CP Flashcards
1
Q
Which two antipsychotics effect the QTc the least?
A
Aripiprazole and olanzapine
2
Q
Clonidine is an agonist at what receptor?
A
alpha 2a 2b 2c
3
Q
Guanfacine is an agonist at what receptor
A
alpha 2, primarily 2a
4
Q
What does marijuana impair?
A
short term memory, visual motor functioning
5
Q
What are the side effects of PCP?
A
agitation, delusions, hypertension, flushing, diaphoresis
6
Q
What are the consequences of inhalant use?
A
hearing loss, peripheral neuropathy, CNS brain damage, liver, kidney, bone marrow deterioration
7
Q
What are the stages of stopping behavior in motivational interviewing?
A
Pre-contemplation, contemplation, preparation, action
8
Q
Does anxiety precede substance use disorders or ‘post’cede them?
A
Likely to precede
9
Q
What is successful at treating night fears?
A
Emotive imagery. Children are trained to imagine a super hero
10
Q
What percent of children have at least one sleep walking episode?
A
15%
11
Q
How do yo treat sleep terrors and sleep walking?
A
Time them and wake 10-15 minutes earlier
12
Q
What percentage of children 6 to 12 years have nightmares?
A
20%
13
Q
A closed head injury leads to what sleep disorder?
A
Circadian rhythm sleep disorder
14
Q
By what age should imaginary companions end?
A
8 years of age
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
16
Q
What is the disease fatality rate for Neuroleptic Malignant Syndrome NMS in children?
A
9%
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
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)
19
Q
Discontinuing lithium makes a difference or no difference in pediatric bipolar disorder?
A
Relapse more likely (Strober 1990)
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.
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).
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.
23
Q
What are the key cognitive side effects of topiramate?
A
Cognitive blunting and word retrieval difficulties
24
Q
What is the prevalence of bipolar disorder in adults?
A
1-2%
25
What percent of highschoolers have tried drugs or alcohol by 12th grade?
85%
26
Which persons with alcoholism do worse by Cloninger and Babor's classification?
Type 2, Type B
27
Is THC use genetic or environmental?
Experimental use has a more environmental component. Dependence is more likely to have genetic underpinnings
28
What is the mean elimination half-life of THC?
4 days
29
What percentage of suicide victims have/had relatives with suicidal tendencies
60% (compared with 12% for non-suicidal teens)
30
A family history of suicide increases risk of suicide by how much?
5 times for females and 3 times for males
31
in one study, what percent of children who commit suicide had history of attempt(s)
26-33%
32
Do LGBTQQIAP youth have an increased risk of suicide?
Yes. Although, sexual identity or orientation per se has likely little to do with the increased risk
33
What is the suicide rate for youths aged 10 to 18?
5/1000
34
CDC data has shown what percentage of high school students have had a suicidal idea, a plan, and an attempt in the last year?
17 %, 14%, and 2% respectively
35
The Youth Risk Behavior Surveillance System showed what percentage of high school youth report rarely or never wearing a seatbelt?
6%
36
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?
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
37
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?
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
38
The Youth Risk Behavior Surveillance System showed what percentage of high school students had ever drunk alcohol?
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.
39
The Youth Risk Behavior Surveillance System showed what percentage of high school students had used THC?
36%
40
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?
40%
41
The Youth Risk Behavior Surveillance System showed what percentage of high school students had sexual intercourse?
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.
42
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
46%
43
In a self-report measure of children with depression, what were the top three symptoms?
1. Aches and pains 2. Sad affect 3. Helplessness/ hopelessness
44
What is higher, the number of suicides or homicides?
Homicideses
45
What is a crisis hotline and text line for suicidal thinking?
Calling: 1-800-273-TALK (8255)
Texting: text home to 741741
46
What percentage of children and adolescents have a second depressive episode within two years after the first remits?
40% within two years, 75% within 5 years
47
What has been found of mothers of depressed children in their management of their children?
They use more reactive and fewer pre-emptive strategies; reactive strategies predict conduct problems
48
What are features of children with depression, besides symptoms?
Heightened empathy; misplaced sense of responsibility; unrealistic ideas about helping others
49
What percentage of high school students report having been bullied in the previous year?
19%
50
What is the ratio of suicide attemtps to suicide completions in youth?
50:1
51
What percent of suicide victims have had mental health treatment?
30 to 50%
52
What are the odds ratios of suicide in an adolescent with: 1) a prior attempt 2) major depressive disorder 3) substance use disorder
1) 22.5 for prior SA
2) 8.6 for MDD
3) 7.1 for Sub Use
53
In interpersonal psychotherapy by Klerman what are the four areas of interpersonal concern?
1. interpersonal deficits 2. interpersonal role conflicts 3. abnormal grief 4. role transitions. A modification for adolescents is single parent families
54
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?
31.5%
55
What are the elements of problem-solving?
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
56
What are two types of cognitive dysfunction?
