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CAP Review > CP > Flashcards

CP Flashcards

1
Q

Who first showed immune reactivity could be conditioned?

A

Ader 1974. Rats were given cyclophosphamide and saccharine solution –> when just given saccharine solution –> led to immune suppression

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2
Q

What is the age of onset of Tourette’s disorder?

A

5 to 8 years of age

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3
Q

Children with separation anxiety disorder have an increased risk of what?

A

Panic disorder

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4
Q

What percent of probands have a first degree relative with OCD?

A

30%

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5
Q

What recombination fraction indicates complete linkage?

A

0.0; 0.5 = independent assortment

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6
Q

What is the monozygotic concordance rate for autism?

A

90%. Risk for non MZ siblings is 3 to 8%

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7
Q

Cocaine can be measured as far back as the first trimester in an infant. How?

A

By hair or meconium samples

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8
Q

What is rate of fetal alcohol syndrome in children of mother’s with alcoholism?

A

2.5 to 10%

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9
Q

What are some findings for infants exposed to prenatal opiates?

A

Decreased birth weight and head circumference. Increased risk of sudden death. At the age of 1, more active, less attentive and decreased motor coordination

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10
Q

What are the effects of prenatal THC exposure?

A

Tremor and increased startle response the first one to two weeks of life.

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11
Q

What are the effects of prenatal cocaine exposure?

A

Increased arousal, inattention, reactivity to stress; effect on the developing mono-amine system. Increased risk of IUGR by 4. However, Bayley Scales are okay

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12
Q

What can be features of mother-child interactions in substance using mothers?

A

Impoverished use of language; restriction of exploration (seen as ‘getting into things’); decreased response of mother to infant social bids

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13
Q

What percent of widows are depressed after the death of a spouse?

A

16% at 1 year (42% immediately)

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14
Q

What percent of children are born to unmarried mothers?

A

25%

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15
Q

What percent of preschoolers are cared for by their father when mother is at work?

A

23%

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16
Q

What percent of mothers who were abused abuse their own children?

A

20%

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17
Q

What is failure to thrive (FTT)?

A

Wt and Ht less than 5% or deviation off growth curve over time > 2 major percentiles

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18
Q

What has MRI shown in anorexia nervosa?

A

Enlarged lateral ventricles and cortical sulci a/w degree of weight loss

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19
Q

By adulthood what percent of those with Tourette’s have OCD?

A

40%

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20
Q

Is ADHD genetic or environmental?

A

Some say two subtypes

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21
Q

What are anatomic findings of the brain in ADHD?

A

Loss of assymetry of the caudate and changes in the corpus callosum

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22
Q

Paterson (1982) found what two symptom clusters in conduct disorder?

A

Problem of aggression and problem of theft

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23
Q

Wolf (1971) found what two symptom clusters for conduct disorder?

A

The aggressive-overactive and the antisocial

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24
Q

In a longitudinal study by Cloninger what traits were risk factors for juvenile delinquency?

A

High impulsivity, low anxiety, and low reward dependence (Definition: individuals high in reward dependence are tender-hearted, sensitive, socially dependent, and sociable; Individuals low in reward dependence are practical, tough-minded, cold, socially insensitive, irresolute, and indifferent if alone)

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25
Q

What are family factors in conduct disorder?

A

A large family size with the child most at risk a middle child separated by several years from an older brother. Absence of bio-father is not mitigated by presence of stepfather or socio-economic class

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26
Q

Family risk factors for juvenile violence are?

A

Parental criminality; physical discipline, poor supervision, low attachment; child maltreatment; parental conflict; large family size; family poverty

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27
Q

What are the rates for fears, worries, and scary dreams in healthy kids?

A

76% have fears; 68% worries; 81% scary dreams

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28
Q

What does the literature show about custody regarding boys and girls about whether they are with their mother or father?

A

Females fair less well with father custody. Boys are less well adjusted with mother custody but this is improved with father contact

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29
Q

What communication difficulties are present in patients with schizophrenia?

A

Pragmatics, prosody, auditory processing and abstract language

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30
Q

What percent of patients refractory to other antipsychotics are responsive to clozapine?

A

30%

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31
Q

What percent of child and adolescent patients with bipolar disorder have anxiety?

A

Child 33%; Adolescent 12%

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32
Q

What is the lifetime risk of major depressive disorder in children if parents have depression?

A

15 to 45%

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33
Q

Do stressful life events influence depression in children?

A

Unclear. It appears remarriage of parent for male and death of parent for female does. Lewisohn found that death of parent or having less than 2 parents did not specifically correlate with MDD

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34
Q

What are symptoms of toxoplasmosis?

A

Chorioretinitis, neurologic deficits at birth or later in infancy and childhood. 90% of children effected have an intellectual disability and 80% have seizures. It is acquired from the oocysts of cats or uncooked meat

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35
Q

What are cytomegalo symptoms?

A

Jaundice, hepatosplenomegaly, anemia, neuro abnormalities. Most newborns however are asymptomatic; some can also have delayed sequelae such as school difficulties

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36
Q

When is the greatest risk of maternal transmission of rubella during pregnancy

A

Majority first 12 weeks; then 13-14 weeks; then end of 2nd trimester. Results in deafness, cataracts, chorioretinitis, severe intellectual disability (25%), spasticity

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37
Q

What happens to school achievement in HIV infected kids?

A

67% normal at 9.5 years. Have difficulties in visual spatial, time orientation, speech and language delays

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38
Q

What predicts psychopathology after a traumatic brain injury?

A

Persistent neurologic abnormalities 2.5 years out is the biggest predictor. Other factors are pre-injury behavior, family adversity. Younger children suffer from more cognitive difficulties although age is not a factor in psychopathology.

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39
Q

What is the twin concordance rate for OCD?

A

80% MZ, 25% DZ

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40
Q

For children who were exposed to heroin in utero, what percent are living with their bio mother?

A

12% are with bio M; 60% with family or friends; 25% adopted. At the age of 1 yo half live away from their bio mother

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41
Q

In Werner’s study of children in Hawaii what infant temperaments were associated with resiliency?

A

Active, affectionate, cuddly, good natured, easy to deal with

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42
Q

What are some classifications by Zeanah for attachment?

A

Disorder of non-attachment, secure base distortions, disrupted attachment disorder. Boris and Zeanah use the term “disorder of attachment” to indicate a situation in which a young child has no preferred adult caregiver. Such children may be indiscriminately sociable and approach all adults, whether familiar or not; alternatively, they may be emotionally withdrawn and fail to seek comfort from anyone. Boris and Zeanah also describe a condition they term “secure base distortion”. In this situation, the child has a preferred familiar caregiver, but the relationship is such that the child cannot use the adult for safety while gradually exploring the environment. Such children may endanger themselves, may cling to the adult, may be excessively compliant, or may show role reversals in which they care for or punish the adult. The third type of disorder discussed by Boris and Zeanah is termed “disrupted attachment”. This type of problem, which is not covered under other approaches to disordered attachment, results from an abrupt separation or loss of a familiar caregiver to whom attachment has developed. The young child’s reaction to such a loss is parallel to the grief reaction of an older person, with progressive changes from protest (crying and searching) to despair, sadness, and withdrawal from communication or play, and finally detachment from the original relationship and recovery of social and play activities.

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43
Q

What are Nagy’s (1948) categories for kids’ concept of death?

A

3-5 year olds, long sleep; 5-9, people die, not them, not everyone; 9-10+ death inevitable and may happen to me (The grasping of death has been revised downward since)

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44
Q

What percent of children will lose a parent to any death by age 15?

A

4% (7,000 to 12,000 kids lose a parent to suicide every year)

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45
Q

After the death of a parent when do behavioral problems appear to show up?

A

Two years later; this is impacted by childcare. 37% of prepubertal children meet criteria for depression at 1 month

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46
Q

In anorexia what is the reason for amenorrhea?

A

Hypothalamic hypogonadism

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47
Q

What happens to FSH and LH in anorexia?

A

decreases to levels typical of puberty

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48
Q

In anorexia, does amenorrhea cease with weight gain

A

+/-

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49
Q

Exogenous administration of GnRH (gonadotropin releasing hormone) in anorexia does what to FSH and LH levels?

A

Increases them, indicating the pituitary is intact and the problem is at the level of the hypothalamus

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50
Q

Describe the actions or phase of gonadotropin secretion in children and adolescents?

