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CAP Review > CP > Flashcards

CP Flashcards

1
Q

Which two antipsychotics effect the QTc the least?

A

Aripiprazole and olanzapine

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2
Q

Clonidine is an agonist at what receptor?

A

alpha 2a 2b 2c

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3
Q

Guanfacine is an agonist at what receptor

A

alpha 2, primarily 2a

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4
Q

What does marijuana impair?

A

short term memory, visual motor functioning

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5
Q

What are the side effects of PCP?

A

agitation, delusions, hypertension, flushing, diaphoresis

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6
Q

What are the consequences of inhalant use?

A

hearing loss, peripheral neuropathy, CNS brain damage, liver, kidney, bone marrow deterioration

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7
Q

What are the stages of stopping behavior in motivational interviewing?

A

Pre-contemplation, contemplation, preparation, action

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8
Q

Does anxiety precede substance use disorders or ‘post’cede them?

A

Likely to precede

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9
Q

What is successful at treating night fears?

A

Emotive imagery. Children are trained to imagine a super hero

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10
Q

What percent of children have at least one sleep walking episode?

A

15%

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11
Q

How do yo treat sleep terrors and sleep walking?

A

Time them and wake 10-15 minutes earlier

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12
Q

What percentage of children 6 to 12 years have nightmares?

A

20%

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13
Q

A closed head injury leads to what sleep disorder?

A

Circadian rhythm sleep disorder

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14
Q

By what age should imaginary companions end?

A

8 years of age

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15
Q

What symptoms might be found in Dissociative Identity Disorder that may overlap with Schizophrenia?

A

DID remains a controversial diagnosis. Command hallucinations, voices speaking to one another, delusional beliefs, illogical thought patterns, thought blocking. There is a normal range of affect and ability to relate warmly

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16
Q

What is the disease fatality rate for Neuroleptic Malignant Syndrome NMS in children?

A

9%

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17
Q

Geller’s study of Lithium for BiPD and SUD in adolescents showed what?

A

Better function on lithium and decreased substance use but no change on manic depression

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18
Q

What did a long-term naturalistic study of BiPD classic and lithium in 59 children over 10 years show?

A

Effective in 39/59, i.e. 2/3 (DeLong 1987)

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19
Q

Discontinuing lithium makes a difference or no difference in pediatric bipolar disorder?

A

Relapse more likely (Strober 1990)

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20
Q

What is the mechanism of action of lithium?

A

Unknown precisely. Affects a number of neurotransmitters and receptors, decreasing norepinephrine release and increasing serotonin synthesis.

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21
Q

What is the mechanism of action of valproate?

A

Although the mechanism of action of valproate is not fully understood, traditionally, its anticonvulsant effect has been attributed to the blockade of voltage-gated sodium channels and increased brain levels of gamma-aminobutyric acid (GABA).

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22
Q

What is the mechanism of action of topiramate?

A

Blocks voltage-dependent sodium and calcium channels. It also inhibits the excitatory glutamate pathway while enhancing the inhibitory effect of GABA.

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23
Q

What are the key cognitive side effects of topiramate?

A

Cognitive blunting and word retrieval difficulties

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24
Q

What is the prevalence of bipolar disorder in adults?

A

1-2%

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25
Q

What percent of highschoolers have tried drugs or alcohol by 12th grade?

A

85%

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26
Q

Which persons with alcoholism do worse by Cloninger and Babor’s classification?

A

Type 2, Type B

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27
Q

Is THC use genetic or environmental?

A

Experimental use has a more environmental component. Dependence is more likely to have genetic underpinnings

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28
Q

What is the mean elimination half-life of THC?

A

4 days

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29
Q

What percentage of suicide victims have/had relatives with suicidal tendencies

A

60% (compared with 12% for non-suicidal teens)

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30
Q

A family history of suicide increases risk of suicide by how much?

A

5 times for females and 3 times for males

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31
Q

in one study, what percent of children who commit suicide had history of attempt(s)

A

26-33%

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32
Q

Do LGBTQQIAP youth have an increased risk of suicide?

A

Yes. Although, sexual identity or orientation per se has likely little to do with the increased risk

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33
Q

What is the suicide rate for youths aged 10 to 18?

A

5/1000

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34
Q

CDC data has shown what percentage of high school students have had a suicidal idea, a plan, and an attempt in the last year?

A

17 %, 14%, and 2% respectively

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35
Q

The Youth Risk Behavior Surveillance System showed what percentage of high school youth report rarely or never wearing a seatbelt?

A

6%

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36
Q

The Youth Risk Behavior Surveillance System showed what percentage of high school students had ridden one or more times during the 30 days before the survey in a car or other vehicle driven by someone who had been drinking alcohol?

A

Nationwide, 16.5% of students had ridden one or more

times during the 30 days before the survey in a car or other vehicle driven by someone who had been drinking alcohol

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37
Q

The Youth Risk Behavior Surveillance System showed what percentage of high school students had carried a weapon at least one day in the previous 30 days?

A

Nationwide, 15.7% of students had carried a weapon (e.g., gun, knife, or club) on at least 1 day during the 30 days beforethe survey

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38
Q

The Youth Risk Behavior Surveillance System showed what percentage of high school students had ever drunk alcohol?

A

60% ever. 16% before age 13 (more than a few sips). 30% of high school students had had a drink at least one day in the last 30 days.

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39
Q

The Youth Risk Behavior Surveillance System showed what percentage of high school students had used THC?

A

36%

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40
Q

The Youth Risk Behavior Surveillance System showed what percentage of high school students had texted or e-mailed while driving in the previous 30 days?

A

40%

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41
Q

The Youth Risk Behavior Surveillance System showed what percentage of high school students had sexual intercourse?

A

Nationwide, 39.5% of students had ever had sexual intercourse and 9.7% had had sexual intercourse with four or more persons during their life.

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42
Q

The Youth Risk Behavior Surveillance System showed what percentage of high school students in the previous 30 days had not used a condom (they or their partner) in their last sexual intercourse

A

46%

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43
Q

In a self-report measure of children with depression, what were the top three symptoms?

A
  1. Aches and pains 2. Sad affect 3. Helplessness/ hopelessness
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44
Q

What is higher, the number of suicides or homicides?

A

Homicideses

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45
Q

What is a crisis hotline and text line for suicidal thinking?

A

Calling: 1-800-273-TALK (8255)
Texting: text home to 741741

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46
Q

What percentage of children and adolescents have a second depressive episode within two years after the first remits?

A

40% within two years, 75% within 5 years

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47
Q

What has been found of mothers of depressed children in their management of their children?

A

They use more reactive and fewer pre-emptive strategies; reactive strategies predict conduct problems

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48
Q

What are features of children with depression, besides symptoms?

A

Heightened empathy; misplaced sense of responsibility; unrealistic ideas about helping others

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49
Q

What percentage of high school students report having been bullied in the previous year?

A

19%

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50
Q

What is the ratio of suicide attemtps to suicide completions in youth?

A

50:1

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51
Q

What percent of suicide victims have had mental health treatment?

