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CAP Review > CP > Flashcards

CP Flashcards

1
Q

What percentage of males with gender dysphoria (who do not like their male gender) are sexually attracted to males?

A

50% are attracted to males, and 50% to females

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2
Q

What is the risk of major depressive disorder in relatives of suicide victims?

A

Three times the rate for siblings, mothers, and friends

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3
Q

How do tricyclic antidepressants cause cardiovascular problems and seizures?

A

They block sodium channels in the heart and brain leading to cardiac arrhythmias and arrest in overdose

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4
Q

What are the dynamic issues involved in elopement or self-injurious behaviors in treatment settings?

A
  1. Fear of improvement that leads to discomfort 2. Lack of insight leading to non-compliance with treatment and discouragement 3. Ambivalence about attachment to or dependence on others 4. Fear that external control is lacking when opportunities for more independent function are offered 5. Projection of internal conflicts on the milieu 6. Perception that the milieu doe not allow for individual emotional growth
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5
Q

What is a feeling often overlooked with adolescents in treatment?

A

Shame (as a result they may attack self, attack others, and show shame avoidance)

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6
Q

Who wrote about shame?

A

Donald Nathanson

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7
Q

How did tricyclic antidepressants come about?

A

They were first considered for schizophrenia, given their 3 ring structure which is similar to other agents with 3 ring structures meant for schizophrenia

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8
Q

What is the tripartite model?

A

Id, ego, superego

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9
Q

What is drive in psychodynamics?

A

Stimulus arising within an individual that arouses the mind and incites mental activity

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10
Q

Is the rigidiity of the superego proportional to the parents’ severity?

A

No. More related to the intensity of aggressive wishes and relative weakness and immaturity of an individual’s ego and defenses

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11
Q

What is a representation?

A

Enduring organization or schema constructed from a multitude of images, each derived from a multitude of experiential impressions

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12
Q

What is ‘observing ego’

A

Self observation

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13
Q

What is ‘objective’ countertransference?

A

Anyone would find the behavior provocative. The word ‘counterreaction’ has also been used here.

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14
Q

Who said that there is no evidence that personal psychotherapy is not an important part of training?

A

Marks 1982

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15
Q

In which Piagetian stage do children find it hard to have two feelings at once?

A

Pre-operational

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16
Q

What is negative reinforcement?

A

The removal of an aversive stimulus after a positive behavior has occurred.

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17
Q

What are examples of punishment?

A

Time out, response cost (e.g. agree upon reward–car use–upon completing desired behavior–coming in for curfew); overcorrection (e.g. deface poster, make money to replace it and do favor for the roommate)

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18
Q

How should one proceed with dosing of tricyclic antidepressants?

A

EKG. 10 - 25 mg dose and increase by 20 to 30% every 4 to 5 days; at 3.0 mg/kg (1.5 mg/kg for nortriptyline) check EKG and at steady state levels. Typical dose range is 2 to 5 mg/ kg, half for nortriptyline

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19
Q

Is methylphenidate psychosis similar to schizophrenia?

A

No, more of a toxic psychosis with visual hallucinations, etc.

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20
Q

What is a manual based treatment of anxiety in autism spectrum disorders?

A

Manual-based cognitive-behavioral treatment program to target anxiety symptoms as well as social skill deficits in adolescents with ASD (Multimodal Anxiety and Social Skills Intervention: MASSI)

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21
Q

What are the active enantiomers of methylphenidate

A

D-threo > L-threo

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22
Q

In family treatment, Stierling proposed ‘binding, delegating, expulsion’. What are they?

A

Three ways to overcome fear of prolonged fusion. 1. Binding: forces suicidal or psychotic thinking for the child and adolescent to get out 2. Delegating: family lets child out on long leash to share vicariously in the exploits 3. Expulsion: a child is rejected to free from the unit

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23
Q

What percentage of child patients never complete treatment to the satisfaction of therapists?

A

50%

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24
Q

What do outcome studies of residential treatment centers show?

A

Depends more on ecologic and post discharge factors than the RTC itself. An RTC at times serves as a secure base.

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25
Q

What receptors does ziprasidone effect?

A

Inhibits 5HT2c, 5HT1d, norepinephrine, and serotonin reuptake. Stimulates 5HT1a

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26
Q

What placebo-controlled discontinuation trial showed nortriptyline to be effective for ADHD?

A

Prince et al. 1999. Useful for enuresis in the context of ADHD or if other agents are not effective for ADHD

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27
Q

What circuit is involved in Tourette’s?

A

cortico-striato-thalamo-corical

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28
Q

What are the two monoamine oxidase neurotransmitter subtypes and what neurotransmitters do they metabolize?

A

A and B, serotonin and norepinephrine

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29
Q

What were the first anti-depressants?

A

MAOIs (anti-tubercular)

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30
Q

What are two benzodiazepine substrates of P450 3A4?

A

Alprazolam and triazolam

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31
Q

What are two SSRI inhibitors of P450 3A4?

A

fluoxetine, fluvoxamine

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32
Q

Fluvoxamine inhibits what CYP?

A

1A2

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33
Q

Which cytochrome does nicotine induce?

A

1A2

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34
Q

Tricylics antidepressantss are substrates for what cytochrome?

A

2D6 (hydroxylates and therefore inactivates the TCA)

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35
Q

Cytochrome 1A2 does what with certain Tricyclic antidepressants?

A

Demethylates them but does not inactivate them. Clomipramine–> desmethylclomipramine, imipramine–>desipramine

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36
Q

What is the family, subtype, gene in cytochrome nomenclature?

A

E.g. 2D6: 2 = family, D = subtype, 6 = gene product

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37
Q

What is the explanation for the development of tolerance to acute side effects of antidepressants?

A

Densisitization of postsynaptic receptors

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38
Q

What is a candidate mechanism as the site of possible flaw in signal transduction from monoamine receptors?

A

The target gene for brain derived neurotrophic factor (BDNF)

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39
Q

What does brain derived neurotrophic factor (BDNF) do?

A

Normally BDNF sustains the viability of brain neurons but under stress the gene for BDNF is repressed, leading to the atrophy and possible apoptosis of vulnerable neurons when their BDNF is cut off. Theory: anti-depressants cause genes for neurotrophic factors to be activated

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40
Q

What is the monoamine theory of depression?

A

Pseudomonoamine deficiency due to a defiency in signal transduction from the monoamine neurotransmitter to its postsynaptic neuron in the presence of normal amounts of neurotransmitter and receptor (second messenger system could be a site of dysfunction)

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41
Q

Acute stimulation of what receptors results in GI cramps and diarrhea?

A

5HT3 and 5HT4 in the gut

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42
Q

Acute stimulation of what receptor leads to nausea of vomiting?

A

5HT3 in the brainstem vomit center

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43
Q

Acute stimulation of what results in sexual dysfunction?

A

5HT2A in the spinal cord

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44
Q

Explicit memory is mediated by what structures?

A

Medial temporal lobe and hippocampus and related structures that enable verbal representations

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45
Q

Are traumatic memories processed like ordinary memories?

A

No. This results in failure to organize the traumatic event into coherent verbally represented narrative. There are repetitious and non-consecutive memory chunks

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46
Q

What is the condom use of adolesents?

A

Those who had casual sex partners tended to use condoms more than those with just a main partner (47% versus 37%) but because they reported more sex, the mean number of unprotected sex acts was not significantly different (Lescano 2006)

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47
Q

Is the risk of tardive dyskinesia (TD) and extrapyramidal symptoms (EPS) the same across conventional antipsychotics?

A

The risk for acute EPS varies but there is not difference in risk for TD

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48
Q

What is a strength-based paradigm after exposure to trauma rather than posttraumatic stress?

A

Resilience

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49
Q

What did Teicher et al. find regarding maltreatment and ‘limbic irritability’?

A

Verbal abuse is more detrimental than non-familial sex abuse; domestic and verbal abuse is = to familial sexual abuse (AJP 2006)

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50
Q

In enuresis, who are those that are more likely to have urinary tract incontience?

A

Those with daytime wetting

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51
Q

What is the success rate of the alarm clock method for enuresis?

A

77% if the alarm is set when the bladder may be reaching maximal capacity (alarm clock and not bell and pad method here)

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52
Q

What is the success rate of the bell and pad method?

A

75%

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53
Q

Are children with enuresis at increased risk of psychopathology?

A

No

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54
Q

What findings are there in children with enuresis?

A

General developmental delays, lower functional bladder volume, lag in maturity for age (suggests maturational delay of CNS)

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55
Q

Enuresis at night occurs in what stage of sleep?

A

Each stage, according to the proportion of time spent in that stage

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56
Q

What is secondary enuresis?

A

Enuresis that occurs after first having maintained continence for one year

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57
Q

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

A

66% MZ, 0 % DZ,; according to Treasure and Holland 1989

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58
Q

Does the data suggest that patients with an eating disorder have a higher rate of experiencing sexual abuse?

