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Psychosocial Medicine > Lecture 10: Pediatric Psychiatry > Flashcards

Lecture 10: Pediatric Psychiatry Flashcards

1
Q

Goals of psychiatric interview-overall (3)

A
  1. Come to a diagnostic formulation
  2. Provide a therapeutic intervention
  3. Create a foundation for treatment
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2
Q

Parental Interview Goal (3)

A
  1. Form an alliance
  2. Obtain a formal hx
  3. Obtain info about
    - relationships
    - family dynamics
    - values
    - communication
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3
Q

Infant Interview Goals (4)

A
  1. Determine causes of disturbances
    - in regulation
    - social
    - psychophysiologic
    - developmental delays
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4
Q

Child Interview Goals (6)

A
  1. How the child feels
  2. What the child thinks the purpose is
  3. Correct misunderstandings
  4. Assess development
  5. Gauge coping skills
  6. Establish alliance
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5
Q

Adolescent Interview Goals (3)

A
  1. Establish possible diagnosis
  2. build rapport
  3. build a foundation for treatment
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6
Q

Family Interview Goals (5)

A
  1. Gather comprehensive history
  2. Observe and assess family interactions
  3. Formulate family diagnosis and treatment plan
  4. Educate and motivate for treatment
  5. Build therapeutic relationship
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7
Q

Interviewing Parents (2)

A
  1. intake questionnaires and checklists

2. Work through the domains of a psychiatric evaluation

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8
Q

Interviewing Infants (3)

A
  1. interview the parents
  2. observe parent-child interactions
  3. standardized testing (developmental level scales)
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9
Q

Interviewing Children (4)

A
  1. Interview structure depends on the child
  2. Unstructured vs. semi-structured vs. structured
  3. Help them relax; toys, no white coats, no notebooks
  4. little ones are concrete-ask pointed questions
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10
Q

Interviewing Adolescents (5)

A
  1. listen
  2. don’t be too formal
  3. start with easier topics
  4. ask about SI
  5. discuss confidentiality
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11
Q

Family Interview (2)

A
  1. Identify problems

2. Observe family interactions

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12
Q

Mental Status Exam (2)

A
  1. organized observations and assessments of behavior during the assessment
  2. helpful in refining diagnosis and knowing where to look further

**OBJECTIVE

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13
Q

Treatment Planning (5)

A
  1. safety first
  2. identify goals of treatment
  3. look at all factors
  4. treat -> monitor -> revise
  5. consider risks and benefits
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14
Q

Intellectual Disability Dx

A
  1. not a single d/o
  2. Onset before age 18
  3. Impairment in intellectual and adaptive functioning
  4. varying levels of severity
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15
Q

Mild MR

A

IQ 50-55 to 70

*verbal skills lack below 50 typical

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16
Q

Moderate MR

A

IQ 35-40 to 50-55

*verbal skills lack below 50 typical

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17
Q

Severe MR

A

IQ 20-25 to 35-40

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18
Q

Profound MR

A

IQ 20-25

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19
Q

Intellectual Disability Epidemiology (5)

A
  1. 0.7%-1% prevalence
  2. 2/3 of cases are mild
  3. increased rx for comorbidities
  4. multitude of cases: prenatal/perinatal/postnatal
  5. can be genetic or external
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20
Q

Diagnostic Testing for Intellectual Disability (7)

A
  1. psychological testing**
  2. genetic testing
  3. metabolic screening
  4. EEG
  5. hearing acuity evaluation
  6. ophthalmologic assessment
  7. neuroimagining
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21
Q

DDX for intellectual disability (5)

A
  1. dementia
  2. PDD -austism
  3. learning d/o
  4. communication d/o
  5. other mental d/o
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22
Q

Treatment intellectual disability (5)

A
  1. treatment and education based on strengths and weaknesses
  2. behavioral management programs
  3. early intervention services
  4. psychopharmacologic bass on specific symptoms
  5. other: OT, PT, ortho, GI, etc.
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23
Q

Special consideration intellectual disability (5)

A

When using medication in this population

  1. rule out all other causes for behaviors
  2. use least intrusive medication at the lowest effective dose
  3. avoid poly pharmacy if possible
  4. monitor closely
  5. goal is maximizing quality go life not eliminating challenging behaviors
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24
Q

Learning D/O diagnosis

A
  1. Significant difficulties in learning and using skills such as listening, speaking, writing, reasoning or math
  2. achievement well below average on standardized testing and interferes with achievement or daily activities
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25
Q

DSM 3 types learning d/o

A
  1. reading d/o
  2. math d/o
  3. written expression d/p
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26
Q

Epidemology learning d/o (2)

A
  1. estimated 2%-8% of school aged children

2. can be intrinsic or environmentally influenced

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27
Q

Dx and Tx learning d/o (4)

A
  1. Psych testing (WISC-III)
  2. Remedial Approach- improve specific skills
  3. Compensatory approach- work about deficit
  4. interventions for related social/emotional issues
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28
Q

Motor D/o Dx (4)