A

2 to 4 year olds, increased gonadotropin secretion; juvenile phase of quiet activity; adolescent phase of increased amplitude and duration of GnRH

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51
Q

What cytokines are associated with psychosocial findings?

A

IL-1, IL-6, and TNF-alpha. Lead to social withdrawal, decreased energy, increased sleep, poor appetite. IL-6 specifically leads to decreased mood and appetite. Anxiety has been a/w with decreased IL-2 production; PTSD with decreased natural killer cells and T-lymphocytes

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52
Q

What are characteristics of psychosocial dwarfism?

A

Growth failure and developmental delay with hyposecretion of growth hormone; delayed bone age without malnutrition; decreased basal secretion of GH; onset 2-3 years; parents have psychiatric disturbance; blunted GH response (to challengers); separation from mother leads to increased sensitivity of HPA axis

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53
Q

Amygdala growth is greater in boys or girls?

A

Boys (there are more androgen receptors in the amygdala)

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54
Q

Hippocampal growth is greater in boys or girls?

A

Girls (there are more estrogen receptors in the hippocampus)

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55
Q

The peak differentiation of neurons and formation of synapses occurs at what age?

A

The second year postnatally (i.e. one to two)

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56
Q

What is Wilson’s disease?

A

An error of copper metabolism. There is degeneration of the basal ganglia; liver cirrhosis; presents as hepatitis and/or dystonia and gait disturbance in mid childhood; other findings include intellectual changes, affective lability, anxiety, psychotic symptoms, tremor, dysarthria, ataxia, choreoathetosis. There is partial recovery with oral chelation agents

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57
Q

When is the onset of multiple sclerosis and what is its etiology?

A

Most cases occur after puberty. The etiology is autoimmune

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58
Q

What does the thalamus do?

A

It is the ‘Grand Central Station’ of the sensations. There is decreased verbal fluency with central lesions; decreased pattern recognition with right lesions

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59
Q

What age defines precocious puberty?

A

Less than 8 years old

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60
Q

What are the three classifications of precocious puberty?

A

Peripheral, central and combined. This leads to premature epiphyseal closure

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61
Q

What is peripheral precocious puberty?

A

Excessive production of adrenal/gonadal steroids or exogenous ingestion

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62
Q

What is central precocious puberty?

A

Premature activation of HPG axis by GnRH or gonadotropins

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63
Q

Lesion of the paraventricular nucleus leads to what?

A

Hyperphagia and hypothalamic obesity

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64
Q

Is the activity of the hypothalamic pituitary axis increased or decreased in anorexia nervosa?

A

Increased

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65
Q

Is growth hormone increased or decreased in anorexia nervosa?

A

Increased

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66
Q

What happens to T3 in anorexia nervosa?

A

Decreased but T4 and TSH are the same

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67
Q

A larger number of depressed patients than healthy controls have increased antibodies to what?

A

The thyroid. Antimicrosomal and antithyroglobulin antibodies

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68
Q

Is oxytocin increased or decreased in autism?

A

Oxytocin is decreased in autism (1/2 of typical controls)

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69
Q

The hypothalamic and amygdala mediated responses in shy children are hyperactive or hypoactive?

A

Hyperactive

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70
Q

What is the function of the basal ganglia?

A

Modulate motor and some autonomic function. Maintain attention, regulate motor, and information flows to and from the cortex

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71
Q

The sexually dimorphic nuclei are involved in what?

A

Sexual orientation and gender identity. It is found in the pre-optic area of the hypothalamus. It is increased in men (decreased in transexual men)

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72
Q

How does increased HPA activation damage the hippocampus?

A

Increased HPA leads to increased corticosteroids which indirectly damage neurons via NMDA. Loss of neurons leads to cognitive and memory impairments, stress and anxiety disorder

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73
Q

Frontal lobe activation on the left leads to depression or happiness?

A

Happiness. Decreased activation of the left frontal lobe leads to depression

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74
Q

Describe the synthetic pathway of serotonin?

A

Tryptophan–tryptophan hydroxylase–> 5HTP(phan) –L-aromatic decarboxylase –> 5HT (5-hydroxytryptamine) –MAO–> 5-HIAA 5-Hydroxyindoleacetic acid

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75
Q

Describe the synthesis and catabolism of norepinephrine and dopamine?

A

Tyrosine + tyrosine hydroxylase–> DOPA + L-Aromatic AA decarboxylase–>Dopamine. Dopamine + Dopamine betahydroxylase–> Norepinephrine –> Epinephrine. Dopamine + MAO or COMT –> homovanillic acid Norepinephrine + MAO or COMT–> MHPG –> Vanillylmandelic acid

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76
Q

When is the neuronal density in the brain the greatest?

A

There is a dramatic decrease right before birth and steady decrease to 6 to 15 months and then there are adult values

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77
Q

When is synaptic density the greatest?

A

Increases before birth until 8 months in the visual cortex; 3 years in the auditory cortex; 1 to 3 years in the prefontal cortex. It then decreases to adult values from the age of 12 to mid-adolescence. The dendritic neuronal architecture matures until late adolescence

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78
Q

How late does myelinization last and where?

A

3rd decade of life in the intracortical association areas

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79
Q

How much does an infant sleep at birth?

A

16 hours

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80
Q

How much does an adolescent sleep?

A

8 hours

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81
Q

What is the percent of time spent in REM sleep at birth and at adulthood?

A

50% at birth. 20% at age 3 (adult values)

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82
Q

Infants enter REM sleep right away. At what age is sleep onset without REM?

A

2 1/2 months

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83
Q

Does sensory inhibition increase or decrease with age?

A

Increase

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84
Q

At what age is REM identified?

A

28 to 30 weeks (prenatally)

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85
Q

Describe neuronal synapses before and after puberty

A

Before puberty there is formation and elimination (competitive elimination). After puberty, learning and memory depend on strength of already existing synapses

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86
Q

What is the chromosomal deletion in Williams Syndrome?

A

7

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87
Q

Wiliams Syndrome is characterized by what clinical presentation?

A

Intellectual disability, cardiovascular disease, adequate verbal skills, cannot integrate complete picture; play instrument. 1/20,000

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88
Q

What chromosome is affected in Angelman Syndrome?

A

15 (deletion or two copies)

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89
Q

What are the clinical characteristics of Angelman Syndrome?

A

Intellectual disability, no speech, large mandible with open mouth expression, hypotonia, motor delays. 1/10,000

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90
Q

What is the clinical presentation of Prader-Willi?

A

Obesity, temper tantrums, aggression, OCD. 1/10,000

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91
Q

What chromosome is affected in Prader-Willi?

A

Chromosome 15 q11-q13 deletion from father. Two copies also a cause

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92
Q

What is lissencephaly?

A

Most common disorder of normal migration of neurons. There are 4 cortical layers instead of the normal 6. There is a smooth cortical surface

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93
Q

What percentage of those with the Fragile X gene are not intellectually impaired?

A

20%

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94
Q

What gene is affected in Fragile X?

A

FMR-1

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95
Q

Which repeat defect is there in Fragile X?

A

CGG (200-1000 vs. 29 found normally)

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96
Q

What is often the first clinical symptom of Rett’s disorder?

A

Loss of purposeful hand movements

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97
Q

What chromosome is affected in Rett’s?

A

Xq28

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98
Q

Which protein is implicated in Rett’s?

A

MECP2 (a mutation leads to inappropriate gene expression and its protein product)

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99
Q

When a young child learns two languages they are represented by a single language center or two?

A

A single language center. In adults, a new language is represented by a new language center separate from the primary language center

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100
Q

How many genes are there in a person?

A

80,000

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101
Q

How many genes are present in the CNS?

A

30,000

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102
Q

Do the anterior cingulate and hippocampus show increased or decreased regional blood flow in PTSD?

A

Decreased

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103
Q

Is reading dysfunction located in the left or right hemisphere?

A

Left hemisphere

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104
Q

Which brain area has shown an incraese in size in PANDAS?

A

Basal ganglia

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105
Q

Are the basal ganglia increased or decreased in size in Tourette’s disorder?

A

Decreased, especially putamen and globus pallidus. There is also reduced assymetry

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106
Q

Is cortical blood flow and metabolism increased or decreased in the basal ganglia in Tourette’s?

A

Decreased

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107
Q

Which area of the brain shows increased activity during efforts at tic suppression?