A

30 to 50%

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52
Q

What are the odds ratios of suicide in an adolescent with: 1) a prior attempt 2) major depressive disorder 3) substance use disorder

A

1) 22.5 for prior SA
2) 8.6 for MDD
3) 7.1 for Sub Use

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53
Q

In interpersonal psychotherapy by Klerman what are the four areas of interpersonal concern?

A
  1. interpersonal deficits 2. interpersonal role conflicts 3. abnormal grief 4. role transitions. A modification for adolescents is single parent families
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54
Q

The Youth Risk Behavior Surveillance System showed what percentage of high school students reported feeling felt so sad or hopeless almost every day for 2 or more weeks in a row that they stopped doing some usual activities?

A

31.5%

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55
Q

What are the elements of problem-solving?

A
  1. Problems are part of everyday life; inhibit impulse to avoid 2. Formulate problem into a workable problem and goals 3. Generate alternative solutions 4. Evaluate them and implement one 5. Verify the merit/outcome of the chosen solution
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56
Q

What are two types of cognitive dysfunction?

A
  1. Deficiency 2. Distortion
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57
Q

What does “cognitive structures” refer to?

A

AKA cognitive schemata. Refers to memory principally–information that is internally represented in memory. Cognitive content is the information actually represented (self talk). Cognitive processing refers to how we go about perceiving and interpreting experience. Cognitive products (attributions) is a result of the interaction of the above

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58
Q

Does psychotherapy work?

A

In a meta-analysis of 100 studies Weisz 1987 found an effect size of 0.79 for all therapies combined

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59
Q

What percentage of adolescents will have a depressive episode by age 18?

A

20%

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60
Q

Where do most adolescent suicides occur?

A

After school hours and in a teen’s home; most are precipitated by an interpersonal conflict

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61
Q

What time do most adolescent suicides occur?

A

Late afternoon, early evening

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62
Q

What precipitates suicide attempts in adolescents?

A

Family fight, parent-child discord, lower grades, long absence from school

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63
Q

What is the presumed lifetime risk of a mood disorder if both parents have mood disorders in their sides of the family?

A

100%; 24% if one parent’s family; 17% if no extended family has a mood disorder

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64
Q

In one study, what percentage of children who were depressed and hospitalized were re-hospitalized within two years of first hospitalization?

A

80%

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65
Q

In Emslie’s study of depression in children and adolescents, what percentage who responded had a clinical global impression (CGI) score of 1 or 2 for fluoxetine and placebo, respectively?

A

56% for fluoxetine and 33% for placebo (CGI 1 = very much, 2 = much improved)

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66
Q

What are the key ‘rhythmic’ interventions in bipolar disorder?

A

Sleep and regular daily activities

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67
Q

What therapy has been shown to reduce suicidal behavior in adults?

A

Dialectical behavior therapy (DBT)

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68
Q

A history of sexual abuse increases the risk of a suicide attempt by how much?

A

8

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69
Q

Do suicide prevention telephone interventions seem to help reduce suicidality?

A

Yes with a small positive effect

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70
Q

What is the point prevalence of schizophrenia in 2 to 12 year olds?

A

2/100,000

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71
Q

What are some premorbid findings in schizophrenia?

A

Language development, speech and learning disorders, disruptive behaviors

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72
Q

What is the age of onset for schizophrenia

A

Rare before age 9. Less than 1% have it before age 13; less than 10% have it before age 15; the rest are diagnosed above 16 years of age

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73
Q

What percentage of children with schizophrenia have visual hallucinations?

A

Close to 100%

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74
Q

What did a group with childhood onset schizophrenia studied by Eggers 1978 and 1989 show about outcome?

A

20% showed remission, 30% had satisfactory social adaptation, 50% remained impaired

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75
Q

When was depression in children and adolescents first recognized in the US?

A

The first official recognition occurred at an NIMH conference in 1975. (In part, prior to this, psychodynamic ideas about superego and ego formation precluded the ideas of depression in children.)

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76
Q

Emil Kraepelin found what percentage of persons with mania had an onset before 10 years of age?

A

0.4%

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77
Q

What percentage of children have atypical depression?

A

16.5%

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78
Q

The age of onset of depression is associated with duration or recovery?

A

Duration

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79
Q

What findings are there for cortisol and growth hormone in children with depression?

A

Cortisol hypersecretion and blunting of nocturnal growth hormone

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80
Q

What is the tricyclic antidepressant response compared to placebo in child and adolescent depression?

A

The same, a 50% response for both

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81
Q

What percentage of adolescents present with depressed mood as the index episode in bipolar disorder?

A

60%

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82
Q

What percentage of child and adolescent patients with bipolar disorder have ADHD?

A

57 to 98% (Geller, Wozniak)

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83
Q

What is the concordance rate for depression in monozygotic and dizygotic twins, respectively?

A

54% MZ, 24% DZ

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84
Q

What is the concordance rate for bipolar disorder in Monozygotic and dizygotic twins, respectively?

A

65% MZ, 14% DZ

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85
Q

What is the ‘cognitive triad’ in depression?

A

Pessimistic and deprecatory about: 1) oneself 2) one’s experience, and 3) the future

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86
Q

What lab tests might be obtained before lithium use?

A

Renal and thyroid function, calcium leve. Others include a CBC with differential since a slight leukocytosis can occur

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87
Q

What is the risk of schizophrenia if one parent has schizophrenia?

A

10 to 15%

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88
Q

Is there an association between temporal lobe epilepsy (TLE) and the development schizophrenia?

A

One study showed 10% of children with TLE developed SZP

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89
Q

What is found in the conversational language of patients with schizophrenia?

A

They use fewer linguistic cohesive devices

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90
Q

What structures of the brain are reduced in schizophrenia?

A

Frontal-temporal area (the ventricles are increased)

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91
Q

When depressed, what percentage of adolescents would meet criteria for a personality disorder?

A

60%, i.e. about 2/3. 30% of these are for BPD. After the remission of the depression the PD symptoms are no longer evident

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92
Q

After a depressive episode in children and adolescents, do social skills deficits and psychological morbidity persist?

A

Yes

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93
Q

What are some elements of ‘pragmatic language’?

A

Conventions for eye contact, gestures, verbal and non-verbal cues, sustaining conversation, maintaining a shared topic, taking turns in dialogue

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94
Q

Does a Jehovah’s Witness practitioner have the right to refuse a blood transfusion for their child?

A

No

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95
Q

What percent of divorces have custody issues and conflicts arise?

A

<10%. 1.5% need to rely on a judge. When conflict is present 75% of families have little conflict; 25% have severe conflict

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96
Q

What is the central principal of custody and placement decisions?

A

The least detrimental alternative

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97
Q

What is the least detrimental alternative for children in extreme cases where parents are ‘addicted’ to fighting?

A

In such instances it is best to support and protect the child’s relationship with the custodial parent

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98
Q

Which are more sensitive to findings, structured or semi-structured interviews?

