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Psychiatry Part 2 > Child Psychiatry > Flashcards

Child Psychiatry Flashcards

1
Q

What is the primary symptom of pediatric depression?

A

Irritability (temper tantrums)

Being oppositional

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2
Q

What percent of kids have a comorbid diagnosis with depression?

A

40-70%

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3
Q

What percent of kids have substance misuse with depression?

A

20-30%

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4
Q

What percent of kids have disruptive and neurodevelopmental disorders (conduct disorder, ADHD, learning disorder) with depression?

A

10-80%

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5
Q

What percent of kids have SI with depression? Suicide attempts with depression?

A

60% SI

30% attempts

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6
Q

What diagnosis is difficult to distinguish from ADHD?

A

Bipolar mania

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7
Q

What percent of kids have a clinically significant disorder?

A

5-15%

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8
Q

Below age 12, which sex has higher rates of disorders? What kinds of disorders?

A

Boys outnumber girls

Usually behavioral, learning, developmental disorders

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9
Q

Ages 12-18, which sex has higher rates of disorders? What kinds of disorders?

A

Girls outnumber boys

Usually anxiety/affective disorders

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10
Q

Which behavior contributes to the most mortality and morbidity in kids?

A

Unintentional injuries and violence

Then tobacco use

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11
Q

What are the leading causes of mortality and morbidity in kids?

A

Behaviors (i.e. injuries and violence)
Obesity
Asthma

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12
Q

What is the leading cause of death in people aged 10-24 in the U.S.?

A

Motor vehicle crashes (30%)

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13
Q

What is juvenile delinquency?

A

Participation in illegal behavior by minors

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14
Q

What percent of adolescents engage in some form of juvenile offense?

A

60-80%

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15
Q

What percent of teen deaths are due to suicide?

A

12%

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16
Q

What percent of adolescents have SI?

A

20% per year

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17
Q

What percent of adolescents attempt suicide?

A

6% per year

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18
Q

Which sex attempts suicide more often?

A

Females

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19
Q

Which sex completes suicide more often?

A

Males

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20
Q

How long to teens contemplate suicide prior to an attempt?

A

Hours (esp. males)

- compared to 1 day for young adult and 3 days for elders

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21
Q

British suicide rate dropped by 29% after what intervention was implemented?

A

Tracer odors were put in household heating gas

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22
Q

What meds have FDA warnings regarding increased SI?

A

Antidepressants
Atomoxetine
Antiepileptics

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23
Q

What meds have FDA warnings regarding metabolic disease?

A

Atypical antipsychotics

24
Q

What is the response rate for stimulants for ADHD?

A

65-75%

All stimulants equally effective

25
Q

What stimulant is more effective for ADHD if comorbid autism is present?

A

Methylphenidate

26
Q

What FDA black box warning was recently removed from amphetamine salts?

A

Cardiotoxicity

27
Q

What extended-release preparations are available for ADHD?

A

Transdermal methylphenidate
D-threo methylphenidate
Lisdexamfetamine

28
Q

What meds are recommended for ADHD with “autonomic reactivity” (e.g. hypervigilance, overarousal)

A

Alpha-adrenergic agents (e.g. clonidine/guanfacine)

29
Q

What is the response rate for SSRIs for depression in kids compared to placebo?

A

40-70% vs. 30-60% for placebo

30
Q

What are the only FDA approved medications for pediatric depression?

A

Fluoxetine (8 y/o or older)

Escitalopram (12 y/o or older)

31
Q

What is the FDA black box warning for SSRIs in kids?

A

Suicidal ideation (no increase in suicide attempts)

32
Q

What SSRIs are approved for pediatric OCD?

A

Fluvoxamine, sertraline, fluoxetine

33
Q

What medication is indicated for enuresis?

A

Imipramine (TCA)

34
Q

What TCA is indicated for OCD?

A

Clomipramine (esp. helpful for repetitive behaviors in autism)

35
Q

Combination of psychotherapy and pharmacotherapy is most effective for what pediatrics diagnoses?