A

Not more than other clinic based populations

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59
Q

What is the incidence and prevalence of anorexia nervosa?

A

8.1/100,000 per year and 0.28%. The prevalence for bulimia nervosa is 1%

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60
Q

What is the male to female ratio of anorexia nervosa?

A

1 to 10-20

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61
Q

Who first described cases of anorexia nervosa?

A

John Reynolds in 1669 and Richard Morton 1689

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62
Q

Who first described and named bulimia nervosa?

A

Gerald Russell 1979. Descriptions of bulimia existed and it was thought to be a part of anorexia. Russell first described it as a separate disorder

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63
Q

What are some observations in children who fireset?

A

Decreased achievement, conduct disordered behaviors, stressors, do not call for help after the fire is started

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64
Q

What is process trauma?

A

Trauma related to secondary events of trauma (e.g. a disaster can be traumatic and then the move because it also disrupts life)

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65
Q

Is the blood brain barrier permeable in children?

A

More permeable than adults

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66
Q

1 in 200 white persons are slow metabolizers for what 2 CYPs together?

A

2D6 and 2C19.

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67
Q

What percent of whites have a genetic deficiency of 2D6

A

7% to 10% of whites have a genetic deficiency of CYP 2D6 and are less efficient in metabolizing 2D6 substrates,

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68
Q

How do lamotrigine and valproate interact?

A

VPA increases lamotrigine by inhibiting glucuronidation by which lamotrigine is metabolized alone

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69
Q

Post-synaptic cells have which two types of receptors?

A

Fast acting class I (inotropic) receptors and slow acting classs II (g-protein coupled) receptors

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70
Q

How is dopamine degraded?

A

Catechol-o-methyltransferase (COMT)

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71
Q

What does glutamate potentiate?

A

Glutamate neurons and NMDA receptors are involved in long-term potentiation, a crucial component of memory

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72
Q

What is psychic determinism?

A

The principle that nothing in the mind happens by chance or in a random way

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73
Q

What important areas of the limbic system are associated with aggression?

A

Hypothalamus, septal area, amygdala

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74
Q

Are the cerebral volumes of children who have been abused increased or decreased?

A

Decreased by 7% (De Bellis et al. 1999)

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75
Q

What is the juvenile arrest rate for violent crimes per 1000 juveniles?

A

4

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76
Q

Dementia can be diagnosed by what age?

A

4 to 6 years of age, after the IQ is stable

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77
Q

Pain travels by what fibers?

A

Unmyelinated C, smaller and slower. Thinly myelinated A-delta, larger and faster

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78
Q

What projection mediates the effect of norepinephrine on attention?

A

Locus coeruleus to prefrontal cortex

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79
Q

What projection is thought to be responsible for norepinephrine’s regulation of mood?

A

Locus coeruleus to the fontal cortex

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80
Q

Where are the presynaptic 5HT autoreceptors located?

A

5HT1a = somatodendritic autoreceptor (decreases neuron impulse flow). 5HT1D (axon terminal autoreceptor inhibits release)

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81
Q

What are the key postsynaptic serotonin receptors?

A

5HT1a, 5HT1d, 5HT2a, 5HT2c, 5HT3, 5HT4

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82
Q

What are the two key serotonin presynaptic receptors?

A

5HT1a and 5HT1d

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83
Q

Where is the serotonin transporter pump located on the synapse?

A

Presynaptically

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84
Q

Where are presynaptic alpha 2 receptors located?

A

Axon terminal (autoreceptors)

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85
Q

At what age are the greatest number of synapses present?

A

6 years. 50% of connections are removed over time. 100 trillion synapses are present with 10,000 synapses for some neurons

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86
Q

The brain makes its own ‘morphine’. What is it called?

A

Beta endorphin

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87
Q

What is anandamide?

A

An endogenous cannibinoid receptor

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88
Q

Where are neuropeptides made?

A

Cell body

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89
Q

Where does monoamine synthesis occur?

A

Axon terminal (pieces are gathered in the cell body and sent to axon terminal for synthesis and synaptic vesicle packaging)

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90
Q

In what way are children at birth more at risk with morphine?

A

The blood brain barrier is immature at birth and more permeable to morphine

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91
Q

Is feminine behavior in boys related to homosexuality?

A

Its persistence rather than its mere presence

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92
Q

What are the typical ages for firesetting?

A

Child 8 years of age; adolescent 13 years of age

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93
Q

What is the treatment of encopresis?

A
  1. Initial bowel catharsis 2. Daily laxative or mineral oil 3. Daily timed timed interval on toilet with reward for success. 80% success rate with this
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94
Q

In encopresis what percentage of children have abnormal contractions of the external anal sphincter?

A

About half

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95
Q

What is the workup for encopresis?

A

A rectal exam usually reveals retention. If not one can check an abdominal x-ray

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96
Q

What is the prevalence of encopresis?

A

1.5% of 7 to 8 year olds. The male to female ratio is 3:1

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97
Q

What does increased maternal cortisol associate with postnatally?

A

Increased aggression postnatally

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98
Q

By what age do infants alternate their vocalizations?

A

3 months

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99
Q

What percentage of children with ADHD no longer have hyperactivity as adolescents?

A

20 to 30% (same with impulsivity); attentional problems persist. In adults, 40% no longer have hyperactivity

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100
Q

What percentage of children with hyperactivity have a hyperactive parent?

A

20%

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101
Q

What does clonidine do?

A

Agonist for alpha 2 leading to reduced norepinephrine (autoreceptor signal to decrease)

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102
Q

What is the risk of tardive dyskinesia?

A

5% per year for conventional antipsychotics

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103
Q

Which antipsychotics are associated with 1A2?

A

Clozapine, olanzapine

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104
Q

Which antipsychotics are associated with 2D6?

A

Risperidone, clozapine, olanzapine

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105
Q

Which antipsychotics are associated with 3A4?

A

Clozapine, quetiapine, olanzapine

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106
Q

What do anticonvulsants generally block?

A

Sodium channels

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107
Q

What is the likely mechanism of action of ECT?

A

Probable mobilization of neurotransmitters caused by the seizure

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108
Q

At what age do numerical ratings start to work for pain?

A

> 8 years old

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109
Q

How does the mesolimbic dopamine pathway project?

A

Dopamine cell bodies in the ventral tegmental area project to to axon terminals in the limbic areas, such as the nucleus accumbens (which leads to positive symptoms)

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110
Q

Bupropion blocks reuptake of what neurotransmitters?

A

Weak dopamine and weaker norepinephrine. Bupropion is a prodrug metabolized to an active metabolite that is a more powerful inhibitor of norepinephrine reuptake than bupropion and is also concentrated in the brain (hydroxylated active metabolite)

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111
Q

Which of the following are fast acting: GABA, glutamate, norepinephrine, or serotonin?

A

GABA and glutamate

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112
Q

Which of the following are slow acting: GABA, glutamate, norepinephrine, or serotonin?

A

Norepinephrine and serotonin

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113
Q

What is the principal function of the locus coeruleus?

A

To determine wether attention is being focused on the environment or the internal milieu of the body

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114
Q

How does alpha 2 antagonism work in regard to norephinephrine?

A

Normally, norepinephrine (NE) lands on the presynaptic alpha 2 receptor, and the system ‘thinks’ there is plenty of NE, so this leads to decreased NE. An alpha 2 antagonist blocks NE so the system thinks there is not enough NE, and NE increases.

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115
Q

How does alpha 2 antagonism work in regard to serotonin type neurons which have presynaptic alpha 2 receptors on them (i.e. heteroreceptors)?

A

Normally NE lands on the alpha 2 site leading the system to decrease serotonin release. When an alpha 2 antagonist lands on the site it leads to increased serotonin release

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116
Q

Define impulsivity

A

Failure to resist an impulse, drive, or tempation, resulting in rapid unplanned reactions to internal or external stimuli

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117
Q

Define affective instability

A

Emotional dysregulation as exaggerated reactions to negative or frustrating stimuli (unlike in impulsivity there is a rush of affect)

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118
Q

Emotional regulation involves what circuitry?

A

Orbital frontal cortex, amygdala, anterior cingulate, cerebellum (temporal)

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119
Q

What brain structures are involved in anxiety/hyperarousal?

A

Limbic system perceives stress resulting in the hypothalamus releasing CRF which stimulates the pituitary to release ACTH which stimulates the adrenals to release glucocorticoids. CRF = corticotropin releasing factor. ACTH = adrenocorticotrophic hormone

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120
Q

Acute stimulation of 5HT2a in the brainstem leads to what?

A

Myoclonus, disrupted slow wave sleep, and nocturnal awakenings

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121
Q

What is the data on tricyclic antidepressants in ADHD?

A

They are effective, albeit more for behavior than cognition perhaps

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122
Q

What percentage of those with Tourette’s disorder have ADHD?

A

For those 6 to 18 years old, 50 to 60% (Cohen and Leckman 1989)

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123
Q

What is noradrenergic deficiency syndrome?

