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Psychiatry > Child Psych > Flashcards

Child Psych Flashcards

1
Q

List the inattentivity symptoms in ADHD

A

Require >=6 for >=6 months (or >=5 for those >17)

  • fail to provide close attention to detail
  • difficulty sustaining attention
  • does not listen
  • does not follow through on instruction
  • difficulty organizing tasks
  • avoids tasks requiring sustained mental effort
  • often loses things
  • Easily distracted
  • Forgetful
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2
Q

List the hyperactivity symptoms in ADHD

A

Require >=6 for >=6 months (or >=5 for those >17)

  • Fidgets or taps hands/feet
  • leave seat when should remain seated
  • often runs about or climbs when not appropriate
  • inability to engage in leisure activities
  • often on the go
  • talks excessively
  • often blurts out answer
  • difficulty waiting turn
  • interrupts
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3
Q

List the diagnostic criteria for ADHD

A
  • persistent inattention and/or hyperactivity than interfere with functioning
  • symptoms present before age 12
  • symptoms present in more than 2 settings
  • interference with psychosocial function
  • other disorder ruled out
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4
Q

List the medications most commonly used for ADHD

A

Medications necessary for behavioural treatment
- Adderal XR 5-10mg qAM titrated by 5mg every 7 days until max 30mg
- Biphentine: 10-20 qAM titrated by 5mg every 7 days until max 60mg
- Concerta 18mg qAM titrate by 9-18mg every 7 days until make 72mg
- Vyvanse 20-30mg qAM titrating by 10mg every 7 days until max 60mg
- prodrug so no ability for abuse
Second Line
- short acting psychostimulants
3rd Line:
- antidepressants

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5
Q

List the side effects and contraindications of psychostimulants

A

Side Effects
- headache, stomachache, anorexia, insomnia
- risk of abuse
- rebound psychosis
- arrhythmia, hypertension
Contraindications
- any child with hypertension, heart disease/abnormality, hyperthyroidism
- require screen of cardiac symptoms and family history
- if screen positive require ECG

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6
Q

List the psychosocial intervention for ADHD

A 
Behavioural Intervention
Psychotherapy
- CBT
- IPT
- Family therapy
Social Intervention
Education/Vocational Accomodations
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7
Q

List the risk factors for oppositional deviant disorder

A
  • maternal depression
  • family history of disruptive behaviour
  • parenting style with inconsistent and severe discipline
  • multiple caregivers
  • family discord
  • low income
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8
Q

List common comorbidities with ODD

A
  • ODD increase risk of ADHD
  • 25-30% of ODD with develop conduct disorder and is usually more serious and risk of developing antisocial personality disorder
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9
Q

List the diagnostic criteria for ODD

A
  • Angry/irritable mood, argumentative/defiant behaviour or vindictiveness for >=6 months with >=4 symptoms with interactions with more than 1 person that is not a sibling
  • disturbance in behaviour leads to distress in people around individual and impair psychosocial function
  • substance use or other disorder ruled out
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10
Q

List the angry/irritable mood, argumentative/defiant behaviour and vindictive symptoms

A 
Angry/Irritable
- often loses temper
- easily annoyed
- often angry or resentful
Argumentative/Defiant
- argue with authority figure
- actively defies or refuses to comply with rules or request from authority
- often deliberately annoys others
- often blames others for mistakes
Vindictiveness
- spiteful or vindictive >=2 times in last 6 months
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11
Q

List the frequency of symptoms in ODD

A
  • <5yo then symptoms most days for >=6 months

- >5 yo then symptoms weekly for >=6months

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12
Q

List the treatment for ODD

A 
- medication usually not helpful unless comorbid ADHD
Psychosocial
- anger mangement
- CBT
- family counselling
- parent training
Prevention
- parents and school training
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13
Q

List the risk factors for conduct disorder

A
  • family member with conduct disorder
  • parent history of substance abuse or mental health disorder
  • marital conflict
  • exposure to antisocial behaviour
  • inconsistent parental discipline
  • delinquent peer group
  • exposure to violence
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14
Q

List the diagnostic criteria for conduct disorder

A
  • Repetitive and persistent behaviour that violates basic rights of others or major age-appropriate social norms with >=3 of the following symptoms in past 12 months and >=1 in past month
    - aggression to people or animals
    - destruction of property
    - deceitfulness or theft
    - serious violation of rules
  • disturbance in behaviour impair psychosocial function
  • > 18 and antisocial criteria not met
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15
Q