A

Structured

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99
Q

Do increased levels of income lead to decreased levels of psychiatric disorders?

A

Yes, up to a point.

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100
Q

What percentage of children live in two parent families?

A

69%

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101
Q

In one study, what percentage of daycare centers are considered of good quality?

A

1 in 9. Family based daycares fare even more poorly

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102
Q

What percent of divorces involve children?

A

60%

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103
Q

What is an IEP?

A

Individualized Education Plan

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104
Q

How often is an IEP reviewed?

A

Every 3 years (Triennial)

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105
Q

Children subject to discipline who have not been evaluated for special education but who are suspected of meeting criteria have the same protections, true or false?

A

True

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106
Q

How many children are in out of home non-relative placements in the U.S.?

A

500,000 (1998 data)

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107
Q

What is the average number of foster care placements for a child who enters the foster care system in Connecticut?

A

3.5

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108
Q

Who was among the first to use home visitation as part of a comprehensive intervention?

A

Sally Provence (also David Olds)

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109
Q

What is MST

A

Multisystemic Therapy

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110
Q

Who developled MST?

A

Henggeler and Boroduin

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111
Q

What population does MST primarily serve?

A

Children and adolescents with delinquency

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112
Q

When was AACAP formed?

A

1953

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113
Q

What is a fiduciary relationship?

A

One in which one person receives the trust or confidence of another and is under a duty to act for the benefit of that person

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114
Q

What is the difference between confidentiality and privilege?

A

Privilege is a patient’s right to bar disclosure of treatment information in judicial or quasi-judicial proceedings. Confidentiality refers to treatment information and third parties

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115
Q

Who popularized the term adolescence?

A

Stanley Hall in his two volume work on adolescence (1904)

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116
Q

When did the subspecialty of child psychiatry emerge from the ABPN?

A

1957

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117
Q

When did child guidance clinics emerge?

A
  1. A psychiatrist worked with the patient; a psychologist did testing; a social worker worked with the family
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118
Q

Arnold Gesell saw behavior and life determined by____?

A

Biopsychosocial events; like Hall, his mentor, and unlike Watson a behaviorist

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119
Q

How many children are substantiated victims of abuse, neglect or both?

A

One million

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120
Q

How many children die each year because of abuse or neglect?

A

2000

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121
Q

How many children are sexually abused each year?

A

130,000

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122
Q

How many adolescents run away from home and live on the street?

A

Two million

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123
Q

What percentage of runaways are absent from home many weeks or months?

A

15%

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124
Q

There are two main types of runaway, what are they?

A

Pushed from home and running from home

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125
Q

What is the lower age of consent to treat for drugs or alcohol?

A

There is no lower age limit. A 9 year old has the same rights to confidentiality as 17 year old.

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126
Q

What are clinical features associated with Rett’s disorder?

A

Sleep-wake cycle disturbance; increased Q-T; orthopedic problems; decreased T4 and TSH; decreased bone density; feeding problems; respiration apneustic

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127
Q

According to Thomas and Chess, what percentage of children are: easy, slow to warm-up, and difficult, respectively?

A

40% easy, 15% slow to warm-up, 10% difficult. The rest do not fit into a category. The temperaments are not a/w adult adjustment, but difficult temperaments have a harder time with stress.

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128
Q

What constellation of behaviors in the NYLS by Thomas and Chess led to behavior disorder at age 9 for many?

A

Irregularity, withdrawal, predominanty negative mood, slow adaptability, high intensity

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129
Q

By the age of 3 years, what percentage of child utterances continue the previous topic of conversation?

A

50% (Two year old kids can handle conversational breakdowns)

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130
Q

At what age do telegraphic sentences appear?

A

18 months

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131
Q

At what age do children utter 3-4 word sentences?

A

2 years

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132
Q

What number of words does an 18 month old know?

A

100

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133
Q

What number of words does a 24 month old know?

A

300

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134
Q

What number of words does a 3 year old know?

A

900

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135
Q

What number of words does a 4 year old old know?

A

1500

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136
Q

What number of words does a 5 year old know?

A

2500

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137
Q

What percentage of children who stutter at age 4 years recover?

A

Up to 85%

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138
Q

By what age is the typical developing child fully intelligible?

A

4 years old

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139
Q

At what age does the babbling of a child with deafness differ from a child with hearing?

A

4 to 8 months old

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140
Q

When does reduplicative babbling occur?

A

6 months to 1 year. AKA ‘canonical babbling’, consonant-vowel sounds

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141
Q

What are the four major components of language?

A
  1. Comprehension 2. Acquisition of speech sounds 3. Expression of words and sentences 4. Pragmatic communication
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142
Q

At what age do babies distinguish the mother’s breast pad from others’?

A

Newborn

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143
Q

At what age do sounds evoke movement in the fetus?

A

Third trimester

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144
Q

Attention as a construct consists of what elements?

A

Strategic scanning, exclusion of irrelevant stimuli, sustained attention, divided attention, inhibition of impulsive action, selection and monitoring of response

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145
Q

When does metacognition, thinking about thinking, begin?

A

3 years of age

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146
Q

Which emerges first, implicit or explicit memory?

A

Implicit

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147
Q

How many neurons are in the human brain?

A

Tens of billions (there are 10,000 synaptic junctions per neuron)

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148
Q

Early child abuse is associated with impairment in what brain anatomic areas?

A

Corpus callosum and decrease in brain size

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149
Q

The Australia temperament study showed that adolescents with anxiety disorders were shy as children, true or false?

A

False. They were not more shy. 2,443 kids studied

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150
Q

Variability in temperament is accounted for by parent practice, true or false

A

False

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151
Q

The difficult versus easy temperament at age 3 related to early adult disposition, true or false?

A

True

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152
Q

What are the Thomas and Chess temperament categories

A
  1. Activity level 2. Rhythmicity 3. Approach or withdrawal 4. Adaptability 5. Threshold of responsiveness 6. Intensity of reaction 7. Quality of mood 8. Distractibility 9. Attention span and persistence
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153
Q

An inhibited style is associated with right or left activation on EEG?

A

Right activation

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154
Q

What did Jerome Kagan find regarding the development of anxious symptoms?

A

A 4 month old temperamental profile of high reactivity (and not the level of fearful or inhibited behavior in lab). This was better predictor than 14 and 21 month old behavior

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155
Q

Describe the attachments of the Strange Situation

A

Securely attached; insecure-avoidant/ambivalent (delayed acknowledgment);insecure-resistant (anger or high passivity); insecure-disorganized (e.g. approaches parent with head avoided)

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156
Q

Who introduced systemic desensitization?

A

Joseph Wolpe (1915-1997)

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157
Q

What experiment are Watson and Rayner especially known for from 1920?

A

Study of Albert, an 11 month old. White animal (rat) for which he had no fear + loud noise (the latter is an unconditioned stimulus) –> startle. Eventually the white animal became the conditioned stimulus (CS) and a startle resulted from it alone (stimulus generalization)

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158
Q

Who are key historical figures in operant conditioning?

