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1. Child and Adolescent Psychiatry > Child Specific Notes: Deck 1 (Neurodev, SCZ, Mood) > Flashcards

Child Specific Notes: Deck 1 (Neurodev, SCZ, Mood) Flashcards

1
Q

Name four psychological tests of intelligence

A
  1. WPPSI–> Wechsler Preschool and Primary Scale of Intelligence
  2. WISC–> Wechsler Intelligence Scale for Children
  3. WAIS–> Weschler Adult Intelligence Scale
  4. WIAT–> Weschler Individual Achievement Test
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2
Q

What does the WPPSI test for?

A

FSIQ
verbal and performance intelligence

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3
Q

what is the age range within which the WPPSI is validated?

A

2.5 years - 7.5 years roughly

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4
Q

what does the WISC test for?

A

verbal comprehension
visual spatial
fluid reasoning
working memory
processing speed

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5
Q

what is the age range within which the WISC is validated?

A

ages 6-16

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6
Q

what does the WAIS test for?

A

verbal and performance intelligence
verbal–> working memory and verbal comprehension
performance–> perceptual organization, processing speed

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7
Q

what is the age range within which the WAIS is validated?

A

ages 16-90 years

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8
Q

what does the WIAT test for?

A

areas of academic schoolwork–> reading, writing, math, oral language

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9
Q

what is the age range within which the WIAT is validated?

A

ages 4-19 years

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10
Q

beyond the WPPSI, WIAT, WAIS and WISC, list three other tests for IQ

A
  1. Stanford Binet Intelligence Scale –> can be used starting age 2
  2. Kaufman Assessment Battery for Children–> 2-12 years old
  3. Kaufmann Adolescent and Adults Intelligence Test–> 11-85 years old
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11
Q

for what ages is the Stanford Binet Intelligence Test validated?

A

starting at age 2

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12
Q

what is the age range within which the Kaufmann Assessment Battery for Children is validated?

A

ages 2-12 years

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13
Q

what is the age range within which the Kaufmann Adolescent and Adult Intelligence Test is validated?

A

ages 11-85 years

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14
Q

list two adaptive functioning scales that can be used in assessment

A
  1. Vineland Adaptive Behaviour Scale (VABS)
  2. Adaptive Behaivour Assessment System (ABAS II)
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15
Q

what is the age range within which the VABS is validated?

what does it test for?

A

birth to adulthood

communication
ADLs
social
motor
maladaptive behaviours

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16
Q

what is the age range within which the ABAS is validated?

A

birth to 89 years old

teacher/parent/caregiver reports

conceptual (reading, writing, math)
social
practical (ADLs, iADLs, school org)

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17
Q

list four behaviour rating scales you can use in assessment

A
  1. Aberrant Behaviour Checklist (ABC)–> can be used in the full range of ID and can be used to assess med response and treatment effects
  2. Behaviour Problem Inventory (BPI)
  3. Developmental Behaviour Checklist (DBC)–> can be used in the full range of ID, and daily monitoring forms are available
  4. Reiss Scales for Children’s Dual Diagnoses (RSCDD)–> psychiatric comorbidities vs norms w ID
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18
Q

what might you consider using to treat OCD in down syndrome

A

maybe memantine

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19
Q

what is the most common genetic disorder associated wtih ASD

A

Fragile X

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20
Q

how does intellectual functioning change over time in Fragile X

A

there is an intellectual functional decline in puberty

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21
Q

why might you consider acamprosate when treating someone with fragile X

A

open label trials show benefit of acamprosate in ADHD and language in fragile X–> this is the med of choice in fragile X and AUD

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22
Q

what medication has been shown to improve secondary language outcomes in those with Fragile X + ASD

A

sertraline–> in early childhood

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23
Q

what % of those with Prader Willi have ADHD

A

80%

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24
Q

are there any medications that have been shown to reduce food intake in prader willi

A

no–> must be environmental tx

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25
Q

what % of kids with DiGeorge have ADHD? anxiety? ASD?

