Child Specific Notes: Deck 3 (conduct/impulse, SUD, CL, PTx, ethics/policy, psychopharm)

Question 1

what is the difference in criteria for gender dysphoria between kids vs adolescents and adults

Answer 1

in kids, need gender incongruence plus SIX or more of the other symptoms

in teens and adults, you only need gender incongruence plus TWO or more of the other symptoms
–> adults also have symptom of wanting to be rid of secondary sexual characteristics which of course kids dont have yet

Question 2

what % of trans gender youth are estimated to have ASD

Answer 2

up to 11-13%

Question 3

can you become pregnant on testosterone

Answer 3

yes

Question 4

up to what Tanner stage can GnRH analogues provide benefit

Answer 4

up to Tanner stage 4

thus you basically move from puberty suppression to HRT between ages of 13-16

Question 5

contraindications for hormone replacement therapy for gender dysphoria

Answer 5

for AMAB:
VTE risk
severe liver dysfunction
estrogen-sensitive tumor

for AFAB:
tesosterone-sensitive tumor
polycythemia
severe liver dysfunction

Question 6

list protective factors in gender dysphoria

Answer 6

individual social and coping skills

family

friends

faith

community

school

medical system

Question 7

at what age can a youth receive top surgery (assuming no other contraindications)

Answer 7

16

Question 8

at what age can a youth receive bottom surgery (assuming no other contraindications)

Answer 8

18

Question 9

what do you use for menstrual suppression

Answer 9

OCP, IUD

Question 10

name an androgen blocker

Answer 10

spironolactone

Question 11

name a GnRH puberty blocker

Answer 11

lupron

Question 12

why should an AFAB person who is on tesosterone be counselled about risks of getting pregnant

Answer 12

Testosterone is teratogenic

Question 13

what is required before gender affirming surgery is considered in an adolescent

Answer 13

must have had at least 12 months of gender affirming hormone therapy or longer, if required, to achieve desired surgical result for gender affirming procedures

*unless HRT is either not desired or is medically contraindicated

Question 14

at what tanner stage would you consider puberty blockers in gender dysphoria

Answer 14

tanner stage 2 (around ages 9-11)

Question 15

how should you screen for the disruptive/conducy disorders

Answer 15

with a HEADSS interview

Question 16

list the 9 principles of multisystemic therapy

Answer 16

1. finding the fit
2. focusing on positives and strengths including family
3. increasing responsibility
4. present focused, action oriented, and wellbeing defined ==> tracks progress of treatment and provides clear criteria of success
5. targeting sequences–> what is sustaining the problems?
6. developmentally appropriate–> emphasis on getting along with peers, academics, social skills
7. continuous effort–> daily or weekly
8. evaluation and accountability–> no labeling families
9. generalization–> invest parents or carers in ability to address needs after intervention is over

Question 17

are there long term impacts of parental divorce on kids

Answer 17

yes–> while emotional problems decrease over time, adult outcomes for children of divorced parents are poorer compared to non-divorced families

more depression and alcohol use in adulthood

Question 18

what is the impact of a child’s exposure to high levels of parental conflict (regardless of marital status)

Answer 18

predictive of poorer emotional adjustment

higher levels of antisocial behaviour, suicide rates

lower academic achievement

males more affected than females

Question 19

which has more of an impact on a child: parental death or parental conflict and separation

Answer 19

parental conflict and separation

Question 20

can daycare contribute to insecure attachment

Answer 20

daycare more than 4 months at less than 1 year old for more than 20 hours per week can increase insecure attachment

Question 21

what is the impact on children of absent fathers

Answer 21

ASPD

child onset CD

ADHD

more likely to get divorced (2X)

20-25% have adjustment problems at teenagers

Question 22

treatment for depression/anxiety post concussion/TBI

Answer 22

1st–> SSRIs

2nd–> SNRI, mirtazapine, TCA

maintenance for 6-9 months

Question 23

treatment for aggression post concussion/TBI

Answer 23

1st–> beta blockers

if there are no contraindications, consider VPA, carmabazepine

Question 24

treatment of sleep problems post concussion/TBI

Answer 24

trazodone, TCAs

non benzo meds may have fewer SEs

Question 25

there is no evidence for which meds post TBI/concussion

Answer 25

benzos, APs, amantadine

Question 26

is the capacity to consent to medical treatment determined by a specific age in canada?

Answer 26

no–> the evolving capacity of adlescents for self determination is recognized by common law

assessment is based on:
–emancipation from parental control and guidance
–cognitive competence
–emotional and social maturity
–volunatriness of the decision

“judged to be sufficiently mature enough to understand the nature and consequences of a decision” = may consent to own treatment

Question 27

what is the most commonly used illicit substance in canadian youth

Answer 27

cannabis–> canadian youth are the top cannabis users in the developed world –> 20% have daily or near daily use between ages 15-19

Question 28

why does the CPA suggest age based restrictions on cannabis access (also how might you counsel a teen on risks of cannabis in youth)

Answer 28

1. early and regular cannabis use is associated with increased risk of primary psychotic disorders in those who are vulnerable
2. early and regular cannabis use may interact negatively with depression, bipolar disorder, anxiety disoders due to effects on brain maturation
3. worse cognitive performance persistently is associated with earlier adolescent onset of use
4. early age of use increases risk for cannabis dependence in adulthood
5. cannabis may be associated with increased progression to other illicit drug use in the context of particular factors
6. prenatal cannabis exposure may have implications for cognitive development, behaviour and acadmic achievement in offspring

Question 29

list 4 populations that are known to have higher rates of alterations in CYP metabolism relevant to psychiatry

Answer 29

1. Asians–> lower CYP2D6 activity
2. Ashkenazi Jews–> lower CYP2D6 activity
3. Caucasians–> 7% are slow 2D6 metabolizers
4. African Americans are at greater risk of NEUTROPENIA and T2DM

**note that 1-7% of the general population are RAPID 2D6 metabolizers

Question 30

list 5 differences in pharmacokinetics in kids vs adults

Answer 30

1. greater hepatic capacity in kids
2. higher GFR in kids
3. less fatty tissue in kids (less drug goes into fat)
4. kids require a higher dose to weight ratio for adults
5. kids have faster elimination of the drug

Question 31

how might monitoring clozapine differ in kids vs adults

Answer 31

in kids, you might consider a pre-treatment and comparison EEG due to decreased seizure threshold

also you NEED an EEG if there is acute behavioural change while on clozapine in a kid