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child psych Flashcards

1
Q

Criteria for autism spectrum disorder

A

A. Persistent deficits in social interaction and communication in more than one context as manifested by the following
-Deficits in emotional reciprocity
-Deficits in nonverbal communicative behaviors usually
employed for social interaction
-Deficits in understanding, developing and maintaining
relationships

B. Restricted and repetitive patterns of behaviour,
interests and activities
-Repetitive or stereotyped motor movements, speech or
use of objects.
-Inflexible adherence to sameness and/or routines
-Hyper/or hyposensitivity to sensory stimulation or input,
or unusual peroccupation with sensory aspects of the
environment.

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2
Q

What percentage of children with autism spectrum disorder will never achieve useful speech ?

A

50%

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3
Q

Differential diagnosis for autism

A

Rett syndrome (child with normal birth and developmental history until 5 months loses previosly attained developmental milestones)

Schiophrenia (prodrome looks like autism)

Intellectual disability with autism (quite similar, usually social and communication difficulties in terms of non verbal skills exceed what is expected)

Language disorders (not associated with repetitive patterns of behavior)

Selective mutism (early development not impaired in these kids)

Stereotypic movement disorder

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4
Q

Chance of bedwetting if both parents were effected

A

70%

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5
Q

Emotional mechanisms in enuresis

A
  1. Regression: often follows stressor. Child goes back to earlier developmental stage. Loss of previously attained maturity.
  2. Aggression: Child appears to be intentionally wetting the bed or himself. Angry reaction to circumstance, or reaction to domineering/ rejecting parent.
  3. Anxiety: Physical/ sexual abuse, unfamiliar social situations (moving, starting new school), major family events ( death, birth of sibling, divorce), moving to new environment, chaotic family with uninvolved parents.
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6
Q

Likely causes of nocturnal enuresis

A
  1. slower physical development
  2. overproduction of urine at night
  3. inability to recognise bladder filling when asleep.
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7
Q

Which psychiatric conditions are ass with nocturnal enuresis

A

ADHD
Obstructive sleep apnoea
anxiety

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8
Q

Causes of daytime enuresis ( dirunal )

A
  1. UTI
  2. Structural problem
  3. Overactive bladder
  4. Infrequent or incomplete voiding
    (voluntary witholding, bladder overfills and leaks urine..often also develp UTI)
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9
Q

What is an overactive bladder

A

2 of the following

  • Urinary urgency: inability to delay urination
  • Urge urinary incontinence: Leakage when the bladder contracts unexpectadly
  • Urinary frequency: Urination eight or more times/day, or more than twice at night.
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10
Q

Investigations in a child with enuresis

A
  1. Exclude general medical condition
    - infection
    - neuro conditions
    - DM/ insipidus
    - convulsions
    - adverse effects of medication

2.Take detailed hx: durartion, development, toilet training, functioning in other areas, relationships, school performance
3. Identify child alone
-identify emotional problems
- how does child feel about problem
-Identify stressors
.Child cooperation in treatment problem
-assess whether development and intellect are normal

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11
Q

Treatmetn of enuresis

A

Supportive therapy

Parents must use positive reinforcement/ no punishment
#Behavioural methods
Check that toilet training had occured
Star chart…with reward
Fluid restriction, avoid caffeine
Parents may wake child to take him to toilet
Bladder training (taught to delay urination during the day..use reward system)
Electric alarm system

  1. Desmopressin: increase ADH levels
  2. Imipamine
  3. Oxybutinin ( only for overactive bladder
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12
Q

Adverse effects of desmopressin

A

headache
nasal congestion
epistaxis
hyponatremic convulsions

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13
Q

What percentage of kids we will wet the bed less after Rx with imipranine?

A

85% wet the bed less

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14
Q

Diagnostic criteria for encopresis

A

A: Repeated passage of stool in inappropriate places, whether involuntary or intentional
B: Occurs at least once a month, for at least previous 3 months
C:Age >4years
D: behavior not due to general medical condition or effect of a substance (laxative)

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15
Q

Types of encopresis

A

With retention & without retention

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16
Q

Differential for psychosis in adolescent/ child

A
  1. Delirium
  2. Substance induced psychosis
  3. Bipolar, ( bipolar usually presents with depressive episode with psychosis)
  4. schizoid, schizotypal personality traits
  5. Autism spectrum disorder
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17
Q

True or false:

ASD can present with hallucinations and delusions

A

false. delusions and hallucinations should not be present in ASD.

