CP Flashcards
1
Q
What percentage of patients with suicidal ideas go on to make an attempt?
A
33%. 66% do so within the first year
2
Q
What is the odds ratio of suicidal ideation, plan, attempt if three or more psychiatric disorders are present?
A
OR 6, 9, 9
3
Q
Which disorder, depression or anxiety, is associated with a likelihood of suicidal thinking and which is associated with an attempt?
A
Depression–SI; anxiety–SA
4
Q
What test examines automatic links in the mind?
A
Implicit Association Test
5
Q
What is a measure of self-injurious behavior?
A
Functional Assessment of Self Mutilation
6
Q
Do those who self injure have a higher or lower physiologic response to stress?
A
Higher
7
Q
Among individuals who commit suicide in inpatient settings, what percentage deny suicidal ideas on last contact?
A
78%
8
Q
What is an evidence based measure for suicidality?
A
Columbia-Suicide Severity Rating Scale (C-SSRS)
9
Q
What might be more effective than the MMSE for screening cognition in emergency populations?
A
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
10
Q
What is a reliable screen for depression for teens
A
The PHQ-9 (Patient Health Questionnaire - 9 items) screens for major depression in adolescents
11
Q
Describe the clock drawing test
A
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.
12
Q
Describe the animal fluency test
A
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
13
Q
Describe the Oral Trail Making Test (OTMT)
A
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
14
Q
What are the scores for response and remission on the Children’s Yale-Brown Obsessive Compulsive Scale.
A
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.
15
Q
What are three trait areas in psychopathy?
A
Interpersonal (egocentric), affective (callous), behavioral (impulsive)
16
Q
What seems to distinguish high psychopathic traits in children compared to adults?
A
High trait anxiety is associated with high psychopathy, which contrasts with adult findings
17
Q
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
A
Interleukin 8
18
Q
Do callous-unemotional states extend lengths of stay for inpatient youth, beyond a diagnosis of conduct disorder or oppositional defiant disorder?
A
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
19
Q
What is a diagnostic instrument for children less than 7
A
Diagnostic Infant Preschool Assessment (DIPA)
20
Q
Atomoxetine has been shown to block which receptor, besides norepinephrine?
A
NMDA (of the glutamate system)
21
Q
Enuresis in ADHD is associated with what additional diagnosis?
A
ODD
22
Q
What do teenage girls who have a propensity for violence fail to discern in others’ faces?
A
Anger or disgust
23
Q
Over a 6-month period does risperidone cause cognitive decline?
A
No
24
Q
Do antipsychotics increase risk of insulin resistance mechanistically?
A
Increased insulin resistance may not be related to weight gain alone
25
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
26
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
27
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).
28
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.
29
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)
30
In bipolar I is recovery from mania, hypomania or major depression more quick?
Mania, hypomania
31
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)
32
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)
33
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)
34
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)
35
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.
36
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.
37
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
38
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.
39
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
40
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
41
Those with borderline personality disorder show what finding about empathy compared to controls?
Higher affective empathy compared to cogntive empathy. Opposite in controls
42
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.
43
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.
44
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.
45
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
46
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.
47
For acutely agitated patients with psychosis what is the pharmacotherapy approach with the best evidence?
Lorazepam administered with haloperidol. Battaglia 1997
48
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
49
What do suicide attempts show in bipolar I and II?
30%+
50
Is there a difference between parent delivered ABA or therapist delivered ABA?
Not if there is sufficient supervision and training for parents
51
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.
52
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
53
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
54
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
55
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
56
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.
57
Patients with learning disabilities seem to have what kind of coping pattern?
Ignoring the problem and not coping
58
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.
59
What is the effect size for cognitive behavior therapy after taking into account publication bias?
0.42
60
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.
61
Do stimulants increase anxiety in the treatment of ADHD?
Not according to a meta-analysis. M. Bloch 2015
62
Use of stimulants in pediatric settings showed what?
Improvement in parent and teacher symptom ratings, but not change in functional impairment
63
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
64
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
65
What is potentially more efficacious than usual care for suicidal and depressed adolescents according to one RCT?
Attachment Based Family Therapy
66
What is the effect of stimulants on growth in ADHD treatment?
Weight and height effects
67
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.
68
What is a problem with clinical outcome measures and recovery?