A

Pavlov, Thorndike, Skinner

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159
Q

What is negative reinforcement?

A

The likelihood of a response increasing by the removal of a negative or unpleasant stimulus or situation

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160
Q

What is observational learning?

A

Social learning, learning by observing others (Bandura 1969)

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161
Q

How is information processing related to cognitive development?

A

Encoding occurs; hold info on screen for appraisal and transform it into knowledge by connecting it to prior knowledge

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162
Q

What are the views of Vygotsky?

A

Intelligence begins in the social environment and directs itself inward. Cognitive development is rooted in 3 genetic domains, phylogenesis, cultural hx, and ontogenesis. Culture’s psychological tools–language–are shared with and internalized by the child. Internalization of language gives rise to metacognition (thinking about thinking).

163
Q

What is the zone of proximal development?

A

The potential of a child to do something with support as opposed to what they can actually do. Scaffolding

164
Q

Children require higher or lower doses of opioids mg/kg than adults for pain?

A

Higher 2/2 more rapid tolerance (and relatively higher doses of chemo)

165
Q

What are some sequelae of bone marrow transplant?

A

Learning disorder, growth retardation, and infertility

166
Q

Which is ‘worse’, emotional or physical abuse?

A

Emotional abuse is a stronger predictor for internalizing and externalizing behaviors, low self-esteem, SI, social impairment, psychiatric disorders, and hospitalization

167
Q

Psychopathology in a proband tends to show what psychiatric disturbances in a parent

A

Mother depression; Father etoh, ASPD, lability

168
Q

What are the types or patterns of emotional abuse?

A

Rejecting, isolating, terrorizing, ignoring, corrupting

169
Q

What is the most common type of inflicted burn?

A

Scald

170
Q

What has been shown about kids who disclose their HIV status to peers?

A

No decrease in function or self concept. Increase in immune response

171
Q

There are approximately 20 million cases of STDs in the U.S.A. What percentage are in those aged 15 to 24?

A

50%

172
Q

Cyclosporine levels are effected by drugs which interact with which P450 system?

A

3A4

173
Q

If a mother reacts with depressive symptoms to a birth defect, is the severity of the reaction related to the magnitude of the defect?

A

No

174
Q

What percentage of mothers have a medical background in Caregiver Fabricated Illness?

A

30 to 50%

175
Q

What might be a father’s presentation in Caregiver Fabricated Illness?

A

Father may be demanding, overbearing, legal minded

176
Q

What is the presentation of a child with Caregiver Fabricated Illness?

A

Passively tolerates medical procedures. Child, especially older, may collude

177
Q

What percentage of children die from Caregiver Fabricated Illness?

A

9%. Another 8% may have permanent disfigurement. It is unclear if removal or not from family improves outcome. Brief foster placement appears to improve situation.

178
Q

At what age can children manage their insulin dependent diabetes on their own?

A

Starting at 12 years. Some older, some younger.This does not mean parent should not be involved.

179
Q

What do studies show about psychiatric disorders and malignancies in children?

A

Contradictory. Generally, if problems persist they are usually related to school (missed days). Those that do worse are children with cranial irradiation and intrathecal methotrexate.

180
Q

What is the perspective taking of 3 to 6 year olds?

A

Attributes own perspective to others

181
Q

What is the perspective taking of 6 to 12 year olds?

A

Self reflective and reciprocal perspectives; can see from another’s perspective

182
Q

What is the perspective taking of 10 to 15 year olds?

A

Third person and mutual; observing ego

183
Q

What is the perspective taking of 12 year olds?

A

In depth and societal, symbolic; understand that observing ego cannot understand the complexity of internal reactions; something is always hidden

184
Q

What is empathy?

A

Empathy has both an affective and cognitive component; vicarious affective response to another and the cognitive awareness of another person’s internal states. A person with sociopathy will often have cognitive empathy.

185
Q

What is theory of mind?

A

The ability to attribute mental states, such as thoughts, beliefs, intentions, desires, and feelings, to others and oneself

186
Q

What tests assess first order theory of mind, second order, third and higher order?

A

Smarties and Sally Anne Test, Ice Cream Van Story, 12 Stranger Stories.

187
Q

What is an example of second order theory of mind?

A

Where does person Y think person X will look for the object. E.g. false-belief test (Sally and puppet)

188
Q

What is an example of higher order theory of mind?

A

Does X mean what he says; what is X thinking or feeling

189
Q

What is mentalizing?

A

The ability and the drive to predict relationships between external states of affairs and internal states of mind

190
Q

What are the prevalence rates of psychiatric disorders for children, pre-adolescents, and adolescents, respectively?

A

10%, 13%, and 16.5%

191
Q

What percentage of children identified with a psychiatric disorder have two or more, according to the Great Smoky Mountain Study?

A

33%

192
Q

What percentage of infants have a temperamental trait that predisposes them to being highly reactive in novel situations

A

20%

193
Q

What percentage of sex abuse cases are by adolescents?

A

20%

194
Q

What percentage of prepubertal children with depression have hallucinations?

A

48%. 36% report complex AH

195
Q

What is the point prevalence of depression in adolescents?

A

2 to 5%

196
Q

What did the National Comorbidity Survey show for lifetime prevalence of depression in adolescencts?

A

15.3% (For adults it was 17% suggesting most adult depression starts in adolescence)

197
Q

What percent of those with severe TBI have seizures as a complication?

A

33% (6% in mild TBI)

198
Q

For a proband with a reading disorder, what percentage of relatives have a reading disorder

A

40%

199
Q

What percentage of children with OCD have tics?

A

Up to 55% have tics. 15% have Tourette’s

200
Q

What is the concordance rate for depression in monozygotic and dizygotic twins

A

76% MZ, 19% DZ

201
Q

What percentage of those with bulimia nervosa had prior anorexia nervosa?

A

25 to 33%

202
Q

What is the rate of new psychiatric disorders after severe injury?

A

60%; 25% mild

203
Q

What percentage of infants have temperamental trait that predisposes them to being highly reactive in novel situations

A

20%

204
Q

What percentage of sex abuses are by adolescents?

A

20%

205
Q

What percentage of depressed prepubertal children have hallucinations?

A

48%; 36% report complex AH

206
Q

What is the point prevalence of depression in adolescents?

A

2 to 5%

207
Q

What percentage of those with learning disorders have ADHD?

A

20%

208
Q

What percentage of those with learning disorders have a psychiatric diagnosis?

A

50% (refers to children and adol)

209
Q

What percentage of children with learning disorders have social skills deficits?

A

up to 75%

210
Q

What percentage of children with subtance use disorders have a learning disorder?

A

Up to 70%

211
Q

What percentage of those with disruptive or depressive disorders have a learning disorder?

A

10 to 25%

212
Q

What percentage of those with a learning disorder have substance use disorder?

A

24%

213
Q

What percentage of those with conduct disorder have speech and language difficulties?

A

33%

214
Q

When there is the death of a parent what factors are associated with risk of psychiatric morbidity?

