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Psychiatry > Child + Geriatric Psychiatry > Flashcards

Child + Geriatric Psychiatry Flashcards

1
Q

what is pseudodementia?

A

apparent decline in cognitive and memory function caused by symptoms of major depression

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2
Q

∆ btwn dementia and pseudodementia in terms of

  • onset
  • sundowning
  • how they answer when they don’t know an answer
  • insight to problem
  • cognitive improvement with antidepressants
A

DEMENTIA

  • onset: insidious, slow
  • sundowning: +
  • how they answer: confabulate/guess at answers
  • insight to problem: unaware
  • cognitive improvement with antidepressants: no

PSEUDODEMENTIA

  • onset: more acute
  • sundowning: -
  • how they answer: “i dont know”
  • insight to problem: aware
  • cognitive improvement with antidepressants: yes
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3
Q

treatment of pseudodementia

A

antidepressants: SSRI (preferred over MAOi and TCAs)
supportive psychotherapy
community resources

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4
Q

If using TCAs in the elderly, which one should you use and why?

A

nortriptyline - fewest anticholinergic effects

“no trip”

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5
Q

benefit of using mirtazapine in the elderly with pseudodementia

A

increases appetite and is also sedating - best for patients who suffer from decreased appetite and sleep ∆s

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6
Q

benefits of using methylphenidate in elderly with pseudodementia

A

used to treat patients with psychomotor retardation

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7
Q

5 stages of grief

A 
denial
anger
bargaining
depression
acceptance
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8
Q

What is bereavement?

A

Normal grief - encompasses intense feelings of guilt and sadness, sleep ∆s, appetite changes, illusions; usually abate within 6 months of the loss

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9
Q

what is complicated bereavement?

A

bereavement that lasts >6 months

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10
Q

what is bereavement associated depression? how is it different from complicated bereavement?

A

bereavement associated depression = major depression; has generalized feelings of hopelessness, helplessness, severe guilt/worthlessness and SI

complicated bereavement = bereavement that lasts >6 months

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11
Q

When should you treat bereavement associated depression?

A

when patients have had 2 straight weeks of depressive symptoms 6-8 weeks after the precipitating loss

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12
Q

What are some age-related effects of the body’s response to alcohol?

A

1) decreased OH dehydrogenase - higher blood alcohol levels (BALs)
2) increased CNS sensitivity to EtOH

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13
Q

most common psychiatric disorder in the elderly:

A

MDD

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14
Q

result of concurrent EtOH use and H2 blockers

A

higher BALs

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15
Q

result of concurrent EtOH use and benzodiazepines, TCAs, narcotics, barbiturates, anti-histamines

A

increased sedation

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16
Q

result of concurrent EtOH use and NSAIDs/Aspirin

A

prolonged bleeding time, irritation of gastric lining

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17
Q

result of concurrent EtOH use and metronidazole, sulfonamides, long-acting hypoglycemics

A

N, V

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18
Q

result of concurrent EtOH use and reserpine, NTG, hydralazine

A

increased risk of hypotension

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19
Q

result of concurrent EtOH use and acetaminophen, isoniazid, phenylbutazone

A

hepatotoxicity

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20
Q

result of concurrent EtOH use and anti-HTN, anti-diabetics, ulcer Rx, gout Rx

A

worsens underlying disease

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21
Q

visual hallucinations early in dementia suggests a diagnosis of:

What should you do in this case?

A

lewy body dementia

DO NOT GIVE ANTIPSYCHOTICS

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22
Q

main 3 psychiatric manifestation of dementia

A

behavioral disinhibition, agitation, aggression

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23
Q

how to treat sleep disturbances in the elderly? 2

A

hydroxyzine (Vistaril) or trazodone - both are safer than benzodiazepines

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24
Q

why do most elderly suffer from more drug ADRs because of these 3 reasons

A

1) decreased lean body mass
2) impaired liver fxn
3) impaired kidney fxn

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25
Q

mental retardation/intellectual disability is coded on which axis?

A

axis II

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26
Q

how is mental retardation/intellectual disability diagnosed in DSM?

A

IQ score <70 + ∆s in adaptive skills (conceptual skills, social skills, and practical skills)

onset before 18 yo

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27
Q

which type of mental retardation is still functionally able to hold jobs? What IQ score corresponds to this?

A

mild mental retardation

IQ 55-70

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28
Q

what are the common causes of mental retardation?

A

idiopathic
down syndrome
fragile X syndrome most common inherited form
ToRCH infections

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29
Q

What is a learning disorder?