Consumer definitions of recovery and outcomes do not necessarily match clinicians'
69
What is one clinical tool to assess patients' capacities to make treatment decisions
MacArthur Competence Assessment Tool-Treatment (MacCAT- T)
70
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
71
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.
72
What might have an effect on compulsiveness?
Activation of NMDA receptors may have an anti-compulsive effect in OCD patients
73
What does stress do to DNA in rats brains?
One week after a single stressful event, a reversible DNA damage was identified in the prefrontal cortex and in the amygdala, whereas DNA damage in the hippocampus still remained.
74
In adolescent parricides what may play a large role, emotionally?
Shame and humiliation (rather than PTSD or maltreatment)
75
What percentage of patients report a 10 minute interval between a suicidal thought and act in referrals to a psychiatric university hospital center?
50%
76
What is the increased rate of pregnancy in adolescents who had been sexually abused?
CSA increases the odds of experiencing an adolescent pregnancy by two-fold. Up to 4.5 out of 10 pregnant adolescents may have a prior history of CSA.
77
What is the predictor of first episode psychosis 3 years out?
Demographic and neuropsychological measures relating to premorbid functioning are the best predictors of long-term outcome in first episode psychosis, with baseline psychiatric symptoms not contributing
78
What can be said about perspective taking in children with ADHD?
Children with ADHD use lower levels of social perspective taking, defining of problems, identification of feelings, and evaluation of outcomes than children without ADHD (irrespective of other factors)
79
What does sleep do for suicide?
Short sleep appears to be associated with increased likelihood of suicidal ideation and suicidal attempt in adults independent of the effects of comorbid mental disorders
80
Who first introduced the term psychiatry?
Professor Johann Christian Reil of Halle, Germany, first introduced the term 'psychiatry' in 1808. He argued that mental illness should be treated by physicians. He stressed the important relationships between physical and mental factors in illness and the role of psychotherapy as one of the main treatment approaches in medicine. He was a strong advocate of humane treatment and reduction of stigma.
81
What can be said about race and hospitalization from an emergency room?
African-American pediatric patients are more likely to be hospitalized (OR=1.50)
82
What is the link between threats to kill and future violence?
Of 613 individuals convicted of threats to kill, within 10 years, 44% of threateners were convicted of further violent offending, including 19 (3%) homicides. Sixteen threateners (2.6%) killed themselves, and three were murdered. Warren et al.
83
What does ADHD treatment show when comparing meds to psychosocial treatment?
Both methylphenidate and psychosocial interventions can be effective in reducing ADHD and associated symptoms, e.g. ODD. Overall, core ADHD symptoms in the classroom respond better to medications.
84
What is involved in the genetic testing of those with intellectual disabilities who do not have a clear etiology?
The approach to the evaluation of the patient in whom an etiologic diagnosis is not suspected after the history and physical examinations can include a standard karyotype, Fragile X molecular genetic testing, aCGH (array comparative genomic hybridization ), and neuroimaging, based on the evidence to date.
85
What percentage of patients with first episode psychosis discontinue treatment within 12 months.
The number of patients who discontinue treatment for any cause within 12 months is 63%. Comparisons with haloperidol show lower risks for any-cause discontinuation with olanzapine, quetiapine and ziprasidone. However, symptom reductions are virtually the same in all groups at around 60%. Kahn et al.
86
What has been found about self-harm in 14 year old adolescents?
Correlations between deliberate self-harm and general psychopathology, a relative absence of positive feelings toward parents, and a ruminative style of emotional regulation. Rumination/negative thinking and a relative absence of positive feelings toward parents are predictors of self-harm independently of general psychopathology.
87
What does one need to be concerned about in the gastrointestinal system on clozapine?
Gastric hypomotility. Assess for constipation, use laxatives
88
What can be said about Omega 3s and ADHD?
Might help with executive function
89
What is the effect on religiosity and psychiatric illness?
The rates of psychiatric illness among those who report never attending religious services are not statistically different from those who either have always been religiously active or those who report changing patterns of attendance
90
For young adult males what is the rate of substance use and sex during incarceration?
A survey of men with a history of incarceration, ages 18-29, revealed that 50% and 17% of participants, respectively, had used substances or had sex while confined. Seal et al.
91
Can intelligence be trained?
Fluid intelligence is intelligence independent of prior experience and knowledge and is considered immutable. (However, one study showed that training on a demanding working memory task might help improve intelligence. Jaeggi et al.)
92
Does outpatient versus inpatient treatment for anorexia nervosa make a difference?