A

Depression that is associated with fatigue, apathy, notable cognitive disturbance, impaired concentration, problems with sustaining and focusing attention, slow information processing, and decreased working memory

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124
Q

Acute stimulation of 5HT2a in the mesocortical pleasure center leads to what?

A

Decreased dopamine, which can lead to apathy or decreased libido

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125
Q

Acute stimulation of 5HT2a in the spinal cord leads to what?

A

Inhibition of the spinal reflexes of orgasm and ejaculation

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126
Q

Acute stimulation of 5HT2a in the basal ganglia leads to?

A

Akathisia, psychomotor retardation or agitation, parkinson’s, dystonia (because serotonin inhibits dopamine release)

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127
Q

Acute stimulation of 5HT2a and 2c in the projection from the raphe nuclei to the limbic cortex results in?

A

Acute mental agitation, anxiety, panic attacks

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128
Q

Projection of 5HT neurons from the raphe nuclei to which area leads to therapeutic action?

A

Frontal cortex

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129
Q

What does the presence of serotonin in the synaptic space lead to?

A

Postsynaptic receptors become desensitized (2a, 2c, 3). These receptors send information to the cell nucleus of the postsynaptic neuron resulting in the instruction to downregulate these receptors. The time course for this to happen corresponds to the tolerance of side effects.

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130
Q

The increased ratio of serotonin to serotonin receptors after antidepressant treatment as a mechanism of action is supported by what evidence among other?

A

Deceased suicidal and otherwise depressed patients have had more 5-HT2A receptors than normal patients. These considerations suggest that 5-HT2A overactivity is involved in the pathogenesis of depression.

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131
Q

What serotonin receptor does trazadone block?

A

5HT2a receptor. It also blocks reuptake but less so than other agents

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132
Q

By what process does trazodone effet sleep?

A

By inhibiting histamine H1 leading to sedation and by inhibiting 5HT2a which induces and restores slow wave sleep

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133
Q

When selective serotonin reuptake inhibitor treatment is initiated where does serotonin first rise?

A

Cell bodies in the raphe nuclei and not at the axon terminal where the re-uptake pump is located (somatodendritic autoreceptors 5HT1a)

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134
Q

Increased serotonin at the somatodendritic autoreceptor 5HT1a leads to?

A

Downregulation and densitization. Once desensitized and down regulated it can no longer efffectively inhibit its own release and the serotonin neuron is disinhibited. This correlates with time of onset of anti-depressant action

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135
Q

Mirtazapine blocks which alpha receptors?

A

Alpha 2

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136
Q

Mirtazapine inhibits which serotonin and histamine receptors?

A

2a, 2c, 3, H1

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137
Q

Mirtazapine’s blockade of which receptor contributes to its antidepressant effect?

A

5HT2a

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138
Q

Mirtazapine’s blockade of which receptors leads to anxiolysis and relaxation?

A

5HT2a, 5HT2c and H1

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139
Q

Mirtazapine’s blockade of which receptors mitigates side effects?

A

5HT2a, 5HT2c, 3

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140
Q

Mirtazapine’s blockade of which receptors leads to sedation?

A

5HT2a and H1

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141
Q

Mirtazapine’s blockade of which receptors leads to weight gain?

A

5HT2c and H1

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142
Q

Mirtazapine’s blockade of 5HT2a, 5HT2c, and 5HT3 leads to preferential stimulation of which receptor?

A

5HT1a and therefore anxiolysis, antidepressant effects

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143
Q

How does alpha 2 antagonism increase the release of serotonin?

A

The locus coeruleus has norepinephrine neurons stimulating alpha 1 receptors in the midbrain which stimulates release of serotonin. When alpha 2 is antagonized this disinhibits release of norepinephrine. The norepinephrine stimulates alpha 1 which stimulates serotonin release

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144
Q

What is the most significant parental factor in the incidence of child psychopathology?

A

Presence of conduct disorder in one or both parents (Rutter and Quinton)

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145
Q

What is the general outcome for gifted (IQ 130-150) individuals who are deaf?

A

52% college grad, 30% unemployed, 40% have had psychotherapy and 9% hospitalized

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146
Q

What is the prevalence of emotional and behavioral problems in children who are deaf compared to the general pediatric population?

A

Three times greater. There can be impulsivity, hyperactivity, rigidity, suspiciousness, immaturity [as a gross stereotype]

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147
Q

What are the classifications for children with hearing impairment?

A

Hard of hearing, hearing impaired, or deaf. Prelingual deafness is when it occurs at less than 2 years of age

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148
Q

What percentage of those with ADHD have another disruptive behavior disorder?

A

50%

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149
Q

What do many schools for children with deafness use as a communication method?

A

A teacher articulates and uses sign language

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150
Q

How many children in the U.S. have joint deafness-blindness?

A

7 to 8,000

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151
Q

Most reading disorders involve an inability to do what?

A

Segment the written word into its underlying phonologic components

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152
Q

What is the most prevalent type of communication disorder?

A

Phonologic

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153
Q

What is the outcome of preschoolers with speech and language impairment who do not speak in full sentences at by age 6?

A

There can be an intellectually disabled range of IQ even if was in the normal range when in preschool

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154
Q

What are examples of environmental contributions to language difficulties?

A

Fetal alcohol syndrome, cocaine exposure, maltreatment (especially neglect)

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155
Q

How many known genetic causes of intellectual disability are there?

A

750+ if not more at the time of this writing. Half of those with an intellectual disability have a known organic cause

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156
Q

Focal lesions in the CNS affect language if on which side of the brain?

A

Left

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157
Q

What is the behavioral profile of William’s syndrome?

A

Social disinhibition, anxiety, fear, inattention, hyperactivity, hyperacusis, cardiac problems

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158
Q

What is the behavioral profile of Down’s syndrome?

A

Non-compliance, stubborness, inattention, depression, dementia

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159
Q

What is the behavioral profile of Prader-Willi?

A

Hyperphagia, non-food OCD, skin picking, tantrums

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160
Q

What is the behavioral profile of Fragile X?

A

Social anxiety, shyness, gaze aversion, inattention, hyperactivity, autism/PDD

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161
Q

What percentage of those with an intellectual disability have psychiatric difficulties?

A

25%

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162
Q

Stimulants which increase dopamine can lead to what?

A

Stereotypies

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163
Q

In autism, does facilitated communication work?

A

No

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164
Q

What is the purported advantage of the KABC over the WISC?

A

Focuses more on problem-solving and less on verbal abilities and acquired knowledge

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165
Q

What are common soft neurological findings in schizophrenia?

A

Perceptual-sensory, motor coordination, right-left orientation, balance, motor overflow

166
Q

What percentage of those with schizophrenia have EEG changes?

A

25%

167
Q

What are some easy ‘physical exam’ tests for problems with the frontal lobes?

A
  1. Smooth pursuit: follow finger smoothly, left to right. Abnormal is discontinuous jerks (saccadic) or deviation (looking away). 2. Tapping forehead. If tap = or > 3 times and blinking persists, it suggests inflexibility 3. Antisaccade test: 5x: 2x left, 2x right, 1x left 3. 2 stepped Luria, palm, fist hand. The most sensitive and specific are the smooth pursuit and the Luria.
168
Q

Describe the 3 step Luria task, used to explore frontal lobe probolems?

A

With fingers fully extended and the patient following, the examiner places his right hand with a cutting motion on his right knee or on a table, then in a fist with the knuckles down, and then palm down with fingers extended. Examiner and patient then repeat this three more times. The hand motions could be reinforced by counting from 1 to 3 along with each segment, or by saying “cut, fist, and slap.” Patients are then asked to repeat the movements unguided by the examiner A score of 0 is recorded if the patient is unable to mimic the movement or complete three independent cycles. Performance on the Luria test is scored as normal or abnormal. The test is judged to be abnormal if the hand motions differed in type or sequence from that of the examiner. A common error was having the fingers flexed instead of extended for the first movement. (Weiner et al. 2011)

169
Q

Describe the antisaccade test

A

The examiner faces the patient, holds his or her hands to either side of the patient’s eyes, and asks the patient to look at the examiner’s nose. She instructs the patient to deviate her eyes to the side of the examiner’s briefly raised index finger and then return his or her gaze to the examiner’s nose. Alternately, the examiner moves her right and then left index fingers. The patient looks towards the moving finger and then back at the examiner’s nose. Once it is clear to the examiner that the patient has mastered this and looks to the moving finger and then back to the examiner’s nose, the examiner asks the patient to look toward the opposite side, toward the side that does not move. Patients with frontal damage have trouble suppressing the urge to look at the moving finger and first look there before correcting. This test uncovers impulsivity and inattentiveness in children. It is performed five times, twice to the left, twice to the right, and then once to the left. Two or more failures count as an error. (Lewis et al. 2002)

170
Q

Describe the smooth pursuit task to explore frontal lobe function

A

The examiner asks the patient to follow the examiner’s smoothly moving finger as it goes slowly from left to right horizontally in front of the patient. An abnormal response would be visual tracking in brief, staccato, discontinuous (saccadic) jerks or inattentiveness with brief deviations of the patient’s eyes from the examiner’s finger rather than smooth movements. A normal response would be smooth visual tracking of the moving finger. The patient should also be able to stare for 30 seconds at the examiner’s stationary finger without deviating his or her gaze. This helps to demonstrate an ability to concentrate. (Lewis et al. 2002)

171
Q

The Mullen Scales can be given from what age range?