List the limited prosocial emotion criteria in conduct

A 
>2 in following 12 months
- lack of remorse or guilt
- callous lack of empathy
- unconcerned about performance
- shallow or deficient affect
Usually associated with childhood onset and is more severe
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16
Q

Discuss the management of conduct disorder

A 
Medication for comorbidities
- hyperactivity with psychostimulants
- impulsivity with mood stabilizer, neuroleptic or clonidine
Psychosocial
- CBT
- Parent management training
- family therapy
- Multi-systemic therapy
17
Q

Discuss the differential for those children with disruptive disorders

A
  • Impaired language comprehension
  • intellectual disability
  • mood disorder
  • social phobia
18
Q

Discuss the screening for autism

A

Evaluation required if miss developmental milestones

  • 12 months with no babbling, gesturing, or response to name
  • 16 months does not speak
  • 24 months does not speak 2 word phrases
  • Any age have loss of language or social skill
  • Any age have abnormal eye contact, no interactive play, lack of interest in other children
19
Q

List the diagnostic criteria for autism

A
  • Persistent deficit in social communication and interaction in multiple contexts:
    • deficit in social emotional reciprocity (abnormal social approach to failure to initiate contact)
    • deficit in nonverbal communication behaviour (poor verbal/non-verbal communication to total lack of facial expression)
    • deficit in developing, maintaining, and understanding relationships (difficulty adjusting to social behaviour to absence of interested in peers)
  • Restricted and repetitive behaviour
    - stereotyped motor movements, use of an object, or speech
    - insistance on sameness, inflexible adherence to routine
    - highly restricted and fixated interests
    - hyper or hypo-activity to sensory input
  • symptoms present in early developing years (age 4)
  • symptoms impair psychosocial functioning
  • intellectual disability and global developmental delay ruled out
20
Q

List the goals of therapy for autism

A
  • require multimodal treatment in order to improve and promote social interaction and conversational language
  • normalize sensory responses and mitigate self-stimulatory behaviour
21
Q

Discuss the management for autism

A

Psychotherapy
- applied behaviour analysis which teaches new behaviour by explicit reinforcement of those behaviours
Medication
- atypical antipsychotics (risperidone or aripiprazole) to treat irrability, tantrum, aggression, and self-injurious behaviour

22
Q

List the differences in depressive symptoms between children and adolescents

A

Onset
- sudden with stressors in adolescents (switching schools, social pressures, biological changes, loss of loved one)
Mood
- irritable, behavioural problem in children
- hopeless in adolescent
Behaviour
- school refusal, social withdrawal and aggression in children
- substance abuse, truancy, promiscuity and hypersensitivity in adolescents
Sleep and Appetite
- no affect in children
- hypersomnia and hyperphagia on adolescents
Psychosis
- auditory hallucinations in childrne
- delusions in adolescents
Somatic
- yes in children

23
Q

List good and poor prognosticators for depression

A 
Good
- acute stressor
- child well equipped to cope with feelings
- support from home, school and social 
Poor
- genetic susceptibility
- chronic and recurring stresses
- child/adolescent has poor coping skills
- early onset depression
24
Q

Discuss MSIGECAPS with common symptoms in children

A 
Must meet >=5 criteria for at least 2 weeks where mood and interest must be included
Mood
- depressed or irritable or vague physical complaints
Sleep
- insomnia or hypersomnia
Interest
- loss of interest in peer play
Guilt/Worthlessness
- self-depreciation
Energy
- lack of peer play, school refusal, or frequent abscense
Concentration
- lead to behavioural difficulties
Appetite
- not gaining weight
Pscyhomotor agitation/retardation
- hyperactive behaviour
Suicide
- non-verbal cues
25
Q

Work up for depression in children and adolescents

A
  • CBC for anemia
  • Electrolytes
  • Metabolic workup for hypercalcemia, hypo/hyperglycemia, B12
  • kidney function
  • liver funtion
  • TSH for hypothyroidism
26
Q

Discuss the management of depression in children

A
  • mild to moderate depression have CBT or IBT first line and then SSRI second line
  • severe require SSRI first line with CBT
  • first episode require treatment for at least 6 months
  • second episode treat for 1 year
  • > 2 episodes treat 1-3 years or indefinitely
27
Q