First-line in-patient psychiatric treatment does not appear to provide advantages over out-patient management.
A multicenter randomized controlled trial of 167 young people comparing inpatient, specialist outpatient and general child and adolescent mental health service treatment. Results: each group made considerable progress at 1 year, with further improvement by 2 years. Full recovery rates were poor (33% at 2 years, 27% still with anorexia nervosa). Adherence to in-patient treatment was only 50%. Neither in-patient nor specialist out-patient therapy demonstrated advantages over general mental health treatment by intention to treat. In-patient treatment (randomized or after out-patient transfer) predicted poor outcomes. Gowers et al.
93
How does appraisal of trauma effect outcome in kids?
The majority of the variance of chronic posttraumatic stress is accounted for by negative appraisals about future harm. Cognitive models of PTSD would explain this and suggest that younger children who exaggerate their vulnerability after trauma exposure are at higher risk for PTSD after trauma
94
What has been found about physical abuse and sexualize behaviors?
Maltreatment other than sexual abuse, and the developmental periods in which it occurs, may be linked to the development of sexualized behaviors
95
Non-suicidal self injury is related to sexual trauma or psychiatric illness?
In studies that statistically controlled for psychiatric risk factors, childhood sexual abuse explains little or no unique variance in self-injurious behavior
96
What is an example of a college suicide prevention program and how much did it reduce suicide?
In the fall of 1984, the University of Illinois instituted a formal program to reduce the rate of suicide among its enrolled students. At the core of the program is a policy that requires any student who threatens or attempts suicide to attend four sessions of professional assessment. The consequences for failing to comply with the program include withdrawal from the university. In the 21 years that the program has been in effect, reports on 2,017 suicide incidents have been submitted to the Suicide Prevention Team. The rate of suicide at locations within Champaign County (where the university is located) have decreased from a rate of 6.91 per 100,000 enrolled students during the 8 years prior to the program's start to a rate of 3.78 during the first 21 years of the program. This represents a reduction of 45.3 percent. This reduction occurred against a backdrop of stable rates of suicide both nationally and among 11 peer institutions within the Big Ten.
97
What percentage of parents are unaware of self-harm behavior by their children?
50%
98
What is the relative risk of suicidal thinking on anti-epileptic drugs?
About 2
99
What has been found about mothers and their view of sexual abuse on their child?
Practitioners should ask mothers whether they believe the abusers’ behavior was sexual and abusive. If mothers do not perceive sexual abuse, then they will not believe abuse occurred or attribute responsibility to the abusers.
100
Stigma begins at what age?
Children as young as three show some endorsement of stereotypes, which increases and seems to peak around age five to six. Older children show lower rates of prejudice
101
What is the prevalence of depression and anxiety in adolescent substance users?
50 to 75%
102
What can be said about high functioning autism and math?
Many have average ability, some have weaknesses, some are gifted
103
What is the connection between child temperament and maternal discipline?
Children with difficult temperaments are more susceptible to negative discipline (i.e., they show more externalizing problems) as well as more susceptible to positive discipline (i.e., they show fewer externalizing problems and less physical aggression), as compared with children with relatively easy temperaments
104
What are the rates of tardive dyskinesia for youths on second generation antipsychotics?
Annualized TD rates of 0.38%.
105
What is nonviolent resistance to child behavior?
(a) parents commit themselves to a strictly nonviolent and non-humiliating stance; (b) parents assume responsibility for their own side in the escalation process; (c) whereas in a more usual kind of fight one’s goal is to defeat the adversary, in NVR the goal of the parents is to resist the child’s destructive behaviors, while protecting themselves and the children (both the perpetrator and the potential victims); and (d) the parents fight the child’s violence while at the same time maintaining and furthering the positive elements in the relationship.
106
What are the effect sizes for the medication and therapeutic treatment of obsessive-compulsive disorder in children?
0.48 for pharmacotherapy and 1.45 for cognitive behavioral therapy (adjusted for publication bias)
107
When stopping a stimulant when a child is taking both risperidone and a stimulant what should one watch for?
Acute dystonic reaction when a concomitant stimulant medication is discontinued.
108
What is the role of prior trauma in PTSD emergence?
Prior trauma increases the risk of PTSD after a subsequent trauma only among persons who developed PTSD in response to the prior trauma.
109
What does the Treatment for Adolescent Depression trial show for maintenance and continuation?