A

2 to 69 months

172
Q

What is a drawback of the Bayley Scales of Infant Development

A

There is no language assessment

173
Q

What age range does the Millon Adolescent Personality Inventory Cover?

A

The MAPI has 150 T-F questions. 13-18 year olds, 20 minutes

174
Q

What age range applies to the Behavior Assessment System (BASC), Third Edition for children, which is commonly used in schools?

A

2:0 to 21:11 year

175
Q

What are the instructions for the Kinetic Family Drawing, KFD?

A

The KFD involves the examiner instructing the child to draw a picture of themselves and everyone in his or her family doing something.

176
Q

What is the Rotter Incomplete Sentence Blank?

A

It comes in three forms, for different age groups, and comprises 40 incomplete sentences, usually only 1-2 words long such as “I regret …”. The subject is asked to complete the sentence. It is a projective test.

177
Q

What are the instructions for the Machover Draw-A-Person ?

A

In administering the DAP, the examiner always starts by providing the examinee with a blank sheet of paper and a pencil with eraser. The examiner then instructs the examinee to “draw a person”, thus, the name of the test. After drawing one person, the examinee then proceeds to draw another person of the opposite sex with the first one. The exam ends with the examinee narrating a story that features the figures he or she has drawn as characters. The figure of the same sex with that of the examinee is seen to be reflective of impulses the examinee finds acceptable while the unacceptable instincts are portrayed by the figure of the opposite sex Use 8 1/2 x 11” paper; pencil and eraser.

178
Q

What functional domains are assessed by the Vineland Adaptive Behavior Scales?

A

Communication, Daily Living, Socialization, Motor Skills

179
Q

What is the age range for the KABC-II?

A

3 to 18

180
Q

The Kaufman Brief Intelligence Test, Second Edition (KBIT-2) can be administered to what ages?

A

4 to 90

181
Q

What is the Leiter International Performance Scale?

A

Widely used today, Leiter devised an experimental edition of the test in 1929 to asses the intelligence of those with hearing or speech impairment and with non English speaking examinees. For ages 2 to 20

182
Q

What are some difficulties to bear in mind about the DISC-IV?

A

The Diagnostic Interview Scale for Children is a widely used and useful structured self-report diagnostic assessment. The issues are that unusual symptoms are over-endorsed (OCD, psychosis) and that diagnoses based on symptom report are unusually high.

183
Q

What are the prevalences of reading disorder, math, and disorder of written expression?

A

4%, 1%, 4%

184
Q

At what age is handedness consolidated? Footedness?

A

5, 7

185
Q

At what age can a child successfully touch their left hand to their opposite, right ear (or vice versa) when instructed to do so?

A

7 (they can touch their left hand to their left ear or right to right by 6)

186
Q

What did Klein and Young (1979) say regarding hyperactivity?

A

It is the combination of hyperactivity with high disruptiveness that distinguishes ADHD from typical. Children in free play look same; the structured sitting situations bring out the children with ADHD

187
Q

What is the data on child sexual abuse victims and incidence/prevalence?

A

Cases known to and reported to authorities: U.S. Department of Health and Human Services reports that 88,656 children, or 1.2per 1,000 children, were sexually abused in 2002, according to cases reported to authorities. Limit: only known to authorities A national survey of youth and caretakers suggested that about 4.6 children per 1,000,or 320,400 children were sexually abused or assaulted in a year. Limit: those willing to report. National surveys of adults suggest that between 9-32% of women and 5-10% of menreport that they were victims of sexual abuse and/or assault during their childhood.

188
Q

What does trend data over time show about sexual abuse and assault?

A

It has declined

189
Q

What percentage of child sexual offenses are committed by juveniles?

A

29 to 41%

190
Q

Child sexual abuse and sex crimes are committed by which group the most, family, acquaintances or strangers?

A

Acquaintances, then families, then strangers

191
Q

What did one group of researchers find about rates of offense in non-incestuous pedophiles first entering treatment?

A

The non-incestuous pedophiles who molested boys had committed an average of 282 offenses against 150 victims (Rossman et al. 1999). Someone with pedophilia has an exclusive interest in boy or girls, i.e. children, as opposed to child sex offenders who do not

192
Q

One study found what percentage of fathers or stepfathers found to have committed extrafamilial abuse had also molested their own children?

A

50%(Glasser and Kovin 2001)

193
Q

What does Kagan emphasize?

A

Biogenetic tendencies and their contributions to development

194
Q

If a man is involved in the physical care of his child before the age of 3 what drops dramatically?

A

Sexual abuse of his and another’s children

195
Q

What percentage of married women with children under 6 years of age are in the labor force?

A

74% in 2017, 65% in 1999, 20% in 1960. Employed
fathers with younger and older children were about equally likely to work full time, 95.7% (Bureau of Labor Statistics 2017)

196
Q

What percentage of the population identifies as lesbian, gay, bisexual or transgender?

A

4.5% (Gallup 2018)

197
Q

Who has greater left hemisphere specializataion, men or women?

A

Men. Ostensibly, and grossly, this leads to more affective skills for women, and more logical, analytic, visual-spatial for men

198
Q

Who has a transactional view of infant development?

A

Sameroff (each impacts other)

199
Q

2-week-old infants have what visual acuity?

A

20/500. At 5 1/2 months they have 20/70. At birth, infants are aware of high contrast features

200
Q

By what age does auditory location ability reach adult ability?

A

6 months

201
Q

What at 6 months predicts intellectual development at 3 years of age?

A

Maternal involvement, verbal responsiviity, organization of physical environment, variey in daily stimulation, and play materials

202
Q

What are the frequencies of hallucations for the different senses when hallucinations are present?

A

AH 80 to 100%, VH 30 to 80%, Olfactory 20%, Tactile 35%

203
Q

What are reliable, valid and specific measures in schizophrenia?

A

Illogical thinking and loose associations (note children, under 7 are illogical and loose to an extent)

204
Q

What are the most commonly found signs and symptoms in adolescent depression?

A

Decreased mood, hopelessness, social withdrawal, agitation, nihilistic ideas

205
Q

In fear states, projection neurons rely on what neurotransmitter?

A

Glutamate. Thalamus –> amygdala –> effector organs. GABA mediates glutamate in the amygdala

206
Q

What brain structure plays a key role in fear conditioning?

A

Nuclei in the amygdala, a medial temporal lobe structure anterior to the hippocampus

207
Q

Who said a period of semi-criminality is normal for all healthy boys?

A

Stanley Hall 1904

208
Q

What percentage of adolescents have diagnosable clinical disorders?

A

20%

209
Q

At what age do feelings of sexual awareness and attraction make their conscious appearance?

A

10 (perhaps linked to rising adrenal androgens). This is also true for same sex attraction

210
Q

In synaptic pruning how many synapses are pruned per second?

A

30,000. Persons lose half of the cortical synapses present before puberty, mostly excitatory synapses

211
Q

What are the initial manifestations of puberty in boys?

A

Growth of penis and testes

212
Q

What are the initial stages of puberty in females?

A

Breast development (9) and pubic hair (9)

213
Q

What marks puberty proper (hormonally)

A

Pulsatile release of gonadotropin-releasing hormone (GnRH) leads to increased pituitary follicle-stimulating hormone (FH) and luteinizing hormone (LH), leading to increased gonadal hormones (testosterone for men and estrogen for females)

214
Q

The effects of a model pre-school disappear when?

A

3 to 6 years after children enter public school (they have fewer special education needs)

215
Q

Sociometric studies of children reveal which 5 groups?

A

Popular, average, rejected, neglected, controversial The rejected: a) undervalued type–i.e. low self-esteem b) those with a positive view of self but who are seen as defensive and aggressive

216
Q

The opinions and descriptions we form of ourselves by what age are thought to continue throughout life?

A

10 years of age

217
Q

What is “hitting the cultural wall”?

A

According to Gilligan, pre-adolescent girls discern that society values appearance more than accomplishment and they become self-critical (Gilligan 1990)

218
Q

What is the corresponding percentage of adult brain weight achieved at birth, age 5, and age 14?

A

10%, 90%, 100%

219
Q

At what age do infants stop automatically crying in response to their peers’ cries and instead attend to their distress?

A

6 months of age

220
Q

According to Ainsworth, what percentage of infants are securely attached?

A

65% (2/3); 20% are avoidant; 15% are ambivalent

221
Q

By what age do infants display all the facial expressions of adults?