1. Deficiency 2. Distortion
57
What does "cognitive structures" refer to?
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
58
Does psychotherapy work?
In a meta-analysis of 100 studies Weisz 1987 found an effect size of 0.79 for all therapies combined
59
What percentage of adolescents will have a depressive episode by age 18?
20%
60
Where do most adolescent suicides occur?
After school hours and in a teen's home; most are precipitated by an interpersonal conflict
61
What time do most adolescent suicides occur?
Late afternoon, early evening
62
What precipitates suicide attempts in adolescents?
Family fight, parent-child discord, lower grades, long absence from school
63
What is the presumed lifetime risk of a mood disorder if both parents have mood disorders in their sides of the family?
100%; 24% if one parent's family; 17% if no extended family has a mood disorder
64
In one study, what percentage of children who were depressed and hospitalized were re-hospitalized within two years of first hospitalization?
80%
65
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?
56% for fluoxetine and 33% for placebo (CGI 1 = very much, 2 = much improved)
66
What are the key 'rhythmic' interventions in bipolar disorder?
Sleep and regular daily activities
67
What therapy has been shown to reduce suicidal behavior in adults?
Dialectical behavior therapy (DBT)
68
A history of sexual abuse increases the risk of a suicide attempt by how much?
8
69
Do suicide prevention telephone interventions seem to help reduce suicidality?
Yes with a small positive effect
70
What is the point prevalence of schizophrenia in 2 to 12 year olds?
2/100,000
71
What are some premorbid findings in schizophrenia?
Language development, speech and learning disorders, disruptive behaviors
72
What is the age of onset for schizophrenia
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
73
What percentage of children with schizophrenia have visual hallucinations?
Close to 100%
74
What did a group with childhood onset schizophrenia studied by Eggers 1978 and 1989 show about outcome?
20% showed remission, 30% had satisfactory social adaptation, 50% remained impaired
75
When was depression in children and adolescents first recognized in the US?
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.)
76
Emil Kraepelin found what percentage of persons with mania had an onset before 10 years of age?
0.4%
77
What percentage of children have atypical depression?
16.5%
78
The age of onset of depression is associated with duration or recovery?
Duration
79
What findings are there for cortisol and growth hormone in children with depression?
Cortisol hypersecretion and blunting of nocturnal growth hormone
80
What is the tricyclic antidepressant response compared to placebo in child and adolescent depression?
The same, a 50% response for both
81
What percentage of adolescents present with depressed mood as the index episode in bipolar disorder?
60%
82
What percentage of child and adolescent patients with bipolar disorder have ADHD?
57 to 98% (Geller, Wozniak)
83
What is the concordance rate for depression in monozygotic and dizygotic twins, respectively?
54% MZ, 24% DZ
84
What is the concordance rate for bipolar disorder in Monozygotic and dizygotic twins, respectively?
65% MZ, 14% DZ
85
What is the 'cognitive triad' in depression?
Pessimistic and deprecatory about: 1) oneself 2) one's experience, and 3) the future
86
What lab tests might be obtained before lithium use?
Renal and thyroid function, calcium leve. Others include a CBC with differential since a slight leukocytosis can occur
87
What is the risk of schizophrenia if one parent has schizophrenia?
10 to 15%
88
Is there an association between temporal lobe epilepsy (TLE) and the development schizophrenia?
One study showed 10% of children with TLE developed SZP
89
What is found in the conversational language of patients with schizophrenia?
They use fewer linguistic cohesive devices
90
What structures of the brain are reduced in schizophrenia?
Frontal-temporal area (the ventricles are increased)
91
When depressed, what percentage of adolescents would meet criteria for a personality disorder?
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
92
After a depressive episode in children and adolescents, do social skills deficits and psychological morbidity persist?
Yes
93
What are some elements of 'pragmatic language'?
Conventions for eye contact, gestures, verbal and non-verbal cues, sustaining conversation, maintaining a shared topic, taking turns in dialogue
94
Does a Jehovah's Witness practitioner have the right to refuse a blood transfusion for their child?
No
95
What percent of divorces have custody issues and conflicts arise?
<10%. 1.5% need to rely on a judge. When conflict is present 75% of families have little conflict; 25% have severe conflict
96
What is the central principal of custody and placement decisions?
The least detrimental alternative
97
What is the least detrimental alternative for children in extreme cases where parents are 'addicted' to fighting?
In such instances it is best to support and protect the child's relationship with the custodial parent
98
Which are more sensitive to findings, structured or semi-structured interviews?
Structured
99
Do increased levels of income lead to decreased levels of psychiatric disorders?
Yes, up to a point.
100
What percentage of children live in two parent families?
69%
101
In one study, what percentage of daycare centers are considered of good quality?
1 in 9. Family based daycares fare even more poorly
102
What percent of divorces involve children?
60%
103
What is an IEP?
Individualized Education Plan
104
How often is an IEP reviewed?
