CP Flashcards
What percentage of patients with suicidal ideas go on to make an attempt?
33%. 66% do so within the first year
What is the odds ratio of suicidal ideation, plan, attempt if three or more psychiatric disorders are present?
OR 6, 9, 9
Which disorder, depression or anxiety, is associated with a likelihood of suicidal thinking and which is associated with an attempt?
Depression–SI; anxiety–SA
What test examines automatic links in the mind?
Implicit Association Test
What is a measure of self-injurious behavior?
Functional Assessment of Self Mutilation
Do those who self injure have a higher or lower physiologic response to stress?
Higher
Among individuals who commit suicide in inpatient settings, what percentage deny suicidal ideas on last contact?
78%
What is an evidence based measure for suicidality?
Columbia-Suicide Severity Rating Scale (C-SSRS)
What might be more effective than the MMSE for screening cognition in emergency populations?
Brief cognitive screen (BCS). The BCS has four components: the two-part Oral Trail Making Test (OTMT) and animal fluency and and the Clock Drawing Test (CDT). http://onlinelibrary.wiley.com/doi/10.1111/j.1553-2712.2010.00682.x/full
What is a reliable screen for depression for teens
The PHQ-9 (Patient Health Questionnaire - 9 items) screens for major depression in adolescents
Describe the clock drawing test
The CDT requires the patient to generate a graphomotor representation of a clock face with a specific designated time. In the current administration, the patient is instructed to draw a clock and put all the numbers where they belong and to subsequently set the clock for 10 minutes past 11. The CDT can be scored using a 5-point system; 1 point each is given for 1) an adequate contour (size, circularity); 2) presence of all 12 numbers; 3) correct positioning of all numbers within appropriate contour quadrants; and correct placement of both the 4) hour and the 5) minute hands.
Describe the animal fluency test
Name as many animals as quickly as possible. They can be from the farm, ocean, jungle, even house pets. The total animal fluency score represents the number of animals generated within a 1-minute interval. Repetitions are not included in the total score, but superordinate categories and category exemplars are considered valid responses
Describe the Oral Trail Making Test (OTMT)
The OTMT consists of two parts. Part A (OTMT–A) requires the patient to count rapidly from 1 to 25; the patient is timed to completion. Part B (OTMT–B) requires repeatedly shifting between two cognitive sets; the patient is instructed, “I’d like you to count again, but now I want you to switch back and forth between numbers and letters, for example, 1–A–2–B–3–C, and so on. Keep going until I ask you to stop.” Test performance proceeds through number 13 and is timed to completion. If the patient is unable to acquire set or proceed beyond 3–C, the test is terminated and a score of 300 seconds is assigned to the performance. For cases in which the patient progressed beyond the clinician-provided example (1–A, 2–B, 3–C) but is subsequently unable to complete the test in its entirety (ending 12–L–13), his or her performance is prorated to yield an estimated time to completion. The OTMT–B consists of 25 individual steps (e.g., 1–A = 2 steps); estimated time to completion is calculated by multiplying the interval time (in seconds) at discontinuation by 25 and dividing that result by the number of steps actually completed
What are the scores for response and remission on the Children’s Yale-Brown Obsessive Compulsive Scale.
A CY-BOCS reduction of 25% appears to be optimal for determining treatment response, a reduction of 45% to 50% appears to be optimal for detecting symptom remission, and a CY-BOCS raw score of 14 best reflects remission after treatment.
What are three trait areas in psychopathy?
Interpersonal (egocentric), affective (callous), behavioral (impulsive)
What seems to distinguish high psychopathic traits in children compared to adults?
High trait anxiety is associated with high psychopathy, which contrasts with adult findings
Fetal exposure to elevations in which maternal interleukin led to structural neuroanatomic alterations among cases in regions of the brain consistently implicated in schizophrenia research
Interleukin 8
Do callous-unemotional states extend lengths of stay for inpatient youth, beyond a diagnosis of conduct disorder or oppositional defiant disorder?
Yes. To meet the therapeutic needs of hospitalized youth with prominent C/U traits, it has been suggested to utilize non-coercive and non-confrontational treatment programs that encourage patients to take personal responsibility for improving their lives
What is a diagnostic instrument for children less than 7
Diagnostic Infant Preschool Assessment (DIPA)
Atomoxetine has been shown to block which receptor, besides norepinephrine?