A

9 months. The last to occur is fear

222
Q

Make believe play emerges at what age?

A

2.5 years of age

223
Q

Describe imaginative play’s purpose

A

Key to cognitive and emotional development; means by which the uncontrollable qualities of one’s physical and social environment can be gradually miniaturized and manipulated; serves purpose of individuation and self-definition; the capacity to create miniature possible worlds is a critical feature of healthy development.

224
Q

Do children who want transitional objects have more difficulty?

A

They have better sleep, are more self-confident, independent, affectionate, attractable

225
Q

How is the emergence of imaginative play related to attachment?

A

Early optimal attachment predicts later emergence of pretend play

226
Q

Children can produce all sounds of their language correctly by what age?

A

7 (if past this, they have a speech disorder). Kids understand the basic rules of language by age 5

227
Q

Vocabulary grows at a rate of how many words per day in the school years?

A

9

228
Q

By age 5 how many utterances are spent on a single topic?

A

5

229
Q

What are aspects of pragmatic language skills?

A

Taking turns, responding appropriately to others, self-correcting speech, recognizing taboo words, providing clarification when requested (emerges 3 to 5)

230
Q

What was Freud’s view on moral development

A

A harsh superego leads to feelings of guilt and thus antisocial acts (I am bad, guilty and therefore do bad things; or I do acts to set up punishment). In a contrary vein, Freud also thought a harsh superego could lead one to be unduly virtuous

231
Q

What did Damasio believe about moral development?

A

We are born with the neural propensity to generate somatic states accompanied by pleasant or unpleasant emotions in response to stimuli concerning personal and social behaviors

232
Q

What is the impact of maternal depression in moral development?

A

Boys despite being more empathic and prosocial advocate aggression as problem solving (Hay 1994). Zahn-Waxler showed maternal depression in the toddler years led to an exaggerated sense of guilt later

233
Q

What was one of the things Patterson showed about the emergence of aggression in a classroom of 4 year old boys?

A

In an unstructured nursery with little intervention from teachers, 4 year old middle class boys learn to become ever more aggressive in imitation of other assertive children, when they see such behavior rewarded with success (i.e.others getting what they want)

234
Q

At what age do children start to feel proud our ashamed of themselves without an external audience?

A

8 years of age

235
Q

At what age does empathy manifest?

A

By 9 months, children can locate a feeling in others. In the first year they respond to distress as if it were happening to themselves. From 1 to 2 years of age they can offer sympathy. From 2 to 3 years of age, veridical empathy emerges based on their knowledge that others have thoughts and feelings. (At 18 months children understand how to hurt and comfort.) Hoffman 2000

236
Q

What is convention versus morality?

A

Convention, is a standard way of doing things, such as calling a teacher by their last name. Morality is about more universal matters; e.g. pushing a child off the swing is always bad

237
Q

At what age does a sense of winning and losing emerge?

A

> 33 months. Pride emerges at 21 months

238
Q

What is a critique of Gilligan’s work?

A

Limitation of sampling and lack of clarity of analyses

239
Q

At what age does conflict over personal space and toys emerge?

A

1+ year

240
Q

What percentage of abortions are performed in adolescents?

A

1/3

241
Q

What percentage of adolescents masturbate?

A

For 14 to 17 year olds, the percentage of those who had masturbated at least once was 80% for boys and 58% for girls (National Survey of Sexual Health and Behavior 2011)

242
Q

By what age are children capable of describing mixed emotions?

A

8 to 10 (7 year olds can be aware of two emotions if they do not appear incompatible and are directed to the same event). 10 year olds may have a difficult time with two emotions if they are incompatible about the same event; they can be aware/describe two emotions that are incompatible about different events (e.g. thrilled about airplanes, scared being away from home). By 12 years of age children can be aware of fully contradictory emotions toward the same event (e.g. upset that coach yelled but glad that she was honest)

243
Q

By what age can children accept negative feelings like sadness rather than denying or distancing themselves from such feelings?

A
  1. Children under 7 are more likely to deny and distance themselves from negative feelings and present uniformly happy self-portraits. Children between 7 and 11 tend to project negative feelings onto others while they deny their own. Children even under 7 can explain and label emotions (e.g. why the puppet is crying) and think about what makes it better, just not their own feelings.
244
Q

What can be said about a pre-adolescent child and the discussion of negative feelings?

A

It is relatively rare for a pre-adolescent child to discuss negative feelings

245
Q

What are 5 areas children and adolescents cite as most important to them?

A

School achievement, athletic skill, peer acceptance, good behavior, and physical attractiveness (not necessarily in that order) Harter 1993

246
Q

There is no consensus on the definition of metabolic syndrome in children. What is the definition of metabolic syndrome in adults?

A

1) Elevated waist circumference based on population and country-specific definitions;
2) Systolic blood pressure (BP) of 130 mmHg or more and/or diastolic BP of 85 mmHg or more or on treatment for hypertension;
3) Fasting blood glucose of 100 mg/dL or more or on treatment for hyperglycemia;
4) Triglycerides of 150 mg/dL or more or on treatment for elevated triglycerides;
5) HDL cholesterol less than 40 mg/dL in males and less than 50 mg/dL in females or on treatment for reduction of HDL cholesterol.

247
Q

What controlled trial showed bupropion to be effective for ADHD?

A

Casat et al. 1987; 1989. N = 72, multisite

248
Q

Avoidant and defended children do what regarding attachment?

A

Carers are anxious and rejecting when others place demands on them. Children cope by excluding attachment based feelings and behavior from conscious processing. Displays of need, weakness, dependency, vulnerability in the self or others make them anxious and avoidant. To be acceptable and increase others’ availability they become emotionally self contained and are observant about feelings and behaviors in others. More extreme cases (abused) do not seek safety or comfort when ill, upset, vulnerable, or frightened. They have learned that care and protection are not unconditionally available and a state of need only seems to make matters worse. Attachment will trigger anxiety, distress, aggression. Rx: Adults acknowledge, explore, and reflect on their own feelings, especially of need and vulnerability.

249
Q

What antipsychotic agents have the best metabolic profile?

A

In regard to glucose metabolism in order: ziprasidone, lurasidone, aripiprazole, risperidone, quetiapine, paliperidone, asenapine, haloperidol, clozapine, olanzapine (Zhang et al. 2017)

250
Q

Heller’s review of the literature showed what about those resilient to the effects of maltreatment?

A

Above average IQ; higher self esteem; internal locus of control; external attribution of blame (when warranted); presence of spirituality; ego resilience; higher ego control; family cohesion (including competent foster care); positive school experience (Heller 1999)

251
Q

What do children with ambivalent stances (resistant, dependent) show behaviorally?

A

Carers are inconsistent and poor at recognizing other people’s needs and attachment signals. Children cope and adapt by maximizing their distress and attachment behavior to increase their chance of getting noticed. They have high anxiety around being ignored and left alone with their needs unmet and their arousal unregulated. They have little confidence in their own abilities to bring about change and get what they need. They have an angry, dissatisfied, demanding, needy, pleading, provocative approach to relationships. They have a drive to be noticed, valued, acknowledged, and recognized. Often in a crisis state and never satisfied. Rx: help children stop and reflect, help re-structure so they feel valued and worthwhile, and help them think through their feelings and behaviors.

252
Q

Attachment based therapies aim to do what?

A

Affective regulation is key to all interventions. Develop the capacity for empathy, mind-mindedness, and reflective function. Help get in touch with feelings, to recognize them, consider their impact on self and others, and begin to process them in a more reflective, congenial, and regulated way

253
Q

What are the 5 subtypes of agression according to Sudgen

A

Impulsivity, affective instability, anxiety/hyperarousal, cognitive disorganization, predatory/planned/instrumental

254
Q

The amygdala is implicated in what?

A

Development and retrieval of emotional memory; learning of nonverbal motor patterns, trigger of flight or fight; threat detection; production of fear and anxiety

255
Q

Which authors have found that stimulants do not increase tics?

A

Gadow 1995; Nolan and Gadow 1997; Castellanos 1997 among others

256
Q

How do children with disorganized attachment behave?

A

Carers are the direct cause of distress. When there is abuse, children suffer the worst elements of both avoidant and ambivalent caregiving environments. They experience both unpredictable danger and abandonment. Emotional arousal remains acutely and chronically activated. They focus on securing safety rather than pleasure in interactions with the caregiver. Parents do not attune with the child’s mental state resulting in the child not having mental representations of their own or others’ psychological makeup; therefore such children have difficulty regulating their own arousal; with maturation they are less helpless. They take control of their own safety and needs resulting in controlling strategies including compulsive compliance, compulsive caregiving, compulsive self-reliance, and coercion (threatening/aggression vs. helplessness/disarming). The coping strategies breakdown under stress, resulting in fright, anger, sadness, dysregulation. Rx: Feel safe to recognize, acknowledge, and process their emotions. Help them see that they feel safe in anxious control but that this denies understanding of others’ and their minds.

257
Q

What does Schore say?