Every 3 years (Triennial)
105
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?
True
106
How many children are in out of home non-relative placements in the U.S.?
500,000 (1998 data)
107
What is the average number of foster care placements for a child who enters the foster care system in Connecticut?
3.5
108
Who was among the first to use home visitation as part of a comprehensive intervention?
Sally Provence (also David Olds)
109
What is MST
Multisystemic Therapy
110
Who developled MST?
Henggeler and Boroduin
111
What population does MST primarily serve?
Children and adolescents with delinquency
112
When was AACAP formed?
1953
113
What is a fiduciary relationship?
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
114
What is the difference between confidentiality and privilege?
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
115
Who popularized the term adolescence?
Stanley Hall in his two volume work on adolescence (1904)
116
When did the subspecialty of child psychiatry emerge from the ABPN?
1957
117
When did child guidance clinics emerge?
1921. A psychiatrist worked with the patient; a psychologist did testing; a social worker worked with the family
118
Arnold Gesell saw behavior and life determined by____?
Biopsychosocial events; like Hall, his mentor, and unlike Watson a behaviorist
119
How many children are substantiated victims of abuse, neglect or both?
One million
120
How many children die each year because of abuse or neglect?
2000
121
How many children are sexually abused each year?
130,000
122
How many adolescents run away from home and live on the street?
Two million
123
What percentage of runaways are absent from home many weeks or months?
15%
124
There are two main types of runaway, what are they?
Pushed from home and running from home
125
What is the lower age of consent to treat for drugs or alcohol?
There is no lower age limit. A 9 year old has the same rights to confidentiality as 17 year old.
126
What are clinical features associated with Rett's disorder?
Sleep-wake cycle disturbance; increased Q-T; orthopedic problems; decreased T4 and TSH; decreased bone density; feeding problems; respiration apneustic
127
According to Thomas and Chess, what percentage of children are: easy, slow to warm-up, and difficult, respectively?
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.
128
What constellation of behaviors in the NYLS by Thomas and Chess led to behavior disorder at age 9 for many?
Irregularity, withdrawal, predominanty negative mood, slow adaptability, high intensity
129
By the age of 3 years, what percentage of child utterances continue the previous topic of conversation?
50% (Two year old kids can handle conversational breakdowns)
130
At what age do telegraphic sentences appear?
18 months
131
At what age do children utter 3-4 word sentences?
2 years
132
What number of words does an 18 month old know?
100
133
What number of words does a 24 month old know?
300
134
What number of words does a 3 year old know?
900
135
What number of words does a 4 year old old know?
1500
136
What number of words does a 5 year old know?
2500
137
What percentage of children who stutter at age 4 years recover?
Up to 85%
138
By what age is the typical developing child fully intelligible?
4 years old
139
At what age does the babbling of a child with deafness differ from a child with hearing?
4 to 8 months old
140
When does reduplicative babbling occur?
6 months to 1 year. AKA 'canonical babbling', consonant-vowel sounds
141
What are the four major components of language?
1. Comprehension 2. Acquisition of speech sounds 3. Expression of words and sentences 4. Pragmatic communication
142
At what age do babies distinguish the mother's breast pad from others'?
Newborn
143
At what age do sounds evoke movement in the fetus?
Third trimester
144
Attention as a construct consists of what elements?
Strategic scanning, exclusion of irrelevant stimuli, sustained attention, divided attention, inhibition of impulsive action, selection and monitoring of response
145
When does metacognition, thinking about thinking, begin?
3 years of age
146
Which emerges first, implicit or explicit memory?
Implicit
147
How many neurons are in the human brain?
Tens of billions (there are 10,000 synaptic junctions per neuron)
148
Early child abuse is associated with impairment in what brain anatomic areas?
Corpus callosum and decrease in brain size
149
The Australia temperament study showed that adolescents with anxiety disorders were shy as children, true or false?
False. They were not more shy. 2,443 kids studied
150
Variability in temperament is accounted for by parent practice, true or false
False
151
The difficult versus easy temperament at age 3 related to early adult disposition, true or false?
True
152
What are the Thomas and Chess temperament categories
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
153
An inhibited style is associated with right or left activation on EEG?
Right activation
154
What did Jerome Kagan find regarding the development of anxious symptoms?
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
155
Describe the attachments of the Strange Situation
Securely attached; insecure-avoidant/ambivalent (delayed acknowledgment); insecure-resistant (anger or high passivity); insecure-disorganized (e.g. approaches parent with head avoided)
156
Who introduced systemic desensitization?
Joseph Wolpe (1915-1997)
157
What experiment are Watson and Rayner especially known for from 1920?
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)
158
Who are key historical figures in operant conditioning?
Pavlov, Thorndike, Skinner
159
What is negative reinforcement?
The likelihood of a response increasing by the removal of a negative or unpleasant stimulus or situation
160
What is observational learning?
