Child and Adolescent Psychiatry Flashcards

1
Q

Encopresis =

A
  • repeated passing of feces in inappropriate places (involuntary or intentional)
  • must have at least one event monthly for at least 3 mnths and mental age at least 4 y/o
  • exhibits dysregulated bowel fxn: infrequent bowel mvmnts, constipation or recurrent and pain and pain with defecation
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2
Q

Causes of encopresis

A
  • power struggles with parent
  • some abnormal sphincter contractions
  • impaction
  • Birth of sibling/parental separation can precipitate
  • child can be fearful to attempt to defecate because of pain
  • or child is resistant to change patterns of withholding bowels
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3
Q

Encopresis tx:

A
  • pyschotherapy
  • usually resolves on its own
  • daily laxatives, mineral oil along with behavioral intervention in which a child sits on toilet for timed intervals and is rewarded for defecation
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4
Q

Enuresis =

A
  • repeated urination into bed or clothes (involuntary or intentional)
  • must occur twice weekly for at least 3 mnths and have mental age of at least 5 y/o
  • more common in boys, or if familial
  • not related to sleep stages
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5
Q

Causes of enuresis

A
  • nocturnal polyuria
  • overactive detrusor
  • disturbed sleep
  • pinworms
  • LS spine defect
  • inadequate ADH
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6
Q

Enuresis tx

A
  • motivational tx
  • positive reinforcement
  • Bell and pad
  • DDAVP (desmopressin)
  • often spontaneous remission
  • Meds: imipramine
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7
Q

Hinman’s syndrome

A

-neurogenic bladder resulting from habitual, voluntary tightening of external sphincter during urges to urinate

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8
Q

Attention Deficit Disorder: clinical features

A
  • can occur with or without hyperactivity
  • boys more affected than girls
  • difficult to dx in young age (4-6 y/o)
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9
Q

Attention deficit disorder =

A

-pattern of diminished sustained attention and higher levels of impulsivity in childhood/adolescence than someone for that age/developmental level

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10
Q

Etiology of ADD

A
  • Neurochemical tranmission problem (dopamine and NE)
  • Genetics: first degree relatives higher risk of developing
  • executive fxn dysregulation
  • Others: difficult pregnancy, prenatal exposure to EtOH/tobacco, premature delivery, low birth wt, high lead levels, injury to prefrontal regions
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11
Q

ADD is comorbid with:

A
  • ODD
  • conduct disorder
  • Mood disoders
  • anxiety d/o
  • learning disability
  • tics/tourettes
  • substance abuse
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12
Q

ADD DSM IV dx

A
  • sx’s for at least 6 mtnhs to a degree that is maladaptive and INCONSISTENT with developmental level
  • some sx’s prior to age 7
  • need at least 6 out of 9 sx;s
  • sx’s must occur in at least 2 different settings
  • there must be clear evidence of clinically significant impairment in social, academic or occupational fxn’ing
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13
Q

ADD with Inattention sx’s

A
  • careless mistakes or poor attn to details
  • poor organization
  • poor sustained attn
  • does not follow through or fails to finish tasks
  • does not seem to listen when spoken to
  • losed objects
  • easily distracted
  • forgetful in daily activities
  • avoids tasks requiring effort
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14
Q

ADD with Hyperactivity sx;s

A
  • **more likely to get dx’d
  • fidgets
  • leaves seat
  • runs or climbs excessively
  • difficulty playing quietly
  • always “on the go”
  • talks excessively
  • blurts out answers
  • can’t wait turn
  • interrups others
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15
Q

ADD Impulsivity sx’s

A
  • blurts out answers
  • can’t wait turn
  • interrups others
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16
Q

Management of ADD

A
  • organizational and time management skills
  • Meds: stimulants are first line = methylphenidate (ritalin), dextroamphetamine and dextroamphetamine and amphetamine salt combos
  • nonstimulants = NE uptake inhibs: Stratterea
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17
Q

Oppositional Defiant Disorder =

A

-enduring patterns of negativistic, disobedient, and hostile behavior toward authority figures as well as an inability to take responsibility for mistakes, placing blame on others

18
Q

ODD: clinical features

A
  • usually occurs with certain parenting styles: either authoritarian, permissive or overly friendly
  • usually appears by 8 y/o and later than adolescence
  • boys > girls before puberty
19
Q

ODD DSM IV Dx

A
  • a pattern of negativism and defiant behavior lasting greater than 6 mnths and have 4 of the following:
  • loses temper
  • argues with adults
  • actively defies or refuses to comply with rules
  • often deliberately annoys ppl
  • blames others for his/her mistakes
  • often touchy or easily annoyed with others
  • often angry and resentful
  • often spiteful or vindictive
20
Q

ODD Management

A
  • family intervention using both direct training of the parents in child management skills and careful assessment of family interactions
  • behavior therapy: teach parents how to discourage ODD and encourage appropriate behavior
  • individual psychotherapy: practice more adaptive responses to increase self esteem
  • parents: eliminate harsh, punitive parenting and increase positive parent/child interactions
21
Q