A

Young minds develop in the context of relationships

258
Q

What does Fonagy say about children’s minds?

A

Parents’ capacity to observe the child’s mind seems to facilitate the child’s general understanding of minds and hence self-organization through secure attachment

259
Q

What is a social milestone at 6 weeks?

A

Social smile

260
Q

What is a social milestone at 2 months?

A

Recognizing mother

261
Q

What is a social milestone at 8-10 months?

A

Peek a boo; stranger anxiety

262
Q

What is a social milestone at 12 months?

A

Drinking from a cup

263
Q

What is a social milestone at 14-18 months?

A

Imitating housework

264
Q

What is a social milestone at 24 months?

A

Playing interactive games

265
Q

What is a social milestone at 4 years of age?

A

Dressing with supervision

266
Q

What is a social milestone at 5 years of age?

A

Dressing alone

267
Q

What are common personality traits in children?

A

Egocentricity, inhibition, cautiousness, self-confidence; sociability; activity; resentfulness; oppositionality

268
Q

What are language milestones?

A

6 weeks response to bell; 4 months cooing; 6 months laughs; 8-10 dada/mama non-specific; 12 months dad/mom specific; 14-18 months combines two different words; 24 months knows 50 words; 36 months gives first and last names; 4 years recognizes colors

269
Q

When can a child give his first and last name?

A

36 months

270
Q

When can a child name colors?

A

4 years of age

271
Q

When does a child say dada/mama non-specifically?

A

8-10 months

272
Q

When does a child say dada/mama specifically?

A

12 months

273
Q

When does a child combine two different words?

A

14-18 months

274
Q

When does a child know 50+ words?

A

24 months

275
Q

When does a child respond to a bell?

A

6 weeks

276
Q

When does a child coo?

A

4 months

277
Q

When does a child laugh?

A

6 months

278
Q

What domains are typically considered in the neuropsychological evaluation of children?

A

Cognitive function, motor function, perception, visuomotor integration, language, learning and memory, academic abilities, executive function

279
Q

What is a pre-morbid course of schizophrenia when looking at childhood function?

A

One-half to three-quarters had motor, language, social disturbances prior to psychosis (from several studies). In one study Alaghabad-Rad et al, many had repeated a grade prior to psychosis, 50%; 65% had special education; 35% had a specific learning disability

280
Q

What percentage of children aged 3 with aggression have aggression at 8 years of age?

A

68%

281
Q

What are gross motor milestones for 2 mo, 4 mo, 6 mo, 8-10 mo, 12 mo, 14-18 mo, 24 mo, 48 mo olds?

A

2 mo sits with head steady; 4 mo rolls over; 6 mo sits alone; 8-10 mo stands, creeps; 12 mo walks; 14-18 mo throws ball overhand; 24 mo rides tricycle; 4 yrs hops on one foot

282
Q

What are the communication disorders in DSM-5?

A

Language disorder; speech sound disorder; childhood-onset fluency disorder; social (pragmatic) communication disorder; unspecified communication disorder

283
Q

What are four major concepts related to death?

A

Irreversibility, finality (non-functionality), causality, inevitability (universality). Irreversibility, Finality, and Universality are known by 5 to 7 years of age (earlier than previously thought)

284
Q

Juveniles with four or more arrests commit what percentage of violent crimes by juveniles

A

Close to half

285
Q

What is working memory?

A

Attention-like central executive in the dorsolateral prefrontal cortex (DPFC) that manages both an articulatory loop a/w reception of phonological info and production of speech and a visual-spatial scratch pad for encoding images (Eysenck 1990)

286
Q

What is Piaget’s sensorimotor stage?

A

Sensorimotor 0 to 18-24 mo. Physical to psychological stage. Primary circular reactions: getting feedback from one’s own body. Secondary circular reactions, external world provides feedback. Tertiary circular reactions, novelty for its own sake. Symbolic stage

287
Q

What is Piaget’s pre-operational stage?

A

Age 2 to 5-7. Object permanence, magical thinking, one attribute is focus (cannot decenter); egocentrism

288
Q

What is Piaget’s concrete operations?

A

Ages 6 to 11. Classification, seriation, conservation

289
Q

What is Piaget’s formal operations?

A

Age 11 to adult. Hypothetico-deductive: what could be

290
Q

When is the genital-narcissistic phase

A

36 to 48 months

291
Q

When is the anal phase?

A

18 to 36 months

292
Q

When is the oral phase?

A

0 to 18 months

293
Q

Describe aspects of the oedipal phase

A

4 to 6 years. Capacity for neurosis, internal struggle between opposing forces (wishes vs. values, desires vs. parental attitudes and opposing desires)

294
Q

Describe the latency phase

A

7 to 10 years. Rules of the game, sense of right and wrong, empathy

295
Q

What does temperament refer to?

A

Sources of variation in affect, mood, and action influenced by genetic processes in early life

296
Q

What are specific areas that clinicians should observe in language?

A

Inner language (look for play); comprehension (follow conversation); production; phonation (pitch, volume, intonation, prosody); pragmatics (effective communication); metaphoric language

297
Q

How many females get polycystic ovary syndrome with valproic acid?

A

80% (Isojarvi 1993) of the women who started VPA for epilepsy before age 20 developed PCOS.

298
Q

What metabolic syndrome is shown by VPA?

A

Obesity, hyperinsulinemia, lipid abnormalities, PCOS, hyperandrogenism

299
Q

What fine motor milestones are seen at 6 wks, 2 mo, 4 mo, 6 mo, 8-10 mo, 14-18 mo, 24 mo, 3 yo, 4 yo, 5 yo

A

6 wk follows past midline; 2 mo reaches for object; 4 mo holds a rattle; 6 mo passes cube hand to hand; 8-10 mo thumb finger grasp; 14-18 mo four cube tower; 24 mo 8 cube tower; 3 yo copies circle; 4 yo copies cross, draws man in 3 parts; 5 yo copies a square

300
Q

Who found that omega-3 fatty acids may have atherapeutic benefit in childhood depression?

A

Nemets et al. 2006; n = 28 aged 6 to 12 (controlled double blind pilot study). Perhaps reasonable agent to use for families who can afford it and who are initially concerned about psychopharmacology, especially given the benefits of placebo response in addition to supplement effect.

301
Q

What are goals of treatment besides symptom relief?

A

Restore psychological development to normal path; increase management of anxiety; enhance affect regulation; improve self esteem; increase frustration tolerance; increase age appropriate autonomy; increase capacity for pleasure; improve relationship with peers

302
Q

What are phase I reactions?

A

Hydroxylation, reduction, hydrolysis

303
Q

What are phase 2 reactions?

A

Conjugation of metabolites generated in phase I (with glucuronic acid and sulfate)

304
Q

What is the triple-pathway model to describe the development of violent behavior?

A

Overt pathway: minor aggression leads to physical fighting leads to personal violence, assault, rape, murder. Covert/reactive: non-confrontational behaviors: lying, shoplifting leading to property damage (vandalism, fire setting). Authority conflict pathway: defiant stubborn behavior, out at night, run away, truancy

305
Q

What happens after 8 hours of fasting?

A

Corticotropin-releasing hormone (CRH) increases, a potent anorexic agent

306
Q

How does abuse lead to aggression?

A

Deficits in verbalization, the putting of feelings into words; decreased empathy; misperception of threats; turning anger into action

307
Q

What is IDEA?

A

Individual with Disabilities Act (Succeeded Public Law 94-142 passed 1975)

308
Q

What is transductive reasoning?

A

Things related in time and space are believed to be related casaully

309
Q

What is the legal criterion for disclosure in the context of medical practice?

A

“Material Risk”. Standard for this is what a ‘reasonable person’ would view as material

310
Q

What is the purpose of the Adoption Assistance and Child Welfare Act of 1980 (Public Law 96-272).

A

The Adoption Assistance and Child Welfare Act of 1980 requires that child protective services (CPS) agencies make reasonable efforts to avoid unnecessary removal of children from their homes and to reunify children in foster care with their families whenever possible.

311
Q

What are two civil rights laws that prohibit discrimination on the basis of disabilities?

A

American Disabilities Act of 1990 (allows for accommodations). Section 504 of the Rehabilitation Act of 1973

312
Q

Family Preservation and Support Services was enacted by Congress what year?

A
  1. Originally named the Family Preservation and Family Support (FP/FS) Services program, the program’s scope was expanded in 1997 and was reauthorized as the Promoting Safe and Stable Families (PSSF) program. The primary goals of Promoting Safe and Stable Families (PSSF) are to prevent the unnecessary separation of children from their families, improve the quality of care and services to children and their families, and ensure permanency for children by reuniting them with their parents, by adoption or by another permanent living arrangement. The programs include: family support, family preservation, time-limited family reunification and adoption promotion and support services. (OPRE 2002)
313
Q

The EAHCA (Education for All Handicapped Children Act) was revised to the Individuals with Disabilities in Education Act (IDEA) in 1990 for what main reason?

