child and adolescent - mentor & more 8 Flashcards
1
Q
The Paediatric OCD Treatment Study (POTS I)
A
- First randomized trial in pediatric OCD
- Compared efficacy of:
- Sertraline (established medication)
- OCD-specific cognitive behavioral treatment (CBT)
- Combination of both
- Placebo control
-for 12 weeks
- Focused on children and adolescents with clinically significant OCD in the USA.
2
Q
Main points of POTS study
A
- CBT alone: P = .003
- Sertraline alone: P = .007
- Combined treatment: P = .001 (superior to CBT and Sertraline)
- CBT vs Sertraline: no difference
3
Q
Did the remission rate for combined treatment differ from that for CBT alone ? POTS study
A
No
4
Q
Did the remission rate for combined treatment differ from that for Sertraline ?POTS study
A
Yes
5
Q
Did the remission rate for sertraline alone differ from that for placebo ?POTS study
A
No
6
Q
Did the remission rate for CBT alone differ from that for Placebo and sertraline ?POTS study
A
Placebo Yes
Sertraline No
7
Q
Conclusion of POTS
A
Children with OCD should start treatment with CBT and a serotonin inhibitor or CBT alone.
8
Q
One of the most robust findings relates to exposure to maternal smoking in pregnancy, which has been repeatedly observed to be associated with
A
offspring attention-deficit hyperactivity disorder (ADHD) and antisocial behaviour (conduct disorder).
9
Q
One of the most robust findings relates to exposure to maternal smoking in pregnancy, which has been repeatedly observed to be associated with internalizing disorders like anxiety and depression?
A
Reports are fewer
10
Q
Psychosexual development
Stage
Oral
A
0-18 month
11
Q
Psychosexual development
Stage
Anal
A
18-36 months
12
Q
Psychosexual development
Stage
Phalic
A
3-5 years
13
Q
Psychosexual development
Stage
Latency
A
5-puberty
14
Q
Psychosexual development
Stage
Genital
A
puberty-adulthood
15
Q
Oedipal complex and girls the Electra complex during which stage?
A
phallic -3-5 years
16
Q
Rett syndrome incidence
A
approx. 1:10,000 female births
17
Q
Rett’s Male or female?
A
almost exclusively female
18
Q
Rett’s sporadic?
A
yes
19
Q
Rett’s genetic associations?
A
mutations in the MECP2 gene (Xq28)
20
Q
Rett’s concordance in monozygotic twins
A
Complete
21
Q
Rett syndrome unique presentation
A
Children develop normally until 6-18 months, then may show language loss, stereotypic movements, ataxia, and psychomotor delays.
22
Q
Rett’s: Head circumference
A
normal at birth but growth begins to decelerate between 6-12 months resulting in microcephaly
23
Q
Rett’s: language
A
All language skills are lost, both receptive and expressive and social skills plateau at developmental levels between 6-12 months.
24
Q
Rett’s seizure
A
75% (almost all have EEG findings)
25
Rett's Breathing
Breathing problems are also seen with episodes of hyperventilation, apnoea, and breath holding.
26
Rett's prognosis
Many children are wheelchair bound and lack language after 10 years of the disorder.
27
Autism Diagnostic Interview Revised (ADI-R)
Comprehensive interview for ages 2+. (with carer)
28
Autism Diagnostic Observation Schedule (ADOS)
gold standard for observational assessment of ASD.
Can be used to assess both children (aged 12 months or over) and adults.
29
Can be used to assess both children (aged 12 months or over) and adults.
Autism Diagnostic Observation Schedule (ADOS) (+1 y.o)
Diagnostic Interview for Social and Communication Disorders (DISCO)
Social Communication Questionnaire (SCQ) (+2)
30
Diagnostic Interview for Social and Communication Disorders (DISCO)
Used in both children and adults. Combines developmental history and observation (think of like a combination of the ADI and ADOS)
31
Social Communication Questionnaire (SCQ) (ASD)
Screening version of the ADI. Can be used to assess both children (aged 2 or over) and adults
32
Purpose of Conner's 3 (This has superceded Conners' Rating Scales-Revised (CRS-R) to account for the DSM-V changes)
ADHD and associated conditions (e.g. conduct disorder)
33
Wechsler Intelligence Scale for Children (WISC)
Used to assess children's intellectual ability. For use in children aged 6-17
34
Minimum age for use in children for BDI?