A

Right caudate nucleus

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108
Q

Obsessive-compulsive disorder shows an increase or decrease in caudate volume?

A

Decrease

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109
Q

Patients with OCD show an increase or decrease in glutamate?

A

Increased glutamate in the caudate, which normalizes with treatment in one study

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110
Q

In patients with OCD is there an increase or decrease in the thalamus?

A

Increase

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111
Q

What is the most consistent finding in childhood onset schizophrenia?

A

Decreased brain size (especially frontal-temporal) and increased ventricles

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112
Q

Is the NAA (N-acetylaspartate) to Cr (creatine-phosphocreatine) ratio increased or decreased in schizophrenia?

A

Decreased

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113
Q

Which area in the temporal lobe fails to light up in autism in facial recognition tasks?

A

Fusiform gyrus

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114
Q

Velocardiofacial syndrome has which chromosomal deletion?

A

22q11.2

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115
Q

What percentage of patients with velocardiofacial sydnrome have schizophrenia?

A

30%

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116
Q

Do patients with velocardiofacial syndrome have increased or decreased brain size?

A

Decreased

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117
Q

Children born weighing less than 1500 g have a decreased IQ score by how much?

A

15 points (1 SD)

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118
Q

What percentage of children born weighing less than 1500 g repeat a grade by age 8?

A

20% (although, in preemies, age based on birthdate rather than ‘due date’ means developmentally younger for age)

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119
Q

What are the components of the basal ganglia?

A

Caudate nucleus, putamen, globus pallidus, subthalamic nuclei, substantia nigra.

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120
Q

What does the basal ganglia do?

A

Influences movement and muscle tone and also mediates higher cognitive functions

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121
Q

The frontal, parietal, temporal, and occipital gray matter each peak at what age?

A

Frontal gray, 11 year old for females and 12 year old for males and then decreases in adolescence; same for parietal gray; temporal gray peaks at age 16; occipital grey increases mildly through childhood and adolescence. This differing gray matter development is uniquely human

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122
Q

What does magnetic resonance spectroscopy do?

A

Measures concentrations of chemical compounds in the brain. It has poor temporal and spatial resolution

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123
Q

What is diffusion tensor imaging?

A

MRI technology that looks at orientation of fiber tracks. Useful in strokes and multiple sclerosis.

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124
Q

Which is the correct order of spatial resolution for MRI, CT, PET, SPECT?

A

MRI>CT>PET>SPECT

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125
Q

When are testicular hormones first secreted?

A

8th week of fetal life

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126
Q

In Tourette’s Disorder and OCD, neuronal circuits fail in what way?

A

They reverberate rather than switch off (failure to self inhibit)

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127
Q

Which major anatomical areas of the brain have deficits in schizophrenia?

A

Frontal and temporal

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128
Q

Is brain size increased or decreased in Down’s syndrome?

A

Decreased by 25% but not so until age 3 to 5

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129
Q

Which gender exhibits more lateralization of the brain?

A

Males

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130
Q

What is the function of the amygdala?

A

It is a/w with fear provoked aggression. Lesions result in decreased control, spontaneity, flexibility, affect, cognition

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131
Q

Do children with one psychotic parent or one depressed parent and a healthy other parent have increased psychopathology?

A

No [what about genetic contribution?]. Absence of hostility is a key factor

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132
Q

Who appears more affected by an ill parent, boys or girls?

A

Boys

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133
Q

Is suicidality heritable?

A

Yes

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134
Q

Is mental illness of a parent or overall family function the greater mediator of mental illness or difficulties in a child?

A

Family function and not parent illness per se

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135
Q

Parent child conflict is usually characterized by what strategies?

A

Negative, insensitive, harsh (rather than reassuring, negotiating, and compromising)

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136
Q

Mothers in high conflict marriages use what technique with their children?

A

Guilt and anxiety inducing ones

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137
Q

What percent of mothers of preschool children have reported depressive symptoms?

A

40%

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138
Q

How many substantiated reports of child maltreatment are there per year?

A

1,000,000 (with 1000 deaths per year)

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139
Q

What year were special education laws revised to mandate special services for 3 to 5 year olds and allow states early intervention from 0 to 3?

A

1986

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140
Q

What is the most widely used neonatal test?

A

Brazelton Neonatal Behavioral Assessment Scale

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141
Q

What is the most widely used infant and toddler test?

A

Bayley Scales of Infant Development (1 to 42 months)

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142
Q

What infant/toddler screening test can be used with language and visually impaired children?

A

DASI. Developmental Activity Screening Inventory

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143
Q

What is subacute sclerosing panencephalitis?

A

Chronic progressive encephalitis. Persistent infection of measles virus. Occurs rarely after one has had measles. Symptoms emerge 4 to 15 years later. There is personality change, poor school function, myoclonic seizures, involuntary movements, ataxia, dementia. 1/1,000,000

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144
Q

Most children with HIV infection obtain it how?

A

Vertical (maternal) transmission

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145
Q

How does one diagnose lyme disease?

A

IgM antibodies to B. Burgodoferi or by polymerase chain reaction

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146
Q

What fraction of children have lyme neuroborreliosis when infected?

A

1/620. Psychosis can be seen

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147
Q

When is syphilis most likely to be acquired by a fetus?

A

4 to 7 months gestation. General paresis occurs 6 to 21 years later. Treatment is with Penicillin G

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148
Q

What percent of survivors of meningitis have sequelae?

A

50%. Lower IQ, hearing loss. The sequelae are worse for infants and if treatment is delayed

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149
Q

What is most common cause of meningitis in those greater than a month old?

A

S. Pneumoniae, N. Meningitidis, B. Hemolytic Strep, Listeria. Starts with an upper respiratory infection

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150
Q

What is the most common type of psychiatric disorder after a traumaic brain injury?

A

Postconcussive–>labile, aggressive, disinhibited

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151
Q

What do prospective studies of traumatic brain injury outcomes show about psychopathology?

A

After accounting for premorbid psychopathology, severe but not mild TBI increases risk of psychopathology

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152
Q

What is post-concussional syndrome?

A

Headache, dizziness, fatigue, decreased concentration, memory, irritability, anxiety, insomnia, hypochondriasis, hypersensitivity to noise, photophobia, seizure like symptoms

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153
Q

Traumatic brain injury incidents peak at what age?

A

15 years

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154
Q

What is the definition of a concussion?

A

Transient but widespread loss of neuronal function

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155
Q

What is the most common lesion on MRI after closed head injury?

A

Diffuse axonal injury. Clinical sign is loss of consciousness. There are small focal injuries in white matter tracts. The second most common finding on MRI is cortical contusion

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156
Q

What brain area is involved in the acquisition of emotional memories?

A

The amygdala

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157
Q

What area of the brain constrains impulsive acts?

A

Orbital-frontal cortex

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158
Q

What area of the brain is involved in delay gratification

A

Ventromedial prefrontal cortex

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159
Q

Behavioral inhibition is related to what four executive neuropsychological functions?

A

Working memory, self-regulation, internalization of speech, reconstruction. Separation of affect as well

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160
Q

Is there a correlation between IQ and suicidal behavior?

A

No. Mood disorder, alcohol use, personality disorder, and impulsive-aggressive traits are correlated

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161
Q

What does the evidence suggest regarding the use of lithium in adults with major depressive disorder and bipolar and suicide?

A

Reduced the rate by 9 times (discontinuing lithium led to 7 times more attempts and 9 times more completions). Tondo et al. 1997 reviewed 28 studies involving 17,000 patients. More recent evidence supports this, too, Song et al. 2017

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162
Q

What is the outcome for children with depression?

A

Based on 10 to 15 year follow-up of pre-pubertally depressed children, the outcome was 3 times an increase of suicide attempts, bipolar disorder, and adult depression (when psychopathology continued)

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163
Q

Is there a gender difference for severity or recurrence of childhood depression?

A

No

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164
Q

At what age does a gender difference emerge for depression?

A

15 to 18 years of age

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165
Q

What symptoms of depression are present equally in children and in adolescents?

A

Decreased mood, decreased concentration, insomnia, suicidal thinking.

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166
Q

What are the differences in children and adolescents in their manifestation of depression?

