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PSYCH ROTATION > First Aid: Psychiatric Disorders in Children > Flashcards

First Aid: Psychiatric Disorders in Children Flashcards

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1
Q

What intelligence test can be used in children ages 2.5-12?

A

Kaufman Assessment Battery for Children (K-ABC)

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2
Q

What test can be used to assess IQ in patinets 6-16?

A

Weschler Intelligence Scale for Children-Revised (WISC-R)

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3
Q

What test is used to assess academic achievement?

A

Peabody Individual Achievement Test

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4
Q

What is the DSM-IV criteria for mental retardation?

A
  • Significant subaverage intellectual functioning with IQ of 70 or below
  • Deficits in adaptive skills appropriate for age group
  • Onset before age 18
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5
Q

What percentage of the population are mentally retarded?

A

2.5%

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6
Q

What gender is more commonly mentally retarded?

A

males

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7
Q

What is considered mild retardation?

A

IQ 50-70

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8
Q

What is considered moderate retardation?

A

IQ 40-50

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9
Q

What is considered severe mental retardation?

A

IQ 25-40

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10
Q

What is considered profound mental retardation?

A

IQ under 25

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11
Q

What is the most common severity of mental retardation?

A

mild (80%)

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12
Q

What are the two major genetic causes of mental retardation?

A

Trisomy 21

Fragile X

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13
Q

What prenatal infections can cause mental retardation?

A

TORCH

  • Toxoplasmosis
  • Other (syphilis, AIDS)
  • Rubella
  • CMV
  • HSV
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14
Q

What are some perinatal causes of mental retardation?

A

Anoxia
Prematurity
Birth trauma

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15
Q

What are some postnatal causes of mental retardation?

A
  • Hypothyroidism
  • Malnutrition
  • Toxin exposure
  • Trauma
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16
Q

What must always be ruled out before diagnosing a learning disorder?

A

Hearing and visual deficits

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17
Q

What are the 3 areas (DSM-IV) that can have learning deficits?

A

-Reading
-Mathematics
-Written expression
(and NOS)

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18
Q

Learning deficits are often due to what?

A

cognitive processing

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19
Q

What learning disorder affects 4% of school age children and is 3-4X more common in boys?

A

reading disorder

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20
Q

What learning disorder affects 5% of school age children and may be more common in girls?

A

mathematics disorder

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21
Q

What learning disorder affects 3-10% of school age children and has unknown gender ratio?

A

disorder of written expression

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22
Q

What is the treatment for learning disorders?

A

Remedial education tailored to child’s specific needs

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23
Q

List the 2 disruptive behavioral disorders.

A

Conduct d/o

Oppositional defiant d/o

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24
Q

What is the most common diagnosis in outpatient child psych clinics?

A

conduct disorder

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25
Q

What is the DSM-IV criteria for conduct d/o?

A

A pattern of behavior that involves violation of the basic rights of others or of social norms and rules, with at least 3 acts within the following categories during the past year:

  • Aggression toward people or animals
  • Destruction of property
  • Deceitfulness
  • Serious violations of the rules
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26
Q

What is the prevalence of conduct d/o?

A
  • 6-16% in boys

- 2-9% in girls

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27
Q

What is the prognosis for conduct d/o?

A
  • 40% develop antisocial personality disorder in adulthood

- increased comorbid mood disorders, substance abuse and criminal behavior in adulthood

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28
Q

What is the common comorbidities seen in conduct d/o?

A

ADHD

Learning disorders

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29
Q

What is the most effective treatment for conduct d/o?

A

Multimodal treatment approach (structured home environment, psychotherapy focusing on behavior modificaiton and problem solving, adjunctive pharmacotherapy)

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30
Q

What pharmacotherapy may be useful in conduct d/o?

A
  • Aggression (antipsychotics, lithium)

- Impulsivity, irritability, and mood lability (SSRIs)

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31
Q

What is the DSM-IV criteria for diagnosing oppositional defiant disorder?

A

At least 6 months of negativistic, hostile, and defiant behavior during which at least 4 of the following have been present:

  • Frequent loss of temper
  • Arguments with adults
  • Defying adults’ rules
  • Deliberately annoying people
  • Easily annoyed
  • Anger and resentment
  • Spiteful
  • Blaming others for mistakes or misbehaviors
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32
Q

How does ODD differ from conduct disorder?

A

ODD does not involve violation of the basic rights of others

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33
Q

What is the prevalence of ODD?

A

16-22%

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34
Q

When does ODD usually begin?

A

by age 8

onset before puberty more common in boys, onset after puberty equal in boys and girls

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35
Q

What are the common comorbidities with ODD?

A

Substance abuse
ADHD (2/3 with ADHD have it)
Mood disorders

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36
Q

What is the prognosis for ODD?

A

Remits in 25% of children

May progress to conduct d/o

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37
Q

What is the treatment for ODD?

A
  • Individual psychotherapy that focuses on behavior modification and problem solving
  • Parenting skills training
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38
Q

What are the 3 subcategories of ADHD?