A

academic achievement (in reading, math, written language) that is significantly lower than expected for chronological age, level of education, and level of intelligence

(fyi - often due to ∆ cognitive processing)

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30
Q

what should you do before diagnosing learning disorders?

A

always rule out sensory deficients (hearing, vision, etc)

31
Q

treatment for learning disorders?

A

remedial education

32
Q

DSM criteria for oppositional defiant disorder (ODD), include duration

A

> 6 months of negativistic, hostile, and defiant behavior during which there is

  • a frequent loss of temper
  • arguments with adults
  • defying adult’s rules
  • deliberately annoying people
  • easily annoyed
  • anger and resentment
  • spitefulness
  • blaming others for mistakes/misbehaviors
33
Q

oppositional defiant disorder (ODD) is usually comorbid with

A

substance abuse
mood disorders
ADHD

34
Q

DSM criteria for conduct disorder (CD), include duration

A

1 year of persistent pattern where there is

  • aggression towards people/animals
  • property destruction
  • deceitfulness/theft
  • serious violations of rules

higher risk of substance abuse and suicidal ideations/attempts

35
Q

conduct disorder (CD) is usually comorbid with

A

ADHD

learning disorders

36
Q

treatment for conduct disorder (CD)

A
  • multimodal treatment approach involving both family + community
  • consistent rules and consequences
37
Q

3 diagnostic criteria of ADHD

A

impulsivity
inattention
hyperactivity

38
Q

pathophysiological cause of ADHD?

A

decreased DA and NE tracts in the prefrontal cortex -> hyperactivity + impulsivity

39
Q

DSM criteria for ADHD, include duration

A

≥ 6 sx of inattentiveness, hyperactivity, or both that

  • lasted for 6 mo
  • onset prior to age 7
  • observed in ≥1 setting (home + school)
40
Q

ADHD is highly comorbid with:

A 
conduct disorder
anxiety disorder
mood disorder
personality disorder
ODD

ADHD = CAMP O

41
Q

∆ btwn stimulants (methylphenidate, dextroamphetamine, amphetamine salts) and atomoxetine (non-stimulant)

how quickly do they work?
how does this affect sleep?
who are these usually given to?

A

stimulants (methylphenidate, dextroamphetamine, amphetamine salts)

  • RAPID onset
  • ADR: insomnia

atomoxetine - non-stimulant

  • GRADUAL onset (2-3 weeks)
  • ADR: sedation
  • given to people/families with substance abuse
42
Q

What alternatives are there to stimulants (methylphenidate, dextroamphetamine, amphetamine salts) and atomoxetine (non-stimulant) for treatment of ADHD?

When is it usually given?

A

clonodine, guanfacine (both alpha-2 agonist)

usually given if patients cannot tolerate 1st line treatments, or as an adjunct therapy to stimulants (help with sleep disturbances/agitated behavior

43
Q

What is pervasive developmental disorder (PDD)?

A

developmental disorder that results in impairment in multiple areas of development (social, communicative, cognitive)

44
Q

5 types pervasive developmental disorder (PDD)

A 
Austistic d/o
Asperger d/o
Rett d/o
Childhood disintegrative disorder
PDD-NOS
45
Q

DSM criteria for Autistic disorder, include duration

A

symptoms present by age 3:

≥ 2 problems in social interaction (lack of reciprocity, lack of relationships)

≥ 1 problem in communication (delayed speech, lack of make-believe/imaginative play)

stereotyped patterns of behavior and activities (spinning wheels, toe walking, hand flapping)

(side note: 70% have IQ < 70)

46
Q

In evaluating a toddler who shows no interest or does not speak unless spoken to directly, it is important to order what test before making a diagnosis of autism

A

hearing test

47
Q

Autistic disorder is associated with these 3 medical problems

A

fragile x
tuberous sclerosis
seizures

48
Q

neurochemical composition of children with autistic disorder

A

higher peripheral serotonin levels

49
Q

What are the 2 most important predictors of prognosis in autistic disorder?

A 
level of intellectual functioning
communicative competence (ie language skills)
50
Q

What Rx can you use to control the aggression, hyperactivity, and mood lability commonly seen in children with autistic disorder?

A

antipsychotic Rx

51
Q

How is autistic disorder different than asperger disorder?