A

Child: depressed appearance, somatic, psychomotor agitation, separation anxiety, phobias. Adolescents: drug use, hopelessness, hypersomnia, anhedonia, weight changes. Both groups have decreased mood and concentration, insomnia, suicidal thinking

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167
Q

What percentage of OCD patients respond to OCD treatment

A

50% have 25 to 40% reduction in symptoms

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168
Q

What percent of children 12 and under who are raped know the attacker?

A

96%. 20% are fathers, 16% are relatives; 50% are friends or acquaintances; others less known/close; 4% are strangers

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169
Q

When child sexual abuse involves abuse by females what percentage is by mother only?

A

3.8%. 12% by both parents. 11% by mother with others. 2.2% by female relative.

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170
Q

When are children most vulnerable for sexual abuse?

A

8 to 12 years of age

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171
Q

What percentage of child sexual abuse offenders are adolescents?

A

50%

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172
Q

What percentage of child sexual abuse reports are concluded to be false?

A

2% (6% for adult reports).

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173
Q

What percentage of children recant statements of sexual abuse?

A

22%. Recantation should be viewed as part of disclosure process since the allegations rarely prove false

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174
Q

In confirmed cases of sexual abuse, what percentage of time do children intially deny it or are tentative in disclosing?

A

The vast majority

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175
Q

In the Isle of Wright cross sectional study, what percentage of 11 year olds have school phobia?

A

3%

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176
Q

What is the percentage of adoptees in the population?

A

3.5%

177
Q

Are adoptees more likely to be referred for treatment?

A

Yes, for externalizing behaviors. 20% of inpatients are adoptees

178
Q

According to the U.S. Department of Health and Human Services parent surveys, what percentage of children who require treatment for emotional, developmental, or behavioral problems receive it?

A

0-5 yo, 40%; 6 to 11, 60% ; 12 to 17, 65%. This differs from other methods which shows lower figures.

179
Q

What is the percent genetic contribution to anorexia nervosa?

A

56%. 5% is shared environment, 38% is unique environment (Bulik 2006; based on 31,000+ twins in Sweden)

180
Q

The rate of diagnosable psychiatric disturbances among children of depressed parents can be as high as?

A

50%

181
Q

What are the different types of family therapy?

A
  1. Intergenerational (Bowen family systems; Boszomenyi-Nagy contextual) 2. Systems/Community (Minuchin structural; strategic, narrative; triadic based 3. Psychodynamic 4. Experiential 5. Behavioral
182
Q

What do meta-analyses show about group treatment?

A

73% better off than those in control group

183
Q

How many inpatient discharges per year are there for children and adolescents.

A

143,000

184
Q

What factors are associated with a negative outcome in residential facility treatment?

A

Psychosis, lower IQ, antisocial and bizarre behavior, dysfunctional family, inadequate duration for consolidation of gains, stay of less than one month

185
Q

In a 10 year follow-up study of adolescents and adults who had received residential vs. adolescent day hospital care, what difference was shown?

A

No difference in social-personal adjustment. There was improvement at follow-up in 65% of subjects

186
Q

What percentage of children live in poverty?

A

20% or more

187
Q

What percentage of mothers with children less than 6 years of age are working?

A

65%. 55% return to work within weeks of birth

188
Q

What percentage of chronic school absentees have a psychiatric disorder?

A

50%

189
Q

What did the 1997 amendment of the IDEA (Individuals with Disabilities Education Act) do regarding dangerous behaviors and drugs and alcohol?

A

A child who brings a weapon or who uses, sells, or buys drugs at school or a school function may be removed immediately and placed in an alternate setting. School officials may suspend a child for 10 days for conduct disordered behaviors and the placement changed if it is determined there is a danger to self or others

190
Q

What is the prevalence of one or more psychiatric disorders in community surveys of children and adolescents?

A

11% (18-22% if functional impairment is not included)

191
Q

What percentage of adolescent probands with OCD have first degree relatives with OCD?

A

30%

192
Q

What are the most common compulsions in OCD?

A

Cleaning > repeating (do/undo) > checking

193
Q

What is the most common obsession in OCD?

A

Contamination/cleanliness (dirt and germs)

194
Q

Is OCD more common in males or females?

A

It is equal but males have earlier onset

195
Q

What is the prevalence of OCD?

A

0.5 to 3%

196
Q

Do students with previous suicide attempts respond well or poorly to programs about suicide?

A

Poorly

197
Q

What are the classifications of prevention?

A

Universal: target the whole population, not selected by risk. Selective: target individuals who have elevated risk Indicated: target high risk individuals who display early precursors or signs of the disorder or have symptoms predicting the disorder

198
Q

What are families like in patients with recurrent abdominal pain?

A

They tend to reward illness behavior (but there are no difference in rates of negative life events or family functioning)

199
Q

What is recurrent abdominal pain (RAP)?

A

Three episodes of abdominal pain over 3 months severe enough to affect the activities of the child

200
Q

Conversion disorder in children usually resolves in how much time?

A

3 months

201
Q

Is conversion disorder more common in males or females?

A

Females in all age groups

202
Q

What disorders cluster with somatization disorder?

A

Antisocial personality disorder; ADHD; Alcoholism

203
Q

What should be considered in somatization disorder found in a child?

A

Sexual abuse

204
Q

How soon does phototherapy work in seasonal affectiver disorder?

A

1 to 2 weeks. Adults exposed to 10,000 lux daily for 30 minutes have a response rate of 75 to 80%; as such 2 week treatment is recommended. Children respond to lower intensities and shorter exposures

205
Q

What is the epidemiology of seasonal affective disorder?

A

1 to 2% of the general population. A recent study 2017 questioned the validity of the disorder.

206
Q

What time of year is the onset of seasonal affective disorder?

A

Sept - Nov. Presents with atypical depression symptoms

207
Q

What is risk of fatal hepatotoxicity for children taking valproate?

A

Close to zero after age 10. It is greatest less than 2 years of age

208
Q

What is the rate of bipolar disorder in family members of prepubertal compared to adolescent probands with bipolar disorder?

A

3 times the rate for the prepubertal children

209
Q

What percent of children who are depressed develop bipolar disorder?

A

20 to 30%. The risk is greatest if the depression included rapid onset, psychosis, psychomotor retardation, family with mood disorders, and a history of drug induced mania

210
Q

In one study of patients with pediatric bipolar disorder, what percentage endorsed suicidality?

A

25% (Geller)

211
Q

What percentage of patients with pediatric bipolar disorder report psychotic symptoms?

A

60% (Geller study of 93 patients). Most common is grandiose delusion

212
Q

How do younger children present with bipolar disorder?

A

Irritability and emotional lability

213
Q

What predicts lack of recovery, chronicity and recurrence of depression in children?

A

The level of depression at baseline; the self-reported level of parent-child conflict at baseline and follow-up

214
Q

What is the Self-Control Model for depression?

A

This model assumes that depressed individuals have deficits in self-reinforcement, -evaluation, and -monitoring. Often they focus on the short- rather than long-term consequences of their actions. They often misattribute personal success to external forces and personal failure to themselves

215
Q

What is the Cognitive Triad in depression?

A

The negative view of the self, world, and future

216
Q

Do all children of parents who are depressed do poorly?

A

No. Beardslee (1988) found that at 2.5 year follow-up 15 of 18 adolescents were doing well if the following were present: self-understanding, problem-solving ability, commitment to relationships, action orientation, thinking and acting separately from the depressed parent

217
Q

What age do infants recognize their mother’s voice (vs. another’s)?

A

3 days

218
Q

When do babies smile?

A

By 1 month

219
Q

When do babies smile and laugh in response to speech?

A

By 3 months

220
Q

When do infants vocalize in response to sounds?

A

By 4 months

221
Q

What brain structure is associated with implicit memory?

A

Basal ganglia, amygdala, and perhaps motor and somatosensory cortices

222
Q

What brain structure is associated with expicit memory?

A

Medial temporal lobe including hippocampus

223
Q

What are 4-5 valid temperamental categories according to the evidence?

A

High and low reactivity, irritability, activity, frequency of smiling, laughter

224
Q

What percentage of high reactive, inhibited children will develop a profile associated with an anxiety disorder?

A

33% (the reactivity is key)

225
Q

What are the two primary temperamental dimensions in infants, according to Mary Rothbart?

A

Ease of arousal (reactivity) and self-regulation

226
Q

What are the stages of the Strange Situation?