Total rates of sustained response by week 36 were 88.4% combined treatment, 82.5% fluoxetine, and 75.0% cognitive behavioral therapy.
110
What is the stability of borderline personality disorder?
Of children known to have BPD in the primary school age-group, 80% meet the criteria for a personality disorder in adulthood and 16% met the criteria for BPD. In adults with BPD, 30% still meet the criteria two years later. The most stable symptoms are feelings of emptiness, anger, affect-instability, and identity problems. Less stable symptoms are suicidality, self-harm, impulsiveness, unstable relationships, derealisation, and paranoid thinking. Deschamps and Vreugdenhil
111
What are the neuropsychological deficits for those at risk of psychosis?
Individuals with an at risk mental state for psychosis already show impairment of neuropsychological functions prior to the onset of the first psychotic episode and can best be distinguished from healthy controls on the basis of working memory.
112
What are peer relations like for children with ADHD in regard to likability?
Children with ADHD like identified others more than they are liked back by the same
113
What has been shown as an effect of melatonin in individuals with chronic insomnia and intellectual disability?
Advance of mean sleep onset time by 30 min, decrease of mean sleep latency by 30 min, increase of mean total sleep time by 50 min, reduction of the mean number of times the person wakes during the night by 0.4, decreases the mean duration of the night waking periods by 17 min, and advances endogenous melatonin onset at night by an average of 2 hours
114
What is the rate of missed psychotic depression in one academic center study?
Psychotic depression had not been diagnosed prior to research assessments for one-quarter of patients
115
When is suicide most likely to happen, during a patient's first episode or second episode of Major Depression?
First
116
Is youth aggression influenced by parental ideas?
Parent attitude can predict a youth's aggressive behavior, even after controlling for a youth's attitude
117
Is the drug placebo difference greater than previously believed?
Perhaps, according to one hypothesis. In unipolar depression trials, perhaps all the placebo responders might have been anti-depressant responders as well, and so drug placebo difference is greater than thought
118
Is paternal incarceration an independent risk factor?
Not necessarily. Controlling for socio-economic status, maternal mental health and substance use, parenting style and family adjustment, associations became non-significant. Kinner et al.
119
What is the relationship between psychiatric treatment and later offense?
One study in Sweden, looked at 1,400 former patients followed into adulthood. Every third child patient treated between 1975 and 1990 (every second man and every fifth woman) had entered the Register of Persons Convicted of Offences during the observation period, a significantly higher rate than the general population; Engqvist and Rydelius. In a U.S. based study, youth with 3 or more diagnoses (16.0% of the studied population) accounted for 54.1% of youth self-reporting arrest for violent crime; Coker et al. Another study showed that of 1,420 child patients ages 9, 11, 13 followed from intake, 33% had offended by age 21; Copeland et al.
120
What is a mentalizing model for the development of borderline personality?
The model suggests that disruption of the attachment relationship early in development in combination with later traumatic experiences in an attachment context interacts with neurobiological development. The combination leads to hyper-responsiveness of the attachment system which makes mentalizing--the capacity to make sense of ourselves and others in terms of mental states--unstable during emotional arousal. The emergence of earlier modes of psychological function at these times accounts for the symptoms of BPD. The model has clinical implications and suggests that the aim of treatment is not only to encourage development of mentalizing but also to facilitate its maintenance when the attachment system is stimulated.
121
What is a quick may to assess hyperammonia in valproic acid treated patients?
Urine smell
122
What are the rates of tardive dyskinesia and antipsychotic use for different age cohorts?
Stratified by age, annual tardive dyskinesia incidence rates are 0.35% with second-generation antipsychotics in children, 2.98% with second-generation antipsychotics versus 7.7% with first-generation antipsychotics in adults, and 5.2% with second-generation antipsychotics versus 5.2% with first-generation antipsychotics in the elderly
123
What is the association between child abuse and health care use and costs?
Child abuse is associated with long-term elevated health care use and costs, particularly for women who suffer both physical and sexual abuse.
124
What is the effect f lead level on development?
No level of lead exposure appears to be 'safe' and even the current 'low' levels of exposure in children are associated with neurodevelopmental deficits.
125
What is the relationship of ADHD and substance use disorders?
ADHD is a risk factor for the development of SUD in adulthood. Conversely, approximately one fifth of adults with SUD have ADHD. Individuals with SUD and ADHD have a more severe and complicated course of SUD. Pharmacotherapeutic treatment of ADHD in children seems to reduce the risk for later cigarette smoking and SUD in adulthood.