A
  1. Being less than 5 yo or an adolescent 2. For females less than 11 yo, loss of M; for adolescent males, loss of father 3. Premorbid psychiatric difficulties 4. Lack of social and community supports 5. An unanticipated death or SI or HI 6. Surviving parent has problems 7. Conflictual relationship of parents or parent remarries quickly
215
Q

Who is a key figure in pediatric PTSD research which involved a bus kidnapping?

A

Lenore Terr (Chowchilla CA incident; children kidnapped from bus, held in bunker)

216
Q

What is a re-enactment behavior in PTSD?

A

Replication of some aspect of the traumatic experience

217
Q

What is Type 1 vs. Type 2 trauma?

A

Type 1 is a single acute incident; Type 2 is chronic or ongoing

218
Q

In which type of anorexia, restricting or binge-purging, do majority of patients develop symptoms of the other type?

A

Restricting type develop binge-purging rather than other way around

219
Q

What is Pickwickian syndrome?

A

Respiratory hypoventilation, daytime hypersomnolence a/w severe obesity. Mortality rate of 40%

220
Q

What are the reasons for clinical hypothyroidism in Anorexia Nervosa?

A

Decreased T3

221
Q

What percentage of one’s bone mass is formed during adolescence?

A

90%. Those with onset of anorexia in adolescence are at risk for decreased bone mass

222
Q

How might a patient with anorexia view limits on safety?

A

It is evidence of imposed control but also unconscious relief that someone is taking over a situation that is out of control

223
Q

What therapy other than CBT has been shown to be effective for bulimia nervosa?

A

Interpersonal therapy (IPT)

224
Q

What has been found about the caudate’s size in Tourette’s disorder, increased or decreased?

A

Decrease in size (Peterson 2005)

225
Q

What has been found about oxytocin levels in tic related OCD vs. non-tic OCD?

A

Oxytocin is increased in the CSF for those with non-tic OCD. It is the same for those with tic related OCD

226
Q

If a parasomnia persists or is present in adolescence, what should be considered?

A

A seizure disorder

227
Q

What is the likelihood of obesity if both parents have obesity?

A

80% (50% if one)

228
Q

What is the likelihood of obesity if 2 siblings have obesity?

A

80% (40% if one sibling)

229
Q

What is the correlation between obesity in infancy and later childhood, good or poor?

A

Poor correlation. Infant obesity is not a/w obesity in later childhood

230
Q

What is the definition of obesity in children based on body mass index percentiles

A

95% or greater. Overweight is 85 to 95%

231
Q

What is the key to PTSD treatment?

A

Expose the individual to traumatic cues under safe conditions, incorporating reparative and mastery elements in a structured manner

232
Q

Which researcher said parents are better at alleviating externalizing symptoms and children internalizing ones?

A

EJ Costello 1989, one of the authors of the Great Smoky Mountain Study, a larger epidemiological study run by Angold and Costello

233
Q

What is a social learning theory of PTSD formation?

A

It involves classical and operant conditioning. There is a classic unconditioned event with an unconditioned response. Operant conditioning after the trauma in that avoidant behaviors result in stimulus generalization

234
Q

What is the prevalence of PTSD in children and adolescents?

A

Ranges from 10 to 40% [40 seems high; doubt this figure includes impairment]

235
Q

A study of children with obesity found what three most common psychosocial events may be present in some cases?

A

Early separation from mother < 24 months; family dysfunction; exposure to traumatic or violent events

236
Q

What leads to diabetes insipidus in anorexia nervosa?

A

Abnormal vasopressin secretion

237
Q

What percentage of patients with anorexia nervosa have amenorrhea that precedes the weight loss?

A

20 to 30% and it persists despite weight gain

238
Q

How is insulin-like growth factor (IGF-1) implicated in anorexia nervosa?

A

It is a nutritionally dependent endogenous bone trophic factor

239
Q

What percentage of patients with anorexia nervosa have major depressive disorder?

A

50 to 70%, 50% have anxiety

240
Q

What are some of the psychological characteristics of patients with anorexai nervosa?

A

Inreased sense of responsibility, obsessional, interpersonal insecurity, minimization of emotional expression, perfectionism, identify confusion, excessive conformity and guilt, rigid control over impulses, low self-esteem, industriousness, competitive, envious

241
Q

What is the lifetime prevalence of anorexia nervosa?

A

0.1 to 0.7%

242
Q

What is the general range of onset of anorexia nervosa and what are the bimodal peaks of onset?

A

8 to 30 years of age with peaks at 13 to 14 and 17 to 18

243
Q

How can families of patients with anorexia nervosa present, according to one set of ideas?

A

Happy, conflict free exterior masking feelings of distrust, lack of intimacy between parents, enmeshment, overprotection, rigidity, and lack of conflict resolution. Over nurturance undermines separation and neglecting behaviors undermine attempts at self expression

244
Q

What is the mortality rate of anorexia nervosa?

A

0.56% per year, 12 times the general female population. In one study over 10 years, 5 patients of 76 died, or 6%; none by suicide. (The data did not include males.)

245
Q

What factors predict death in anorexia nervosa?

A

Low albumin, low weight at intake, poor social function, binging and purging type, drugs and alcohol use, and mood disorder

246
Q

What is key in recovery for anorexia?

A

Therapeutic relationship with professional and positive relationship with family and friends. Individuals relate honestly to the the patient with anorexia; the patient expresses feelings and develops trust

247
Q

What percentage of women have an eating disorder?

A

3%

248
Q

Leptin levels are highest in which group, healthy controls, bulimia nervosa, or anorexia nervosa?

A

HC > BN > AN

249
Q

What peptides are associated with eating disorders?

A

Neuropeptide Y and YY, which are increased in bulimia nervosa

250
Q

Which chronic medical illness leads to the risk of developing bulimia nervosa?

A

Insulin dependent diabetes (IDDM)

251
Q

What supplements should be given to prevent osteoporosis in anorexia nervosa?

A

Calcium, phosphorous, and vitamin D

252
Q

Are SSRIs effective in bulimia nervosa?

A

SSRIs appear to be effective even without depression

253
Q

What is the crude mortality rate of bulimia nervosa?

A

5% (efffected by mood disorders, drugs and alcohol)

254
Q

A child with ADHD who is among the brightest in the class is likely to produce little work, true or false?

A

True

255
Q

Is the Continous Performance Test (CPT) sensitive to drug and dose effect in ADHD?

A

Yes

256
Q

How is impulsivity defined?

A

Acting without thought of consequences. Unaware of the relationship between cause and effect

257
Q

What are the four basic categories of conduct disorder?

A

1) Aggression 2) Destruction 3) Deceitfulness 4) Serious violation of rules

258
Q

What is a useful way of subtyping aggression?

A

Instrumental (purposeful), impulsive, affective

259
Q

Higher IQ in conduct disorder is associated with what traits?

A

Callousness

260
Q

How are females thought to more likely to show aggression?

A

Verbal and relational aggression; alienation; and character defamation.

261
Q

The ability of deviant peer affiliation to predict delinquent outcome is related to what?