A
  1. Intro 2. Mother and infant 3. Mother and infant and stranger (stranger plays with infant) 4. Infant and stranger 5. Mother and infant (mother enters stranger departs) 6. Infant alone 7. Infant and stranger 8. Infant and mother (mother enters stranger departs). Studied in 11 to 24 months of age
227
Q

Who developed the Strange Situation?

A

Mary Ainsworth in the 1970s

228
Q

What author found that prn meds may be no more effective than placebo for agitation?

A

Vitiello et al. 1991 Ages 5 to 13, diphenhydramine vs. placebo. IM of placebo or diphenhydramine more effective than oral agents. One can only truly conclude that diphenhydramine was no more effective than placebo; but it wouldn’t be surprising if this extends to other agents

229
Q

What is a theory of dopamine in Tourette’s disorder?

A

Post synaptic D2 receptors are hypersensitive

230
Q

What is the prevalence of tic disorders?

A

1 to 2%

231
Q

What are smooth pursuit deficits in childhood onset schizophrenia (COS)

A

Decreased tracking and increased anticipatory saccades

232
Q

What is the clinical picture like for childhood onset schizophrenia?

A

Very rare in general, especially before 5 years of age. There are non-psychotic disturbances by age 4.6. Psychosis emerges at 6.9 years of age. Full disorder by 9.5 years (Russell 1994)

233
Q

What is the concordance rate for twins in Tourette’s disorder?

A

50% MZ, 10% DZ. If chronic motor tics are included it is 90% for MZ and 30% for DZ

234
Q

Children with HIV tend to become symptomatic quickly (if untreated). 70% can be symptomatic by 1 year. The bimodal distribution of symptom emergence is called what?

A

Slow progressor and rapid progressor

235
Q

What percent of children obtain HIV through sexual abuse?

A

0.3%

236
Q

What number of death in children are associated with burns?

A

1,500 annually. Fires and burns are the 3rd leading cause of death in children 1 to 4 and the 4th leading cause in children 1 to 19

237
Q

What are the three levels of moral development according to Lawrence Kohlberg?

A
  1. Pre-moral 2. Conventional Role Conformity 3. accepted Moral Principles
238
Q

What are the two stages of pre-moral development according to Kohlberg?

A
  1. obedience and punishment 2. egocentricity
239
Q

What are the two stages of conventional role conformity, according to Kohlberg’s theory of moral development?

A
  1. Be a good person 2. Follow the social order
240
Q

What are the two stages of self-accepted moral principles in Kohlberg’s theory of moral development?

A
  1. Legalistic 2. Universal principles
241
Q

As infants grow older, mothers tend to smile more with male or female infants?

A

Males. They show more range with females, and respond more to females’ cries

242
Q

What percentage of children have an imaginary friend?

A

33%

243
Q

When does adrenarche begin?

A

6 to 8 years old. There is increased skeletal growth and body hair

244
Q

What percentage of kids have problems with terrors?

A

1 to 3%. It is a disorder of impaired arousal

245
Q

What percentage of teens abuse drugs and alcohol?

A

10% (as opposed to experimentation)

246
Q

What cognitive functions contribute to a child’s representational world and hence to personality?

A

Attention, memory, affect modulation, and spatial orientation

247
Q

What percentage of high school seniors meet criteria for a substance use disorder by survey?

A

15% (31,000 HS seniors surveyed; this is not a clinically based assessment)

248
Q

What percentage of adolescents with substance use disorders have comorbid psychiatric disorders?

A

40 to 90%

249
Q

What are some basal ganglia diseases in children?

A
  1. Parkinson’s (juvenile form); emerges at 10 to 15 years old with pill rolling tremor, bradykinesia, rigidity, intellectual decline 2. Huntington’s disease presents 1 to 3% in childhood (3 years of age youngest); the juvenile form is usually from the father 3. Dystonia Musculorum Deformans (5 years old) 4. Wilson’s disease; decreased BG function, liver cirrhosis; presentation: hepatitis, +/- dystonia and gait disturbance; mid childhood
250
Q

What is Sturge-Weber Syndrome?

A

Facial port wine stain in trigeminal nerve distribution; intractable seizures with time; intellectual disability; dementia

251
Q

What are findings in neurofibromatosis?

A

Cafe au lait spots, Schwann cell tumors; intracranial tumor (optic gliomas); learning disorders, hyperactive, visual spatial declines. Autosomal dominant, but half by new mutation. Chromosome 17. Intellectual disability can be present

252
Q

Describe tuberous sclerosis

A

Hypopigmented nevi (ash leaf spots); shagreen patches (raised leathery skin); cardiac, renal, lung lesions; sclerotic nodules in CNS that can lead to seizures, developmental delays; up to 50% have autism; some have average IQ; autosomal dominant. Psychiatric findings include aggression, obsessions, hyperactivity, psychosis, poor social skills and poor communication

253
Q

What is Ataxia-Telangiectasia?

A

Cerebellar degenerative disorder. Telangiectasia of conjunctivae. Emerges at age 4 years. Ocular motor apraxia; intention tremor; ataxia; immune dysfunction; lymphomas. Death early 20s

254
Q

What is Duchenne Muscular Dystrophy?

A

X-linked recessive; 1/3 new mutation; there is no dystrophin; appears at age 4; delayed motor milestones

255
Q

What is the association of IQ and Seizure Disorder?

A

Decreased IQ compared to healthy controls (except for classical absence seizures); there are also decreased verbal and attention skills and increased learning disorders. If EEG is subclinical when overt seizures stop, the IQ is decreased; if there is treatment, IQ improves

256
Q

What is the epidemiology of seizures?

A

1% prevalence. Highest prevalence of seizures is less than 5 years old and the second peak is puberty

257
Q

What neuropsychological findings are most consistent in Tourette’s disorder?

A

Visual-motor integration and visual-graphic difficulties

258
Q

What is the familial risk for reading disorder in first degree relatives of children with reading disorder?

A

35 to 45%.

259
Q

Do ADHD and reading disorder commonly co-occur?

A

Yes

260
Q

What are child and adolescent responses to divorce?

A
  1. Preschool children: regress, irritable, demanding, aggressive 2. 5 to 8: grief, fear of replacement, hard to believe permanent, decreased school function; little girls believe father will come back and loves them best. 3. 8.5 to 12: fierce anger, one parent good other bad; lonely, anxious, humiliating sense of powerlessness 4. Adolescents: depression, anger, acting out. These are possible findings and depend on other factors
261
Q

What seems to influence outcome in children of divorce?

A

Whether the child felt rejected by the father

262
Q

When did child psychiatry ‘formally’ begin in the U.S.?

A
  1. Dr. Wiliam Healy formed a child guidance cliinic, the Juvenile Psychopathic Institute in Chicago
263
Q

What is the most common kind of child abuse?

A

Neglect 54%. Physical abuse 23%. Sex abuse 11.5%. 25% experience more than one type

264
Q

Who tends to abuse prepubertal children?

A

Single parent, ethnic minority, low income

265
Q

Who tends to abuse adolescents?

A

White, middle class, two parent families

266
Q

Who physically abuses pre-pubertal children?

A

Mothers do so more

267
Q

Who physically abuses adolescents?

A

Fathers do so more

268
Q

What percentage of those who were abused, maltreat their offspring?

A

33% (Kaufman & Zigler)

269
Q

What ages are appropriate for the administration of the Wechsler Preschool Primary Scale of Intelligence (WPPSI)?

A

2 years 6 months to 7 years 7 months of age

270
Q

What are the cognitive consequences of cancer treatment?

A

Decreased performance skills, arithmetic, perceptual motor skills, visual processing, visual motor integration, sequencing ability, short term memory. Adverse events may not be seen for years

271
Q

What percentage of children with cancer are non-adherent to oral meds?

A

33% if less than 13 and 59% of adolescents

272
Q

How many infants die of SIDS each year?

A

3,000. Peak is at 2 to 4 months. 95% by 6 months. Rare for full term infants

273
Q

Doses of 5 to 40 mg of prednisone do what?

A

Impair explicit memory

274
Q

Transmission of HIV to infant from mother during birth is reduced by what protocol?

A

infant receives zidovudine within 6 to 12 hours of birth. Mother continues to take HIV medications during pregnancy, and if there is a high viral load at birth, zidovudine IV and C-Section are considered. Breast milk can transmit HIV.

275
Q

How is information processed in the brain?