A

To address children with serious emotional disturbance (SED) who were underserved. (SED later became ED so that the barrier to services was not overly restrictive.)

314
Q

Which Congressional Act led to a right for an appropriate education?

A

The Education for All Handicapped Children Act (EAHCA) 1975.

315
Q

What is the academic benefit of retaining a student versus promoting them?

A

None according to best evidence (Mattison 2000)

316
Q

What did the Cambridge-Somerville study show?

A

That treatment intervention can be detrimental

317
Q

When and where the first partial hospital programs?

A

Russia late 1930s for adults; Canada 1940s; England 1950s; USA 1950s. The MHC Act of 1963 mandated services including PHP for children and adolescents.

318
Q

What do we know about the effect of time in psychotherapy?

A

Most gain is within the first 10-20 sessions. Effect size increases if time is limited. Effect may decrease with longer periods of therapy

319
Q

How does parental harshness weaken the superego?

A

Punishment that hurts the child leads the child to focus on external struggle and is distracted from the internal struggle with shame, guilt or remorse

320
Q

What are the most common delusions in children?

A

Persecutory and somatic

321
Q

What are the four symptom categories of conduct disorder?

A

Aggression, destruction of property, deceitfulness or theft, serious violation of rules

322
Q

What is the outcome of COS?

A

20% remission, 30% improve, 50% mod-poor outcome (Eggers 1978). 18 with SZP in hospital –> 11/18 still with SZP symptoms 2-7 years later (Asarnow 1994). 15 kids with SZP, 11 still with SZP symptoms (Kidd and Werry 1992)

323
Q

Using 10% increase in body weight as a threshold, what percent of those with clozapine, olanzapine, and risperidone increase their weight by 10%?

A

40% CLZ, 30% OLZ, 10% Ris

324
Q

Green assessed 66 boys with gender stereotypical feminine traits and 56 controls at a mean age of 7.1 years and followed up when they had a mean age of 18.9 years. What were the findings?

A

In the control males at follow up, all had heterosexual fantasies; of those who had sex, one had had bisexual sex, and the rest had heterosexual sex. The other males, 75% were bisexual or homosexual and 25% heterosexual; if had had sex 80% had had bisexual or homosexual sex; only one of the boys attracted to males was considering a sex change.

325
Q

What percentage of boys with gender identity disorder (now gender dysphoria in DSM-5) in one study, applied for sex reassignment surgery?

A

23%

326
Q

Most children and adolescents relapse to drug or alcohol use because of_____?

A

Peer pressure

327
Q

What are the five stages of motivational interviewing?

A

Pre-contemplation, contemplation, preparation, action, maintenance

328
Q

What does the data show regarding 12 step programs for adolescents?

A

2 or more meetings per week leads to 6 times the abstinence at one year compared to those who do not attend

329
Q

What is the drug detection time for stimulants in a urine drug screen?

A

48 hours

330
Q

What is the drug detection time for the cocaine metabolite benzoylecgonine?

A

3 days

331
Q

What is the drug detection time for opiates (morphine, codeine)?

A

2 days

332
Q

What is the drug detection time for barbiturates?

A

1 day

333
Q

What is the drug detection time for diazepam?

A

4 days

334
Q

What is the drug detection time for methaqualone?

A

2 weeks

335
Q

What is the drug detection time for THC?

A

4 days to 1 month

336
Q

What trial showed fluoxetine to be potentially useful in selective mutism?

A

Double blind PBO N=16, 4/6 improved vs 1/9 on PBO. Black and Unde 1994

337
Q

What are the FDA approved ages for OCD for sertraline, fluoxetine, and fluvoxamine?

A

6 years old, 7 years old, and 8 years old

338
Q

What percentage of reduction in symptoms of OCD is there on an SSRI?

A

30-40% reduction. At times it takes 6 to 12 weeks for an effect.

339
Q

How are personality traits defined in the DSM?

A

Enduring patterns of perceiving, relating to, and thinking about oneself and the environment that are exhibited in a wide range of social personal contexts

340
Q

What five types of specific phobias are there?

A

Animal type, natural environment type, blood injection injury type, situational, other

341
Q

When did the U.S. Congress enact legislation restricting confinement of status offenders?

A
  1. A status offense is a crime only by virtue of not being an adult (e.g. drinking under age)
342
Q

The legal case Gault did what?

A

Expanded on Kent requiring due process for all juveniles in delinquency proceedings

343
Q

What did Kent v. US 1966 decide?

A

Due process needed when a child is waived (transferred) to adult court

344
Q

What court decision upheld the practice of parents volunteering their kids into a hospital?

A

Parham vs. JR and JL 1979

345
Q

What does MST (Multisystemic Therapy) show regarding treatment effect?

A

Long term rate of criminal offenses by serious juvenile offenders is decreased; reduced rates of out of home placements; reduced rates of drug use and drug related offenses; improvement in family function; decreased rates of other mental health problems

346
Q

What might be the function of REM?

A

Conversion of short-term memory to long-term of daytime experience

347
Q

Do benzodiazepines work in kids?

A

Not really (Simon 1992 alprazolam; Graae 1994 clonazepam)

348
Q

What meds have been studied (have trials) in anxiety disorder in children?

A

Rynn Rupp Study 2001 N= 22 sertraline for GAD; N 74 2003 Birmaher fluoxetine for GAD, SP, SAD (61% response vs. 35%); a trial of fluvoxamine non-response to fluoxetine with response justifies a medicaton switch

349
Q

What did Kendall show regarding cognitive behavioral therapy for generalized anxiety disorder and social anxiety disorder?

A

High response 65% vs. 5% and 50% vs. 6% response in two studies. Kendall developed the Coping Cat manual

350
Q

What two factos in parenting style may impact the development of an anxiety disorder?

A

Warmth and rejection –> less accepting. Parental control –> granting less autonomy

351
Q

What are the most common symptoms in children with generalized anxiety disorder?

A

Tension, apprehension, reassurance need, irritability, negative self image, physical complaints. Adolescents ruminate and children need reassurance

352
Q

What did Alexander et al., developer of family functional therapy (FFT), find regarding parents of children with juvenile delinquency?

A

Can be more defensive and blaming of others

353
Q

What does Patterson (1989) propose as a reliable sequence of antisocial behavior?

A

Ineffective parenting–>academic failure–>peer rejecrtion–> depressed mood –> deviant peer group

354
Q

What did Connor find about aggression in ADHD?

A

Stimulants are effective for aggression within ADHD as core symptoms of inattention and hyperactivity/impulsivity but there is less effect size if conduct disorder is present

355
Q

What is the learning theory of aggression?

A

Child learns to escape unpleasant tasks by becoming hostile and negative (however, why some adopt this stance is unclear given the negative relationship consequences)

356
Q

What did Widom (1989) say regarding parental aggression and child aggression?

A

No convincing evidence of a clear link that a child who is aggressive has parents who are aggressive; rather certain processes transmit aggression: 1) injurious actions are normal and justified. 2) egocentrism is normal and virtuous

357
Q

What did a 10-15 year follow-up study of inpatient patients with anorexia show regarding outcome?

A

75% do not have an eating disorder and recovery time is about 5 years (Strober et al. 1997); 15% had chronic anorexia

358
Q

What do bone density findings show in anorexia?

A

90% have bone density 1 standard deviation below normal; 38% have 2.5 standard deviations below

359
Q

What is the outcome of OCD per follow up data?

A

In children, Swedo found that 30% met criteria 2 years later and had lower scores of OCD; there was a 70% recovery rate. Many, however, had depression and anxiety despite the improved OCD

360
Q

What did an RCT multisite study by March et al. 1998 show regarding SSRI treatment?

A

In children, 42% of patients had a reduction of 25% of symptoms. Sertraline was used.

361
Q

What are the recommendations regarding tricyclic antidepressants and the cardiovascular system?

A

Obtain an EKG at baseline and at 3mg/kg/day and at the final dose not to exceed 5mg/kg/day. Parameters should remain be follows: PR interval less than .21; QRS changes no more than 30% over baseline; heart rate less than 130; systolic BP less than 130; diastolic BP less than 85 (Elliott and Popper 1990)

362
Q

What is the long -term urinary continence for treatment with imipramine, DDAVP, and the alarm system after weaning from therapy?

A

Imipramine 36% with treatment, 16% once discontinued; DDAVP 68% with treatment and 10% discontinued; alarm 63% with treatment and 56% when discontinued

363
Q

What are common laboratory findings in anorexia?

A

Decreased anemia, leukopenia, hypoproteinemia, estrogen, testosterone, T3, diurnal cortisol, metabolism, bone density, hyposecretion of GnRH, and leptin. Increased CRH, hypercarotenemia, GH fasting (decreased response), HCG

364
Q

What are the key mental representations in attachment?

A

1) Attachment figure is accessible and emotionally available in time of need. 2) Feeling self-worthy and lovable

365
Q

What is the effect of a punitive style on moral development?

