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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
What stimulant is more effective for ADHD if comorbid autism is present?
Methylphenidate
26
What FDA black box warning was recently removed from amphetamine salts?
Cardiotoxicity
27
What extended-release preparations are available for ADHD?
Transdermal methylphenidate D-threo methylphenidate Lisdexamfetamine
28
What meds are recommended for ADHD with "autonomic reactivity" (e.g. hypervigilance, overarousal)
Alpha-adrenergic agents (e.g. clonidine/guanfacine)
29
What is the response rate for SSRIs for depression in kids compared to placebo?
40-70% vs. 30-60% for placebo
30
What are the only FDA approved medications for pediatric depression?
Fluoxetine (8 y/o or older) | Escitalopram (12 y/o or older)
31
What is the FDA black box warning for SSRIs in kids?
Suicidal ideation (no increase in suicide attempts)
32
What SSRIs are approved for pediatric OCD?
Fluvoxamine, sertraline, fluoxetine
33
What medication is indicated for enuresis?
Imipramine (TCA)
34
What TCA is indicated for OCD?
Clomipramine (esp. helpful for repetitive behaviors in autism)
35
Combination of psychotherapy and pharmacotherapy is most effective for what pediatrics diagnoses?
Moderate to severe depression | OCD
36
What medications are FDA approved for bipolar disorder in adolescents?
Lithium (first line), risperidone, aripiprazole
37
What side effect of atypical antipsychotics are youth more susceptible to?
Metabolic disturbances
38
What are the indications for using risperidone in pediatrics?
Irritability for children and adolescents with autism Adolescents with schizophrenia Adolescents with bipolar disorder
39
What are the indications for using aripiprazole in pediatrics?
Adolescents with schizophrenia | Adolescents with bipolar disorder
40
What pediatrics disorders does CBT have the best evidence for?
Depression Anxiety PTSD
41
What pediatric disorder do behavioral strategies have the best evidence for?
Conduct problems
42
What pediatric disorder does parent training have the best evidence for?
Preschool challenges | Conduct problems
43
What pediatric disorder does Multi-Systemic Therapy have the best evidence for?
Conduct problems (more effective than hospitalization or incarceration)
44
What are the criteria for ADHD inattentive type?
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
What are the criteria for ADHD hyperactive-impulsive type?
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
What is the prevalence of bipolar disorder in kids? Adolescents?
Kids 0.4-6% | Adolescents 1%
47
What percent of adults with bipolar disorder had symptom onset before 10 y/o?
0.3-0.5%
48
What are the criteria for oppositional defiant disorder?
``` At least 6 months of the following: - Loses temper, argues - Defies - Deliberately annoys/easily annoyed - Angry, resentful, spiteful Wonder about the family variables? ```
49
What are the criteria for conduct disorder?
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
What is reactive attachment?
Markedly disturbed and developmentally inappropriate ways of relating socially in most contexts Related to extreme/insufficient care Significant impact on affiliation
51
What are the criteria for PTSD in kids?
Re-experiencing phenomena (flashbacks, nightmares) Avoidance and trust issues Re-enactment issues (play themes, conduct regulation)
52
Until proven otherwise, hallucinations in pre-adolescents are often what?
Anxiety (including PTSD)
53
Criteria for autism spectrum disorder?
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
What is the most life-endangering psychiatric diagnosis in kids?
Anorexia nervosa
55
What is the female:male ratio in anorexia nervosa?
10:1
56
What are the timeline criteria for bulimia nervosa?
Bingeing at least once a week for 3 months

Psychiatry Part 2 (8 decks)

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