Lecture 10/10 Flashcards
Pseudoseizures are most common in what condition
Conversion rxn
What is the most common depressive mood disorder in children
Adjustment disorder
mainstay treatment in ADHD
Stimulants
where are most of peds with mental illness managed?
PCP
__ percentage of peds office visits involve behaviors, psychoscoial or educational concerns
50%
Do PCPs identify most kids with emotional/ behavioral problems?
No, <20% are identified
When are Ages and Stages Socio-emotional surveys done?
Infants and young children
What does a child have if they present with
Loss of interest, feelings of worthlessness, decreased energy, crying spells, irritability, isolation, low self esteem.
Depression
What does P.S.Y.C.H stand for?
Parent Child interactions
School – academically, behaviorally, socially
Youth – peers, friendships, relationships
Casa – things at home..siblings..stress
Happiness – how would you describe your mood? Your childs mood?
Common comorbidities with depression
ADHD, conduct disorders, anxiety, substance abuse,
DDx for depression
Hypothyroid
Substance abuse
Eating disorder
2ndary to medical illness
tx for depression
CBT- cognitive behavioral therapy
referral to psychotherapy
SSRI (black box warning- suicide)
What are some hallmark symptoms of depression in kids
Irritability/ lashing outs
apathy
persistent sadness
Why may kids present with somatic symptoms due to depression?
Inability to tolerate sadness
Disorder with decreased interesting or participation feelings of inadequacy, low self esteem social withdrawl irritability decrease in sleep/ appetitie Less severe than those of a major depressive disorder but are more persistent, lasting for at least 1 year.
Dysthymic Disorder
Symptoms of major depressive disorder in infants
Failure to thrive, speech and motor delays
Poor attachment
Repetitive self-soothing behaviors
Loss of previously learned skills
Middle childhood presentation of this disorder
Persistently irritable mood, aggressive and uncontrollable outbursts, extreme fluctuations in mood, reckless behavior, inappropriate sexual behavior.
Bipolar disorder
the most common depressive mood disorder in children and adolescents. Symptoms start within 3 months of an identifiable stressor, usually lasts less than 6 months
Adjustment disorder with depressed mood
In adolescence.
Agitated behaviors, pressured speech, racing throughs. Reckless behavior, illicit activities, psychotic symptoms (hallucinations, delusions, irrational thought)
Bipolar
Is bipolar a true diagnosis in someone younger than puberty?
Usually not
When does depression become more common in girls?
During and after puberty
What is a scale for pediatric depression
Beck
Complications with depression
suicide ,
school performance,
loss of friends,
family tension
type of bipolar with a little less mania
Bipolar II
DDx for bipolar
physical or sexual abuse
domestic violence
organic disorders
Treatment for bipolar
Lithium
What is the only agent approved by FDA for depression/ suicidal ideation
fluoxetine (prozac)
most commonly used method for suicide
firearms
what are suicides most commonly associated with?
Mood disorders
high achievers anxious about a failure
who has the highest risk of suicide?
white adolescent males
When is the onset of schizophrenia?
middle teens- early 30s
more common in boys, high family risk
What should you do is a child is exhibiting psychotic symptoms.
medical evaluation for neurologic disease (MRI, EEG), metabolic disease, wilsons disease
Who is OCD most common in?
boys in children
girls in adolescence
In adolescence what can schizophrenia be confused with?
Mania
How do you treat schizophrenia?
antipsychotics
what has a lot of overlap with ADHD?
conduct disorders
Presents with truancy, aggression, defiance, fighting, theft, sexual perpetration, substance abuse.
Commonly a boy in a bad home
Conduct disorders
How do you treat OCD?
CBT
SSRI
What infection is commonly associated w/ OCD?
Group A Streptococcal infection
Must do this to relieve a feeling of anxiety
Compulsions
what is PANDA?
pediatric autoimmune neuropsychiatric disorder associated w/ strep
How do you treat general anxiety disorder?
CBT
SSRI
These are an example of what : Handwashing, ordering, checking, counting, repeating words silently, hoarding?
Compulsions
A child experiencing this probably has what : Fear, anxiety, hypervigilance. May regress developmentally. Nightmares
PTSD
How do you treat PTSD?
individual and family psychotherapy
drugs (don’t need to know specifics)
Many people with GAD have what qualities
perfectionist
overly concerned w/ approval of others
disorders involve a complaint of physical symptoms (pain or loss of function) that suggest a medical condition but are not fully explained by either a medical condition, a pharmacologic effect, or another psychiatric condition
Somatoform disorders
Who are somatoform disorders common in?
Girls
lower socioeconomic status
hx of sexual trauma, physical threats
phobias often occur along with what?
anxiety disorders
treatment for somatoform disorders
CBT
some also with SSRI
A neurodegenerative disorder
Age of onset: typically between ages 2 and 4 (can be recognized in first 12-18mo)
Consistent failure to orient to one’s name, regard people directly, use gestures, and develop speech.
Autism
What are some hallmarks of Autism spectrum disorders?
Impaired communication
impaired social interaction
stereotypic behavior, interests, activities
MR is common
tx for autism
Occupational therapy Sensory integration services Behavioral therapy ( self care, linguistics)
treatment for non autistic pervasive development disorder
cognitive-behavioral approach
impairment in social interaction and restricted interest/repetitive behaviors
Not delayed in cognitive, language or self help
Asperger
Impairment in reciprocal social interaction
Impairment in communication skills
Restricted interests and repetitive behaviors
(don’t meet full criteria for autism – mild sx)
PPD-NOS
Genetic, due to mutation on X chrom
Almost exclusively girls
Regression in skills in the first year of life
Characteristic handwringing
Rett Syndrome
tests for mental retardation
Bayley for young kids
Wechsler intelligence for older (and stanford binnet)
3 major characteristics of ADHD
impulsivity
hyperactivity
inattention
3 subtypes of ADHD
Hyperactive Impulsive : 10% . Can pay attention
Inattentive :30-40% (old ADD term)
Combined : 50-60%
What is a scale for ADHD?
Vanderbilt Assessment Scales for AD/HD
What is a main finding with the cortex of a child with ADHD?
same overall pattern of brain development, but everything tends to be delayed (especially frontal cortex)