Social learning, learning by observing others (Bandura 1969)
161
How is information processing related to cognitive development?
Encoding occurs; hold info on screen for appraisal and transform it into knowledge by connecting it to prior knowledge
162
What are the views of Vygotsky?
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
What is the zone of proximal development?
The potential of a child to do something with support as opposed to what they can actually do. Scaffolding
164
Children require higher or lower doses of opioids mg/kg than adults for pain?
Higher 2/2 more rapid tolerance (and relatively higher doses of chemo)
165
What are some sequelae of bone marrow transplant?
Learning disorder, growth retardation, and infertility
166
Which is 'worse', emotional or physical abuse?
Emotional abuse is a stronger predictor for internalizing and externalizing behaviors, low self-esteem, SI, social impairment, psychiatric disorders, and hospitalization
167
Psychopathology in a proband tends to show what psychiatric disturbances in a parent
Mother depression; Father etoh, ASPD, lability
168
What are the types or patterns of emotional abuse?
Rejecting, isolating, terrorizing, ignoring, corrupting
169
What is the most common type of inflicted burn?
Scald
170
What has been shown about kids who disclose their HIV status to peers?
No decrease in function or self concept. Increase in immune response
171
There are approximately 20 million cases of STDs in the U.S.A. What percentage are in those aged 15 to 24?
50%
172
Cyclosporine levels are effected by drugs which interact with which P450 system?
3A4
173
If a mother reacts with depressive symptoms to a birth defect, is the severity of the reaction related to the magnitude of the defect?
No
174
What percentage of mothers have a medical background in Caregiver Fabricated Illness?
30 to 50%
175
What might be a father's presentation in Caregiver Fabricated Illness?
Father may be demanding, overbearing, legal minded
176
What is the presentation of a child with Caregiver Fabricated Illness?
Passively tolerates medical procedures. Child, especially older, may collude
177
What percentage of children die from Caregiver Fabricated Illness?
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
At what age can children manage their insulin dependent diabetes on their own?
Starting at 12 years. Some older, some younger.This does not mean parent should not be involved.
179
What do studies show about psychiatric disorders and malignancies in children?
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
What is the perspective taking of 3 to 6 year olds?
Attributes own perspective to others
181
What is the perspective taking of 6 to 12 year olds?
Self reflective and reciprocal perspectives; can see from another's perspective
182
What is the perspective taking of 10 to 15 year olds?
Third person and mutual; observing ego
183
What is the perspective taking of 12 year olds?
In depth and societal, symbolic; understand that observing ego cannot understand the complexity of internal reactions; something is always hidden
184
What is empathy?
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
What is theory of mind?
The ability to attribute mental states, such as thoughts, beliefs, intentions, desires, and feelings, to others and oneself
186
What tests assess first order theory of mind, second order, third and higher order?
Smarties and Sally Anne Test, Ice Cream Van Story, 12 Stranger Stories.
187
What is an example of second order theory of mind?
Where does person Y think person X will look for the object. E.g. false-belief test (Sally and puppet)
188
What is an example of higher order theory of mind?
Does X mean what he says; what is X thinking or feeling
189
What is mentalizing?
The ability and the drive to predict relationships between external states of affairs and internal states of mind
190
What are the prevalence rates of psychiatric disorders for children, pre-adolescents, and adolescents, respectively?
10%, 13%, and 16.5%
191
What percentage of children identified with a psychiatric disorder have two or more, according to the Great Smoky Mountain Study?
33%
192
What percentage of infants have a temperamental trait that predisposes them to being highly reactive in novel situations
20%
193
What percentage of sex abuse cases are by adolescents?
20%
194
What percentage of prepubertal children with depression have hallucinations?
48%. 36% report complex AH
195
What is the point prevalence of depression in adolescents?
2 to 5%
196
What did the National Comorbidity Survey show for lifetime prevalence of depression in adolescencts?
15.3% (For adults it was 17% suggesting most adult depression starts in adolescence)
197
What percent of those with severe TBI have seizures as a complication?
33% (6% in mild TBI)
198
For a proband with a reading disorder, what percentage of relatives have a reading disorder
40%
199
What percentage of children with OCD have tics?
Up to 55% have tics. 15% have Tourette's
200
What is the concordance rate for depression in monozygotic and dizygotic twins
76% MZ, 19% DZ
201
What percentage of those with bulimia nervosa had prior anorexia nervosa?
25 to 33%
202
What is the rate of new psychiatric disorders after severe injury?
60%; 25% mild
203
What percentage of infants have temperamental trait that predisposes them to being highly reactive in novel situations
20%
204
What percentage of sex abuses are by adolescents?
20%
205
What percentage of depressed prepubertal children have hallucinations?
48%; 36% report complex AH
206
What is the point prevalence of depression in adolescents?
2 to 5%
207
What percentage of those with learning disorders have ADHD?
20%
208
What percentage of those with learning disorders have a psychiatric diagnosis?