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18
Q

Differential for Bipolar disorder in children/ aldolescents

A
  1. Delirium
  2. Brief reactive psychosis
  3. Substance induced psychosis or mania
  4. Mania/ psychosis due to another medical condition
  5. Factitious disorder
  6. Extreme hyperactivitiy/ ADHD
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19
Q

Which substances typically cause substance induced psychosis

A

Cannabis

Methamphetamine

20
Q

When would one consider ECT in child with Bipolar

A

only in the presence of life threatening catatonia or depression

21
Q

Diagnostic criteria for seperation anxiety disorder

A

A: Excessive and developmentally inapproporiate anxiety about seperation from home or attachment figures as shown by at least 3 of the following:

(1) Recurrent, excessive distress when seperation from attachment figures occurs/ is anticipated
(2) unrealistic fear that harm will come to parents, or that child is lose them
(3) unrealistic fear that something will happen to child themselves, that can seperate them from parent
(4) refusal/reluctance to go to school
(5) refusal/ unwillingness to be alone
(6) refusal to sleep alone
(7) Repeated nightmares about seperation situations
(8) Recurrent somatic symptoms

B: >4weeks
C: Causes clinically significant distress or impairment
D: Symptoms not caused by another medical condition

22
Q

Associated symptoms with separation anxiety disorder

A 
#fear of the dark
#bizarre fears that are inapproproate for developmental age (eg monsters)
#depressed mood
#panic attacks, and possibel comorbid panic disorder
23
Q

Differential diagnosis of seperation anxiety disorder

A
  • General medical condition that causes child to feel unsafe
  • Normal seperation anxiety appropriate for developmental age
  • Panic disorder/ agoraphobia
  • major depressive episode
  • psychosis, especially with persecutory delusions
  • Conduct disorder
24
Q

What is agoraphobia

A

irrational fear of places or situations where help may not be available, or where escape is difficult

25
Q

RX for seperation anxiety disorder

A

+Multidisciplinary approach
+re-establish regular school attendence
+ CBT
+Liason with the school, make arrangements
someone to accompany child to school
Teacher to accompany child
sympathetic but firm approach
+Medication: Fluoxetine (20-60mg…in biological therapies chapter, not sure if its less in kids)
+Admission sometimes necessary to start behavioral therapy programme

26
Q

Diagnostic criteria for generalised anxiety disorder

A

A: excessive anxiety for more than 6months about several events or activities.
B: Child finds it difficult to control anxiety
C: One of the following symptoms is present for at least 6 months.
-restlessness or tension
-easily fatigued
-difficulty concentrating
-irritability
-muscle tension
- disturbed sleep
D: Symptoms cause significant distress or impaired functioning in the child
E: Symptoms are not directly caused by a substance or general medical condition, & do not occur exclusively during another psychiatric disorder.

27
Q

panic disorder definition

A

Characterised by recurrent and spontaneous, unexpected panic attacks
Symptoms must be present for a period of 1 month :
persistent worry about having attacks
worry about implications of attacks
significant change in behavior because of attacks

28
Q

Panic attack

A

rapid escalation of symptoms over approx 10 min..
severe, intense feeling that something terrible is going to happen…
accompanied by any number of somatic symptoms

29
Q

Diagnostic criteria for Obsessive compulsive disorder

A
  1. Obesessions or compulsions or both are present
  2. The symptoms cause distress or functional impairment, or are time consuming
  3. Not caused by substances or general medical condition
  4. Not better explained by another psychiatric condition.
30
Q

Provisional tic disorder

A

Motor/ vocal or both

duration <1year

31
Q

persistent motor/ vocal tic disorder

A

Motor OR vocal

>1 year

32
Q

Tourettes disorder

A

Motor AND Vocal

> 1 year

33
Q

Approach & management to suicidal teenager

A
  1. Acknowledge that they might feel embarrased and not want to talk about it: beware of counter transference , remain non judgemental be accepting and sympathetic.
  2. Provide medical treatment and stabilise pt
    3.History: gender, age, what happened, (stressor, premeditated), method, irretractable stressors, prescence of chronic/ incurable medical/ mental illness
    *collat
  3. Assess severity of attempt by identifying high risk factors
  4. Arrange for admission when medically indicated or if the child falls into a high risk group
  5. Diagnosis and refer to psych, especially if depression
  6. Refer for further management to psychiatrist, psychologist or social worker if there are difficulties (family pathology, substance abuse, social problems)
    8.discharge with legal guardian, or to a place of safety
  7. If MDE: mild -mod- psychosocial intervention for 4-6weeks and watcg
    Moder-severe: psychosocial intervention + antiidepressant
  8. follow up in 1 week
34
Q

diff dx of distracted child

A
  1. ADHD
  2. ASD
  3. Hearing/ vision problems
  4. Intellectual disability
  5. Substances
  6. conduct disorder
  7. low or very high IQ
  8. Anxiety
  9. depression
35
Q