A

Input: receive and record the information (perception) Integration: understand the information (sequenced, abstracted/contextualized, organized input (auditory or visual) Memory: Storage and retrieval (short-term) Output: Info is communicated from the brain (language, muscles)

276
Q

What is the legal definition of blindness?

A

20/200 or less in the better eye with corrective glasses

277
Q

The NEPSY is applicable for what ages?

A

3 to 12 years of age, Developmental NEuroPSYchological Assessment for attention and executive functions, language, sensorimotor, visual-spatial, learning and memory, social perception

278
Q

The Child Personality Questionnaire is for what ages?

A

8 to 12 years of age. It is primarily used to counsel pre-adolescents in school or clinical settings. The report reveals important information about academic achievement, leadership potential, and the tendency toward disciplinary problems. The CPQ report also provides narrative interpretations relative to traits such as creativity, emotional stability, self-concept level, excitability, and apprehension, as well as derived scores and predictions for extraversion, anxiety, and other broad trait patterns.

279
Q

What is the most highly developed pictorial interview?

A

Dominic R (6 to 11 years of age). Allows assessment of of younger children, in a non-auditory based manner.

280
Q

What is the K-SADS?

A

The Kiddie Schedule for Affective Disorders and Schizophrenia. Administered to 6 to 17 year olds. It is a semi-structured interview assessing a wide range of disorders

281
Q

What is the CAPA?

A

Child and Adolescent Psychiatric Assessment. The Child and Adolescent Psychiatric Assessment is an interviewer-based structured diagnostic interview with versions for use with children (ages 9-18) and their parents.

282
Q

What is the prevalence of autism?

A

1/59

283
Q

What is Landau Klefner Syndrome?

A

Expressive and receptive language deficits accompanied by seizures after a period of normal development. Onset is at 4 to 7 years of age. Leads to permanent aphasia

284
Q

What is the DISC?

A

Diagnostic Interview Schedule for Children 9 to 18 years of age. The computerized Diagnostic Interview Schedule for Children (C-DISC) is a comprehensive, structured interview that covers 36 mental health disorders for children and; adolescents.

285
Q

What is post irradiation syndrome?

A

Somnolence, anorexia, lethargy within 4 to 8 weeks of treatment. (There is also decreased growth hormone resulting in decreased growth, hypothyroidism, hearing deficits)

286
Q

What are the symptoms of craniopharyngioma?

A

Growth retardation, delayed sexual maturation, obesity, somnolence, visual and olfactory hallucinations

287
Q

What is the 5-year survival rate of children with low grade astrocytoma after excision and irradiation?

A

70%

288
Q

What is the the epidemiology of brain tumors in children?

A

2-5/100,000 children less than 15 years of age are affected. Infratentorial tumors predominate. The second most common cancer after leukemia.

289
Q

What is the most common cancer in children?

A

Leukemia

290
Q

What percentage of patients with Non-epileptifrom seizure disorder have a bona fide seizure disorder?

A

15 to 50%

291
Q

Who first conducted systemic studies on tics?

A

Itard 1825; Gilles de la Tourette 1885. Tics were also recognized in antiquity, of course

292
Q

At what age does an infant recognize the mother’s face?

A

1 month. Moving eyes are of interest at 2 months. There is adult visual acuity level at 6 months

293
Q

What percentage of Rett’s cases is familial?

A

1% is familial, usually from the father. Most cases are spontaneous mutations

294
Q

What genes have been identified in Rett’s disorder?

A

MEPC2, CDKL5 and FOXG1 (the latter two, uncertain of role)

295
Q

What did John Dewey believe?

A

In progressive and functional education. School should prepare for life outside; a practical education instead of a classical education

296
Q

What did Erikson believe regarding education?

A

If a child is given the chance to explore and undertake projects on his own, the sense of initiative will be stronger than guilt

297
Q

What did Montessori believe?

A

Young children should always be exposed to an object’s property or quality before before given the name (i.e. sensory learning should precede symbolic learning)

298
Q

What are school dropout rates in large urban centers?

A

50% (and are two years behind those from better educated families)

299
Q

What are the three main mechanisms/groupings of the Yale School Development Program (Comer Program)

A
  1. Government and management team 2. Mental health team 3. Parent team
300
Q

Are children with our without siblings more affected by school avoidance?

A

There is no difference

301
Q

Who is more affected by school avoidance, boys or girls?

A

The rates are equal

302
Q

Do children who are truant usually have conduct disorder?

A

No

303
Q

What are definitions of special needs in adoption through public agencies?

A

Greater than 10 years of; serious physical, intellectual, or emotional problems; member of a large sibling group. The most common special needs are emotional disturbance and intellectual disability

304
Q

What works better generally, open or closed adoption?

A

Open leads to better behavioral function. Adoptive mothers who have prenatal contact with the bio-mother had a better attitude to both the child and the bio-mother. Public agencies tend to have fewer open adoptions than private agencies. Open adoption may not be possible nor recommended in certain circumstances

305
Q

What does data show on transracial adoptions show?

A

Adjustment is no different

306
Q

Does a child’s initial response predict outcome in divorce?

A

No

307
Q

How many children of divorce experience a second divorce?

A

Up to 50%

308
Q

Does custody arrangement impact psychological health?

A

No. Nor did frequency of access and visitation with father (as long as the father is involved).

309
Q

What most impacts the psychological health of children of divorce?

A

Prior psychological functioning of the parents and the amount of postdivorce conflict

310
Q

What are recidivism rates for sexual offenders who receive treatment vs. those who do not in adults?

A

11% with treatment, 18% without (Alexander 1999)

311
Q

Who edited DSM III, which was considered the transition to a more scientific approach in the DSM?

A

Spitzer

312
Q

What did Clifford Beers write?

A

“A Mind That Found Itself” in 1908. It contributed to the mental health hygiene movement. (Beers was a Yale student who ended up in psychiatric hospitals–with presentations of psychosis.)

313
Q

What are good age ranges for groups?

A

Generally, 4 to 6, 6-10, 10-14, 14-19. Mixed sex is fine except in early adolescence, because of pubertal issues

314
Q

Poor adaptation after discharge from a residential treatment facility is associated with what findings?

A

Absence of adequate family support and perceived stress

315
Q

Is there a genetic component to hypnotizability?

A

Yes

316
Q

Time out or other formsm of isolation may be counterproductive for children with what behaviors?

A

Deviant behaviors

317
Q

When did the first residential type setting for children emerge?

A

First orphanage in the U.S. was 1729; Program for intellectual disability 1848. The 1850s showed an increase in child care institutions and group foster homes

318
Q

Baker found what about family contact for children ages 5 to 19 in residential settings?

A

1/3 had no contact with family over the year. 1/2 had 3 or fewer contacts over the year. Driving time and lower SES were a/w less contact.

319
Q

Even in programs with good resourcdes for discharge planning, what percentage of adolescents are homeless within 5 years of discharge from a residential?

A

1/6 after 1 year, and 1/3 by 5 years. The risks are being in state custody before admission, history of physical abuse and history of drug or alcohol abuse

320
Q

What is pseudomutuality?

A

A family’s intense need to be unified to the extent that differentiation of personalities is denied

321
Q

What is pseudohostility?

A

Defensive interactional pattern to ward off intimacy

322
Q

In family therapy what is projective identification?

A

Describes the projection of unresolved parental conflicts onto a child who assumes an identity based on a historically assigned role

323
Q

What are the three phases of family therapy?

A
  1. Symptoms of the child are the focus 2. If the child’s symptoms are better, focus on the marital dysfunction or parental psychopathology 3. Higher goal of maturity, creativity. If one focuses prematurely on phase two, there is a bad outcome for the child and parents
324
Q

In conduct disorder what are coercive family processes?

A

Parents lack management skills –> they are punitive and aggressive but withdraw in the face of strong opposition by the child

325
Q

What is expressed emotion?

A

Index of family criticism and overinvolvement with the patient

326
Q

In conduct disorder what are coercive family processes?

A

Parents lack management skills –> punitive and aggressive but withdraw in the face of strong opposition by child

327
Q

What percentage of families have at least one number who abuses alcohol or drugs?

A

30%

328
Q

What is a positive of day treatment rather than inpatient regarding staffing?

A

Only one shift = better continuity of care

329
Q

Measured by successful reintegration into regular school settings, studies show day treatment is effective in what percentage of cases?

