Child Psychiatry Flashcards
What is the criteria for Autism spectrum disorder?
A. Persistent deficits in social communication and social interaction (all 3):
- Social-emotional reciprocity
- Non-verbal communicative behavior
- Developing, maintaining and understanding relationships
B. Restricted, repetitive patterns of behavior interests or activities (>2/4)
- Stereotyped or repetitive motor movements
- Insistence on sameness, inflexible adherence to routines, ritualized patterns of behavior
- Restricted, fixated interests that are abnormal in intensity
- Hyper/hypo-reactivity to sensory input
C. Must be present in early developmental stages
D. Causes clinical significant impairment
E. Not better explained by global developmental delay or ID
Core deficits of ASD
- Social impairement or disconnectedness
- Communication impairement
- Inflexibility, repetitive movements and preoccupation
- May have cognitive and/ neurological deficits
ASD red flags
- Lack of showing
- Lack of coordination or non-verbal communication
- Lack of sharing interests
- Repetitive movements
- Lack of appropriate gaze
- Lack of response to name
- Lack of warm, joyful expressions
Diagnostic criteria for ADHD
A. At least 6 symptoms of Attention deficit for at least 6 months that is inappropriate for developmental age
- Can’t give attention to detail or careless
- Difficulty keeping attention
- Often appears to not listen when spoken to directly
- Difficulty organising tasks
- Easily distracted
- Forgetfull
B. At least 6 symptoms of Hyperactivity/Impulsivity for at least 6 months that is inappropriate for developmental age
- Fidgets
- Often leaves seat in class
- Often runs around/climbs when inappropriate
- Difficulty playing quietly
- Talks excessively
- Blurts out answers before question is complete
- Cannot wait for a turn
- Often interrupts
- Often on the go
C. Some symptoms present before 12 years
D. Symptoms in at least 2 settings
E. Significant impairment in social/educational functioning
F. Symptoms not caused by another psychiatric disordre
Methylphenidate treatment of ADHD
- Use the lowest effective dose
- Prescribe only for kids 6-12 years with confirmed diagnosis
- Start low, 5mg 2-3 times daily, after food intake, with last dose no later than 3PM
- If no improvement, increase dose weekly by 5-10mg until symptoms controlled
- Do not exceed 1mg/kg/day or 40mg/day
- Monitor - BP, HR, weight and height
- Monitor efficacy by school reports (connor forms)
- STOP immediately if psychosis or tic develops
- Reduce if depressive/anxiety symptoms
- Stop treatment if no improvement after 1 month
Treatment for first onset psychosis in adolescents
- Admission - Involuntarily/parental consent for 72 hour evaluation
- Treat with atypical antipsychotics - Respiradone
- start low and up titrate slowly.
- start 0.5mg/day and increase by 0.25mg/0.5mg every 1-2 weeks
- max 3mg/day
- Monitor for side-effects - EPSE, weight gain, glucose and lipid abnormalities
- Family support and counselling
- Psychoeducation, Psychosocial rehab, school rehab
Approach to Suicide in a teenager
- Acknowledge embarrassment and remain non-judgmental, be accepting and empathetic
- Medical stabilization - Treat injuries / OD
- History
- age
- what happened - precipitants and stressors
- details of attempt and previous attempts
- family hx - pysch illness, divorce, parental conflicts
- psych hx
- medical hx
- social hx - crisis as school, bullying, break-ups
- Assess severity of attempt by identifying high risk factors
- Admit if medically indicated
- Arrange and refer for further psych assessment if needed
- Arrange and refer further for management by multidisciplinary team - social workers, psychologists
- Discharge with legal guardian or to a place of safety
- Follow up
High risk factors for assessing suicide severity in adolescents
- signs of depression
- severity of method
- suicide note
- previous attempt
- planning/premeditation
- persistence of suicidality
- adult concept of death
- secrecy
- male / older age