A
  1. performance in daily motor functioning is far below expected
  2. disturbance interferes with academic achievement or ADLs
  3. Not due to general medical condition or PDD
  4. if MR is present, motor difficulties are more than expected
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29
Q

Motor Disorders (6)

A
  1. clumsiness
  2. Adventitious movements
  3. Dyspraxia
  4. material-specific dyspraxia
  5. neurologic soft signs
  6. pathologic handedness
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30
Q

Clumsiness

A

Motor D/O

inefficiency in performance of fine motor movements

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31
Q

Adventitious Movements

A

Motor D/O

synkinesis, chorea, tremor, tics

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32
Q

Dyspraxia

A

Motor D/O

inability to learn or perform serial voluntary movements to complete skilled acts

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33
Q

Material-Specific Dyspraxia

A

Motor D/O

motor execution below expected age with regard to writing (dysgraphia), drawing (constructional dyspraxia), or speech (verbal dyspraxia)

34
Q

Neurologic Soft Signs

A

Motor D/O

non normative performance on motor or sensory neurologic tests in the absence of localizable neurologic disease or defect

35
Q

Pathologic Handedness

A

Motor d/o

left-handedness assoc with left-hemispheric defect and paresis of the right hand

36
Q

Epidemiology Motor d/o (3)

A
  1. 6% school aged children
  2. genetic cause, possibly “minimal brain damage”
  3. typically improved throughout development
37
Q

Diagnostic Testing (5)

A
  1. development hx (questions about motor performance)
  2. neuro exam
  3. specific assessment procedures based on sx
  4. psych testing
  5. neuroimaging
38
Q

DDX Motor d/o (4)

A
  1. neuroleptic/anticonvulsant toxicity
  2. neuromuscular d/o
  3. upper motor neuron d/o
  4. other d/o involving motor issues
39
Q

Motor d/o tx

A
  1. pysiotherapy and occupational therapy for remediation of motor handicaps
40
Q

Communication D/O

A
  1. must be severe enough to interfere with patient’s
    - school
    - occupational achievement
    - social communication
  2. must exceed expectations for age/IQ/Dialect
41
Q

Communication D/o types (4)

A
  1. expressive language d/o
  2. mixed expressive-receptive language d/o
  3. phonological d/o
  4. stuttering
42
Q

Signs/Sx Expressive Language D/O (4)

A

Communication D/O

  1. limited vocabulary
  2. errors in grammar
  3. difficulties with word recall
  4. difficulties with sentence production
43
Q

Signs/Sx Mixed Expressive-Receptive Language D/O

A

Communication D/O

  1. same as expressive language d/o
    - difficulties processing or understanding spoken words/sentences
44
Q

Phonological D/O signs/symptoms

A

Communication D/O

  1. developmentally inappropriate difficulties with sounds (production, use, organization)
45
Q

Suttering D/O signs and sx

A

Communication D/O

  1. disturbance in normal fluency and patterning of speech
46
Q

Epidemiology Communication d/o (5)

A
  1. 2-7%
  2. elevated rate psych comorbidity
  3. occurs more frequently in families with hx of language d/o
  4. 4x more likely in boys than girls
  5. genetic or acquired
47
Q

DDX Communication D/O (3)

A
  1. autism
  2. PDD
  3. ADHD
48
Q

Diagnosis Communication D/O

A
  1. psych testing
  2. audiological testing
  3. neuroimaging if neuro exam abnormal
49
Q

Tx Communication D/o

A

Therapeutic services

50
Q

Autism Signs/Sx (6)

A
  1. Wide range sx and severity
  2. Difficulties with social interactions
  3. abnormal eye contact
  4. delays/abnormalities in language
  5. lack of interest ing environment
  6. repetitive behaviors/ difficulties with change in routine
51
Q

Autism Dx (4)

A
  1. qualitative impairment in social interactions (at least 2)
  2. Qualitative impairment on communication (at least 1)
  3. Restricted, repetitive, and stereotyped patterns of behavior, interests, and acitivites (at least 1)
  4. 6 total items from diagnostic list
52
Q

Epidemiology Autism (5)

A
  1. 4.5-9 per 10,000
  2. boys 3-4x more likely than girls
  3. high rates seizure d/o, persistence of primitive reflexes, “soft” neurological signs
  4. 2%-10% in siblings
  5. work being done on genetic factors, obstetrical risk, environmental factors
53
Q

Diagnostic testing autism (5)

A
  1. psych testing
    - strengths in nonverbal tasks, but deficiencient in verbal cognitive abilities
  2. most function in MR range
  3. savant skils
  4. EEG abnormalities may be seen (not diagnostic)
54
Q

DDX Autism (4)

A
  1. other developmental d.o including PDD
  2. sensory impairment
  3. MR
  4. Language d/o
55
Q

Treatment Autism (6)

A
  1. Education and behavioral interventions
  2. antipsychotics
  3. SSRIs
  4. mood stabilizers
  5. psychodynamic therapy
  6. 20% + able to become independently functioning adults
56
Q