A

children with Asperger disorder have NORMAL language and cognitive development

but same symptoms in SOCIAL INTERACTION (lack of reciprocity, lack of relationships, lack of interest in sharing enjoyment with others) & REPETITIVE STEREOTYPED BEHAVIOR (spinning wheels, toe walking, hand flapping)

52
Q

DSM criteria for Asperger disorder

A

same symptoms as Autistic disorder in terms of problems with SOCIAL INTERACTION (lack of reciprocity, lack of relationships, lack of interest in sharing enjoyment with others) & REPETITIVE STEREOTYPED BEHAVIOR (spinning wheels, toe walking, hand flapping), but children with Asperger disorder have NORMAL language and cognitive development

53
Q

Children with Asperger disorder are at risk of what psychiatric disorder in adolescence and why?

A

depression because the social difficulties often lead to chronic frustration and ultimately depression

54
Q

What is Rett disorder?

A

developmental disorder where there is normal physical and psychomotor development during the first 5 months after birth, followed by

  • a decreasing rate of head growth
  • loss of previously learned purposeful hand skills btwn ages 5-30 months
  • development of stereotyped hand movements (hand wringing, hand hashing), impaired language and psychomotor retardation, problems with gait or trunk movements

risk of abnormal EEGs, seizures, & sudden death are common

55
Q

How does Rett disorder differ from Childhood disintegrative disorder

A

Rett disorder - slowed head growth, unusual hand movements present

Childhood disintegrative disorder - normal head growth, no unusual hand movements

56
Q

What is Childhood disintegrative disorder?

A

normal development in the first 2 years of life (in ALL aspects), but by the age of 10, there is a loss of previously acquired skills

≥ 2 in

  • language skill
  • social skills
  • adaptive behavior
  • bowel/bladder control
  • play
  • motor skills

≥ 2 in

  • impaired social interactions
  • impaired communication
  • restricted, stereotyped behaviors and interests
57
Q

What are examples of motor tics?

A

eye blinking
shoulder shrugging
neck jerking

58
Q

What are examples of vocal tics?

A

grunting
sniffing
snorting
using obscene words

59
Q

DSM criteria for Tourette Syndrome

A

onset of MOTOR + VOCAL tics prior to 18 years; occurs almost daily for >1 year with no tic-free period >3 months

60
Q

Tourette Syndrome is highly comorbid with these 2 psychiatric disorders

A
  • OCD

- ADHD

61
Q

Tourette Syndrome - neurochemical basis and treatment 2

A

increased DA + decreased GABA in the caudate nucleus

first-line agents: alpha-2 agonist (clonodine, guanfacine)
Adjunct agents: atypical neuroleptics (risperidone)

62
Q

Tourette Syndrome - possible infectious cause; how to diagnose?

A

PANDAS
- get anti-streptolysin O (ASO) and anti-streptococcal DNAse B (anti-DNAse B)

(can also cause OCD along with the tics)

63
Q

Why is the use of stimulants in ADHD-associated with tic disorders controversial?

A

it can exacerbate tics

64
Q

when is urinary incontinence generally established by

A

4 yo

65
Q

definition of enuresis

∆ btwn 1˚ and 2˚ enuresis

What must you rule out?

A

enuresis - involuntary voiding of urine after age 5 (> 2x/week for 3 consecutive months)

1˚ enuresis - occurs in a child without previous history of dryness

2˚ enuresis - occurs in a child who has achieved continence

must rule out: infection (ie UTI), diabetes, seizures

66
Q

definition of encopresis

What must you rule out?

A

involuntary or intentional passage of feces in appropriate places by age 4 (> 1x/month for 3 months)

must rule out: hypothyroidism, anal fissure, IBD, dietary factors

67
Q

Enuresis and encopresis may be associated with this psychiatric disorder

A

conduct disorder

68
Q

what could be a possible cause of enuresis? 2

A

small bladder

low nocturnal levels of ADH

69
Q

what could be a possible cause of encopresis? 2

A

lack of sphincter control

constipation with overflow incontinence

70
Q

pharmacological therapy for enuresis

A

anti-diuretics (DDVAP)

TCAs (imipramine)

71
Q

What is selective mutism?

A

refusal to speak in certain situations for ≥ 1 month despite the ability to comprehend and use language; more common in girls

72
Q

What is separation anxiety disorder?

How do children normally present?

A

excessive fear ≥ 4 weeks of leaving one’s parents or 1˚ caretaker, usually precipitated by a stressful live event (ie parent receives a life threatening disease)

refuse OR complain of physical symptoms to avoid going to school or sleeping alone

when forced to separate, they become extremely distressed and worry excessively about losing their parents forever

73
Q

treatment of separation anxiety disorder?

A

low-dose SSRI (fluoxetine); MUST MONITOR FOR SUICIDAL THOUGHTS

Psychiatry (12 decks)

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