Child & Adolescent Psychiatry Flashcards
top reasons for presentation to psych clinics - children & adolescents
*disruptive behavior disorders
*anxiety disorders
*depressive disorders
*neurodevelopmental disorders
interview techniques for children and adolescents
*children - draw, play, emotions, etc
*ask about school (grades, fav subjects, friends, bullying, getting in trouble)
*adolescents - confidentiality, friends, interests, dating, substances, trauma, why do you think your parents brought you in?
*parents - externalizing behaviors, developmental hx, family hx
major depressive disorder (kids & teens) - dx criteria
*same DSM-5 as adults, with 2 exceptions: (1) irritability may be predominant instead of sad mood; (2) failure to gain appropriate weight instead of weight loss
major depressive disorder (kids & teens) - epidemiology
*point prevalence: 2% of children; 4-8% of adolescents
*lifetime prevalence by age 18yo: 10-20%
*more common in females
*genetic loading: 40-60% heritable
major depressive disorder (kids & teens) - first line treatment
psychotherapy +/- meds:
*meds: SSRIs (fluoxetine, escitalopram)
*therapy: CBT or interpersonal psychotherapy (IPT)
bipolar disorder (kids & teens)
*same DSM-5 criteria as adults
*controversial in kids and teens
*competing approaches to dx
*narrow phenotype
*broad phenotype (severe mood dysregulation)
bipolar disorder (kids & teens) - first line treatment
meds:
*lithium: 12+ yo
*atypical antipsychotics (aripiprazole, risperidone, quetiapine, lurasidone, asenapine)
children “diagnosed with bipolar disorder” are most likely to meet criteria for which disorder in adulthood?
generalized anxiety disorder
disruptive mood dysregulation disorder (DMDD) (kids & teens)
*severe, recurrent TEMPER OUTBURST (inconsistent with developmental level, outbursts > 3 weeks)
*mood between outbursts is predominantly angry or irritable + observable by others
*present > 12 months, no period of 3 months without meeting criteria
*present in at least 2 settings, severe in as least 1
*onset usually by age 10 (must be dx b/w 6-18)
disruptive mood dysregulation disorder (DMDD) (kids & teens) - treatment
meds:
-stimulants to target impulsive components of disorder
-SSRIs for irritability/anger as depression equivalent
-antipsychotics if warranted for aggression and emotion dysregulation symptoms
separation anxiety (kids & teens) - diagnosis
*developmentally inappropriate and excessive fear/anxiety about separation from attachment figures
*associated features - thinking something catastrophic will happen upon separation
separation anxiety (kids & teens) - epidemiology
*prevalence: 4% in children, 1.5% in adolescents
*highly heritable (73% concordance in twins)
*risk factors: sudden attachment disruption, intrusive/overprotective parenting
selective mutism (kids & teens) - diagnosis
*failure to speak in social situations that have expectation for speaking
*interferes w/ educational achievement or social function
*duration at least 1 month
*not attributable to lack of knowing/comfort with language
*not attributable to communication disorder, ASD, or psychosis
selective mutism (kids & teens) - epidemiology
*prevalence 0.03-1%
*no differences w/ gender or ethnicity
*highly comorbid with social anxiety disorder
social anxiety (kids & teens) - diagnosis
dx differences from adults:
*anxiety must occur with peers, not just adults
*fear/anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, failing to speak
social anxiety (kids & teens) - epidemiology
*2-7% 12-month prevalence
*female predominance (2:1), maybe even higher in adolescents
PTSD (kids & teens)
*<6 yo: may not show distress with intrusions, reenactments
*exposure to trauma not just through media
*intrusive memories or dissociations (flashbacks) may be through repetitive play reenactments
*nightmares may be frightening without discernment of actual content/themes
treatment of anxiety and trauma disorders - kids & teens
*CBT:
-for separation anxiety, selective mutism: exposure-based CBT
-for PTSD: trauma, focused CBT
*meds: SSRIs (fluoxetine, sertraline)
*also, for PTSD, prazosin (peripheral alpha-1 adrenergic antagonist) can be effective for reducing nightmares
obsessive compulsive disorder (kids & teens) - diagnosis
*key difference from adults: kids may NOT be able to explain the aims/goals of compulsions
obsessive compulsive disorder (kids & teens) - epidemiology
*approx 1-2% of population
*males w/ earlier age of onset, 25% by age 10
*heritable: 2x higher risk if 1st degree relative with OCD, 10x higher risk if relative’s onset was in childhood
*highly comorbid with Tourette’s disorder
obsessive compulsive disorder (kids & teens) - first line treatment
*CBT (exposure & response prevention)
*meds: SSRIs (fluoxetine and sertraline); TCA (clomipramine)
disruptive behavior disorders (kids & teens)
*oppositional defiant disorder (6% prevalence)
*conduct disorder (4% prevalence)
*M:F = 1.4:1 until adolescence
oppositional defiant disorder (kids & teens)
*angry/irritable mood: often loses temper, touchy/easily annoyed, angry/resentful
*argumentative/defiant behavior:
-argues with authority figures
-defies/refuses to comply with rules/requests
-deliberately annoys others
-blames others for mistakes
*spiteful or vindictive (at least 2x in past 6 months)
conduct disorder (kids & teens)
*aggression to people and animals (physical fights, weapons, physically cruel, steals)
*destruction of property (fire-setting with intention of causing damage, deliberately destroying others’ property)
*deceitfulness/theft
*serios violation of rules
overlap between oppositional defiant disorder and ADHD
80% of kids who meet criteria for ODD have ADHD
treatment for disruptive behavior disorders
*PARENT TRAINING: give effective commands, improve positive attention and overall monitoring, implement immediate & fair & consistent consequences
*individual therapy (+/-)
*meds: stimulants, SGAs
general differences in med use in kids & teens
*start lower but get to same dose
*sometimes split dosing/give meds more frequently
*increased risk in suicidality in kids taking antidepressants is only 1% increase