50% (refers to children and adol)
209
What percentage of children with learning disorders have social skills deficits?
up to 75%
210
What percentage of children with subtance use disorders have a learning disorder?
Up to 70%
211
What percentage of those with disruptive or depressive disorders have a learning disorder?
10 to 25%
212
What percentage of those with a learning disorder have substance use disorder?
24%
213
What percentage of those with conduct disorder have speech and language difficulties?
33%
214
When there is the death of a parent what factors are associated with risk of psychiatric morbidity?
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
Who is a key figure in pediatric PTSD research which involved a bus kidnapping?
Lenore Terr (Chowchilla CA incident; children kidnapped from bus, held in bunker)
216
What is a re-enactment behavior in PTSD?
Replication of some aspect of the traumatic experience
217
What is Type 1 vs. Type 2 trauma?
Type 1 is a single acute incident; Type 2 is chronic or ongoing
218
In which type of anorexia, restricting or binge-purging, do majority of patients develop symptoms of the other type?
Restricting type develop binge-purging rather than other way around
219
What is Pickwickian syndrome?
Respiratory hypoventilation, daytime hypersomnolence a/w severe obesity. Mortality rate of 40%
220
What are the reasons for clinical hypothyroidism in Anorexia Nervosa?
Decreased T3
221
What percentage of one's bone mass is formed during adolescence?
90%. Those with onset of anorexia in adolescence are at risk for decreased bone mass
222
How might a patient with anorexia view limits on safety?
It is evidence of imposed control but also unconscious relief that someone is taking over a situation that is out of control
223
What therapy other than CBT has been shown to be effective for bulimia nervosa?
Interpersonal therapy (IPT)
224
What has been found about the caudate's size in Tourette's disorder, increased or decreased?
Decrease in size (Peterson 2005)
225
What has been found about oxytocin levels in tic related OCD vs. non-tic OCD?
Oxytocin is increased in the CSF for those with non-tic OCD. It is the same for those with tic related OCD
226
If a parasomnia persists or is present in adolescence, what should be considered?
A seizure disorder
227
What is the likelihood of obesity if both parents have obesity?
80% (50% if one)
228
What is the likelihood of obesity if 2 siblings have obesity?
80% (40% if one sibling)
229
What is the correlation between obesity in infancy and later childhood, good or poor?
Poor correlation. Infant obesity is not a/w obesity in later childhood
230
What is the definition of obesity in children based on body mass index percentiles
95% or greater. Overweight is 85 to 95%
231
What is the key to PTSD treatment?
Expose the individual to traumatic cues under safe conditions, incorporating reparative and mastery elements in a structured manner
232
Which researcher said parents are better at alleviating externalizing symptoms and children internalizing ones?
EJ Costello 1989, one of the authors of the Great Smoky Mountain Study, a larger epidemiological study run by Angold and Costello
233
What is a social learning theory of PTSD formation?
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
What is the prevalence of PTSD in children and adolescents?
Ranges from 10 to 40% [40 seems high; doubt this figure includes impairment]
235
A study of children with obesity found what three most common psychosocial events may be present in some cases?
Early separation from mother < 24 months; family dysfunction; exposure to traumatic or violent events
236
What leads to diabetes insipidus in anorexia nervosa?
Abnormal vasopressin secretion
237
What percentage of patients with anorexia nervosa have amenorrhea that precedes the weight loss?
20 to 30% and it persists despite weight gain
238
How is insulin-like growth factor (IGF-1) implicated in anorexia nervosa?
It is a nutritionally dependent endogenous bone trophic factor
239
What percentage of patients with anorexia nervosa have major depressive disorder?
50 to 70%, 50% have anxiety
240
What are some of the psychological characteristics of patients with anorexai nervosa?
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
What is the lifetime prevalence of anorexia nervosa?
0.1 to 0.7%
242
What is the general range of onset of anorexia nervosa and what are the bimodal peaks of onset?
8 to 30 years of age with peaks at 13 to 14 and 17 to 18
243
How can families of patients with anorexia nervosa present, according to one set of ideas?
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
What is the mortality rate of anorexia nervosa?
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
What factors predict death in anorexia nervosa?
Low albumin, low weight at intake, poor social function, binging and purging type, drugs and alcohol use, and mood disorder
246
What is key in recovery for anorexia?
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
What percentage of women have an eating disorder?
3%
248
Leptin levels are highest in which group, healthy controls, bulimia nervosa, or anorexia nervosa?
HC > BN > AN
249
What peptides are associated with eating disorders?
Neuropeptide Y and YY, which are increased in bulimia nervosa
250
Which chronic medical illness leads to the risk of developing bulimia nervosa?
Insulin dependent diabetes (IDDM)
251
What supplements should be given to prevent osteoporosis in anorexia nervosa?
Calcium, phosphorous, and vitamin D
252
Are SSRIs effective in bulimia nervosa?