A
  • Inattentive type
  • Hyperactive-Impulsive type
  • Combined
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39
Q

What are features of the inattention of ADHD?

A
  • Problems listening, concentrating, paying attention to details, or organizing tasks
  • Easily distracted
  • Often forgetful
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40
Q

What are features of hyperactivity-impulsivity in ADHD?

A
  • Blurting out
  • Interrupting
  • Figeting
  • Leaving seat
  • Talking excessively
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41
Q

What is the DSM-IV criteria for diagnosing ADHD?

A
  • At least 6 symptoms involving inattentiveness, hyperactivity or both that have persisted for at least 6 months
  • Onset before age 7
  • Behavior inconsistent with age and development
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42
Q

What is the prevalence of ADHD in school aged children?

A

3-5%

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43
Q

What is the gender difference in ADHD?

A

3-5X more common in boys

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44
Q

What are the common comorbidities of ADHD?

A
  • Mood disorders
  • Personality disorders
  • ODD
  • Conduct disorder
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45
Q

What is the prognosis for ADHD?

A
  • Most cases remit in adolescence

- 20% have symptoms into adulthood

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46
Q

What neurochemical factors are involved in ADHD?

A

Dysregulation of peripheral and central noradrenergic systems

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47
Q

What is considered first-line therapy for ADHD?

A

methylphenidate (Ritalin)

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48
Q

What is the rate of improvement for patients on methylphenidate?

A

75%

49
Q

What type of drug is methylphenidate?

A

stimulant

50
Q

What other stimulants are used to treat ADHD?

A
  • Dextroamphetamine (Dexedrine)

- Pemoline (Cylert)

51
Q

What other drug classes are used as adjunctive therapy in ADHD?

A

SSRIs

TCAs

52
Q

What is a manifestation of depression more common in children or adolescents?

A

-Irritableness

53
Q

What is the name for the group of conditions that involve problems with social skills, language and behaivors that is noticed at an early age in life and involves multiple areas of development?

A

Pervasive Developmental Disorders

54
Q

List 4 Pervasive Developmental Disorders

A

Autistic disorder
Asperger’s disorder
Rett’s disorder
Childhood disintegrative disorder

55
Q

What is the DSM-IV diagnostic criteria for autistic disorder?

A

At least 6 symptoms for the following categories must be present:

  • Problems with social interactions (at least 2)
  • Impairments in communication (at least 1)
  • Repetitive and stereotyped patterns of behavior and activities (at least 1)
56
Q

What are examples of problems with social interactions?

A
  • Impairment in nonverbal behaviors (facial expression, gestures, etc)
  • Failure to develop peer relationships
  • Failure to seek sharing of interests or enjoyment with others
  • Lack of social/emotional reciprocity
57
Q

What are examples of impairments in communication?

A
  • Lack of or delayed speech
  • Repetitive use of language
  • Lack of varied, spontaneous play (and so on)
58
Q

What are examples of repetitive and stereotyped patterns of behavior and activities?

A
  • Inflexible rituals

- Preoccupation with parts of objects (and so on)

59
Q

What is the incidence of autism in children under 12?

A

.02-.05%

60
Q

Which gender is more commonly autistic?

A

males 3-5X higher

61
Q

At what age does autism almost always develop?

A

before age 3 (fail to develop milestones)

62
Q

What conditions are associated with autism?

A
  • Fragile X
  • Tuberous sclerosis
  • Mental retardation (70% of autism patients)
  • Seizures
63
Q

What percentage of autistic patients can function completely independently as adults?

A

1-2%

64
Q

What drug class can be used to control aggression, hyperactivity and mood lability in autistic patients?

A

neuroleptics

65
Q

What drug class can be used as adjunctive therapy to help control stereotyped and repetitive behaviors in autistic patinets?

A

SSRIs

66
Q

What are s/s of Rett’s disroder?

A
  • Normal prenatal and perinatal development
  • Normal psychomotor development during first 5 months after birth
  • Normal head circumference at birth but decreasing rate of head growth between 5-48 months
  • Loss of previously learned purposeful hand skills between ages 5-30 months, followed by development of stereotyped hand movements
  • Early loss of social interaction, usually followed by subsequent improvement
  • Problems with gait or trunk movements
  • Severely impaired language and psychomotor development
  • Seizures
  • Cyanotic spells
67
Q

The cognitive development in Rett’s disorder never progresses beyond what age?

A

the first year of life

68
Q

What is the cause of Rett’s disroder?

A

MECP2 gene mutation on X chromosome

69
Q

What is the DSM-IV criteria for childhood disintegrative disorder?

A
  • Normal development in the first 2 years of life
  • Loss of previously acquired skills in at least 2 of the following areas: language, social skills, bowel/bladder control, play, motor skills
  • At least 2 of the following: impaired social interaction, impaired use of language, restricted, repetitive, and stereotyped behaviors and interests
70
Q

At what age does childhood disintegrative disorder develop?

A

age 2-10

71
Q

What gender more commonly develops childhood disintegrative disorder?