13
35
Strength and difficulties questionnaire (SDQ)
Brief behavioural screening questionnaire for 3-17 year olds.
36
what does Strength and difficulties questionnaire (SDQ) cover?
Covers areas such as emotional symptoms, conduct problems, hyperactivity/inattention, and peer relationship problems.
37
The Child Behaviour Checklist (CBCL)
Assesses internalising (i.e., anxious, depressive, and overcontrolled) and externalising (i.e., aggressive, hyperactive, noncompliant, and undercontrolled) behaviours.
38
to screen behaviours in 6-18 years?
The Child Behaviour Checklist (CBCL)
39
Childrens Depression Inventory (CDI)
28 item Likert scale used in children aged 7-17.
40
Purpose of The Child and Adolescent Functional Assessment Scale (CAFAS)
Global functioning
41
Assess functioning across a range of domains such as school, mood, self-harm, community, substance misuse. For use in children aged 6-17.
The Child and Adolescent Functional Assessment Scale (CAFAS)
42
The prevalence of psychotic disorders in children aged between 5 and 18 years has been estimated to be
0.4% (the figure across all ages and populations in the UK is 0.7%).
43
Psychosis may be preceded by a prodromal period that can last from a few days to around 18 months.
True or false?
True
44
Schizophrenia prodromal period is characterized by
emotional and behavioural changes leading to a deterioration in personal functioning and social withdrawal.
45
emotional and behavioural changes in schizophrenia prodromal
* Decreased interest in activities; sleep and cognitive issues.
* Brief, mild psychotic symptoms, including hallucinations and unusual thoughts.
46
response to treatment within the first year
four out of every five people
47
what number will have no further psychotic episodes within the next five years
1 in 5
48
The most common course of schizophrenia in children
initial improvement of symptoms with ongoing recurrent acute psychotic episodes or relapses over many years.
49
Rate of those with persistent psychotic symptoms that are unresponsive to treatment two years after the acute episode of psychosis?
15%
50
People at increased risk of psychosis:
If a person is distressed, has a decline in social functioning and has:
* Transient or attenuated psychotic symptoms or
* Other experiences or behaviour suggestive of possible psychosis or
* A first-degree relative with psychosis or schizophrenia
51
The NICE Guidelines for children are similar to those for adults.
True or false?
True
52
Rx to offer to people at risk of psychosis?
Offer individual cognitive behavioural therapy (CBT) with or without family intervention.
53
Role of Meds in people at risk of psychosis?
Do not offer antipsychotic medication.
54
First episode psychosis
* Antipsychotic medication (first-generation or second-generation), in conjunction with psychological interventions (family intervention and individual CBT)
55
what if people with first episode of psychosis asked for psychological intervention only?
advise that they work better in conjunction with antipsychotics
56
The choice of antipsychotic medication by whom?
the service user (dependent mainly on which side-effects they expect they can tolerate).
57
in treatment of psychosis
Before starting an antipsychotic record what?
* Weight (plotted on a chart)
* Height
* Waist circumference
* Pulse and blood pressure
* Fasting blood glucose, glycosylated haemoglobin (HbA1c), blood lipid profile and prolactin levels
* Assessment of any movement disorders
* Assessment of nutritional status, diet and level of physical activity
58
when to suggest ECG for patient with psychosis
* Required by the medications SPC (summary of product characteristics)
* Any cardiovascular risk
* If patient is being admitted as an inpatient
59
What is the recommended trial duration for medication at optimum dosage?
4-6 weeks.
60
Should a loading dose of antipsychotic medication be used?
No, a loading dose should not be used (often referred to as 'rapid neuroleptisation').
61
When can regular combined antipsychotic medication be initiated?
Only for short periods, such as when changing medication.