A

50% have ADHD
20% have anxiety or ASD

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26
Q

what med is first line for treatment of ADHD in those with neurofibromatosis

A

MPH–> positiev RCT

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27
Q

what combo of meds was significantly superior to stimulants alone when treating disruptive behaviour + ADHD

A

risperidone + stimulant

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28
Q

when gender has more ID when dx with ASD

A

females with ASD tend to have more ID

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29
Q

what is a red flag for autism

A

no two word sentence by age 2

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30
Q

how should you treat the repetitive/ritualistic behaviours associated with ASD

A

NO evidence for general use of SSRIs for this

haldol and risperidone were better than placebo for repetitive behaviours and social withdrawal

if severe, some evidence for ECT

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31
Q

name two tools that can be used to screen to autism

A
  1. Social Communication Questionnaire
    –> can use in age 4+, 96% sensitivity, 80% specificity
  2. Social Responsiveness Scale
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32
Q

name 2 genes associated with ADHD per CADDRA

A

DRD4

DAT-1

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33
Q

name 5 specific genetic disorders associated with ADHD

A

22q11.2 deletion syndrome

tuberous sclerosis

smith-magenis

fragile X

prader willi

34
Q

list 6 medical conditions that have higher incidence/risk in those with ADHD

A

obesity

asthma

T1DM + T2DM

sleep disorders

epilepsy

dementia

35
Q

what % of those with ADHD will respond to any stimulant

A

70%

36
Q

what % of those with ADHD will respond to at least one stimulant

A

90%

37
Q

why might you choose one stimulant over the other

A

AMP has bigger effect sizes but MPH is better tolerated

38
Q

what ADHD med can cause tic EMERGENCE (not just tic worsening)

A

atomoxetine

39
Q

what is 1st, second and third line when treating ADHD in someone with bipolar

A

1st line–> buproprion

2nd line–> mixed amphetamine salts, MPH, modafinil, CBT

3rd line–> atomoxetine, venlafaxine, lisexamphetamine

40
Q

what did the MTA trial show in terms of recommendations for treatment of ADHD

A

combined med and behavioural treatment is EQUAL to medications alone, and both of these are better than behavioural alone, which is sequentially better than treatment as usual

41
Q

list 3 factors that are associated with high risk of conversion from prodrome to psychosis

A
  1. negative sx
  2. cognitive impairment
  3. poor functioning
42
Q

why might you recommend use of a long acting injectible to treat SCZ

A

30% lower risk of death compared to PO agents

43
Q

prevalence of SCZ increases rapidly after what age

A

age 14

represents 25% of all psych admissions ages 10-18

44
Q

early onset of SCZ is associated with what outcomes

A

early onset of SCZ is associated with:

  1. more severe pathology
  2. higher suicide risk
  3. more delays
  4. worse prognosis

*30% of early onset pop will require long term intensive supports

45
Q

what are the only two AP approved for use in SCZ in ages under 18

A

Aripiprazol

Lurasidone (very recent)

46
Q

name a study that specifically looked at SCZ treatment in youth and kids

A

TEOSS (2007)

47
Q

what were the results of the TEOSS study

A

looked at treatment of early onset SCZ in ages 8-19

no difference in efficacy between olanzapine, risperidone, molindone

higher than anticipated suicide rates

at 12 months, only 12% were on meds

earlier intervention resulted in better neurocognitive scores

48
Q

how do youth with bipolar disorder present differently than adults

A
  1. more psychosis
  2. more irritability
  3. more mixed states than adults
49
Q

how does long term prognosis change for youth dx with bipolar vs adults

A

long term prognosis is the same

50
Q

earlier onset of bipolar disorder increases risk for what outcomes

A

earlier onset of bipolar disorder increases risk for:

longer delay to tx

greater depressive symptom severity

more comorbid anxiety

more comorbid SUD

51
Q

what is the switch rate from MDD to bipolar disorder for youth with MDD

A

28%

52
Q

what are risk factors that predict switch from MDD to bipolar disorder?

A

family history of bipolar disorder

presence of dysregulation

subthreshold manic sx

cyclothymia

atypical depression with or without psychosis

early age of onset of first depressiev episode

53
Q

in C&A populations:

first line for treatment of mania

A
  1. lithium (level 1)
  2. risperidone (level 1, if not obese, or if have adhd)
  3. abilify (level 2)*
  4. asenapine (level 2)
  5. quetiapine (level 2)

*only ABILIFY is HC approved for adolescents with mania/mixed episodes

54
Q

in C&A populations:

second line treatment for mania

A
  1. olanzapine (level 2)
  2. ziprasidone (level 2)
  3. adjunctive quetiapine (level 3)
55
Q

in C&A populations:

third line treatment for mania

A

divalproate (level 4)

56
Q

in C&A populations:

first line treatment for bipolar depression

A
  1. lurasidone (level 2)–> FDA approved
57
Q

in C&A populations:

second line treatment for bipolar depression

A
  1. lithium (level 4)
  2. lamotrigine (level 4)
58
Q

in C&A populations:

third line treatment for bipolar depression

A
  1. olanzapine + fluoxetine (level 1)
  2. quetiapine (level 2)
59
Q

in C&A populations:

first line treatment for bipolar maintenance

A
  1. apripiprazole (level 2)
  2. lithium (level 2)
  3. divalproate (level 2)
  4. adjunctive lamotrigine (level 2–> if older than 13)

*often combo of Li + risperidone/dvp/carbamazepine

60
Q

in C&A populations:

second line treatment for bipolar maintenance

A

none

61
Q

in C&A populations:

third line treatment for bipolar maintenance

A
  1. asenapine (level 4)
  2. quetiapine (level 4)
  3. risperidone (level 4)
  4. ziprasidone (level 4)
    blah blah i wont remember the rest to be honest
62
Q

name a study that focused specifically on treatment of child and adolescent mania

what were the results?

