childhood psychiatric disorders Flashcards
depression rates in children vs adolescents
- even between girls and boys in childhood
- females twice as likely in adolescence
what were the conclusions of the TADS study?
order of benefit: fluoxetine + CBT fluoxetine alone CBT alone placebo
suicidal ideation improved in all groups
conclusions of FDA/Columbia analysis
- adolescent signal for suicide goes up with certain drugs from 2% to 4% but there were no suicides in study
- use antidepressants cautiously with adolescents
childhood anxiety risk factors
- temperament
- genetics
- attachment
- parental mental disorders and parenting style
- trauma/stress
what percent of children attribute their anxiety to a negative life event?
54%
what percent of those under 18 meet criteria for anxiety?
10-20%
what percentage of children with anxiety have a comorbid disorder?
50-70%
what percent of children with depression have cormorbid anxiety?
40-70%
what is more important than content in regard to abnormal childhood fear?
degree and frequency
what are the three types of childhood ADHD?
- inattentive
- hyperactive/impulsive
- combined
ADHD male:female ratio
4:1 male
dysregulation seen in ADHD
NE and DA in fronto-striatal systems
negative life effects of ADHD
education - lower grades, in more trouble sexual - teen pregnancy and sex partners driving - traffic citations substance abuse comorbidities - anxiety
explain the four “contingencies” of managing behavior
1) add a positive stimulus - positive reinforcement
2) add a negative stimulus - punishment
3) remove a positive stimulus - extinction
4) remove a negative stimulus - negative reinforcement
most common treatment for childhood ADHD
- stimulants
methylphenidate or dextro-amphetamine
what new methylphenidate drug uses half the dosage for the full effect by using the active isomer?
focalin
how does Ritalin work?
methylphenidate released like BID
how does Adderall work?
extended release of amphetamines
how does Concerta work?
methylphenidate released like TID
benefits of extended release stimulants
- take care of core symptoms
- don’t have to dose during school
- increased tolerability and compliance
limitations of extended release stimulants
- not working in morning and evenings
- controlled substance with abuse potential
- insomnia, physical development, increased anxiety and tics all possibilities