62
What should be warned about when prescribing chlorpromazine?
It has the potential to cause skin photosensitivity; advise using sunscreen if necessary.
63
Is counselling and supportive psychotherapy routinely offered to children and young people with psychosis or schizophrenia?
No, it is not routinely offered.
64
Is social skills training routinely offered in the treatment of schizophrenia?
No, it is not routinely offered.
65
Should adherence therapy be offered?
No, it should not be offered.
66
When should clozapine be offered to people with schizophrenia?
When their illness has not responded adequately to treatment despite the sequential use of adequate doses of at least 2 different antipsychotic drugs, with at least 1 being a non-clozapine second-generation antipsychotic.
67
What is the recommended duration of treatment to reduce relapse risk?
At least 1-2 years following initiation.
68
What are some consistent findings regarding the treatment of schizophrenia?
Clozapine is more effective for neuroleptic-refractory positive symptoms, TMS can be effective, CBT can reduce symptoms, psycho-education can reduce relapses, social skills training improves outcomes, and early intervention improves outcomes.
69
How can the symptoms of schizophrenia be categorized?
Into positive and negative symptoms.
70
What are examples of positive symptoms of schizophrenia?
Hallucinations, delusions, thought disorder.
71
What are examples of negative symptoms of schizophrenia?
Social withdrawal, apathy, lack of energy, poverty of speech (alogia), flattening of affect, anhedonia.
72
Which medication has robust data supporting its effectiveness in primary negative symptoms?
Amisulpride.
73
What do the Maudsley Guidelines recommend regarding antipsychotics?
Avoid first generation antipsychotics, use olanzapine, aripiprazole, and risperidone, and use clozapine for treatment resistant cases.
74
What is the prevalence estimate for schizophrenia below age 15?
0.05%.
75
What are the two classifications of early onset schizophrenia?
Early onset schizophrenia (EOS) for ages 13-18, and very early onset schizophrenia (VEOS) for ages at or before 13.
76
What are atypical features of EOS and VEOS compared to adult-onset schizophrenia?
- Insidious onset
- Severe premorbid neurodevelopmental abnormalities
- Frequent terrifying visual hallucinations
- Inappropriate or blunted affects
- Higher familial psychopathology
- Minor treatment response
- Poorer outcomes
77
What factors are linked to poor outcomes in schizophrenia?
- Longer duration of untreated psychosis
- Early onset
- Male sex
- Negative symptoms
- Family history
- Low IQ
- Low socioeconomic status
- Social isolation
- Significant psychiatric history
- Continued substance misuse
78
What is school refusal and its prevalence in children?
School refusal occurs in 1-5% of children, similar rates between boys and girls, more common at ages 5, 6, 10, and 11. It is not a formal diagnosis and differs from truancy.
79
What is the onset of school refusal symptoms like?
The onset of school refusal symptoms usually is gradual.
80
When may symptoms of school refusal begin?
Symptoms may begin after a holiday or illness.
81
What triggers school refusal in some children?
Stressful events at home or school, or with peers may cause school refusal.
82
How do some children exhibit school refusal behavior?
Some children leave home in the morning and develop difficulties as they get closer to school, then are unable to proceed.
83
What are common presenting symptoms of school refusal?
Presenting symptoms include fearfulness, panic symptoms, crying episodes, temper tantrums, threats of self-harm, and somatic symptoms that present in the morning and improve if the child is allowed to stay home.
84
What type of treatment is primarily used for school refusal?
Behavioural approaches for the treatment of school refusal are primarily exposure-based treatments.
85
Is school refusal a diagnosis?
School refusal is not a diagnosis, it is a presenting problem.
86
What comorbid diagnoses are common in school refusal behavior?
Common comorbid diagnoses include separation anxiety disorder, generalized anxiety disorder, depression, and oppositional defiant disorder, among others.
87
What developmental disabilities are linked to school refusal behavior?
School refusal behavior has been linked to limited developmental disabilities such as learning disorders and pervasive developmental disabilities such as Asperger's disorder, autism, and mental retardation.
