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
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
