FA Child and Geri Psych Flashcards
What is pseudodementia
Apparent cognitive deficits in patients with major depression. They may appear demented but these sx are secondary to their depression
What is the tx for pseudodementia?
Supportive psychotherapy, community stuff, pharm
What is the pharm tx for pseudodementia
SSRIs generally preferred to TCAs and MAOis. If TCA, choose nortriptyline, least amount of anticholinergic effects. Mirtazipine has effect of increasing appetite and is also sedating. Can also give stimulants like methyphenidate but this may cause insomnia. ECT is effective in elderly and very depressed.
If sedatives-hypnotics are prescribed for sleep, what is safer compared to benzos?
hydroxyzine (vistaril) or trazodone
restless leg movements during sleep due to imbalance of what?
Dopamine
Dx of mental retardation/intellectual disability
IQ equal and less than 70, lack of adaptive skills, onset before 18.
What are the categories of intellectual disability?
IQ 55-70 mild (85% of cases are mild); 40-55 is moderate; 25-40 is severe, less than 25 profound
What are the genetic causes of mental retardation:
Downs syndrome (trisomy 21), Fragile X syndrome, phenylketonuria, prader-wili, tuberous sclerosis, williams syndrome, angelman syndrome
What are the prenatal causes of mental retardation?
TORCH. Taxoplasmosis, Other (syphillis, AIDS, alcohol, drugs), Rubella (german measles), Cytomegalovirus (CMV), Herples simplex (HSV)
What are the perinatal causes of mental retardation
Anoxia, prematurity, birth trauma, meningitis, hyperbilirubinemia
What are the postnatal causes of mental retardation?
hypothyroidism, malnutrition, toxin exposure, trauma, psychosocial causes
What is the presentation of prader willi syndrome baby?
Obesity, almond shaped eyes, obesity, hypogonadism
What is the most common inherited form of mental retardation?
Fragile X due to defect in FMR-1 gene.
How do fragile X syndrome patients present?
Autistic characteristics, delayed speech, motor delay, sensory deficits, large testicles
What is a main difference between oppositional defiant disorder and conduct disorder
ODD usually doesn’t have physical aggression and violation of basic rights of others
Dx criteria for ODD?
6 months of defiant, hostile behavior and at least 4 sx (frequent temper loss, argument with adult, def adult rules, deliberately annoy people, easily annoyed, anger and resentment, spitefulness, blaming others for mistakes or behaviors)
Conduct disordered children - 40% of them go on to develop what in adulthood?
Antisocial personality disorder
Main difference between boys and girls in conduct disorder
Boys: fighting, stealing, firesetting, vandalism. Girls: running away, lying, sexually acting out
There is increased incidence of comorbind what in conduct disorder
ADHD and learning disorders
If aggression is present in conduct disorder, what pharm can help?
antipsychotics, mood stabilizers, and SSRIs
More than 50% of children with ADHD have?
comorbid psych dx, ODD (30-40%), conduct disorder (30-50%), mood disorders, anxiety, personality disorders
What is used to treat ADHD
1st line: CNS stimulants such as methyphenidate (ritalin, concerta, metadate, focalin), dextroamphetamine (dexedrine, dextrostat) and amphetamine salts (adderall). Early and significant improvement in 75% of patients but long term efficiacy controversial. 2nd line: atomoxetine (non stimulant). Alpha 2 agonists (clonidine, gaunfacine) if first 1st line doens’t work or as adjunctive.
What is autistic disorder a/w?
Fragile X syndrome, tuberous sclerosis, and seizures
What are the main categories of sx for autism
1) problems with social interactions 2) impairments in communications 3) repetitive and stereotype patterns of behavior and activities. Abnormalities in functioning begin before the age of 3.
What is the main difference between Asperger syndrome and Autism
Asperger: does not have speech and cognitive development issues. They may have poor social interaction and repetitive/stereotyped behavior patterns like autistic children
in which disorder is social interation more “professorial” or “pedantic”
Asperger
What is the course of cognitive development in Rett disorder?
Cognitive development never occurs past the first year of life
Rett disorder?
Normal development physical and psychomotor for first five months followed by decreased head growth size and loss of previously learned puposeful hand skills between months 5 and 30.
Rett disorder a/w what gene mutation?
MECP2 gene mutation on x chromosome
What kind of movements is common retts
stereotyped hand movements (hand wringing, hand washing), impaired language and psychomotor retardation, strange gait and trunk movements
M/F prevalence for retts
More common in females. Male phenotype is variable
difference in features for Rett and Child Disintegrative disorder?
In CDD, head growth oes not slow and unusual hand presentations not in CDD
Child disintegrative disorder
Normal development for first 2 years of life and then loss of previously acquired skills before 10 years
Child disintegrative disorder a/w what medical conditions
neurolipidoses, CNS infection, metachormatic leukodystrophy, Landau-keffner syndrome, mitochondrial defects
What is the tx of choice for Tourettes?
Pharm
Diagnosis of Tourettes
Fyi, tourettes is the most severe tic disorder. Must have multiple motor and at least one vocal tic that are not attributable to CNS disease, onset prior to 18, tics occur many times a day, almost every day for > 1 year (no tic free period for >3 months), change in anatomic location and character of tics over time, both motor and vocal tics must be present
Tourettes is highly co-morbid with
ADHD and OCD
What is the possible neurochemical etiology of tourettes?
Impaired regulation of dopamine in the caudate and maybe of opiates in noradrenergic system.
What is enuresis?
Involuntary wetting of bed, at least twice a week for 3 consecutive months after 5 years of age
What is encoparesis?
involuntary or intentional passage of feces at least once a month for 3 consecutive months by age 4
Height of stranger anxiety
8-12 months
Separation anxiety occurs?
7 months to 6 years
Childhood separation anxiety is a risk factor for development of?
Panic disorder and agoraphobia as adolescent/adult
Most common drug abused by adolescents?
Alcohol followed by cannabis
Children are most at risk for sexual abuse at what age?
between 7 and 13