Pervasive Developmental D/O

A
  1. Aspbergers
  2. Childhood Disintegrative D/O
  3. Rett D/o
  4. Pervasive Developmental D/O NOS: Autism Spectrum
57
Q

Asperger’s

A

PDD

Social disability with good verbal skills

58
Q

childhood disintegrative d/o

A

PDD

rare condition in which a condition life autism develops after a time of normal development

59
Q

Rett D/O

A

PDD

Neurodegenerative D/O

60
Q

Pervasive Developmental D/O NOS

A

PDD

Autism Spectrum D/O

61
Q

Attention Deficit D/O Signs and sx (6)

A
  1. inattentive
  2. distractible
  3. impulsive
  4. hyperactive
  5. poor organization
  6. daydreaming
  7. frequently changing activities
  8. poor time management ‘
  9. low frustration tolerance
62
Q

ADHD Dx (5)

A
  1. 6+ sx of inattention OR
  2. 6 + or more sx of hyperactivity
  3. some impairment of these symptoms in 2+ settings
  4. Evidence of significant impairment in social/academic/occupational functioning
  5. sx are not only during the course of another d/o
63
Q

Epidemiology ADHD (6)

A
  1. Most common emotional/cognitive/bx d/o treatment in youth
  2. 4-7% children
    - combined= 50-70%
    - inattentive= 20-30%
    - hyperactive/impulsive= <15%
  3. Girls more commonly have inattentive type
  4. biologic adversity rx
  5. psychosocial adversity rx
  6. highly genetic, 77%
64
Q

Diagnostic Testing ADHD

A
  1. Diagnosis made by careful hx
  2. rating scales for screening
  3. psych testing (not necessary but can be beneficial)
65
Q

DDX AHDH (6)

A
  1. ODD and conduct d/o
  2. mood d/o (mania)
  3. anxiety d/o
  4. learning disability
  5. Tics
  6. substance use d/o
66
Q

Tx ADHD (6)

A
  1. Psychostimulants
  2. Strattera (SNRI)
  3. Antidepressants (TCAs, Wellbutrin)
  4. Alpha agnoists
  5. Modafinil
  6. psychotherapeutic interventions
67
Q

Opposotional Defiant D/O

Signs/Sx (10)

A
  1. Oppositional
  2. Tests Limits
  3. disruptive behaviors
  4. moddy
  5. irritable
  6. often in conflict
  7. argumentative
  8. angry
  9. easily loses temper
  10. spiteful
68
Q

ODD Dx (5)

A
  1. Pattern of negative, hostile, and defiant d/o
  2. lasts at least 6 month
  3. disturbances causes impairment in social/ academic/occupational functioning
  4. symptoms not exclusive to another psych d/o
  5. criteria not met for conduct d/o
69
Q

Epidemiology ODD (6)

A
  1. 5.7-9.9%
  2. average onset 6 years
  3. 4:1 M:F
  4. low heritability
  5. increased rx with infants with disorganized attachments, highly stressed families
  6. related to failure to provide adequate praise, attention, and consistent limits
70
Q

DDX ODD (6)

A
  1. normal developmental testing
  2. ADHD
  3. Conduct D/O
  4. Pre-morbid schisophrenia
  5. oppositionality with MR
  6. parental psychopathology
71
Q

Dx and treatment ODD (4)

A
  1. Psych testing (behavioral check list)
  2. under 12: treatment through parents
  3. adolescents: family therapy approach
  4. Problem solving communication training (PSCT)
72
Q

Conduct Disorder Diagnosis (3)

A
  1. Repetitive violation of social norms/rules
  2. Behaviors cause impairment in social, academic or occupational functioning
3. Disruptive or dangerous behaviors 
3+
-Agression to people or animals 
-property destruction 
-deceitfulness of theft
-seroius violations of rules
73
Q

Epidemiology Conduct Disorder

A
  1. 0.9-8.7%
  2. Multiple etiologic theories
    - genetic
    - physiological
    - acquired
74
Q

DDX Conduct D/O

A
  1. Mania
  2. Dysthymia/ MDD
  3. Likely to coexist with
    - ODD
    - ADHD
    - Substance use
    - Learning d/o
    - Depression
    - PTSD
    - Anxiety
75
Q

Dx Conduct D/O (2)

A
  1. comprehensive biopsychosocial evaluation

2. psych testing can provide insight

76
Q

Tx of Conduct D/O (3)

A
  1. psychosocial intervention
  2. ecological intervention
  3. biological intervention s
77
Q

Pharmacological tx conduct d/o

A
  1. methylphenidate
  2. Depakote
  3. Lithim
78
Q

Methyphenidate Tx in conduct d/o

A

reduce defiance, oppositionality, aggression

79
Q

Depakote tx in conduct d/o

A

reduce hyperarousal, anger, agression

80
Q

Lithium tx in conduct d/o

A

reduce agression

81
Q

Prognosis ODD

A

ODD -> Conduct D/O -> antisocial PD

Additional Pathways:

  1. substance use
  2. covert/nonaggressive
  3. aggressive/versatile
  4. authority conflict

Psychosocial Medicine (19 decks)

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