SSRIs appear to be effective even without depression
253
What is the crude mortality rate of bulimia nervosa?
5% (efffected by mood disorders, drugs and alcohol)
254
A child with ADHD who is among the brightest in the class is likely to produce little work, true or false?
True
255
Is the Continous Performance Test (CPT) sensitive to drug and dose effect in ADHD?
Yes
256
How is impulsivity defined?
Acting without thought of consequences. Unaware of the relationship between cause and effect
257
What are the four basic categories of conduct disorder?
1) Aggression 2) Destruction 3) Deceitfulness 4) Serious violation of rules
258
What is a useful way of subtyping aggression?
Instrumental (purposeful), impulsive, affective
259
Higher IQ in conduct disorder is associated with what traits?
Callousness
260
How are females thought to more likely to show aggression?
Verbal and relational aggression; alienation; and character defamation.
261
The ability of deviant peer affiliation to predict delinquent outcome is related to what?
Amount of parental supervision
262
What has been found about the reporting of symptoms in their children by mothers with depression?
They report higher numbers of symptoms in their children.
263
What core features of ADHD have remained in present over time in the DSM?
Motor hyperactivity, inattention in school, and impulsivity with regard to rule governed behavior
264
What happens to hyperactivity over time in ADHD?
It remits or attenuates. Inattention persists.
265
What is the prevalence of conduct disorder?
1 to 16%
266
What is the prevalence of ODD?
2 to 16%
267
How is IQ related to conduct disorder?
Inversely
268
Prenatal tobacco exposure is associated with conduct disorder, true or false?
True
269
What three treatment modalities have been found to be helpful for conduct disorder?
1. Functional Family Therapy 2. Multisystemic Therapy (MST) 3. Parent Management Training (PMT)
270
What has controlled data shown for clonidine in children with ADHD and ODD or CD?
Potential efficacy for aggression
271
Where has propranolol demonstrated effectiveness?
Children and adolescents with chronic brain dysfunction and aggression or conduct disorder refractory to other medications
272
What is the outcome of conduct disorder?
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
What is the most consistently found factor associated with poor outcome in conduct disorder?
Early age of onset
274
What did Werner's long-term study in Hawaii show about psychosocial circumstances regarding males who develop criminal records?
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
What did Werner's long-term study in Hawaii show about high risk, resilient children who did not develop serious behavior disorders?
First born child with higher IQ from smaller families with low family discord
276
Is chumminess protective or not in high risk children?
Yes if a child associates with a non-aggressive friend, and no if the friend is aggressive
277
What percent of arrested juveniles have drugs or alcohol in their blood stream?
40 to 60%
278
What distinguishes pattern of worry in GAD vs. healthy controls?
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
What percentage of children with GAD have GAD alone?
13%. Most have comorbid depression (62%) or separation anxiety disorder (42%; not present in adolescents usually). Outcome not impacted by comorbidity so much
280
The Great Smoky Mountains study showed what 3 month prevalence of SAD and GAD?
SAD about 3.5% and GAD 2%
281
What kind of attachment pattern is a risk factor for a child with anxiety disorder?
Insecure attachment
282
For anxiety based school refusal, what percentage of parents have a history of psychiatric illness?
81%, mostly anxiety and depression
283
What life experiences do children with GAD attribute their main worry to?
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
What has been found to be a variable for separation anxiety disorder or separation experiences in children ages 3, 11, and 18
The variable most important at age 11 was mother's fear of going out alone
285
When should an SSRI be stopped after succes in children?
After one year, during a period of low stress (Pine 2002)
286
Which is more effective, group CBT or individual CBT for children with anxiety?
They are equal
287
Is a family component for CBT in anxious children useful?
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
What is ironic about children with ADHD in physical education?
They have trouble modulating their behavior upward
289
Reading disorder accounts for what percentage of kids with learning disorders
80%
290
What percentage of children seen in psychiatric settings have a language disorder too subtle to be detected without special evaluation?
66%
291
What author clarified the role of physical abuse as an etiology for delinquent behavior?
Kempe
292
What does the assassination of JFK have to do with child psychiatry?
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
A 1 month old infant can rembember a mobile for how long?
24 hours. By 5 to 6 months of age infants can remember objects seen only a few minutes
294
What seems to be the upper limit for becoming securely attached after severe deprivation/neglect?
24 months
295
What can centuries of oppression lead to in style of relating?
Passive or passive aggressive styles of relating
296
When did private, employer sponsored health insurance start?
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
What are two pictorial assessment methods?
1) Dominic R 2) Pictorial Assessment for Children and Adolescents
298
What does the Beck Hopelessness Scale (BHS) do?
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
What are examples of behaviors that show visuomotor integration
Copying a figure or hitting a baseball
300
What urine finding may be useful in patients with bulimia?
Increased ratio of sodium to chloride may predict bulemic behavior
301
What percentage of parents of children with schizophrenia will have schizophrenia?