A

65-70%. The family plays a key role in post treatment outcome

330
Q

What might be a focus of intervention with parents of children and adolescents with conduct disorder?

A

Assist in recognizing that neither side possesses sufficient leverage to win the situation, so that compromise can be formed

331
Q

What is the annual incidence of Caregiver Fabricated Illness?

A

1/200,000 under 16 is estimate

332
Q

In Caregiver Fabricated Illness, what is the time to onset of diagnosis?

A

15 months

333
Q

What is the average age of child and adolescent sexual abuse?

A

females 10.4, males 8.6

334
Q

What percent of child sex abuse victims have no short term symptoms?

A

21 to 35%. The rest can have PTSD, low self esteem, anxiety, fear, depression, SI, somatic complaints, aggression, running away, substance use

335
Q

What is the most common presentation of Caregiver Fabricated Illness?

A

Bleeding then seizures

336
Q

Infants as young as how many weeks respond differentially to voice and touch?

A

32 (hence parents can be involved with premature infants)

337
Q

How do kids with cancer feel socially?

A

Prepubertal shyness, social anxiety. Adoescents social isolation

338
Q

What percentage of renal transplants that fail in adolescents are due to non-compliance?

A

93% of lost transplants are attributable to non-compliance

339
Q

What percent of persons are non-compliant with their post-transplant regimen if there is a psychiatric disorder in children and adolescents?

A

50%. 100% if a severe personality disorder is present

340
Q

What are risk factors for non-adherence to immunosuppressive meds?

A

Females > males, adolescent, personality, no father, lack of community and social supports

341
Q

What percent of 3 year olds play with their genitals or masturbate?

A

50% (Fitzpatrick 1995, Irish sample)

342
Q

What is consequence of father absence on boys and girls

A

Worse on boys. Girls do better but have sex earlier and have more partners

343
Q

What seems to be the concordance rate for homosexuality in monozygotic twins?

A

50%, 20% if DZ (Xq28 is implicated)

344
Q

What age should one wait for if ambiguous genitalia is present to determine sex?

A

4 to 6 years (earlier if a preference is reliably expressed)

345
Q

What is the first sign of approaching pubescence?

A

Adrenarche at 8 yo. Puberty 8-14 females, 9-14 males. It takes 3 to 4 years to complete.

346
Q

Stuttering usually begins between what ages?

A

2 and 7 years of age, peaking at 3 and 4. 1/30 kids go through a period of stuttering by adolescence

347
Q

Does body fat go up or down with age?

A

It increases with the first year of life then decreases until pre-puberty when it increases

348
Q

What order of kinetics do most psychiatric drugs follow?

A

First order. The amount of drug eliminated is proportional to the amount circulating in the blood stream

349
Q

Children starting fires account for how many deaths annually?

A

300

350
Q

Describe fire behaviors

A

Fire interest is common in ages 3 to 5; fire starting in ages 5 to 9. Fires setting is pathologic if there are multiple fires over a 6 month period

351
Q

What are zero order kinetics?

A

A fixed amount of drug is elminated regardless of plasma level

352
Q

Criminal fire setting resulting in arrest and recidivism is related to what?

A

Alcohol dependence in males and self-injury and suicide attempts in females

353
Q

What is the use of cyproheptadine in eating disorders?

A

24 mg/d improves weight and mood

354
Q

What is the presence of enuresis?

A

10% at 7 years of age. (Risk increases by 7 if the father had it, and by 5 if the mother had it)

355
Q

What are risk factors for secondary enuresis?

A

Late attainment of initial nocturnal continence and 4 or more stressful events

356
Q

What does neuroimaging show in youth who are depressed?

A

Decreased ratio of frontal lobe volume to total cerebral volume and increased lateral ventricles to total volume

357
Q

What is seen in children with depression?

A

Hyposecretion of growth hormone with insulin challenge and hypersecretion of growth hormone during sleep

358
Q

What are some symptoms or behaviors of pre-school, school age, and adolescent children of depressed adults?

A
  1. Pre-school: perinatal complications, cognitive and emotional delays, inability to separate 2. School age: depression, hyperactivity, school problems, enuresis, rivalry with peers and siblings for attention 3. Adolescents: defiance, rebellion, withdrawal, conflicts with parents. The groups overall have three times the risk of a DSM diagnosis. Symptoms are worse if there is depression in the mother rather than the father
359
Q

What is the comorbidity of depression in prepubertal children?

A

80% have one other diagnosis, mostly dysthymia (38%), anxiety (33%) and conduct disorder (7%). Another study found 75% anxiety, 50% ODD, 33% CD, 25% Etoh abuse, 25% drug abuse

360
Q

What percentage of adults have bipolar disorder and what percentage of those recalled the onset between ages 5 and 9?

A

1% approximately; 0.5% of these recalled onset 5-9. 7.5% recalled onset from 10 to 14

361
Q

What is the concordance rate for mania in monozygotic twins and dizygotic twins?

A

65% MZ, 14% DZ

362
Q

When tends to be the onset of social anxiety in children?

A

11 to 12 years of age

363
Q

Do boys or girls of pre-pubertal age more often have GAD?

A

Equal rates

364
Q

Do adolescent boys or girls more often have GAD?

A

Girls

365
Q

What is the prevalence of an anxiety disorder in children and adolescents?

A

5 to 18%

366
Q

What is the prevalence of separation anxiety disorder?

A

3.5 to 5.5%

367
Q

What is the prevalence of GAD in children and adolescents?

A

2.7 to 4.6%

368
Q

What are neuroanatomic findings in ADHD?

A

Decreased size and activity of the frontal lobes, especially prefrontal area and corpus callosum and cerebellum. Decreased activitiy of the anterior cingulate. Decreased striatal area activity. Decreased size and activity of the globus pallidus and the caudate

369
Q

What percentage of adolescents have panic attacks?

A

36 to 63%. 0.6 to 5% have panic disorder

370
Q

What percengage of youth appear to receive the necessary treatment for the their anxiety disorder?

A

20%

371
Q

What are neuroanatomic findings in OCD?

A

Ventricular enlargement, decreased mean volumes of the caudate nuclei bilaterally

372
Q

What are positive-emission tomography (PET) findings for OCD?

A

Increased activity of caudate, especially on right; with treatment, this decreases

373
Q

What percentage of OCD are secondary to PANDAS?

A

10 to 20% (Autoimmune reaction to basal ganglia; cross reaction of strep)

374
Q

What percentage of children are physically abused based on documented injury?

A

0.5%

375
Q

What Act by the U.S. government provided financial incentives to discourage foster care drift?

A

The Adoption and Safe Families Act of 1997

376
Q

What is Michael Anderson’s theory on IQ

A

“Minimal Cognitive Architecture”. Individuals differ in data processing speed measured as inspection time, reaction time and average evoked potential, and this accounts for differences in IQ. Higher knowledge obtained through thinking is constrained by this ‘lower level’ of function, speed

377
Q

What percentage of children with asthma have a psychiatric diagnosis?

A

42%, especially anxiety

378
Q

What classification system in traumatic brain injury is used?

A

It is based on the Glasgow Coma Scale, duration of loss of consciousness (LOC) and post-traumatic amnesia (PTA); mild, mod, severe categories

379
Q

What is considered a severe traumatic brain injury?

A

Glasgow Coma Scale < 9, loss of consciousness > 24 hours, post-traumatic amnesia > 1 day

380
Q

What is considered a moderate traumatic brain injury?

A

Glasgow Coma Scale 9-12, loss of consciousness 1 to 24 hours, post-traumatic amnesia 30 minutes to 24 hours

381
Q

What is considered a mild traumatic brain injury?

A

Glasgow Coma Scale 13-15, loss of consciousness < 30 min, post-traumatic amnesia < 1 hour

382
Q

How many children a year have a traumatic brain injury?

A

90,000

383
Q

What did a laboratory classroom study of Concerta show?

A

Concerta was effective for 12 hours with regard to social and task behaviors and academic performance (Pelhman 2001)

384
Q

What did a one year study of Concerta show with regard to weight, height, blood pressure, pulse, and tics?

A

No effect

385
Q

The rights of individuals with disabilities were established by Congress in what Act?

A

Civil Rights Act of 1973, Section 504

386
Q

When a managed care company denies coverage for medical necessity what ethical duties does a physician have?

