Child Psychiatry

Question 1

What is the DSM IV criteria for MDD?

Answer 1

Depressed mood
Loss of interest/pleasure
Weight Change
Sleep Disturbance
Psychomotor Agitation 
Fatigue
Guilt or worthless feeling
Dec Concentration
Thoughts of Death/Suicide
Irritable

Question 2

What is different between CHild and Adult MDD?

Answer 2

Low Frustration tolerance
Somatic Complaints
Separation Anxiety
Behavior Problems
Don't verbalize feelings

Question 3

What are comorbidities for CHildhood MDD?

Answer 3

Substance abuse
Dysthymia
Disruptive disorders

Question 4

What is Double Depression?

Answer 4

Dysthymia coupled with Major Depression

Question 5

What are risk factors that effect prognosis in Childhood MDD?

Answer 5

Severity, Chronicity, Recurrence, Comorbidity, Hopelessness, Residual Symptoms, neg cognitions, family problems, Abuse History

Question 6

What is the Treatment of Childhood MDD?

Answer 6

Therapy versus meds
SSRI/SNRI
TCA
MAOI

Question 7

What are the Adverse Effects of Antidepressats?

Answer 7

Disinhibition, GI symptoms, Headache, BB warning, Seizures(Buproprion), Weight Gain, Bradycardia, Inc in DBP, Arrhythmias

Question 8

What is Serotonin Syndrome?

Answer 8

Autonomic Instibility, delirium, psychosis, myoclonic jerks

ER REFERRAL

Question 9

What are symptoms of Discontinuation of Antidepressants?

Answer 9

Dizziness, Headaches, nausea and emesis, diarrhea, insomnia, tremor, electric shock sensation

Question 10

WHat is the Back Box warning associated with Antidepressants?

Answer 10

Increased rates of Suicide

Question 11

What are the questions to ask someone with suicidal ideation?

Answer 11

Plan?
Access to follow through?
Intent?
Family Hx?
Previous attempt?
Illicit Drug use
Hopelessness
Lack of social support
Recent stressors

Question 12

What are the traits of Childhood Bipolar Disorder?

Answer 12

More severe and chronic
Mixed with rpid cycling
Non episodic course
Initial episode is Major Depression

Question 13

What are the Comorbidities associated with Bipolar Disorder?

Answer 13

ADHD
Conduct Disorder
Anxiety Disorders

Question 14

What are the Tx of Bipolar Disorder?

Answer 14

Antipsychotics and Mood stabilizers (Lithium and Depakote)

Psychosocial Interventions

Question 15

What are the Side effects of Antipsychotics?

Answer 15

Weight Gain, Mets Abn, Akathesia, Tardive dyskinesia, Inc PROLACTIN (Risperdal)
ORTHOSTATIC HYPOTENSION, PARKINSONIAN SYMP

Question 16

What needs to be monitored in Lithium use?

Answer 16

TSH, Cr, CBC

Question 17

What needs to be monitored in Depakote(Valproic Acid) use?

Answer 17

LFT, CBC, PCO

Question 18

What needs to be monitored in Tegretol(Carbamazepine) use?

Answer 18

CMP, LFT(Aplastic Anemia, Agranulocytosis)

Question 19

What is the Feared Side effect of Lamictal(Lamotrigine)?

Answer 19

Steven Johnson Syndrome

Question 20

What are the adverse events of Lithium?

Answer 20

Polyuria, Polydypsia, Hypothyroidism, Acne, Cardiac Arrhythmia, Fine tremor

Question 21

What are clinical pearls for Lithium?

Answer 21

Don’t give with Aspirin, or Ibuprofen ( Don’t give meds if dehydrated)

Question 22

What are the 3 domains of ADHD?

Answer 22

innatention, Hyperactivity, Inpulsivity

Question 23

What is the difference between a learning disability and ADHD?

Answer 23

LD: usually only 1-2 subjects
ADHD: Difficulty in many subjects

Question 24

How is ADHD Diagnosed?

Answer 24

Clinical Diagnosis (Sx at home at school)
Objective Scales
Test Attention span (Serial 7s)
Computerized performance task

Question 25

What is the Tx of ADHD?

Answer 25

Stimulants.

Question 26

What are the Adverse effects of Stimulants for ADHD?

Answer 26

GI symptoms, Dec Appetitie, Insomnia, Headaches, Rebound Sx, BLUNTED AFFECT Monitor Vitals(BP and Pulse) Psychosis if at risk

Question 27

How can we know which Stimulant should be used in an ADHD kid?

Answer 27

Avoid Amphetamine as 1st line | Methylphenidate

Question 28

What are the Impacts of untreated ADHD?

Answer 28

``` Inc in MVAccidents Fired and Expelled more often Inc Substance abuse Inc Parental divorce Inc Sibling fights ```

Question 29

What is the Non-stimulant mediction used for ADHD?

Answer 29

Strattera(Atomoxetine): Better for comorbid anxiety Wellbutrin(Buproprion)- Good for kids with ADHD and MDD Provigil(Modafanil)- Narcolepsy

Question 30

What are the Alpha 2 agonists used for ADHD?

Answer 30

Clonidine and Guanfacine BP Meds Use with ADHD kids with Extreme Hyperactivity, Stim appetite

Question 31

What are the three domains in Autism Spectrum Disorder?

Answer 31

1) Impairment in social interactions 2) Impairment in communication 3) Restricted pattern of interest and Steriotypical Behavior

Question 32

When should an Autistic Patient be referred?

Answer 32

Language Delay Lack of Non-Verbal Communication Lack of Symbolic Play Steriotypic or Self stim Beh

Question 33

What is the Tx of Autism?

Answer 33

Holistic Approach PT/OT/Speech Social Skills Training SSRI, Antipsych, Stimulats

Question 34

What are the Positive and Negative Symptoms of Schizophrenia?

Answer 34

Pos: Aud and Visual Hallucinations, delusions of persecution Neg: Lack of Motivation and Socialization, little verbal output, blunted affect