A

males 4-8X more likely

72
Q

Involuntary movements or vocalizations.

A

Tics

73
Q

What is the most severe tic disorder?

A

Tourette’s disorder

74
Q

What is the DSM-IV criteria for Tourette’s disorder?

A
  • Multiple motor and vocal tics (both must be present)
  • Tics occur many times a day, almost every day, for > 1 year (no tic free periods for >3 months)
  • Onset prior to age 18
  • Distress or impairment in social/occupational functioning
75
Q

Which usually comes first, motor or vocal tics?

A

motor

76
Q

What are the most common forms of motor tics?

A

Face and head tics (ex. blinking)

77
Q

What is coprolalia?

A

repetitive speaking of obscene words (uncommon in kids)

78
Q

What is echolalia?

A

exact repetition of words

79
Q

What is the prevalence of Tourette’s in children?

A

.05% of children

80
Q

What is the gender difference in Tourette’s?

A

boys 3X more likely

81
Q

What is the typical age of onset of Tourette’s?

A

between ages 7 and 8

82
Q

What are the common comorbidities with Tourette’s?

A
  • OCD

- ADHD

83
Q

What is the neurochemical factor of Tourette’s?

A
  • Impaired regulation of DA in the caudate nucleus

- Possibly impaired regulation of endogenous opiates in noradrenergic system

84
Q

What is the treatment for Tourette’s?

A

Haloperidol

Pimozide

85
Q

What is the MOA of haloperidol and pimozine?

A

DA receptor antagonist

86
Q

When in urinary continence usually established?

A

-Before age 4

87
Q

What is primary enuresis?

A

child never established continence

88
Q

What is secondary enuresis?

A

incontinence occurring after period of urinary continence

89
Q

At what age does secondary enuresis usually develop?

A

5-8

90
Q

What does diurnal enuresis mean?

A

includes daytime episodes

91
Q

What is the DSM-IV diagnosis of enuresis?

A
  • Involuntary voiding after age 5

- Occurs at least twice a week for 3 months or with marked impairment

92
Q

What is the prevalence of enuresis?

A

7% of 5 year olds (decreases with age)

93
Q

What leads to enuresis?

A
  • Genetics
  • Small bladder
  • Low nocturnal levels of ADH
  • Psychological stress
94
Q

What is the typical prognosis for enuresis?

A

majority of cases spontaneously remit by age 7

95
Q

What are the treatment options for enuresis?

A
  • Behavior modification (buzzer, wet sensor)

- Pharmacotherapy (DDAVP or TCAs like imipramine)

96
Q

At what age is bowel control usually achieved?

A

age 4

97
Q

What conditions should be ruled out before diagnosing encopresis?

A
  • Hypothyroidism
  • Lower GI problems
  • Dietary factors
98
Q

What is the DSM-IV criteria for encopresis?

A
  • Involuntary or intentional passage of feces in inappropriate places
  • Must be at least 4 yo
  • Has occurred at least once a month for 3 months
99
Q

What are causes of encopresis?

A
  • Psychosocial stressors
  • Lack of sphincter control
  • Constipation with overflow incontinence
100
Q

What is the prevalence of encopresis in 5 yo?

A

1%

101
Q

What other psych conditions are associated with encopresis?

A
  • Conduct disorder

- ADHD

102
Q

What is the rare condition characterized by not speaking in certain situations?

A

selective mutism

103
Q

What gender more commonly has selective mutism?

A

girls

104
Q

What age is selective mutism usually seen?

A

5-6

105
Q

What may trigger selective mutism?

A

stressful life event

106
Q

What is the excessive fear of leaving one’s parents or other major attachment figures?

A

separation anxiety disorder

107
Q

What may children with separation anxiety disorder complain of?

A

Physical symtpoms (to avoid having to go to school)

108
Q

What do children with separation anxiety disorder worry about?

A

losing parents forever

109
Q

What is the prevalence of separation anxiety disorder in school age children?

A

4%

110
Q

When is the typical onset for separation anxiety disorder?

A

7

111
Q

What disorders are common in parents of children with separation anxiety disorder?

A

anxiety disorders

112
Q

What may be done (other than contacting authorities) if a physician expects child abuse?

A

the child may be admitted without parental consent

113
Q

What are examples of evidence of sexual abuse in a child?

A
  • STDs
  • Anal or genital trauma
  • Knowledge about specific sexual acts (inappropriate for age)
  • Initiation of sexual activity with others
  • Sexual play with dolls (inappropriate for age)
114
Q

What conditions are more common in adults who were abused as children?

A
  • Anxiety disorders
  • Depressive disorders
  • Dissociative disorders
  • Substance abuse disorders
  • PTSD
115
Q

True or false: adults who were abused as children are more likely to abuse their own children

A

true

116
Q

Are most people who sexually abuse children pedophiles?

A

no

117
Q

At what age are children most commonly sexually abused?

A

between 9 and 12

118
Q

What percentage of adults have reported being sexually abused as children?

A
  • 25% of women

- 12% of males

PSYCH ROTATION (18 decks)

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