10%
302
Is IQ increased or decreased in patients with schizophrenia?
Decreased by virtue of not making gains
303
What is a side effect of phenobarbital in children?
Hyperactivity
304
What are behavioral-emotional findings in temporal lobe seizures?
Depeened emotions. Changes in sexual function. Aggression. Intensified religion/philosophy. Circumstantiality. Interpersonal viscosity.
305
Do anti-epileptic drugs effect cognition?
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
When treating a child with schizophrenia, when should one try to reduce the antipsychotic dose?
After one year
307
What is the data on the effectiveness of clozapine for childhood onset schizophrenia?
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
Is projective testing useful in schizophrenia?
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
What is the definition of failure to thrive?
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
What is benign nutritional dwarfing?
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
In Tourette's disorder which comes first, phonic or motor tics?
Motor tics precede phonic tics by one to two years
312
What is the adult outcome of seizure disorders?
Psychologically intact (if seizure disorder does not remain chronic)
313
What is psychosocial dwarfism?
Deceleration of linear growth in the absence of weight gain deceleration. A/w parental psychopathology
314
How is intrauterine growth retardation (IUGR) defined?
Ht and wt both less than 10% for gestational age
315
In obesity, is leptin level increased or decreased?
Increased
316
What is the prevalence of PICA?
25-33% in children
317
What is the cutoff in conduct disorder for the childhood onset subtype?
10 years of age
318
On what chromosome is 2D6 located?
22
319
How many varieties of the 2D6 gene are there?
70
320
Patients with which condition are missing a copy of the catecholamine-O-methyltransferase (COMT) gene?
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
Besides an IQ of less than 70, what else is considered for a diagnosis of intellectual disability?
Adaptive behavior
322
Can learning disorders co-exist with an intellectual disability?
Yes
323
What percentage of infants have a major anamoly?
2 to 4% (60% a/w genetic or in-utero causes)
324
Are patients with intellectual disability more prone to depressive disorders?
Yes
325
What endocrine disorder should be considered in Down's Syndrome?
Thyroid dysfunction
326
Anxiety and social avoidance are notable presentations in what genetic disorder?
Fragile X
327
Do children with autism who are overactive often become more active or hypoactive as adults?
Hypoactive
328
What percentage of children with autistic disorder have an IQ > 70?
20 to 30% (Several studies have shown that the lower IQ found in autism is not related to test taking motivation)
329
On the Wechsler Adult Intelligence Scale, what has generally been a/w with an autistic profile?
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
What percentage of patients with autism and intellectual disability have seizures?
33%
331
What are the most common areas of special skills in autism?
Musical, mechanical, mathematatical
332
What seems to be the most common seizure type in autism?
Partial
333
Rett's disorder involves which mutation?
Methyl-CpG-binding protein 2 (MECP2); chromosome Xq28
334
What are feature's described originally by Asperger in his observations?
Argumentative, condescending, verbally abusive, hit other kids, lash out, knock objects over, and interested in violence
335
What percentage of children with tuberous sclerosis have autism?
20-25% or more
336
What is Landau-Klefner Syndrome?
Onset at 3 to 5 years with loss of language and seziures. Social interaction and non-verbal skills are preserved
337
Which gender has a greater rate of seizures in autism?
females
338
What percentage of siblings of a proband have autism?
2-7%
339
What percentage of children with autism will have neurological abnormalities?
30 to 50%
340
What percentage of those with autistic disorder will have increased serotonin levels?
33%
341
What are birth factors associated with autism?
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
Do you have to be female to have Rett's disorder?
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
What percentage of those with Rett have the MECP2 mutation?
80%
344
What are behaviors that distinguish autism from Rett's disorder?
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
What is the prevalence of Rett's disorder?
1-4/20,000
346
What percentile is the ht and wt in Rett's disorder?
Less than 2.5%
347
What is the outcome of Rett's disorder?
Death by 40's
348
What percentage of children have a mathematics disorder?
1 to 6%; females > males
349
What percentage of children have a disorder of written expression?
2 to 8%
350
When there is a diagnosis of a learning disorder, when is it appropriate to use a nonverbal IQ test?
When reading is a concern. One can use the Leiter International Performance Scale
351
What should one first verify when there is concern for a learning disorder, either by exam or medical records?
Vision and hearing
352
What is the most common neurocognitive impairment in reading disorder?
Deficit in phonological processing
353
For developmental coordination disorder, what history should be obtained?
Developmental motor milestones, including sucking, swallowing, crying, tracking, grasping, toiletting, feeding, dressing, drawing, and others. DCD can be diagnosed with intellectual disability
354
What are Mahler's stages of development?
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
In the Isle of Wright Study, what percentage of 9 to 11 year olds with an intellectual disability had other psychiatric illness?
30 to 42%
356
When does babbling begin?
6 weeks
357
When does a whole smile begin?
4 to 6 weeks
358
What explains hand flapping?