NMDA (of the glutamate system)
Enuresis in ADHD is associated with what additional diagnosis?
ODD
What do teenage girls who have a propensity for violence fail to discern in others’ faces?
Anger or disgust
Over a 6-month period does risperidone cause cognitive decline?
No
Do antipsychotics increase risk of insulin resistance mechanistically?
Increased insulin resistance may not be related to weight gain alone
What was concluded in a randomized controlled trial with a total of 225 patients diagnosed with bipolar I who were randomly assigned in to 21 days of double-blind treatment with divalproex ER or placebo?
No difference from placebo
What has been found, in one study, about the treatment of obsessive-compulsive disorder by experienced and non-experienced therapists?
Results indicated that clinically inexperienced master’s students with no postgraduate training can be as capable as experienced and certified behavior therapists in treating OCD patients, as long as therapists adhere to a standardized treatment manual and adequate training and supervision is provided. In contrast to other studies, it did not find a supposed benefit of therapist-controlled ERP versus self-controlled ERP in patients with OCD. RCT trial of 100+ patients. van Oppen et al. 2010
What is the odds ratio for developing schizophreniform disorders by age 26 if psychotic symptoms are self reported at age 11?
A research team previously reported that members of the Dunedin (New Zealand) Longitudinal Study birth cohort who self-reported psychotic symptoms at age 11 years had an elevated risk of developing schizophreniform disorders by age 26 (odds ratio, 16.4; 95% confidence interval, 3.9-67.8).
Children’s psychotic symptoms are familial and heritable and associated with what risk factors?
Children’s psychotic symptoms are familial and heritable and are associated with social risk factors (e.g, urbanicity); cognitive impairments at age 5; home-rearing risk factors (eg, maternal expressed emotion); behavioral, emotional, and educational problems at age 5; and co-morbid conditions, including self-harm.
What did subjects with Research Diagnostic Criteria bipolar I disorder prospectively followed up for as long as 25 years show?
Mood episodes last on average 13 weeks. More than 75% recover from their mood episode within 1 year. Severe onset of an episode or years spent ill impact recovery (Solomon et al. 2010)
In bipolar I is recovery from mania, hypomania or major depression more quick?
Mania, hypomania
What has been found about racial disparities in psychotherapy use from 1996 to 2006?
Caucasians and African Americans access therapy equally and slightly more than Latinos. (Chen and Rizzo from date from the Medical Expenditure Panel Survey 1996 to 2006)
One study showed the sustained recovery rate for mild to moderate depression to be?
25%. A total of 39 (24%) achieved sustained recovery, associated with being female, married/cohabiting, having a low BSI score and receiving preferred treatment. Based on 220 participants. (Dowrick et al. 2010)
Psychotic-like experiences are common in the population. What are some factors that effect the persistence or increase over time in the adolescent population?
Three developmental subgroups of PLEs: (1) persistent; (2) increasing; (3) low. Adolescents on the persistent trajectory reported frequent victimization and consistently elevated scores in depression and anxiety. Adolescents on the increasing trajectory were engaging in cigarette use prior to any increases in PLEs and were engaging in cocaine, cannabis and other drug use as PLEs increased at later time points (Mackie et al. 2010)
Who ends up worse, children with private coverage or those enrolled in public plans?
Children with special health care needs do better with public plans overall (Davis 2010)
What’s an advantage of the MINI Kid International compared to the K-SADS PL?
The MINI-KID generates reliable and valid psychiatric diagnoses for children and adolescents and does so in a third of the time as the K-SADS-PL.
Do highly aggressive boys, whether prosocial or less social, prefer highly aggressive or low aggressive friends?
They have no preference but they end up with aggressive peers. They also seek out peers that can provide emotional support but get peers who do not provide it.
What about marital conflict is distressing to children?
Marital conflict that is intense, poorly resolved, and child-related has adverse effects on children, whereas conflicts that do not concern children and are resolved constructively and non-aggressively even if they occur frequently do not
How do parents in marital conflict respond to their opposite sex children?
Fathers lower in marital satisfaction are more negative toward their daughters, and less maritally satisfied mothers are more likely to reciprocate sons’ negative affect and to respond negatively when their daughters were assertive. The reciprocal nature of this relationship is illustrated by the finding that, compared with children from happy marriages, daughters from less-satisfied marriages are less compliant with their fathers than with their mothers.
