enable verbal representations
168
Are traumatic memories processed like ordinary memories?
No. This results in failure to organize the traumatic event into coherent verbally represented narrative. There are repetitious and non-consecutive memory chunks
169
What is the condom use of adolesents?
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
Is the risk of tardive dyskinesia (TD) and extrapyramidal symptoms (EPS) the same across conventional antipsychotics?
The risk for acute EPS varies but there is not difference in risk for TD
171
What is a strength-based paradigm after exposure to trauma rather than posttraumatic stress?
Resilience
172
What did Teicher et al. find regarding maltreatment and 'limbic irritability'?
Verbal abuse is more detrimental than non-familial sex abuse; domestic and verbal abuse is = to familial sexual abuse (AJP 2006)
173
In enuresis, who are those that are more likely to have urinary tract incontience?
Those with daytime wetting
174
What is the success rate of the alarm clock method for enuresis?
77% if the alarm is set when the bladder may be reaching maximal capacity (alarm clock and not bell and pad method here)
175
What is the success rate of the bell and pad method?
75%
176
Are children with enuresis at increased risk of psychopathology?
No
177
What findings are there in children with enuresis?
General developmental delays, lower functional bladder volume, lag in maturity for age (suggests maturational delay of CNS)
178
Enuresis at night occurs in what stage of sleep?
Each stage, according to the proportion of time spent in that stage
179
What is secondary enuresis?
Enuresis that occurs after first having maintained continence for one year
180
What is the concordance rate for anorexia nervosa in monozygotic and dizygotic twins?
66% MZ, 0 % DZ,; according to Treasure and Holland 1989
181
Does the data suggest that patients with an eating disorder have a higher rate of experiencing sexual abuse?
Not more than other clinic based populations
182
What is the incidence and prevalence of anorexia nervosa?
8.1/100,000 per year and 0.28%. The prevalence for bulimia nervosa is 1%
183
What is the male to female ratio of anorexia nervosa?
1 to 10-20
184
Who first described cases of anorexia nervosa?
John Reynolds in 1669 and Richard Morton 1689
185
Who first described and named bulimia nervosa?
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
What are some observations in children who fireset?
Decreased achievement, conduct disordered behaviors, stressors, do not call for help after the fire is started
187
What is process trauma?
Trauma related to secondary events of trauma (e.g. a disaster can be traumatic and then the move because it also disrupts life)
188
Is the blood brain barrier permeable in children?
More permeable than adults
189
1 in 200 white persons are slow metabolizers for what 2 CYPs together?
2D6 and 2C19.
190
What percent of whites have a genetic deficiency of 2D6
7% to 10% of whites have a genetic deficiency of CYP 2D6 and are less efficient in metabolizing 2D6 substrates,
191
How do lamotrigine and valproate interact?
VPA increases lamotrigine by inhibiting glucuronidation by which lamotrigine is metabolized alone
192
Post-synaptic cells have which two types of receptors?
Fast acting class I (inotropic) receptors and slow acting classs II (g-protein coupled) receptors
193
How is dopamine degraded?
Catechol-o-methyltransferase (COMT)
194
What does glutamate potentiate?
Glutamate neurons and NMDA receptors are involved in long-term potentiation, a crucial component of memory
195
What is psychic determinism?
The principle that nothing in the mind happens by chance or in a random way
196
What important areas of the limbic system are associated with aggression?
Hypothalamus, septal area, amygdala
197
Are the cerebral volumes of children who have been abused increased or decreased?
Decreased by 7% (De Bellis et al. 1999)
198
What is the juvenile arrest rate for violent crimes per 1000 juveniles?
4
199
Dementia can be diagnosed by what age?
4 to 6 years of age, after the IQ is stable
200
Pain travels by what fibers?
Unmyelinated C, smaller and slower. Thinly myelinated A-delta, larger and faster
201
What projection mediates the effect of norepinephrine on attention?
Locus coeruleus to prefrontal cortex
202
What projection is thought to be responsible for norepinephrine's regulation of mood?
Locus coeruleus to the fontal cortex
203
Where are the presynaptic 5HT autoreceptors located?
5HT1a = somatodendritic autoreceptor (decreases neuron impulse flow). 5HT1D (axon terminal autoreceptor inhibits release)
204
What are the key postsynaptic serotonin receptors?
5HT1a, 5HT1d, 5HT2a, 5HT2c, 5HT3, 5HT4
205
What are the two key serotonin presynaptic receptors?
5HT1a and 5HT1d
206
Where is the serotonin transporter pump located on the synapse?
Presynaptically
207
Where are presynaptic alpha 2 receptors located?
Axon terminal (autoreceptors)
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At what age are the greatest number of synapses present?
6 years. 50% of connections are removed over time. 100 trillion synapses are present with 10,000 synapses for some neurons
209
The brain makes its own 'morphine'. What is it called?
Beta endorphin
210
What is anandamide?
An endogenous cannibinoid receptor
211
Where are neuropeptides made?
Cell body
212
Where does monoamine synthesis occur?
Axon terminal (pieces are gathered in the cell body and sent to axon terminal for synthesis and synaptic vesicle packaging)
213
In what way are children at birth more at risk with morphine?
The blood brain barrier is immature at birth and more permeable to morphine
214
Is feminine behavior in boys related to homosexuality?
Its persistence rather than its mere presence
215
What are the typical ages for firesetting?
Child 8 years of age; adolescent 13 years of age
216
What is the treatment of encopresis?
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
In encopresis what percentage of children have abnormal contractions of the external anal sphincter?
About half
218
What is the workup for encopresis?
A rectal exam usually reveals retention. If not one can check an abdominal x-ray
219
What is the prevalence of encopresis?
1.5% of 7 to 8 year olds. The male to female ratio is 3:1
220
What does increased maternal cortisol associate with postnatally?
Increased aggression postnatally
221
By what age do infants alternate their vocalizations?
3 months
222
What percentage of children with ADHD no longer have hyperactivity as adolescents?
20 to 30% (same with impulsivity); attentional problems persist. In adults, 40% no longer have hyperactivity
223
What percentage of children with hyperactivity have a hyperactive parent?
20%
224
What does clonidine do?
Agonist for alpha 2 leading to reduced norepinephrine (autoreceptor signal to decrease)
225
What is the risk of tardive dyskinesia?
5% per year for conventional antipsychotics
226
Which antipsychotics are associated with 1A2?
Clozapine, olanzapine
227
Which antipsychotics are associated with 2D6?
Risperidone, clozapine, olanzapine
228
Which antipsychotics are associated with 3A4?
Clozapine, quetiapine, olanzapine
229
What do anticonvulsants generally block?
Sodium channels
230
What is the likely mechanism of action of ECT?
Probable mobilization of neurotransmitters caused by the seizure
231
At what age do numerical ratings start to work for pain?
> 8 years old
232
How does the mesolimbic dopamine pathway project?
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
Bupropion blocks reuptake of what neurotransmitters?
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
Which of the following are fast acting: GABA, glutamate, norepinephrine, or serotonin?
GABA and glutamate
235
Which of the following are slow acting: GABA, glutamate, norepinephrine, or serotonin?
Norepinephrine and serotonin
236
What is the principal function of the locus coeruleus?
To determine wether attention is being focused on the environment or the internal milieu of the body
237
How does alpha 2 antagonism work in regard to norephinephrine?
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
How does alpha 2 antagonism work in regard to serotonin type neurons which have presynaptic alpha 2 receptors on them (i.e. heteroreceptors)?
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