A
  1. Appeal 2. Discuss with patient; patient can pay out of pocket or appeal 3. Treat patient in an emergency without payment 4. Make alternate treatment plans
387
Q

What kind of fee for court work is unethical?

A

Contingency

388
Q

Children who are abused may preferentially set fire to what?

A

Beds or mattresses

389
Q

When do suicidal gestures and self-injurious behaviors start to occur after initiation of an incestuous relationship?

A

In the months following

390
Q

What is important to determine in the treatment of sexual abuse?

A

Perception and attribution for the abuse. Help the child reduce self-blame and attribute the responsibility for the abuse to the perpetrator

391
Q

What are factors that increase likelihood of subsequent psychopathology in the case of sex abuse?

A

Violence, completed intercourse, negative response to disclosure

392
Q

What number of fatalities yearly occur from maltreatment?

A

1,100

393
Q

Who first described the ‘battered child syndrome’?

A

Kempe 1962

394
Q

When were child protective services established?

A

1965 with mandatory reporting laws

395
Q

What is a profile for a perpetrator of child sexual abuse?

A

May select victims of a similar age and appearance to when they were abused; passive and inadequate in most of life, so like the power and control with children; usually males select females; up to half of female perpetrators can be adolescent babysitters

396
Q

List some major contributors to family therapy with children

A

Patterson (delinquency); Forehand and McMahon (delinquency); Alexander and Parsons; Zilbach; Scharff and Scharff

397
Q

What are common fractures in abuse?

A

Less than 2 years of age, rib. Spiral fractures occur in 36% of abuse cases, but also 27% of accidents. Transverse fractures are common, too, but less investigated than spiral

398
Q

What is the radiologic workup for physical abuse?

A
  1. Radiographic evaluation of possibly abused children < 2 years of age: dedicated skeletal survey, brain CT scan, other studies (e.g., upper GI), as the symptoms may warrant 2. Radiographic evaluation of possibly abused children > 2 years of age address specific symptoms; consider brain CT or MRI scan to evaluate for current or prior head trauma and sequelae
399
Q

What is one risk of tricyclic antidepressants for enuresis?

A

Child may take whole bottle to stop the enuresis

400
Q

What is the odds ratio of having a mental health problem if your parent was depressed?

A

In a 20 year follow-up of 101 offspring by Myrna Weissman the OR was 3, with mood 3.3, anxiety 2.9, phobia 4.0, substance use, 2.7, cardiovascular disease 5. Anxiety was present before puberty and depression after

401
Q

Acute stimulation of 5HT2a in sleep centers does what?

A

Leads to insomnia (SSRI side effect)

402
Q

Acute stimulation of 5HT2a in basal ganglia does what?

A

Akathisia and agitation (SSRI side effect)

403
Q

The brainstem chemoreceptor trigger center can mediate vomiting via what receptors?

A

5HT3 (hence SSRI side effect of nausea)

404
Q

Projection from the Raphe Nuclei to what area and what receptors may regulate appetite and eating?

A

Hypothalamus, 5HT3 receptors (SSRI side effect)

405
Q

Projection from Raphe Nuclei to what area and what receptors may be involved in anxiety and panic?

A

Limbic area, 5HT2a and 5HT2c

406
Q

Projections from Raphe Nuclei to what area and what receptors may help control movement and obessions and compulsions?

A

Basal ganglia, 5HT2a postsynaptic receptors

407
Q

What presynaptic alpha receptor is located on the cell body of the serotonin neuron?

A

Alpha 1. Stimulation of norepinephrine and alpha 1 receptors leads to increased serotonin release

408
Q

Serotonin receptors have what heteroreceptors that turn off serotonin release?

A

Alpha 2 (terminal location)

409
Q

What percentage of maltreatment fatalities are of children less than 3 years of age?

A

75%. Less than a week old, by mother; 1 week to 13 years of age both mother and father; 13+ majority by father

410
Q

What is the percentage distribution of abuse for neglect, physical abuse, and sexual abuse respectively?

A

60%, 20%, 10%

411
Q

What did DeAngelis describe about children who are abused?

A

Fearful and docile, no expectation of comfort, wary of physical contact, on alert for danger, attempt to meet parents’ need by role reversal, afraid to go home

412
Q

What does Biederman say about treatment of pediatric mania and ADHD?

A

Treat the mania first (I think it depends)

413
Q

What are signs of neuroleptic malignant syndrome (NMS)?

A

Muscle rigidity, delirium, autonomic instability, creatine phosphokinase (CPK) elevation. Supportive treatment and can use dantrolene and bromocriptine

414
Q

What drug helps with antipsychotic induced hyperprolactinemia?

A

Cabergoline and aripiprazole

415
Q

What did Kolko (1992) find regarding outcome after inpatient stays for children?

A

At 2, 4, 6 month follow-up there was no difference in outcome as a function of the length of the stay or time from discharge. Overall, there were fewer symptoms on follow-up

416
Q

Approximately what percentage of youth with the most severe difficulties use 80 to 90% of available resources?

A

2 to 5%

417
Q

Which autism scales have been tested for their reliability and validity?

A

ABC, ADI-R, ADOS, PL-ADOS, ASQ (aut scr ques), ASDSQ, CHAT, CARS2

418
Q

What are three things to keep in mind to help protect against malpractice

A

Write with risk in mind, check notes for discrepancy, follow-up on diagnoses and investigations

419
Q

What treatment manuals are available for PMT?

A

Cavell 2000, Forehand and McMahon 1981, Forgatch and Patterson 1989, Patterson and Forgatch 1989, Sanders 1993, Kazdin 2008

420
Q

What is a PMT guide for parents?

A

Forehand and Long 1996

421
Q

What is an assessment measure for suicidal behavior in children, adolescents, and adults?

A

Columbia-Suicide Severity Rating Scale (C-SSRS)

422
Q

What are screening instruments for drugs and alcohol use?

A

POSIT (free, available online, Problem Oriented Screening Instrument for Teens–10 domains. TASI (Teen Addiction Severity Index–semi structured). Drug Use Screen Inventory, self report. Personal Experience Screen Questionnaire, self report

423
Q

Sexual abuse is found most commonly in what socioeconomic status?

A

Equally in all, whereas physical abuse and neglect tend to be in lower SES

424
Q

What are some potential characteristics in families with sex father-daughter abuse?

A

Social isolation, enmeshment, role confusion; rigid patriarchal structure and poor marital relationship; father +/- job history, sexually and emotionally rejected by spouse; father pursues daughter as alternative to spouse (and religiosity, ironically, or social inhibition may increase this risk as an extramarital affair is less likely)

425
Q

What percentage of women report retrospectively having been sexually abused?

A

18% (does not include intercourse only). Some studies show higher, from 27% for women and 16% for boys)

426
Q

What is the most common age range for sexual abuse victimization?

A

8 to 9 years old

427
Q

Before the 17th century the age of consent for sex was considered as low as what age?

A

12 (U.S.A)

428
Q

What should a child be told about any abuse they experienced?

A

It is not their fault and they are not to be blamed; also explore issues of betrayal, overexcitement, sense of personal responsibility; also, ambivalence over any arousal feelings

429
Q

What are treatment elements to selective mutism?

A

Contingency management, exposure-based techniques, self-modeling

430
Q

What percentage of 5 year olds have enuresis?

A

15%

431
Q

Is enuresis associated with a particular sleep stage?

A

No

432
Q

What is the remission rate with DDAVP for enuresis?

A

30%

433
Q

What percentage of chidlren with encopresis have anismus?

A

75% (lack of relaxation of the external sphincter). Uncertain if precedes or emerges after the encorpresis

434
Q

What percentage of high school seniors report having used marijuana in the previous year?

A

46%, 26% in the last month. 7% of 9th to 12th graders have tried at least once before age 13 (YRBSS 2017)

435
Q

What is the lifetime use of steroids for high school students?

A

3%

436
Q

What step of 12 step programs is not useful for teenagers?

A

Step 1, surrending to a higher power. This goes against the developmental stage adolescents are in

437
Q

What is autosynephilia?

A

Male’s propensity to be sexually aroused by the thought of himself as female. Transvestic adolesdcents with autosynephilia are those who most commonly request sex re-assignment surgery

438
Q

In adults transvestic fetishism involves what sexual orientation, homosexual or heterosexual?

A

heterosexual

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