What did a 13 year follow-up study of young Norwegian adults diagnosed with dyslexia in childhood show?
The dyslexia continued but educational attainment was only slightly lower than peers. Undheim 2009
What did a large study show about prevalence rates for ODD if the ‘and-rule’ or the ‘or-rule’ is used?
Prevalence is 2.6% if one informant is used and 0.2% if two (parent and teacher). However, when one informant alone endorses ODD the other still endorses significant problems even if not full ODD
Those with borderline personality disorder show what finding about empathy compared to controls?
Higher affective empathy compared to cogntive empathy. Opposite in controls
What is the course of hyperactivity and innatention after foster care placement?
Average level of inattention declined according to the biological parent, whereas hyperactivity/impulsivity symptoms declined according to both biological and foster parents. Higher inattention was associated with lower parental warmth (foster parent), higher parental hostility (biological, foster, and teacher), and discharge from care (biological parent). Higher hyperactivity was also associated with lower parental warmth (foster parent) and higher parental hostility (biological and foster parent), higher (average) number of foster-home moves, and discharge from care (biological report). Higher teacher-derived hyperactivity symptoms were associated with a history of child abuse (versus neglect); however, abused children showed a steeper decline of hyperactivity over time than those with neglect histories.
What can be said about heart rate response and trauma?
HRR to standardized trauma reminders at 1 month after the trauma differentiate between trauma survivors with and without PTSD, and predict chronic PTSD. Results are consistent with a role of associative learning in PTSD and suggest that early stimulus generalization may be an indicator of risk for chronic PTSD.
In patients with abuse fractures what percentage had at least one visit in which it was missed?
Of 258 patients with abusive fractures, 54 (20.9%) had at least 1 previous physician visit at which abuse was missed. The median time to correct diagnosis from the first visit was 8 days (minimum: 1; maximum: 160). Independent predictors of missed abuse were male gender, extremity versus axially located fracture, and presentation to a primary care setting versus pediatric emergency department or to a general versus pediatric emergency department.
What are the longitudinal outcomes of children with externalizing behaviors?
The developmental trajectories of the four types of externalizing behavior mostly predicted intrusive, aggressive and rule-breaking behavior in adulthood. Non-destructive behaviors in childhood such as opposition and status violations predict adult problems to a larger extent than destructive behaviors such as aggression and property violations. In general, children who develop through high-level trajectories are likely to suffer from both internalizing and externalizing problem behavior in adulthood, regardless the direction of change (i.e. increasing/decreasing/persisting) of the high-level trajectory
How do household routines effect obesity in US pre-school age children?
U.S. preschool-aged children exposed to the three household routines of regularly eating the evening meal as a family, obtaining adequate nighttime sleep, and having limited screen-viewing time had an approximately 40% lower prevalence of obesity than those exposed to none of these routines.
For acutely agitated patients with psychosis what is the pharmacotherapy approach with the best evidence?
Lorazepam administered with haloperidol. Battaglia 1997
What is the 10 year diagnostic consistency of bipolar disorder in a first admission sample?
Overall, 50.3% of 195 respondents were diagnosed with bipolar disorder at every available assessment, but 49.7% (n = 97) had a diagnostic shift to a non-bipolar disorder at least once over the course of the 10-year study. Childhood psychopathology and poorer illness course were among the few variables associated with increased odds of a change in diagnosis. Even with optimal assessment practices, misdiagnosis of bipolar disorder is common, with complex clinical presentations often making it difficult to consistently diagnose the disorder over the long term. Ruggero et al. 2010
What do suicide attempts show in bipolar I and II?
30%+
Is there a difference between parent delivered ABA or therapist delivered ABA?
Not if there is sufficient supervision and training for parents
How are auditory and visual hallucinations impacted by subjected loudness and inner speech network?
Strong activation of the inner speech processing network may contribute to the subjective loudness of AVH. However, a relatively increased contribution from right hemisphere language areas may be responsible for the more complex experiential characteristics, such as the non-self source or how real AVH are.
What is one view of the emergence of inflexibility from a linguistic transactoinal model?
Rather than inflexibility being an inherent deficit, inflexibility emerges from conversational transactional patterns. Muskett et al. 2010
What did the GAZEL youth study find?