Hand flapping is related to motor problems and is seen when children with motor problems become excited or overloaded.
359
What do we know about leptin and neuropeptide Y in eating disorders?
Bulimia has an increase in leptin and neuropeptide Y. Anorexia has decreased levels of both
360
Where is the serotonin transporter gene located?
Long arm of 17q12 (There are 2 polymorphisms, the long and short forms of the gene)
361
What are two neuropsychological theories of autism?
1. Cortical dysfunction with disorder of hemispheric lateralization. 2. Brainstem dysfunction
362
Who coined the term shaken baby syndrome?
John Caffey
363
What is the prognosis of shaken baby syndrome?
1/3 are fine, 1/3 with physical or mental disability, 1/3 die of their injuries
364
Which atypical antipsychotic have some data for use in tics?
Risperidone, olanzapine, ziprasidone
365
Parasomnias tend to occur how long after falling asleep?
90 to 120 minutes
366
What can happen hormonally if non-REM stage 4 sleep is disturbed in young children?
Ostensibly, mild growth retardation because GH secretion usually occurs during NREM stage 4 sleep
367
What is a theory for parasomnias?
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
Which gender is more likely to have a parasomnia?
Male
369
What is the prevalence of narcolepsy?
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
What is the mechanism of action of modafinil?
Activates orexin containing neurons
371
What do sleep studies show about ADHD and sleep?
ADHD has no impact on the sleep-wake state organization
372
What does a careful taking of a sleep history consist of?
Regularity of sleep habits, amount of sleep, disruption of sleep, behaviors a/w going to bed
373
What is the mechanism of action of lamotrigine?
Inhibits sodium and glutamate channels
374
Which SSRI has serotonin and dopamine inhibition?
Sertraline has weak dopamine inhibition
375
Describe the mesocortical pathway
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
Theoretically what should a 5HT1D antagonist do?
Rapidly disinhibit serotonin release
377
What is a serotonin-dopamine hypothesis of OCD?
There is decreased tonic inhibition of dopamine by 5HT resulting in increased dopamine function.
378
Why do zaleplon and zolpidem have fewer cognitive, motor, and memory side effects than benzodiazepines do?
These agents act selectivley at omega 1 and not omega 2; the latter are concentrated in brain areas that affect those functions
379
What is the mechanism of action of benzodiazepines?
They allosterically modulate GABA resulting in increased conductance of chloride through the channel
380
What is pindolol?
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
What is congenital adrenal hyperplasia?
An autorecessive disorder that results in increased adrenal steroid biosynthesis resulting in masculinization of external genitalia
382
What can be prescribed to facilitate presenting as the opposite sex?
Depot leuprolide or depot triptorelin (puberty blocking luteinizing hormone releasing agonists). Both males and females do not develop secondary sex charecteristics.
383
What happens to bleeding time in hemophilia with emotional arousal?
It increases
384
Cancer increases which interleukin that is a/w depression?
Interleukin 6 (IL-6)
385
Which families demonstrate better glycemic control in preadolescents with diabetes? Those with warmth and support or those that are restrictive
Warmth and support.
386
In a child who is chronically ill, what is important regarding psychological symptoms and their history?
The chronology between physical symptoms and emotional, stressful periods
387
What is the best intervention to modify the psychosomatic component of an illness?
Education about the illness
388
What is the lifetime prevalence of OCD in adolescence?
3%
389
What are 5 clinical characteristics of PANDAS?
Tic disorder or OCD or both. Prepubertal onset. Dramatic onset and acute exacerbation with episodic course of symptom severity. GABHS. Neurologic abnormalities
390
What is Syndenham's chorea?
Autoimmune response to in the basal ganglia caused by misdirected antibodies from a streptococcal infection. OCD symptoms can be present
391
What is the prognosis of OCD in pediatric patients?
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
Adolescents with social phobia are at increased risk for what in particular?
Alcohol abuse
393
After 6 years old, enuresis is more common in which gender?
Males. From the age of 4 to 6 years of age it is equal in males and females
394
What is the treatment for encopresis?
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
What are the two subtypes of encopresis?
With or without constipation and overflow incontinence
396
Secondary encopresis (encopresis starting after a year of continence) accounts for what percentage of encopresis?
50 to 60%
397
What are characteristics of histrionic personality disorder in a child?
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
What are characteristics of borderline personality disorder in a child?
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
Can a personality disorder be diagnosed in children?
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
Homicide, suicide, and injuries account for 80% of adolescent deaths. What percent of these are associated with alcohol?
50%. (Therefore 40% of deaths in teens are a/w alcohol)
401
What prevention programs for drug and alcohol use are most successful?
Those that enhance social skills and drug refusal skills; those programs with an informational or affective component have little effect
402
What is a poor prognosis for encopresis?
Non-chalant attitude; soil at night; conduct problems; soil as aggression
403
What percentage of youths in high school have reported a lifetime use of inhalants?
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