A

Amount of parental supervision

262
Q

What has been found about the reporting of symptoms in their children by mothers with depression?

A

They report higher numbers of symptoms in their children.

263
Q

What core features of ADHD have remained in present over time in the DSM?

A

Motor hyperactivity, inattention in school, and impulsivity with regard to rule governed behavior

264
Q

What happens to hyperactivity over time in ADHD?

A

It remits or attenuates. Inattention persists.

265
Q

What is the prevalence of conduct disorder?

A

1 to 16%

266
Q

What is the prevalence of ODD?

A

2 to 16%

267
Q

How is IQ related to conduct disorder?

A

Inversely

268
Q

Prenatal tobacco exposure is associated with conduct disorder, true or false?

A

True

269
Q

What three treatment modalities have been found to be helpful for conduct disorder?

A
  1. Functional Family Therapy2. Multisystemic Therapy (MST)3. Parent Management Training (PMT)
270
Q

What has controlled data shown for clonidine in children with ADHD and ODD or CD?

A

Potential efficacy for aggression

271
Q

Where has propranolol demonstrated effectiveness?

A

Children and adolescents with chronic brain dysfunction and aggression or conduct disorder refractory to other medications

272
Q

What is the outcome of conduct disorder?

A

Mild –> improve; severe –> chronic. Aggression in CD: 1/2 had CD at 2 yr follow up. Persistence is a/w antisocial behavior, fire setting, aggression, early onset, family deviance, inattention

273
Q

What is the most consistently found factor associated with poor outcome in conduct disorder?

A

Early age of onset

274
Q

What did Werner’s long-term study in Hawaii show about psychosocial circumstances regarding males who develop criminal records?

A
  1. A younger sibling born less than two years after the subject 2. Raised by an unmarried mother 3. No father present during early infancy and childhood 4. Prolonged disruption in family life 5. Having a working mother without suitable caregivers
275
Q

What did Werner’s long-term study in Hawaii show about high risk, resilient children who did not develop serious behavior disorders?

A

First born child with higher IQ from smaller families with low family discord

276
Q

Is chumminess protective or not in high risk children?

A

Yes if a child associates with a non-aggressive friend, and no if the friend is aggressive

277
Q

What percent of arrested juveniles have drugs or alcohol in their blood stream?

A

40 to 60%

278
Q

What distinguishes pattern of worry in GAD vs. healthy controls?

A

GAD subjects have on average 6 specific worries; HCs average 1. Those with GAD have a higher frequency of the main worry, stronger interference of the main worry, and increased difficulty controlling the worry

279
Q

What percentage of children with GAD have GAD alone?

A

13%. Most have comorbid depression (62%) or separation anxiety disorder (42%; not present in adolescents usually). Outcome not impacted by comorbidity so much

280
Q

The Great Smoky Mountains study showed what 3 month prevalence of SAD and GAD?

A

SAD about 3.5% and GAD 2%

281
Q

What kind of attachment pattern is a risk factor for a child with anxiety disorder?

A

Insecure attachment

282
Q

For anxiety based school refusal, what percentage of parents have a history of psychiatric illness?

A

81%, mostly anxiety and depression

283
Q

What life experiences do children with GAD attribute their main worry to?

A

55% report a conditioning experience (e.g. death of grandparent); 33% information pathway (e.g. evening news); 13% modeling experience (e.g. see another worry). None of these are critical to developing GAD

284
Q

What has been found to be a variable for separation anxiety disorder or separation experiences in children ages 3, 11, and 18

A

The variable most important at age 11 was mother’s fear of going out alone

285
Q

When should an SSRI be stopped after succes in children?

A

After one year, during a period of low stress (Pine 2002)

286
Q

Which is more effective, group CBT or individual CBT for children with anxiety?

A

They are equal

287
Q

Is a family component for CBT in anxious children useful?

A

According to one study, yes at 12 month follow-up, no at 6 year follow-up. It may be most useful to have a family component if the parent is anxious

288
Q

What is ironic about children with ADHD in physical education?

A

They have trouble modulating their behavior upward

289
Q

Reading disorder accounts for what percentage of kids with learning disorders

A

80%

290
Q

What percentage of children seen in psychiatric settings have a language disorder too subtle to be detected without special evaluation?

A

66%

291
Q

What author clarified the role of physical abuse as an etiology for delinquent behavior?

A

Kempe

292
Q

What does the assassination of JFK have to do with child psychiatry?

A

Oswald was mentally ill as a child but was never treated. In 1965 the Joint Commission on MH of children was created to study the origins and causes of mental illness in children and adolescents

293
Q

A 1 month old infant can rembember a mobile for how long?

A

24 hours. By 5 to 6 months of age infants can remember objects seen only a few minutes

294
Q

What seems to be the upper limit for becoming securely attached after severe deprivation/neglect?

A

24 months

295
Q

What can centuries of oppression lead to in style of relating?

A

Passive or passive aggressive styles of relating

296
Q

When did private, employer sponsored health insurance start?

A

1929 Baylor Texas; 1500 teachers; Blue Cross paid hospital costs. Later Blue Shield paid for professional fees. In 1954 the federal government allowed to give health insurance benefits tax free

297
Q

What are two pictorial assessment methods?

A

1) Dominic R 2) Pictorial Assessment for Children and Adolescents

298
Q

What does the Beck Hopelessness Scale (BHS) do?

A

Studied in adults but used in teens. Discriminates SI from non-SI adolescents and predicts SAs independent of depression. The HSC (Hopelessness Scale for Children) is a downward extension of the BHS.

299
Q

What are examples of behaviors that show visuomotor integration

A

Copying a figure or hitting a baseball

300
Q

What urine finding may be useful in patients with bulimia?

A

Increased ratio of sodium to chloride may predict bulemic behavior

301
Q

What percentage of parents of children with schizophrenia will have schizophrenia?

A

10%

302
Q

Is IQ increased or decreased in patients with schizophrenia?

A

Decreased by virtue of not making gains

303
Q

What is a side effect of phenobarbital in children?

A

Hyperactivity

304
Q

What are behavioral-emotional findings in temporal lobe seizures?

A

Depeened emotions. Changes in sexual function. Aggression. Intensified religion/philosophy. Circumstantiality. Interpersonal viscosity.

305
Q

Do anti-epileptic drugs effect cognition?

A

The better data suggests no (Mandelbaum and Burack 1997, 12 month prospective study of 43 children; Aldencampl 1998; Bates 1998). Others say decreased attention, concentration, memory, motor and mental speed, and mental processing.

306
Q

When treating a child with schizophrenia, when should one try to reduce the antipsychotic dose?

A

After one year

307
Q

What is the data on the effectiveness of clozapine for childhood onset schizophrenia?

A

More effective than haloperidol and other older agents. But 1/2 discontinue because of seizures, hematologic abnormalities, or treatment non-response over time (Kumra 1996)

308
Q

Is projective testing useful in schizophrenia?