A

TEAM trial

for acute mania, risperidone was better than VPA/Li

63
Q

how does diagnosis differ bwteen adults and kids for cyclothymic disorder

A

time criteria for adults = 2 years

for C&A, time criteria is only ONE year

64
Q

list the features of atypical depression

A

mood reactivity PLUS 2+ of:

hypersomnia
hyperphagia
interpersonal rejection sensitivity
leaden paralysis

65
Q

first line treatment for mild to moderate depression in C&A

A

CBT
IPT
internet based psychotherapy

66
Q

are there any meds approved by health canada for treatment of depression in teens/kids

A

no–> all AD meds are off label for use in C&A in canada –> HC only approved for above age 18

67
Q

what is the black box warning for SSRIs

A

1.5-2% risk of of suicidal thoughts and behaviours–> NO deaths reported

68
Q

second line treatment for depression in kids and teens

A

fluoxetine (FDA for above 8)

escitalopram (FDA above 12)

sertraline

citalopram

69
Q

third line treatment for depression in kids and teens

A

venlafaxine (above age 12 only)
**increased self harm and SI rates if history is +ve

TCAs

70
Q

what do you do if there is a minimal or no response to depression treatment in C&A

A
  1. add SSRI to CBT/IPT
  2. switch to another SSRI
  3. venlafaxine XR or TCA
71
Q

how do you treat treatment-resistant depression in C&A

A
  1. SSRI + psychotherapy
  2. switch to another SSRI
  3. venlafaxine, TCA, ECT or rTMA (with lots of caution)

no evidence for MAOIs

72
Q

name the 2 trials that focused on treatment of depression in C&A

A

TORDIA
TASA
TADS

73
Q

what did the TADS trial show

A

combo of fluox + CBT = fluox alone > CBT > placebo initially but all treatments converged at 36 weeks

SI was lower with combo or CBT > monotherapy

74
Q

what did the TASA trial show

A

Teens w/MDD & 90d Hx of SA x 6mo. Rx w/meds, CBT, or meds + CBTàrandomized or
youth chose. Combo had improvement & remission vs teens w/MDD but no SA. Rx focus targets SI, family
cohesion, & sequelae of previous abuse. 40% of events w/in 4 wks of intake (so early contact important).

75
Q

list predictors of poor med response in teen depression

A

history of abuse

family conflict

comorbidity with SUD, anxiety

76
Q

what did the TORDIA trial show

A

12-18yo; Rx options for teens after one SSRI trial: 60% respond to initial. Poor Rx response
predictors: Hx abuse, family conflict, comorbid SUD/anxiety (36% anxiety d/o, 29% dysthymia, 14% ADHD,
10% ODD/CD) à conclusion: switch to other SSRI or venlafaxine (∅ diff) or add CBT to either. Combo > meds.
Fluox w/limited evidence in comorbid AUD. Remission from MDE assoc’d w/↓ in anxiety, ADHD, ODD

77
Q

what is prolonged grief disorder

A

*Prolonged grief disorder [DSM-5TR]àclassified under Trauma and Stressor-Related Disorders
* Bereavement of individual occurring at least 1y ago (6mo for C&A) w/grief responses at least daily, 1 of: intense
yearning/longing for deceased person, or preoccupation w/thoughts/memories of deceased person (C&A – preoccupation may
focus on circumstances of death).
* At least daily, 3+ of relating to the death: identity disruption since, disbelief about, avoidance of reminders, intense emotional
pain related to, difficulty reintegrating into one’s relationships & activities after, emotional numbness as a result of, feeling that
life is meaningless as a result of, intense loneliness as a result of.
* Significant distress. ∅ other mental, sociocultural or religious norms.

78
Q

how does diagnosis of prolonged grief disorder differ between C&A and adults

A

shorter time criteria (6mo vs 1 year)

also, preoccupation may focus on circumstances of the loved ones death

79
Q

with regard to persistent depressive disorder, earlier onset reflects higher likelihood of what other conditions

A

comorbid PD

SUD

80
Q

name a rating scale that can be used in PDD

A

cornell dysthymia rating scale

81
Q
A

1. Child and Adolescent Psychiatry (32 decks)

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