child psychiatry/somatoform disorders Flashcards
childhood disorders: what ds
-attention deficit hyperactivity disorder
-autism spectrum disorder
Somatoform Disorders: Definition and what ds names
A group of psychological disorders where patients experience physical symptoms that are not fully explained by a medical condition
- sx are real to pt with no underlying medical cause
- associated w distress and impairment in function
Diseases:
-CONVERSION DISORDER
-HYPOCHONDRIASIS
-FACTITIOUS DISORDER
-BODY DYSMORPHIC DISORDER
-MALINGERING
ADHD DSM 5 Criteria - inattention
Inattention criteria:
- 6+ sx of inattention for children - 16 yrs,
- 5+ sx for 17 yrs - adults
- sx present for 6+ months and they are inappropriate for developmental level
sx:
-Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
-Often has trouble holding attention on tasks or play activities
-Often does not seem to listen when spoken to directly
-Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
-organizing tasks and activities.
-Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
-Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
-Is often easily distracted
-Is often forgetful in daily activities
ADHD DSM 5 Criteria - hyperactivity and impulsivity
Criteria:
- 6+ sx for children - 16 yrs,
- 5+ sx for 17 yrs - adults
- sx present for 6+ months and they are inappropriate for developmental level
sx:
-fidgets with or taps hands or feet, or squirms in seat.
-leaves seat in situations when remaining seated is expected.
-runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
-unable to play or take part in leisure activities quietly.
-Is often “on the go” acting as if “driven by a motor”.
-talks excessively.
-blurts out an answer before a question has been completed.
-has trouble waiting their turn.
-interrupts or intrudes on others (e.g., butts into conversations or games)
Cause of ADHD: Neurological Basis
Decreased dopamine in the frontal lobe of the brain causes decreased arousal!
Girls typically present with the Inattentive symptoms whereas Boys present with Hyperactivity symptoms = Girls are generally underdiagnosed
ADHD pharm tx
Psychostimulants: first line tx:
- Methylphenidate (Ritalin), Amphetamine salts (Adderall)
- MOA: ↑↑↑ Dopamine levels in brain (and NE)
ADRs:
- ↑ BP, ↑ HR
- Tremor, exacerbation of tics
- Anxiety, Insomnia
- Weight loss
- Nausea
other: non stimulants
- Atomoxetine (Strattera) - SNRI
- Guanfacine (Intuniv): alpha 2 agonist
- MOA: Inhibit reuptake of NE; not a controlled substance - decreased potential for abuse
- ADRs: fatigue, somnolence, hypotension, syncope
autism: Deficits in social-emotional reciprocity
- Abnormal social approach
- Failure for normal conversation
- Reduced sharing of interests, emotions, or affect
- Failure to initiate or respond to social interactions
autism spectrum disorder definition overview and where are there deficits?
Definition: Persistent deficits in social communication and social interaction across multiple contexts. deficits in:
- social-emotional reciprocity
- nonverbal communicative behaviors used for social interaction
- developing, maintaining, and understanding relationships
AND restricted pattens of behavior, interests, or activities
- echolalia, insistence of sameness, etc
autism: Deficits in nonverbal communicative behaviors used for social interaction
- Poorly integrated verbal and nonverbal communication
- Abnormalities in eye contact and body language
- Deficits in understanding and use of gestures
- Total lack of facial expressions and nonverbal communication
autism: Deficits in developing, maintaining, and understanding relationships
- Difficulties adjusting behavior to suit various social contexts
- Difficulties in sharing imaginative play or in making friends
- Absence of interest in peers
Autism spectrum disorder: Severity Levels
Severity is based on social communication impairments and restricted, repetitive behaviors:
- Level 3: Requires very substantial support.
- Level 2: Requires substantial support.
- Level 1: Requires support.
conduct disorder criteria
At least four of the following and pt is UNDER 18, lasting 6 months, and causes significant impairment in functioning:
-Aggressive behavior toward others and animals.
-Frequent physical altercations with others.
-Use of a weapon to harm others.
-Deliberately physically cruel to other people.
-Deliberately physically cruel to animals.
-Involvement in confrontational economic order crime- e.g., mugging.
-Has perpetrated a forcible sex act on another.
-Property destruction by arson.
-Property destruction by other means.
-Has engaged in non-confrontational economic order crime- e.g., breaking and entering.
-Has engaged in non-confrontational retail theft, e.g., shoplifting.
-Disregarded parent’s curfew prior to age 13.
-Has run away from home at least two times.
-Has been truant before age 13! (Skip school)
Autism spectrum disorder: what are behavioral sx
Definition: Restricted, repetitive patterns behavior, interests, or activities
characterized by:
-Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypes, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
-Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day).
-Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).
-Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g. apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).
obesity definitoin and prevalence
Obesity: Body Mass Index (BMI) > 30
-BMI: A measure of an adult’s weight in relation to his or her height, specifically the adult’s weight in kilograms divided by the square of his or her height in meters.
-33.8% of US adults and 17% of children 2-19 are obese
Obesity has increased in
-Both sexes
-All age groups
-All racial/ethnic groups
-However, those at the lowest income levels have increased the most.
-Overweight has replaced malnutrition as the most prevalent nutritional problem for the poor.
oppositional defiant disorder
A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months as evidenced by at least 4 sx and UNDER 18:
-1. Often loses temper.
-2. Is often touchy or easily annoyed.
-3. Is often angry and resentful. Argumentative/Defiant Behavior
-4. Often argues with authority figures or, for children and adolescents, with adults.
-5. Often actively defies or refuses to comply with requests from authority figures or with rules.
-6. Often deliberately annoys others.
-7. Often blames others for his or her mistakes or misbehavior. Vindictiveness
-8. Has been spiteful or vindictive at least twice within the past 6 months, or occupational functioning.