A

Dienstbier study 1984 showed that if children are coerced, they attribute resistance to external forces and if they are not discovered it is okay. If they are not coerced, they attribute resistance to their own choice

366
Q

Auditory hallucinations are associated with what brain structures?

A

Dysfunction in the primary auditory cortex in the anterior and middle superior temporal gyrus

367
Q

How are magical thinking and morbid fantasies related to delusions?

A

They are precursors if they are fixed and pervasive, the child acts on them, or the child does not accept the imaginary quality

368
Q

What can immediate termination of parental rights proceed?

A

Murder, rape, sexual abuse

369
Q

When can the state petition for termination of parental rights?

A

After 18 months if family reunification has failed and the child has been in foster care 18 months

370
Q

What is the most frequent outcome of children who are abused?

A

Aggression and attribution of hostile intent to peers

371
Q

Who helped prosecute the first child abuse case?

A

The Amercian Society for the Prevention of Cruelty to Animals (ASPCA)

372
Q

When was the concept of a child’s best interest originally acknowledged?

A

Chapsky v. Wood 1881

373
Q

Juvenile, family, and surrogate courts deal with what issues respectively?

A

Juvenile–delinquency, abuse, neglect. Family: divorce and child custody. Surrogate: civil commitment, guardianship, adoption, administration of trusts and estates, contested wills

374
Q

What is characteristic of children who are genuine victims of sex abuse compared to those who are not?

A

Children are genuinely ashamed, embarrassed, and less willing to reveal details. Children who falsely accuse embellish events, incorporate unrealistic details, have little discomfort in revealing the alleged acts

375
Q

What is the level of certainty required for termination of parental rights?

A

Clear and convincing evidence

376
Q

What did the federal government enact to address lack of stable, healthy, consistent attachment of children in foster care

A

Adoption Assistance and Child Welfare Act of 1980. It mandated social welfare agencies to help families remedy issues leading to removal of their children, and if reunification failed to begin permanency plans within 18-20 months

377
Q

What does Wheeler v. US (1985) find?

A

A 5 year old is not automatically disqualified as a witness

378
Q

What does media violence do?

A

According to some, increases aggression; desensitized to violence in the real world; creates perception of world as unfriendly and dangerous; risk of psychological problems

379
Q

What did Kent vs. U.S. (1996) decide?

A

Due process for juveniles being transferred to adult court

380
Q

What did in re Gault 1967 decide?

A

Due process rights for children, which includes notice of charges, a right to counsel the right to confront witness and cross examine, the privilege against self-incrimination, and the right to appellate review

381
Q

What decision allowed for pretrial detention of youth?

A

Schall v. Martin 1984

382
Q

What case said juveniles do not have a constitutional right to a jury trial?

A

In re Winship 1970

383
Q

What case declared that the standard of proof in juvenile cases should be beyond a reasonable doubt?

A

McKeiver v. PA 1971

384
Q

What did NJ vs. TLO 1985 decide?

A

A principal can search a student’s purse (belongings) without warrant

385
Q

What is a rationale for interpreting unconscious conflict?

A

To bring such material (and its behavioral and emotional derivatives) under greater control

386
Q

What study looked at children with autism resulting in higher IQ?

A

Lovaas 1987. 30 points higher with 40 hours a week of behavioral modification for two years

387
Q

What is a hypothesis about fathers who can be abusive?

A

The father is extremely jealous of a spouse’s attention toward the targeted child, stemming from his own maternal deprivation and sibling rivalry.

388
Q

What four factors are involved in the extent of the psychological effects in sex abuse?

A

Traumatic sexualization, powerlessness, stigmatization, betrayal

389
Q

What percentage of kids average 5 years in foster care?

A

60% (Massachusetts study)

390
Q

What are cognitive factors in conduct disorder?

A

Social problems are based on the perception that others are hostilely motivated; have fewer and less effective solutions; less likely to get into trouble for exhibiting aggressive behaviors; fewer social problem-solving strategies; negative conflict management; delayed play skills; immature mode of role taking

391
Q

When was the first case of juvenile delinquency recorded?

A

3000-4000 B.C. Sumerian clay tablets

392
Q

What is NVLD?

A

Nonverbal learning disorder. It is postulated to result from right hemisphere deficits. Associated with math disorder; handwriting difficulties; deficits in spatial reasoning; visuomotor integration problems; and social skills deficits

393
Q

What percentage of those with juvenile delinquency have a learning disorder?

A

30% National Council on Disability (2003)

394
Q

In juvenile justice what does the Weinberger inventory show?

A

Personality functions along two dimensions, distress and self-restraint resulting in 4 types. Non-reactives are those that have both low distress and low self restraint. 90% of this subtype is re-arrested at 4.5 years.

395
Q

What are examples of cognitive problem-solving skills?

A

Alternative solution thinking. Means end thinking. Consequential thinking. Causal thinking. Sensitivity to interpersonal problems.

396
Q

What did Lewis say about children who are abused?

A

The capacity of abused children to repress or deny their own painful feelings or those of others, their emotional lability and impulsivity, distortion of reality, feeling of threat where no threat exists, tendency to put angry feelings into action rather than words, results in an enduring adaptational style with unlovable characteristics and results in clinicians’ tendency to dismiss severely abused children as conduct disordered or sociopathic

397
Q

What is the FIND acronym for Bipolar Disoder?

A

Frequency: most days
Intensity: symptoms are severe enough to cause extreme disturbance in 1 domain or moderate in 2 or more
Number: Symptoms 3-4 per day
Duration: 4 total hours per day (and sleep decreased by 2 hours or more)

398
Q

What are elements of PCIT (Parent Child Interaction Therapy)?

A

Praise, reflection, imitation, description, enthusiasm (PRIDE). Deliver commands. For ages 2 to 7 with ADHD; Adapted for age 4-12 for parents who are abusive

399
Q

What are the elements of trauma focused CBT?

A

Child: coping skills training, emotional expression skills, cognitive coping training, relaxation training, gradual exposure and processing, education about child sexual abuse, healthy sexuality, personal safety skills

400
Q

What are resilient positives in a child for adaptation?

A

Good self esteem; engaging; desire to be loved and cared for; hope for the future; appreciates appropriate social behavior; fine and gross motor skills; higher IQ; internal locus of control; problems are viewed as external; psychologically minded; good social relationships; empathy; enjoys leisure; has best friend; can work; responds to discipline; has impulse control; able to put feelings into words

401
Q

What is QT dispersion?

A

Potentially more useful than QTc finding. The difference between the longest and the shortest QT on the EKG leads. Pathological if > 100ms difference among the leads or if increased 100% from baseline); 40-60 ms differences are considered acceptable.

402
Q

What are the detection time for drugs: stimulants, opiates, cocaine, THC, benzodiazepines?

A 
Stimulants 48h	
Cocaine 3 days	
Opiates 2 days	
THC 4 days to 1 mo	
Benzos 4 days
403
Q

What is an alternative to the CAGE questions for adolescents?

A

CRAFFT C - Car; in car with driver high R - Relax; use drugs to relax, feel better, fit in A - Alone; use drugs alone F - Forget; forget things F - Family; family or friends mention it T - Trouble; trouble with law etc. (Knight et al. 1999)

404
Q

What EKG parameters would lead to a dose reduction if on a medication that might prolong them?

A

Qtc > 460, QRS > 120, PR > 200

405
Q

When was the first psychiatric unit established for adolescents?

A

in the 1930s for males; referred by the courts

406
Q

When is the last time a parent successfully sued a physician for the treatment of a minor 15 years or older without parental consent?

A

40 years ago (however a parent is not responsible for the cost of medical care if they do not consent to treat the minor)

407
Q

What is the most frequent source of legal suits against psychiatrists?

A

Drug reactions

408
Q

What is binge drinking definition and what percentage of high school seniors have binged in the last month?

A

Nationwide, 13.5% of students had had four or more drinks of alcohol in a row (if they were female) or five or more drinks of alcohol in a row (if they were male) within a couple of hours on at least 1 day during the 30 days

409
Q

How many cases were referred to child protective services in the USA in 2016?

A

4.1 million referrals. Of these referrals, approximately 2.3 million reports concerning approximately 3.6 million children (duplicate count) were screened in as “appropriate” for CPS response. Approximately 17.2 percent of the children investigated were found to be victims of abuse or neglect. The remainder of the children investigated 82.8 percent were found to be
non-victims (Childwelfare.gov 2018)

410
Q

What is most common form of abuse?

A

ƒIn regard to CPS findings:
74.8 percent of victims suffer neglect.
ƒ 18.2 percent of victims suffer physical abuse.
ƒ 8.5 percent of victims suffer sexual abuse.
ƒ 5.6 percent of victims suffer psychological
maltreatment.
ƒ 2.1 percent of victims suffered medical neglect.
ƒ 6.9 percent of victims experienced “other”
maltreatment, which may include threatened abuse
or parental substance use. States define “other”
differently. (Childwelfare.gov 2018)

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