Conduct disorder clinical features

A
  • aggression toward people or animals
  • destruction of theirs/other’s property
  • theft/acts of deceitfulness
  • serious and frequent violation of rules
  • comorbid with ADHD and LD, depression, antisocial PD and alcohol dependence
22
Q

Conduct d/o Etiology

A
  • Parental factors: harsh, abusive parenting; h/o alcohol abuse and divorce
  • subcultural factors: Low SES, drugs and alcohol use
  • Psych factors: poor modeling of impulse control annd lack of having needs met
23
Q

Conduct disorder in boys vs girls

A
  • Boys: ages 10-12 and occurs more often than girls

- Girls: ages 14-16

24
Q

Conduct D/o DSM IV criteria

A
  • requires bullying, threatening/intimidating others, staying out at night despite parental prohibitions and before 13 y/o
  • must have following at least 3 in last 12 mnths or 1 in last 6 mnths
  • categories: Aggression to ppl/animals; deliberately destroying others property; deceitfulness and theft
25
Q

Conduct d/o: Aggression to ppl/animal sx’s:

A
  • bullies/threatens
  • stolen while confronting a victim
  • forced someone into sexual activity
  • physically cruel to people/animals
  • starts fights
  • used a weapon for harm
26
Q

Conduct d/o: destruction of property sx;s

A
  • has deliberately engaged in fire setting with intention of causing damage
  • deliberately destroyed other’s property
27
Q

Conduct d/o: deceitfulness or theft sx’s

A
  • breaking in
  • lies/cons
  • stealing without confrontation
28
Q

Conduct d/o serious violation of rules ax’s

A
  • stays out late before age 13
  • runs away at least twice
  • school truancy before age of 13
29
Q

Conduct d/o management

A
  • multisystemic therapy: behavioral therapy, fam education/therapy, pharm intervention
  • meds: antipsychs (Haloperidol); atypical antipsychs (risperidone, olanzapine, quetiapine)
30
Q

Anoxrexia Nervosa criteria

A
  • self-induced starvation
  • relentelss drive for thinness/fear of fatness
  • presence of medical signs/sx’s resulting from starvation
31
Q

Anorexia Nervosa dx

A
  • refusal to maintain normal weight for age and ht
  • fear of gaining wt or becoming fat
  • misinterpreting body wt or shape
  • amenorrhea in post menarcheal females
32
Q

Types of AN:

A
  • Restricting: strict dieting, fastinf, or excessive exercising; often have OCD traits and comorbid MDD
  • Binge/Purging: large quantities of food are eaten and then purged; comorbid with substance use, impulse control d/o, personality d/o
33
Q

AN Features

A
  • early mid adolescent to young adult (10-30 y/o)
  • peculiar behaviors with food (hide food, carry in pockets, rearrange food on plate)
  • loss of appetite is late
  • poor sexual adjustment
  • rigid perfectionistic traits
34
Q

Systemic problems with AN

A
  • Cachexia
  • cardiac probs
  • GI
  • reproductive
  • derm
  • heme
  • neuro
  • skeletal
35
Q

AN Tx

A
  • Hospitalize if have: medical sequelae; failed output tx; are 20% below wt for ht
  • daily blind wt
  • monitor I&O
  • check electrolytes (if vomiting)
  • Manage acute medical news, restore wt safely, work on body image and self esteem
  • meds = cyproheptadine, amitriptyline
36
Q

Bulimia Nervosa DSM IV Criteria

A
  • Recurrent episodes of binge eating:
    1) eating more than most in a discrete period of time
    2) sense of lack of control over eating episode
  • Recurrent inappropriate compensatory behavior to prevent wt gain (self induced vomiting, laxative abuse, diuretics or abuse of emetics)
  • Binge eating and compensation at least 2x per week for 3 mnths
  • seld evaluation influenced by body shape and wrt
  • does not occur during episodes of AN
37
Q

AN Etiology

A
  • Biological factors: NT
  • Social Factors: societal pressures, families that are less close
  • psych factors: more outgoing, angry and impulsive
38
Q

Types of Bulimia

A
  • purging: self induced vomiting, or misuse of laxatives, diuretics or enemas
  • nonpurging: fasting, excessive exercise; NOT due to vomiting, laxatives, diuretics or enemas
39
Q

Bulimia Features

A
  • late adolescence or early adulthood
  • ***normal body wt or even overweight
  • more likely to seek help than pts with anorexia and have higher rates of recovery
  • comorbid with substance abuse, impulse d/o, borderline PD
40
Q

Management of Bulimia

A
  • CBT: firstline tx
  • Meds: fluoxetine: can be used without the presence of mood d/o
  • stabilize medical sequelae
41
Q

Obesity dx

A
  • excess body fat; >20% standard weight; BMI > 30 kg/m2

- Health features affected: Cardiac, vascular, GI, DM, gout, kidneys, joints, muscles, reap, neoplasms

42
Q

Obesity tx

A
  • diet
  • exercise
  • pharmacotherapy: orvistat, sibutramine, rimanabant
  • surgery
  • psychotherapy