Child Psychiatry - Brandt Flashcards
5-15% children
have psych disorders
who is patient
parent and child interviewed together and separately
family norms vary widely
physical exam
important
eye exam
hearing
learning disorders
inability to achieve in writing, reading, math** 3 types
diagnosed - formal education testing
fam hx
tx remedial instruction - tutoring
reading disorder
formerly - dyslexia
more in males
ADHD
pattern of extreme inattentiveness or restlessness
at least 2 settings - onset before age of 12 with at least 6 sx
types of ADHD
3 types:
- inattentive
- hyperactive-impulsive
- combined
tx of ADHD
stimulant tx of choice - methylphenidate
epidemiology of ADHD
males 4x than female
without tx - arrest, suicide, substance abuse, poor school and work performance
DSM V for ADHD - inattention 1A
6 or more of following, >6 months - to disruptive point
- Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
- Often has trouble keeping attention on tasks or play activities.
- Often does not seem to listen when spoken to directly.
- Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
- Often has trouble organizing activities.
- Often avoids, dislikes, or doesn’t want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).
- Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).
- Is often easily distracted.
- Is often forgetful in daily activities
DSM V for ADHD - hyperactivity/impulsivity 1B
6 or more of following, >6 months - to disruptive point
- Often fidgets with hands or feet or squirms in seat.
- Often gets up from seat when remaining in seat is expected.
- Often runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless).
- Often has trouble playing or enjoying leisure activities quietly.
- Is often “on the go” or often acts as if “driven by a motor”.
-Often talks excessively.
Often blurts out answers before questions have been finished.
- Often has trouble waiting one’s turn.
- Often interrupts or intrudes on others (e.g., butts into conversations or games).
MRI of ADHD
prefrontal cortex, basal ganglia, cerebellar abnormal
comorbid with ADHD
seizures
conduct disorder
oppositional defiant disorder
learning disorder
adverse of stimulates
decreased appetite, irritablity, insomnia, weight loss, abdomen pain, abuse
nonstimulant
atomoxetine
alpha2 agonist
clonidine, guanfacine
tx of ADHD
start low dose and increase slowly
tx with stimulant - decreased risk of substance abuse
conduct disorder
behavior vilate right of others
- aggressive
- destruction of property
- theft
- violate rules
often to antisocial PD - 40% boys and 25% girls
type of conduct disorder
childhood onset - before age 10 - worse prognosis
adolescent onset - 10 and up
20-30% ADHD
also have conduct disorder
oppositional defiant disorder
defiant qualities
-but don’t violate rights of others
lose temper, argue, refuse follow rules
boys > girls
higher rate substance abuse
tx - individual and family counseling
tic disorder
sudden, rapid, recurrent motor movement or vical sound
transient - motor or vocal - everyday at least 1 month - less than year
chronic -motor or vocal - not both - ay least 1 year and 3 month tic free
tourettes - both motor and vocal - more than 1 year - with no 3 month tic free period
tourettes diagnosis
many a day, nearly every day - for 1 year
-motor AND vocal
boy more than girl
motor - age 3-8 - vocal - later - worsen as teen
etiology of tourette
2/3 first degree relative have tics - many have OCD
PANDAS
children get movement, compulsion, tic after strep infection
pediatric auto immune neuropsychiatric disorder associated with strep infection
tx tourettes
antipsychotics
-rule out other neurologic disorder
alpha-adrenergic - clonidine, guanfacine
antipsychotic - risperidone
separation anxiety disorder
excess anxiety upon separation
at least 3 sx for 4 weeks before 18 yo
9 mo - anxious separated from caregivers
severe, disabling level of anxiety
refuse to go to school somatic complaints
distress and behavior in separation anxiety disorder
distress - separate from home, harm to parents, child lost separate
behavior - school refusal, sleep refusal, clinging
get nightmares and physical complaints
tx separation anxiety
return to school ASAP
other disorders children have
PTSD, schizo, bipolar, anxiety, depression
early intervention - important