126
What reported assymetry is there in the basal ganglia in those with ADHD?
An increased left > right asymmetry of the basal ganglia
127
What is the optimal serum lithium level in the long-term treatment of bipolar disorder?
The minimum efficacious serum lithium level in the long-term treatment of bipolar disorder is 0.4 mmol/L with optimal response achieved at serum levels between 0.6-0.75 mmol/L. Lithium levels >0.75 mmol/L may not confer additional protection against overall morbidity but may further improve control of inter-episode manic symptoms. Abrupt reduction of serum levels of more than 0.2 mmol/L is associated with increased risk of relapse. In the long-term treatment of bipolar disorder clinicians should initially aim for serum lithium levels of 0.6-0.75 mmol/L, while higher levels may benefit patients with predominantly manic symptoms. Severus et al.
128
What has been found about lamotrigine for the acute treatment of bipolar depression in disorder in adults?
The efficacy of lamotrigine as maintenance treatment for bipolar disorder (BD), particularly for delaying depressive episodes, is well established, however, lamotrigine monotherapy has not demonstrated efficacy in the acute treatment of bipolar depression in four out of five placebo-controlled clinical studies; Calabrese et al. A follow up analysis of patient level data showed that lamotrigine can be effective for the more severely depressed patient, one wth a Hamilton Ratings Scale for Depression score of 24 or more; Geddes, Calabrese and Goodwin
129
How does fluoxetine fare compared to placebo in preventing relapse in children and adolescents with depression?
Continuation treatment with fluoxetine is superior to placebo in preventing relapse and in increasing time to relapse in children and adolescents with major depression. Emslie et al.
130
What is the association of pain killer overdose and eventual suicide?
A prior admission for a weak analgesic poisoning increases incident risk ratio of suicide by 24. The effect is highest one week after an overdose with an effect of 740, decreasing over time remaining high three years out
131
What are the three dimensions of oppositionality in youth?
Irritability, hurtful and headstrong
132
What is the optimal blood level for valproate for bipolar I disorder in adults?
The target blood level of valproate for best response in acute mania is above 94 μg/ml. Wozniak 2006
133
What areas of cognitive development does cannabis use affect in adolescents?
Recall memory, perceptual reasoning, inhibition and working memory. Conrod et al.
134
Is violent video game play by adolescents associated with increases in physical aggression over time?
Yes, according to at a Dartmouth meta-analysis published in the Proceedings of the National Academy of Sciences (PNAS) in 2018. This remains a controversy.
135
In male-female teen dating physical violence who is the more common victim?
Depends on the survey question and location. In a study of 35,900 youth in British Columbia in Canada in grade 7 to 12 who were in dating relationships, researchers found 5.8 per cent of boys and 4.2 per cent of girls said they had experienced dating violence in the past year--being pushed, hit or slapped. In the U.S. Youth Risk Behavior Survey, The prevalence of
having experienced physical dating violence was higher among female (9.1%) than male (6.5%) students
136
What percentage of adolescents are considered completely adherent to their medication?
60%. 40% are non-adherent to varying degrees. Niemeyer et al.
137
The Child/Adolescent Anxiety Multimodal Extended Long-Term Study (CAMELS) showed what about remission?
Rates of remission in each year by treatment group ranged from 40% to 60% in CBT, 40% to 52% with sertraline use, and 41% to 49% with combination treatment. When rates of remission were examined within person across all 4 years, results indicated that 21.7% were in stable remission, 30% were chronically ill, and 48% were relapsers
138
What is rapid onset gender dysphoria?
A controversial term that describes the phenomenon of youth who are observed by their parents to rapidly develop gender dysphoria symptoms over days, weeks or months during or after puberty. Until recently, it was unusual for a teen to report initial feelings of gender dysphoria during or after puberty without childhood symptoms.
139
Which two antidepressants does the data most support for children and adolescents with major depression?
The evidence continues to support fluoxetine and escitalopram as first-line treatment and demonstrated effect to prevent relapse. Ignaszewski and Waslick
140
What noradrenergic agent has shown promise for reducing alcohol consumption in adults?
Prazosin. From a double blind randomized controlled trial. Simpson et al.
141
What does maternal depression increase in a child?
