Child and Adolescent Psychiatry

Question 1

Encopresis =

Answer 1

• 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

Question 2

Causes of encopresis

Answer 2

• 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

Question 3

Encopresis tx:

Answer 3

• 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

Question 4

Enuresis =

Answer 4

• 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

Question 5

Causes of enuresis

Answer 5

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

Question 6

Enuresis tx

Answer 6

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

Question 7

Hinman’s syndrome

Answer 7

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

Question 8

Attention Deficit Disorder: clinical features

Answer 8

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

Question 9

Attention deficit disorder =

Answer 9

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

Question 10

Etiology of ADD

Answer 10

• 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

Question 11

ADD is comorbid with:

Answer 11

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

Question 12

ADD DSM IV dx

Answer 12

• 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

Question 13

ADD with Inattention sx’s

Answer 13

• 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

Question 14

ADD with Hyperactivity sx;s

Answer 14

• **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

Question 15

ADD Impulsivity sx’s

Answer 15

• blurts out answers
• can’t wait turn
• interrups others

Question 16

Management of ADD

Answer 16

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

Question 17

Oppositional Defiant Disorder =

Answer 17

-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

Question 18

ODD: clinical features

Answer 18

• 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

Question 19

ODD DSM IV Dx

Answer 19

• 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

Question 20

ODD Management

Answer 20

• 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

Question 21

Conduct disorder clinical features

Answer 21

• 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

Question 22

Conduct d/o Etiology

Answer 22

• 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

Question 23

Conduct disorder in boys vs girls

Answer 23

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

- Girls: ages 14-16

Question 24

Conduct D/o DSM IV criteria

Answer 24

• 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

Question 25

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

Answer 25

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

Question 26

Conduct d/o: destruction of property sx;s

Answer 26

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

Question 27

Conduct d/o: deceitfulness or theft sx’s

Answer 27

• breaking in
• lies/cons
• stealing without confrontation

Question 28

Conduct d/o serious violation of rules ax’s

Answer 28

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

Question 29

Conduct d/o management

Answer 29

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

Question 30

Anoxrexia Nervosa criteria

Answer 30

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

Question 31

Anorexia Nervosa dx

Answer 31

• 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

Question 32

Types of AN:

Answer 32

• 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

Question 33

AN Features

Answer 33

• 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

Question 34

Systemic problems with AN

Answer 34

• Cachexia
• cardiac probs
• GI
• reproductive
• derm
• heme
• neuro
• skeletal

Question 35

AN Tx

Answer 35

• 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

Question 36

Bulimia Nervosa DSM IV Criteria

Answer 36

• 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

Question 37

AN Etiology

Answer 37

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

Question 38

Types of Bulimia

Answer 38

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

Question 39

Bulimia Features

Answer 39

• 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

Question 40

Management of Bulimia

Answer 40

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

Question 41

Obesity dx

Answer 41

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

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

Question 42

Obesity tx

Answer 42

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