Hyperactive-impulsive symptoms independently predict grade retention, failure to graduate from secondary school, obtaining a lower-level diploma, and lower academic performance. Negative academic outcomes are also significantly associated with childhood symptoms of conduct disorder
What may explain the association between depression and mortality?
Cognitive hostility. 20,625 employees of the French national gas and electricity companies gave consent to enter in the GAZEL cohort in 1989. Depressive mood predicted mortality, even after adjustment for age, sex, education level, body mass index, alcohol consumption, and smoking. However, this association was dramatically reduced after further adjustment for cognitive hostility. Cognitive hostility was the only personality measure remaining associated with mortality after adjustment for depressive mood
In assessing sexual recidivism risk in an individual with intellectually disability who sex offends, what must be distinguished?
Differentiating sexual deviance, the primary factor predisposing most individuals to criminal sexual violence, from impulsive, immature, and inappropriate behavior stemming from cognitive deficits
What might be the relative risk for schizophrenia in fathers over 50 and younger than 25?
1.6 and 1.08 respectively. The younger fathers increase risk for male offspring but not females.
Patients with learning disabilities seem to have what kind of coping pattern?
Ignoring the problem and not coping
What is the adolescent clinical outcome for young people with ADHD?
In a UK study, most adolescents (69.8%) continued to meet full criteria for ADHD after 5 years and exhibited high levels of antisocial behaviour, criminal activity and substance use problems. Maternal childhood conduct disorder predicted offspring ADHD continuity; maternal childhood conduct disorder, lower child IQ and social class predicted offspring conduct disorder symptoms.
What is the effect size for cognitive behavior therapy after taking into account publication bias?
0.42
What is the risk of a psychiatric disorder in an offspring if respectively both parents have schizophrenia or both have bipolar disorder?
27.3% of offspring will have schizophrenia (39.2% when schizophrenia-related disorders are included)
24.9% will have bipolar disorder (36% if unipolar depression disorder is included)
Up to 2/3 of offspring will have any psychiatric disorder
One parent with szp: 7% in offspring
One parent with bipolar: 4.4%
No parents with szp: 0.86% szp in offspring
No parents with bipolar: 0.48% bipolar in offspring
Gottesman et al. From a large Danish data set of 2.6 million patients with treatment records.
Do stimulants increase anxiety in the treatment of ADHD?
Not according to a meta-analysis. M. Bloch 2015
Use of stimulants in pediatric settings showed what?
Improvement in parent and teacher symptom ratings, but not change in functional impairment
What is choice impulsivity?
The term delay aversion has been used both to describe a behavioral tendency of greater preference for smaller-immediate over larger-delayed rewards (choice impulsivity) and to refer to a secondary explanatory construct put forward by delay aversion theory
What did a 24 year follow-up study show regarding adult continuity of childhood psychopathology?
Of the participants who were classified as deviant [study term] in childhood, 22.2% were also classified as deviant in adulthood. Both homotypic and heterotypic continuity was found. Childhood aggressive, delinquent, and anxious/depressed problems were associated with most adult psychopathology. Attention problems did not predict later problems independently
What is potentially more efficacious than usual care for suicidal and depressed adolescents according to one RCT?
Attachment Based Family Therapy
What is the effect of stimulants on growth in ADHD treatment?
Weight and height effects
Patients with somatoform disorders may show what on theory of mind and emotional awareness?
Patients with somatoform disorders requiring inpatient treatment manifest deficits in both emotional awareness and ToM functioning. These deficits may underlie the phenomenon of somatization.
What is a problem with clinical outcome measures and recovery?
Consumer definitions of recovery and outcomes do not necessarily match clinicians’
What is one clinical tool to assess patients’ capacities to make treatment decisions
MacArthur Competence Assessment Tool-Treatment (MacCAT- T)
What is misleading vividness?
Misleading vividness is a term that can be applied to anecdotal evidence describing an occurrence, even if it is an exceptional occurrence, with sufficient detail to permit hasty generalizations about the occurrence (e.g., to convince someone that the occurrence is a widespread problem
What is heuristic?
Heuristics refers to experience-based techniques for problem solving, learning, and discovery. Heuristic methods are used to speed up the process of finding a good enough solution, where an exhaustive search is impractical.