Exposure to early and chronic maternal depression can increase a child’s susceptibility to psychopathology and social-emotional problems, including social withdrawal, poor emotion regulation, and reduced empathy to others.
142
What can be said about the height effects of methylphenidate?
1.29 to 2.55 cm decrease in final adult height with treatment. Significant effects on weight and height may require average doses of methylphenidate exceeding 1.5 mg/kg per day which are given continuously. Height suppression might not become statistically significant until the dose of MPH is ≥2.5 mg/kg/day for ≥4 years. Swanson et al.
143
What might be the positive predictive value for an EEG given at 9 months of age for the diagnosis of autism?
Close to 100% in a Boston Children's Hospital Study with a specific EEG algorithm. Bosl et al.
144
Which agent approved for schizophrenia and bipolar depression in adolescents seems to have a good metabolic profile?
In a 6 week, double-blind, placebo controlled trial, lurasidone was not associated with clinically meaningful effects on body weight, lipids, measures of glycemic control, or prolactin. Goldman et al.
145
What are the main cognitive skills that make up executive function?
Three core cognitive skills comprise executive function and its partner, self-regulation: mental flexibility, inhibitory control and working memory.
146
What is a potential advantage about having a 'growth mindset' about intelligence?
Children who believe intelligence can grow pay more attention to and bounce back from their mistakes more effectively than kids who think intelligence is fixed. The validity of the 'growth mindset' for improved function as described by Dweck has been questioned, but here is an example of a benefit.
147
How does angry parenting interact with ADHD?
A logistic regression demonstrated that both mothers’ and fathers’ Angry Parenting at wave 1 significantly predicted an ADHD diagnosis in children at wave 3. Demmer et al.
148
What cognitive process might affect academic performance rather than ADHD symptoms themselves?
Low working memory rather than ADHD Symptoms might predict poor academic achievement in school-aged children. Simone et al.
149
Is emotional dysregulation improved in children treated with methylphenidate independent of the treatment effect on their ADHD symptoms proper?
Yes, according to Kutlu et al. Symptoms of ADHD and ED were significantly improved with 1-year of MPH treatment. The improvement in ED was independent of improvement in ADHD symptoms and parent training.
150
The mortality rate for those with oppositional defiant disorder and conduct disorder is increased in comparison to the general population. Which two additional co-morbid diagnoses increase this rate further?
ADHD and substance use
151
Do patients with anxiety disorder learn from the 'carrot' or the 'stick'?
Patients fail to learn from both rewards and punishments as well as healthy individuals do. Etkin et al.
152
Are emotions innate or cognitive?
Emotions are not innately programmed into our brains, but, in fact, are cognitive states resulting from the gathering of information, according to some researchers.
153
How does our brain process fear?
The amygdala and the hippocampus directly exchange signals when an individual recognizes emotional stimuli.
Neurons in the amygdala fire 120 milliseconds earlier than the hippocampus. A unidirectional flow of information from the amygdala to the hippocampus occurs when fear is present. The amygdala first extracts emotional relevance and then sends this information to the hippocampus to be processed as a memory. Zhang et al.
154
What is one theory about the effect of marijuana on life outcomes?
THC and poorer life outcomes may be due to a drug-induced decrease in willingness to allocate cognitive effort, rather than or in addition to impairments in fundamental cognitive abilities per se. Silveira et al.
155
What is an another explanation for the inability to delay gratification when immediate versus delayed rewards are offered?
The inability to mentally travel in time
156
What was the effect on the QTc in a population of 211 treatment naive children and adolescents receiving quetiapine, risperidone, or olanzapine over 12 months?
There was no observed mean increase in QTc or in heart rate. Alda et al
157
What does the American College of Medical Genetic recommend about genetic testing?
In 2010, the American College of Medical Genetics recommended chromosomal microarray (CMA) as first-tier testing in the population of individuals with developmental delay, intellectual impairment, autism spectrum and multiple congenital anomalies. Fragile X remains indicated as CMA does not detect Fragile X. CMA can also detect most gross chromosome abnormalities detected by standard karyotype. Karyotype is still appropriate for patients who strongly fit the features of a specific chromosomal abnormality diagnosis, such as Down syndrome.
158
Which three genes and their variants may contribute to aggressive or antisocial behavior in a manner of gene and environment interaction?
MAOA, BDNF, and 5-HTTLPR. Among carriers of the low activity variants of all three genes, those exposed to family conflict or sexual abuse or both reported high levels of delinquency while those who reported a positive and warm relationship with their parents reported little or no delinquency. Nilsson et al.