Discuss the medication used for depression in children

A
  • Fluoxetine only one approved for children <12yo
  • Sertaline, Citalopram or Escitalopram used off label
  • when starting medication require safety plan and close monitoring with weekly meetings for first month and then every 2 weeks for 2nd month
  • those with psychotic features have increased risk of suicide so require admission
    • also require antipsychotics
28
Q

Discuss assessment of suicide in children

A 
Suicide plan
- active vs passive
- chronic vs acute
- frequency and intrusiveness
- sense of control and reasoning
Previous Suicide Attempt
- greatest risk for future suicide attempt
Rapport and Engagement
Risk Factors
- age 15-25
- female
- Abnoriginal, White, Hispanic
- psychiatric or physical disorder
Protective Factors
- close attachment
- problem solving skills
- support system
- remorseful regarding attempt
29
Q

List the diagnostic criteria for disruptive mood dysregulation disorder

A
  • Severe recurrant temper outburst
  • Temper outburst inconsistent with behavioural level
  • Temper outburst >=3 times per week
  • Mood between temper is consistently irritable or angry
  • Present for >1 year, where never symptom free for >3 months
  • present in >= 2 settings
  • symptom onsent <10, with diagnosis not made on first time between 6-18
  • no manic episodes
  • no other psychiatric or substance disorder
30
Q

List the risk factors for anxiety in children

A
  • early temperamental trait of passivity and shyness between 3-5
  • behavioural inhibition: show fear or withdrawal in new situation
  • insecure mother-child attachment in infancy
  • imitation of parents poor habits
  • parental concerns regarding seperation
  • close relationship with mother only
31
Q

Define anxiety disorder in children

A

Anxiety that is

  • inappropriate for developmental age
  • prolonged or recurrent
  • distressful for children
  • impairing pscyhosocial function
  • specific symptoms
32
Q

Discuss the management of anxiety disorders in children

A 
Pscyhosocial intervention
- pscyhoeducation
- IPT
- CBT
- school intervention
Medication
- SSRI
- atypical antipsychotic or benzodiazepine used as last line
     - for specific phobia can use benzo PRN
     - for selective mutism CBT 
School Intervention
- address bullying
- remediation for missing class
- school psychoeducation
33
Q

List the diagnostic criteria for separation anxiety disorder

A
  • Developmentally inappropriate and excessive fear concerning separation from those patient is attached with >=3 of the following
    - distress when anticipating or experiencing separation
    - persistant worry about losing attachment figures
    - persistant worry about experiencing event that cause separation
    - reluctance to go out due to fear of separation
    - reluctance of being alone or without major attachment figure
    - reluctance to sleep away for attachment figures
    - repeated nightmares regarding separation
    - complaints of physical symptoms when separated
  • persistent >4 weeks in children <18 or >6 months in adults
  • disturbance leads to distress and impairs psychosocial function
  • not other disorder
34
Q

Differentiate between truancy and school refusal for school absence

A

Truancy
- child and teens with antisocial tendancies
- skipping due to lack of interest or refusing to conform
- no underlying anxiety with school
- conceal absences
School Refusal
- emotional distress about attending school
- Do not conceal absences
- Willingness to complete work from home

35
Q

List the factors associated with school refusal

A 
School factors
- specific fears that occur in school
- escape from social situation
- academic underachievement
Home Factors
- separation anxiety
- attention seeking
- pursue another activity by being away from school
- recent stressor
Psychiatric Factor
Medical Factors
36
Q

Discuss the presentation of school refusal

A
  • usually occur following few days off schools (vacation, weekend)
  • occur following significant stress
  • fearfulness, tantrum, self-harm
  • somatic symptoms
37
Q

Discuss the short and long term impacts of school refusal

A 
Short Term
- difficulty maintaining peer relationships
- difficult family relationships
- poor academic performance
Long Term
- academic underachievement
- employment difficulties
- Increased comorbid psychiatric issue
38
Q

Discuss the management of school refusal

A
  • identify factors leading to refusal
  • early return to school is primary goal
    - education of family and patient
    - behaviour strategies
    - psychotherapy
    - SSRI for anxiety or benzo short term
    - provide support by liasing with school

Psychiatry (15 decks)

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