A

Yes and no. A good clinical exam can determine the presence of psychosis and projective testing for diagnosis is not necessary. However, projective testing is useful to determine the severity of the thought disorder

309
Q

What is the definition of failure to thrive?

A

Marked deceleration in weight and slowing of acquisition of emotional and social developmental milestones. A/w with deceleration in linear and head circumference measures. Malnutrition.

310
Q

What is benign nutritional dwarfing?

A

Maladaptive eating pattern in children or adolescents without elicited psychiatric or medical problems with a slowing of weight gain for at least a year followed by deceleration of linear growth

311
Q

In Tourette’s disorder which comes first, phonic or motor tics?

A

Motor tics precede phonic tics by one to two years

312
Q

What is the adult outcome of seizure disorders?

A

Psychologically intact (if seizure disorder does not remain chronic)

313
Q

What is psychosocial dwarfism?

A

Deceleration of linear growth in the absence of weight gain deceleration. A/w parental psychopathology

314
Q

How is intrauterine growth retardation (IUGR) defined?

A

Ht and wt both less than 10% for gestational age

315
Q

In obesity, is leptin level increased or decreased?

A

Increased

316
Q

What is the prevalence of PICA?

A

25-33% in children

317
Q

What is the cutoff in conduct disorder for the childhood onset subtype?

A

10 years of age

318
Q

On what chromosome is 2D6 located?

A

22

319
Q

How many varieties of the 2D6 gene are there?

A

70

320
Q

Patients with which condition are missing a copy of the catecholamine-O-methyltransferase (COMT) gene?

A

Patients with velocardiofacial syndrome. COMT is associated with 3 phenotypes, high activity, intermediate activity, and low activity; low activity is a/w psychosis. Also, those homozygous for the low activity alleles have an increased risk of alcoholism because they experience more euphoria

321
Q

Besides an IQ of less than 70, what else is considered for a diagnosis of intellectual disability?

A

Adaptive behavior

322
Q

Can learning disorders co-exist with an intellectual disability?

A

Yes

323
Q

What percentage of infants have a major anamoly?

A

2 to 4% (60% a/w genetic or in-utero causes)

324
Q

Are patients with intellectual disability more prone to depressive disorders?

A

Yes

325
Q

What endocrine disorder should be considered in Down’s Syndrome?

A

Thyroid dysfunction

326
Q

Anxiety and social avoidance are notable presentations in what genetic disorder?

A

Fragile X

327
Q

Do children with autism who are overactive often become more active or hypoactive as adults?

A

Hypoactive

328
Q

What percentage of children with autistic disorder have an IQ > 70?

A

20 to 30% (Several studies have shown that the lower IQ found in autism is not related to test taking motivation)

329
Q

On the Wechsler Adult Intelligence Scale, what has generally been a/w with an autistic profile?

A

Verbal IQ is lower than performance IQ, with verbal comprehension lower than block design. In high functioning autism this is a more variable finding.

330
Q

What percentage of patients with autism and intellectual disability have seizures?

A

33%

331
Q

What are the most common areas of special skills in autism?

A

Musical, mechanical, mathematatical

332
Q

What seems to be the most common seizure type in autism?

A

Partial

333
Q

Rett’s disorder involves which mutation?

A

Methyl-CpG-binding protein 2 (MECP2); chromosome Xq28

334
Q

What are feature’s described originally by Asperger in his observations?

A

Argumentative, condescending, verbally abusive, hit other kids, lash out, knock objects over, and interested in violence

335
Q

What percentage of children with tuberous sclerosis have autism?

A

20-25% or more

336
Q

What is Landau-Klefner Syndrome?

A

Onset at 3 to 5 years with loss of language and seziures. Social interaction and non-verbal skills are preserved

337
Q

Which gender has a greater rate of seizures in autism?

A

females

338
Q

What percentage of siblings of a proband have autism?

A

2-7%

339
Q

What percentage of children with autism will have neurological abnormalities?

A

30 to 50%

340
Q

What percentage of those with autistic disorder will have increased serotonin levels?

A

33%

341
Q

What are birth factors associated with autism?

A

Mixed findings. Wing found 1/2 had a history of pre, peri, and post natal complications, such as anoxia at birth. Other studies have found no difference with controls. (Ghaziuddin 1995; Szatmari 1989)

342
Q

Do you have to be female to have Rett’s disorder?

A

No. It is not part of the criteria in DSM, and the latter is based on the International Rett Syndrome Association-CDC. It is overwhelmingly found in females.

343
Q

What percentage of those with Rett have the MECP2 mutation?

A

80%

344
Q

What are behaviors that distinguish autism from Rett’s disorder?

A

In autism, grossly stated, tendency to play with hard obects, dislike to be disturbed in activity, pleased when left alone, rejection of tenderness, hyperactivity, excessive attachment to objects, rotation of small objects, stereotyped play.

345
Q

What is the prevalence of Rett’s disorder?

A

1-4/20,000

346
Q

What percentile is the ht and wt in Rett’s disorder?

A

Less than 2.5%

347
Q

What is the outcome of Rett’s disorder?

A

Death by 40’s

348
Q

What percentage of children have a mathematics disorder?

A

1 to 6%; females > males

349
Q

What percentage of children have a disorder of written expression?

A

2 to 8%

350
Q

When there is a diagnosis of a learning disorder, when is it appropriate to use a nonverbal IQ test?

A

When reading is a concern. One can use the Leiter International Performance Scale

351
Q

What should one first verify when there is concern for a learning disorder, either by exam or medical records?

A

Vision and hearing

352
Q

What is the most common neurocognitive impairment in reading disorder?

A

Deficit in phonological processing

353
Q

For developmental coordination disorder, what history should be obtained?

A

Developmental motor milestones, including sucking, swallowing, crying, tracking, grasping, toiletting, feeding, dressing, drawing, and others. DCD can be diagnosed with intellectual disability

354
Q

What are Mahler’s stages of development?

A

Symbiosis 0-5 months; differentiation 5-10 months (stranger anxiety); practicing 10-15 months; rapprochement 18-24 months; object constancy (consolidation) 24-36 months

355
Q

In the Isle of Wright Study, what percentage of 9 to 11 year olds with an intellectual disability had other psychiatric illness?

A

30 to 42%

356
Q

When does babbling begin?

A

6 weeks

357
Q

When does a whole smile begin?

A

4 to 6 weeks

358
Q

What explains hand flapping?

A

Hand flapping is related to motor problems and is seen when children with motor problems become excited or overloaded.

359
Q

What do we know about leptin and neuropeptide Y in eating disorders?

A

Bulimia has an increase in leptin and neuropeptide Y. Anorexia has decreased levels of both

360
Q

Where is the serotonin transporter gene located?

A

Long arm of 17q12 (There are 2 polymorphisms, the long and short forms of the gene)

361
Q

What are two neuropsychological theories of autism?

A
  1. Cortical dysfunction with disorder of hemispheric lateralization. 2. Brainstem dysfunction
362
Q

Who coined the term shaken baby syndrome?

A

John Caffey

363
Q

What is the prognosis of shaken baby syndrome?

