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
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
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
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
5
Q
Causes of enuresis
A
- nocturnal polyuria
- overactive detrusor
- disturbed sleep
- pinworms
- LS spine defect
- inadequate ADH
6
Q
Enuresis tx
A
- motivational tx
- positive reinforcement
- Bell and pad
- DDAVP (desmopressin)
- often spontaneous remission
- Meds: imipramine
7
Q
Hinman’s syndrome
A
-neurogenic bladder resulting from habitual, voluntary tightening of external sphincter during urges to urinate
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)
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
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
11
Q
ADD is comorbid with:
A
- ODD
- conduct disorder
- Mood disoders
- anxiety d/o
- learning disability
- tics/tourettes
- substance abuse
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
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
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
15
Q
ADD Impulsivity sx’s
A
- blurts out answers
- can’t wait turn
- interrups others
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