159
What's an intervention to reduce repetitive, negative thinking?
Getting enough sleep
160
What is one predictor in pre-school of behavior problems in first grade?
Callous and unemotional behavior. A toddler who doesn't feel guilty after misbehaving or who is less affectionate or less responsive to affection from others may have later behavior problems in 1st grade, and more so than than those who have ADHD or ODD. Waller et al.
161
What is the effect of psychological controlling behavior by parents on teens?
Teens whose parents exert more psychological control over them when they are 13 have more problems establishing friendships and romantic relationships that balanced closeness and independence, both in adolescence and into early adulthood. Oudekerk et al.
162
At what age can children detect anger in social interactions and then use that emotional information to guide their own behavior?
15 months. For some toddlers, their impulsive tendencies are also linked with the tendency to ignore other people's anger, suggesting an early indicator for children who may become less willing to abide by rules. Repacholi and Meltzoff
163
What risky behavior does perfectionism potentially increase?
Suicidality. Perfectionists can experience hopelessness (when they do not meet their own standards), psychological pain, life stress, overgeneralization, and a form of emotional perfectionism that restricts the willingness to disclose suicidal urges and intentions. Flett and Hewitt
164
What is one unifying theory about autism?
It is a disorder of prediction. If we were unable to habituate to stimuli, then the world would become overwhelming very quickly. You cannot escape the cacophony that’s falling on your ears or that you’re observing. From this point of view, the repetitive behaviors, the preference for highly structured and predictable environments may be coping strategies. Sinha et al.
165
What is the best time of day to take guanfacine ER for ADHD, morning, afternoon, or evening?
The time of day makes no difference. Rugino et al.
166
What are the diagnostic cutoff levels for hemoglobin A1C and diabetes?
A1C <5.7 normal, 5.7 - 6.5 high risk (aka pre-diabetes), > 6.5 diabetes
167
What is the evidence for interpersonal therapy for trauma?
It is non-inferior to exposure therapy and the dropout rate is much lower for IPT for those patients with comorbid depression. (14 week, randomized trial Markowitz et al.)
168
One theory about teenage behavior and risk taking is that the prefrontal cortex is not fully developed. What is another?
The teenage prefrontal cortex is not much different than in the adult, but it can be easily overruled by heightened motivation centers in the brain
169
What did Stappenbeck et al. in the journal Nature show about DNA transmission from parent to offspring?
In mice, the DNA of bacteria that live in the body can pass a trait to offspring in a way similar to the parents' own DNA
170
What is the effect of moving from a high poverty neighborhood to a lower poverty neighborhood on adolescents?
Moving from a high-poverty neighborhood to a lower poverty neighborhood is not associated with better mental health and risk behavior outcomes in adolescents. The continued effects of having grown up in a high-poverty neighborhood, the small improvements in the new neighborhood, the comparatively short length of time they live in their new neighborhood, and/or the stress of moving appears to worsen most of the mental health outcomes compared to control group participants who consistently live in the lower poverty neighborhoods. Byck et al.
171
What is the National Sleep Foundation's recommendations for sleep duration in children and adolescents?
School age children (6-13 yo): 9-11 hours
| Teenagers (14-17 yo): 8-10 hours
172
What are trait qualities more important than intelligence for academic success?
Openness and conscientiousness. People who are open to experience are more likely to be imaginative, sensitive to their feelings, intellectually curious and seekers of variety. Conscientious people, meanwhile, are disciplined, dutiful and good at planning ahead.
173
What age is the peak of aggression in humans?
17 to 41 months
174
The activation cannabinoid receptors by endocannabinoids (the brains native cannabinoids) leads to what?
Reduced anxiety. Chronic marijuana use downregulates cannabinoid receptors, leading to anxiety at first but increased anxiety in the longer run.
175
What is the SAFETY Program
A cognitive-behavioral family intervention designed to increase safety and reduce suicide attempt, a brief intervention designed for integration with emergency services for suicide-attempting youths
176
What is a facial expression-emotion children with ADHD may have trouble appreciating?
Anger
177
What study showed that, in mice, that memories can be passed down genetically?
A mouse study by Gaydos et al. in Science showed that fearful memories of a smell could be passed on from parent to child without the child ever having experienced the smell.
178
What is a style of regulation emotion that can lead to depression?
Rumination
