Exam 4 - Lec 65-66 Pediatric Psych Ott Flashcards
T or F: Kids have lower risk of significant adverse effects from medications than adults
F (higher risk)
two criteria for Tourette’s
-tics may wax and wane in freq, but have been present for > 1 year
-onset before age 18
what % of pts with tic disorders also have ADHD and OCD?
~75% also have ADHD
~50% also have OCD
what is the “Rule of Thirds” for tic disorders?
1/3 resolve, 1/3 improve, 1/3 stay the same - ~10% have persistent symptoms as adult
first line drugs for tics (not bolded)
alpha 2 agonists
antipsychotic drug FDA-approved for tics in ages 6-17
aripiprazole
which of the following is FALSE about stimulant use in Tourette’s?
a. ADHD is a common co-morbidity in Tourette’s
b. use of amphetamine-based stimulants can relieve motor and vocal tic sx
c. when treating ADHD and tourette’s, we can give a trial of atomoxetine or a TCA instead of an amphetamine-based stimulant
d. if ADHD sx are not well-controlled, can resume amphetamine-based stim and adjust dose of antipsychotic
b. use of amphetamine-based stimulants can relieve motor and vocal tic sx
(it exacerbates sx)
3 classes of conduct disorder
-childhood-onset type: < 10 yo
-adolescent-onset type: > 10 yo (no sx under 10)
-unspecified onset
which of the following is FALSE about the tx of oppositional defiant disorder and conduct disorder?
a. pharmacotherapy is considered adjunctive, palliative, non-curative and should only be used in certain cases
b. treat underlying conditions such as ADHD
c. stimulants and clonidine/guanfacine are first line before using atypical antipsychotics
d. typical antipsychotics may be used to treat severe sx
e. we often see combo stimulant/alpha agonist tx if ADHD with impulsivity or need for sedation for sleep
d. typical antipsychotics may be used to treat severe sx
(atypical)
first line combo tx for separation anxiety disorder
CBT plus med
what drug class is first line for separation anxiety disorder?
SSRIs
T or F: we should treat co-morbidities such as depression, ADHD, etc in pts with separation anxiety disorder
T
look at slide 15-16 for DSM-5 Autism Spectrum Disorder criteria and signs/sx
Ok
T or F: SSRIs have shown efficacy in treating the core Autism Spectrum Disorder sx
F (no meds have shown efficacy)
T or F: up to 30% of ASD pts have at least one seizure by age 20
T
associated medical problems for ASD include _____ disorder and _____ disorders
seizure; GI
first line tx for disruptive behaviors in ASD
behavioral interventions (applied behavioral analysis)
two FDA approved-drugs for mgmt of irritability/aggression for disruptive behaviors of ASD
-aripiprazole (ages 6-17)
-risperidone (ages 5-16)
what two seizure meds have shown no significant effect on irritability in ASD?
lamotrigine/levetiracetam
tx of repetitive behaviors in ASD (3 drugs)
haloperidol
risperidone
aripiprazole
what is the preferred stimulant for pts with ASD and ADHD?
methylphenidate
T or F: clonidine/guanfacine have a modest effect on irritability and explosive behavior in ASD pts with ADHD
T
what drug reduces sleep latency and inc time asleep in pts with ASD and sleep problems?
melatonin 1-6 mg nightly
what disorder is described?
-Severe recurrent temper outbursts that are out of proportion with the intensity/duration of the situation
-Present in at least two of three settings (home, school, with peers) and are severe in at least one of these
-diagnosis should not be made before age 6 or after age 18
a. ODD
b. CD
c. ASD
d. DMDD
e. PTSD
d. DMDD
(disruptive mood dysregulation disorder)
what two drug classes are first line for DMDD?
SSRIs and stimulants
for DMDD, we need to differentiate from _______ disorder, both for using antidepressants as well as evaluating need for mood stabilizers
bipolar
T or F: DMDD is more similar to bipolar disorder than to depression, ADHD, or anxiety
F (more similar to depression, ADHD, or anxiety; in same chapter in DSM-5)
look at slide 21 for things to know about pediatric depression
sure
only antidepressant FDA-approved for kids down to 8 yrs old
a. sertraline
b. fluoxetine
c. duloxetine
d. escitalopram
e. paroxetine
b. fluoxetine
which of the following is FALSE about pediatric depression tx?
a. non-pharm is first line
b. CBT leads to remission rates of 70%
c. antidepressants have black box warning for suicidality, with the highest risk in the first 3 months
d. fluoxetine is FDA-approved for ages 12-17
d. fluoxetine is FDA-approved for ages 12-17
(this is escitalopram, fluoxetine is for ages 8 and up)
what antidepressant should be avoided in kids with pediatric depression?
a. paroxetine
b. fluoxetine
c. duloxetine
d. escitalopram
e. sertaline
a. paroxetine
(1st antidepressant with suicidal thinking warning)
_______ is first drug option for pediatric bipolar, mixed or manic, with or w/o psychosis
lithium
look at slide 23 for drug tx of pediatric bipolar disorder
You got it boss
first line tx (not drugs) for pediatric PTSD
trauma-focused psychotherapy
first line drug class for tx of pediatric PTSD
SSRIs
which of the following is FALSE about childhoood-onset schizophrenia?
a. use adult diagnositic criteria
b. hallucinations/delusions are not explained by substance use or PDD/autism
c. visual hallucinations are less common than in adults
d. onset of sx before age 13
e. rare in children, adolescent prevalence reaches adult prev of 0.5-1.0%
c. visual hallucinations are less common than in adults (more common)
which atypical antipsychotic is FDA-approved for irritability with autism in pediatrics? SELECT ALL THAT APPLY
a. aripiprazole
b. asenapine
c. brexpiprazole
d. lurasidone
e. olanzapine
f. olanzapine/fluoxetine
g. paliperidone
h. quetiapine
i. risperidone
a. aripiprazole
i. risperidone
which atypical antipsychotics are NOT FDA-approved for pediatric schizophrenia? SELECT ALL THAT APPLY
a. aripiprazole
b. asenapine
c. brexpiprazole
d. lurasidone
e. olanzapine
f. olanzapine/fluoxetine
g. paliperidone
h. quetiapine
i. risperidone
b. asenapine
f. olanzapine/fluoxetine
FDA-approved indication for brexpiprazole and paliperidone in pediatrics
a. bipolar disorder
b. schizophrenia
c. irritability w/ autism
d. tourette’s
e. bipolar depression
b. schizophrenia
FDA-approved indication for olanzapine/fluoxetine in pediatrics
a. bipolar disorder
b. schizophrenia
c. irritability w/ autism
d. tourette’s
e. bipolar I depression
e. bipolar I depression
paliperidone FDA-approved indication in pediatrics
a. bipolar disorder
b. schizophrenia
c. irritability w/ autism
d. tourette’s
e. bipolar depression
b. schizophrenia
asenapine FDA-approved indication in pediatrics
a. bipolar disorder
b. schizophrenia
c. irritability w/ autism
d. tourette’s
e. bipolar depression
a. bipolar disorder
look at slide 26 for full chart about atypical antipsychotics in pediatrics
will do