Comorbidites of ASD

A 
ADHD
Mood: depression 
Anxiety
Sensory impariment 
seizures 
Intellectual disabilities
36
Q

scenario: 16yr with auditory hallucinations, prev hx of depression now refusing to go to school
discuss approach and management

A
  1. History, course of disease, prev epi, stressors, medical hx, substance, fam hx of psych, previos functioning
  2. Thourough physical
  3. MSE
  4. special investigation s
  5. refer to appropriate hospp
  6. Hospitalisation: Involuntary if >14, <14 with parental consent
  7. atpyical antipsychotic
  8. Rehab within school systme
  9. long term occupational rehab
37
Q

side effects of ritalin

A 
Stomach aches
 headaches
insomnia
tic
precipitation/exacerbation of rebound hyperactivity
growth retardation 
risk of abuse
38
Q

5 Behavioral therapy techniques

A 
systemic desensitisation 
aversion therapy 
implosive therapy 
assertiveness training 
token economy
39
Q

5 psychiatric complications of stimulant abuse

A 
Delirium 
Mania
Psychosis
Depression 
Aggression
40
Q

How to differentiate between eating disorder and general medical condition in a 16 year old that presents with weight loss….

A

History: when did it start, how much weight lost,
Constitutional symptoms, family history of weight
loss,
Substance abuse,
Use SCOFF screening questions
take more detailed history of eating problem etc

Psych conditions, and family psych conditions

*look for self harm

Exam: pallor, lymphade, constitutional symptoms, dental caries ( repeated vomiting), parotidomegaly ( repeated vom), any abdo masses, do a PR, cardiac and resp too

Defs FBC; iron and LFTs

41
Q

what are the SCOFF screening questions for eating disorders

A

Do you make yourself SICK
do you worry that you have lost CONTROL
Have you recently lost more than ONE stone
Do you believe yourself to be FAT
Would you say that FOOD dominates your life

42
Q

Criteria for ADHD

A

either 1 or 2

  1. at least 6 of sx´s for 6 months to degree which is inappropriate for childs stage
    Inattentiveness
    a) cannot give careful attnetion to detail
    b) Difficulty keeping attention to tasks
    c) Often appears not to listen when directly spoken to
    d) Does not complete tasks
    e) finds it difficult to organise taks
    f) Avoids tasks requiring sustained attention
    g) Often loses items necessary for tasks
    h) Attention is easily distracted
    i) Often forgetful in daily activities
  2. at least 6 of the following symptoms of hyperactivity/ impulsivity for at least 6 months to a degree inappropriate for stage

a) fidgets
b) leaves seat often
c) Runs or climbs excessively
d) finds it difficult to play quiety
e) Often on the go
f) often talks excessively

g) Blurts out answer
h) cannot await his turn
i) often interrupts others

  • should occur in multiple settings
  • before age 12
  • impairment
  • not explained better by another psych condition
43
Q

Adverse effects of methylphenidate (ritalin)

A 
Loss of appetite
Nausea, vomi
weight loss
gastric pain 
headache
Insomnia
Can increase BP
Pulse rate
intraocular pressure
Seizure threshold lowered 
Execerbation of tic disorders

Possible slowing of growth, but they catch up

Rebound hyperactivity, occurs when effect of short acting rit wears off.. change pt to long acting
depressed mood and anxiety symptoms

44
Q

Contraindications for Methylphenidate

A 
Absolute:
 hyperthyroidism 
 cardiac dyrhythmias
 psychosis 
 glaucoma 
 concomitant MAO inhibitor therapy 
Relative:
 Hypertension 
 anxiety
 agitation 
 epilepsy 
 Congenital cardiac conditions
 tic disorders
45
Q

Guidelines for starting ritalin

A

Start at lowest possible dose:
5mg 2-3 times daily after food intake approx every 3 to 3 and a half hours. and give third dose not later than 3pm.

If no improvement on 5mg increase dose at weekly intervals by 5-10mg until symptoms controlled.

DO NOT exceed 1mg/ kg/ day
DO NOT exceed 40mg/ day
If problem with administration, consider long acting formulations like concerta.
CHildren with ADHD often present with iron def anemia, supplement

Psychiatry (4 decks)

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