Child Psychiatry

Question 1

Autism (3 cardinal symptoms and tx)

Answer 1

• Cardinal Symptoms
  
  • 1- Social Impairment
  • 2- Language Impairment
  • 3- Interest Impairment
• Tx - risperidone (anti-psychotic) often used for irritability and aggression AND behavioral tx

Question 2

ADHD (3 symptoms clusters + associated symptoms)

Answer 2

• 1- Hyperactivity - cannot sit still; talk excessively; more fidgetiness in older post-puberty kids
  
  • 2- Inattention - distractible, disorganized, cannot follow instructions, do not seem to listen, cannot sustain attention
  • 3- Impulsivity - blurt out answers; interrupt others; do not wait until their turn; verbal or physical; intrude on others activities
• Associated Symptoms - difficulty getting along w/ others, difficulty learning, inc behavioral problems, poor self esteem

Question 3

ADHD Prognosis

Answer 3

• Co-Morbidities in 50-60% (ODD, CD, depression, anxiety)

- 1/3 have no symptoms as adults; 1/3 symptomatic but functional; 1/3 impaired

Question 4

ADHD Tx

Answer 4

• Meds&raquo_space; therapy (stimulants)
  
  • Methylphenidate (Ritalin) & amphetamine salts (Adderall)
  • Others - atomoxetine, clonidine, guanfacine, bupropion

Question 5

Oppositional Defiant Disorder

Answer 5

• Less bio basis; more treating a behavioral problem
• Grouchy, mean, stubborn
• Violate rules, irritable, oppositional

Question 6

Conduct Disorder

Answer 6

• Fighting, stealing, conning, property destruction, start fires, hurt animals (break social contracts)
• Often kids w/ ODD develop CD as adol then antisocial personality disorder when older
• High rates of suicide, substance abuse, depression
• Tx - behavioral therapy & parent management training (limit setting and incentive use)

Question 7

Anxiety in Kids

Answer 7

• Separation Anxiety Disorder
  
  • 2% prevalence
  • Worry about harm to parents(5-8 yo) —> distressed by separation (9-12 yo) —> school refusal/ complain of aches to get out of school (in adol)
  • Tx - CBT, SSRIs, occasionally benzos
    
    • Some also use zinc (co factor for neuroT metabolism esp dopamine); may help w/ those w/ low baseline zinc but does not help inattention portion
• Social Anxiety Disorder
• Generalized Anxiety Disorder
• **Panic Disorder is rare in kids

Question 8

Mood Disorders in Kids

Answer 8

• Depression
  
  • Often presents more as irritability or school performance decreases (not motivated and dec conc)
  • Tx - CBT and interpersonal therapy; anti-dep have mixed results (fluoxetine best)
• Bipolar Disorder
  
  • May be less defined, brief, rapid cycling
  • High rate of co-morbidity w/ ADHD and irritable depression

Question 9

Disruptive Mood Dysregulation Disorder

Answer 9

• Severe recurrent temper outbursts in multiple setting and inconsistent w/ developmental age; 3x/week for a yr
• Controversial

Question 10

Epidemiology

Answer 10

• Overall - 15-20% children/adol have psych condition for some 2-6 mo period
• 20-50% co-morbid
• Anxiety 3-8% (children» adol)
• Depression 2-6% (adol&raquo_space; children)
• Disruptive 5-15%

Question 11

What to pay attention to in child MSE

Answer 11

• Ease of separation
• Manner of relating
• Gross and fine motor skills, handedness
• R-L differentiation
• Attention span
• Sensory difficulties
• Reading, writing, language
• Intelligence
• Speech
• Special feelings, fantasies, inferred conflicts

Question 12

Difficulties of Treating Kids (8)

Answer 12

• Rely on parents/teachers/ school
  
  • Undeveloped language and cognitive skills make interviewing kids harder
  • Difficulty reflecting or putting into words internal experiences
  • Must determine what is appropriate for given age or developmental level
  • Be sure symptoms are occurring simultaneously
  • Many symptoms are not specific to 1 diagnosis (ex - irritability)
• Kids are sensitive to transitions
• Children like to please adults; teens like to rebel