A

Moderate to severe depression

OCD

36
Q

What medications are FDA approved for bipolar disorder in adolescents?

A

Lithium (first line), risperidone, aripiprazole

37
Q

What side effect of atypical antipsychotics are youth more susceptible to?

A

Metabolic disturbances

38
Q

What are the indications for using risperidone in pediatrics?

A

Irritability for children and adolescents with autism
Adolescents with schizophrenia
Adolescents with bipolar disorder

39
Q

What are the indications for using aripiprazole in pediatrics?

A

Adolescents with schizophrenia

Adolescents with bipolar disorder

40
Q

What pediatrics disorders does CBT have the best evidence for?

A

Depression
Anxiety
PTSD

41
Q

What pediatric disorder do behavioral strategies have the best evidence for?

A

Conduct problems

42
Q

What pediatric disorder does parent training have the best evidence for?

A

Preschool challenges

Conduct problems

43
Q

What pediatric disorder does Multi-Systemic Therapy have the best evidence for?

A

Conduct problems (more effective than hospitalization or incarceration)

44
Q

What are the criteria for ADHD inattentive type?

A

6 or more of the following for >6 months:

  • careless with details
  • can’t keep on task
  • doesn’t seem to listen when spoken to
  • doesn’t follow through with instructions
  • difficulty organizing
  • reluctant to put in effort for school or homework
  • often loses things necessary for activities
  • is easily distracted
  • is forgetful
45
Q

What are the criteria for ADHD hyperactive-impulsive type?

A

6 or more of the following for >6 months:
Hyperactivity
- often fidgets with hands or feet or squirms in seat
- often climbs or runs about or feels restless
- difficulty playing or engaging in leisure
- often leaves seat when expected to remain in seat
- often is “on the go” or acts as if “driven by a motor”
- often talks excessively
Impulsivity
- often blurts out answers before questions - completely asked
- has difficulty awaiting turn
- often interrupts or intrudes on others

46
Q

What is the prevalence of bipolar disorder in kids? Adolescents?

A

Kids 0.4-6%

Adolescents 1%

47
Q

What percent of adults with bipolar disorder had symptom onset before 10 y/o?

A

0.3-0.5%

48
Q

What are the criteria for oppositional defiant disorder?

A 
At least 6 months of the following:
- Loses temper, argues
- Defies
- Deliberately annoys/easily annoyed
- Angry, resentful, spiteful
Wonder about the family variables?
49
Q

What are the criteria for conduct disorder?

A

3 or more of the following in the last 12 months:
- Truancy, runaways
- Aggression to people, animals
- Destruction of property
- Deceitfulness/theft
- Serious violations of rules
Can occur as part of other diagnoses (e.g. PTSD)

50
Q

What is reactive attachment?

A

Markedly disturbed and developmentally inappropriate ways of relating socially in most contexts
Related to extreme/insufficient care
Significant impact on affiliation

51
Q

What are the criteria for PTSD in kids?

A

Re-experiencing phenomena (flashbacks, nightmares)
Avoidance and trust issues
Re-enactment issues (play themes, conduct regulation)

52
Q

Until proven otherwise, hallucinations in pre-adolescents are often what?

A

Anxiety (including PTSD)

53
Q

Criteria for autism spectrum disorder?

A

Deficits in in social interaction and communication
- Deficits in nonverbal communication skills
- Failure to develop appropriate peer relationships
- Lack of social understanding, interests, reciprocity
Restricted repetitive and stereotyped patterns
of behavior
- Preoccupation with idiosyncratic interests
- Inflexible adherence to routines/rules
- Stereotypic motor mannerisms
Can occur with or without intellectual or language impairments
Now includes wide range of functioning (including Aspergers disorder)

54
Q

What is the most life-endangering psychiatric diagnosis in kids?

A

Anorexia nervosa

55
Q

What is the female:male ratio in anorexia nervosa?

A

10:1

56
Q

What are the timeline criteria for bulimia nervosa?

A

Bingeing at least once a week for 3 months

Psychiatry Part 2 (8 decks)

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