A

1/3 are fine, 1/3 with physical or mental disability, 1/3 die of their injuries

364
Q

Which atypical antipsychotic have some data for use in tics?

A

Risperidone, olanzapine, ziprasidone

365
Q

Parasomnias tend to occur how long after falling asleep?

A

90 to 120 minutes

366
Q

What can happen hormonally if non-REM stage 4 sleep is disturbed in young children?

A

Ostensibly, mild growth retardation because GH secretion usually occurs during NREM stage 4 sleep

367
Q

What is a theory for parasomnias?

A

Normally, REM after NREM stage 4 sleep may arouse a subject from deep sleep. In children with a parasomnia the mechanism that triggers the transition is immature or dysfunctional. As a result there is a failure to properly enter REM, and this leads to parasomnias (talk, walk, night terrors)

368
Q

Which gender is more likely to have a parasomnia?

A

Male

369
Q

What is the prevalence of narcolepsy?

A

0.04 to 0.07%. More common in HLA-DQB1*0602 and HLA-DR2. 85% of patients with narcolepsy are positive for these compared with up to 40% of the general population

370
Q

What is the mechanism of action of modafinil?

A

Activates orexin containing neurons

371
Q

What do sleep studies show about ADHD and sleep?

A

ADHD has no impact on the sleep-wake state organization

372
Q

What does a careful taking of a sleep history consist of?

A

Regularity of sleep habits, amount of sleep, disruption of sleep, behaviors a/w going to bed

373
Q

What is the mechanism of action of lamotrigine?

A

Inhibits sodium and glutamate channels

374
Q

Which SSRI has serotonin and dopamine inhibition?

A

Sertraline has weak dopamine inhibition

375
Q

Describe the mesocortical pathway

A

Ventral tegmental area to the Cortex (limbic). Cell bodies are located in the ventral tegmental area of brainstem and project to the cerebral cortex, especially the limbic cortex. Negative symptoms are a/w deficit in dopamine especially in the DPFC

376
Q

Theoretically what should a 5HT1D antagonist do?

A

Rapidly disinhibit serotonin release

377
Q

What is a serotonin-dopamine hypothesis of OCD?

A

There is decreased tonic inhibition of dopamine by 5HT resulting in increased dopamine function.

378
Q

Why do zaleplon and zolpidem have fewer cognitive, motor, and memory side effects than benzodiazepines do?

A

These agents act selectivley at omega 1 and not omega 2; the latter are concentrated in brain areas that affect those functions

379
Q

What is the mechanism of action of benzodiazepines?

A

They allosterically modulate GABA resulting in increased conductance of chloride through the channel

380
Q

What is pindolol?

A

A beta blocker and an antagonist and very partial agonist at 5HT1A receptors. Midbrain raphe 5-HT(1A) autoreceptors control the activity of ascending 5-HT-mediated pathways

381
Q

What is congenital adrenal hyperplasia?

A

An autorecessive disorder that results in increased adrenal steroid biosynthesis resulting in masculinization of external genitalia

382
Q

What can be prescribed to facilitate presenting as the opposite sex?

A

Depot leuprolide or depot triptorelin (puberty blocking luteinizing hormone releasing agonists). Both males and females do not develop secondary sex charecteristics.

383
Q

What happens to bleeding time in hemophilia with emotional arousal?

A

It increases

384
Q

Cancer increases which interleukin that is a/w depression?

A

Interleukin 6 (IL-6)

385
Q

Which families demonstrate better glycemic control in preadolescents with diabetes? Those with warmth and support or those that are restrictive

A

Warmth and support.

386
Q

In a child who is chronically ill, what is important regarding psychological symptoms and their history?

A

The chronology between physical symptoms and emotional, stressful periods

387
Q

What is the best intervention to modify the psychosomatic component of an illness?

A

Education about the illness

388
Q

What is the lifetime prevalence of OCD in adolescence?

A

3%

389
Q

What are 5 clinical characteristics of PANDAS?

A

Tic disorder or OCD or both. Prepubertal onset. Dramatic onset and acute exacerbation with episodic course of symptom severity. GABHS. Neurologic abnormalities

390
Q

What is Syndenham’s chorea?

A

Autoimmune response to in the basal ganglia caused by misdirected antibodies from a streptococcal infection. OCD symptoms can be present

391
Q

What is the prognosis of OCD in pediatric patients?

A

Berg 1989 followed 16 adolescents: 31% still had OCD at 2 years; 25% had subclinical symptoms. Another study found that 50% of pediatric OCD patients were symptomatic as adults. In 54 patients, 80% improved c/w baseline, 43% met diagnostic criteria

392
Q

Adolescents with social phobia are at increased risk for what in particular?

A

Alcohol abuse

393
Q

After 6 years old, enuresis is more common in which gender?

A

Males. From the age of 4 to 6 years of age it is equal in males and females

394
Q

What is the treatment for encopresis?

A

Laxatives or enema; diet high in fiber and H2O; use of gastro-ilieal reflex by sitting for 10 minutes, 20 minutes after a meal; reinforce with tangible rewards; expectation for cleaning soiled clothes

395
Q

What are the two subtypes of encopresis?

A

With or without constipation and overflow incontinence

396
Q

Secondary encopresis (encopresis starting after a year of continence) accounts for what percentage of encopresis?

A

50 to 60%

397
Q

What are characteristics of histrionic personality disorder in a child?

A

Outgoing, engaging, charming, but soon perceived as irritating, intrusive, selfish, impulsive. Craves attention, hyperemotional, in superficial way. Capricious. Loses friends as quickly as gained.

398
Q

What are characteristics of borderline personality disorder in a child?

A

Relates to mother or father to the exclusion of the other parent; no empathy for others; other children as props; cannot tolerate separation from mother; inability to express a wide range of modulated feelings; not able to maintain a sense of sex and role identity; does not enjoy peer interaction or increased independence from parent; no emancipation from the family; AVH if do not express aggression (because cannot contain affect)

399
Q

Can a personality disorder be diagnosed in children?

A

Yes. It is discouraged because other disorders, such as depression, can lead to behaviors suggestive of a personality disorder, and because aspects of developmental norms can appear PD-like, especially under stress; but nonetheless some children are best captured by a PD diagnosis and are better served with an accurate diagnosis around which to organize care.

400
Q

Homicide, suicide, and injuries account for 80% of adolescent deaths. What percent of these are associated with alcohol?

A

50%. (Therefore 40% of deaths in teens are a/w alcohol)

401
Q

What prevention programs for drug and alcohol use are most successful?

A

Those that enhance social skills and drug refusal skills; those programs with an informational or affective component have little effect

402
Q

What is a poor prognosis for encopresis?

A

Non-chalant attitude; soil at night; conduct problems; soil as aggression

403
Q

What percentage of youths in high school have reported a lifetime use of inhalants?

A

Nationwide, 6.2% of students had sniffed glue, breathed the contents of aerosol spray cans, or inhaled any paints or sprays to get high one or more times during their life

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