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Psychosocial Medicine > Lecture 11: Pediatric Substance Use > Flashcards

Lecture 11: Pediatric Substance Use Flashcards

1
Q

Substance Abuse Diagnosis

A
  1. maladaptive pattern os substance use leading to significant impairment or distress
    a. failure to fulfill obligations (work/school/home)
    b. recurrent substance-related legal problems
    c. continued use despite continuing social problems caused by use
    d. using when physically hazardous
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2
Q

Diagnostic Testing Substance Use

A
  1. self-report
  2. lab testing
    - UDS
    - Blood
    - Breath
    - Hair
    - saliva
    - sweat
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3
Q

Treatment Substance Use (6)

A
  1. treatment intensity should reflect severity of d/o
  2. often outpatient treatment
  3. family therapy is most researched-most comprehensive
  4. other psycollcial models
  5. pharmacologic
  6. relapse rates over 60% at 12 months after treatment
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4
Q

Depressive D/O (8)

A
  1. consistently sad or depressed
  2. anhedonia
  3. changes in appetite or sleep
  4. irritability or agitation
  5. fatigue
  6. hopelessness/helplessness/worthlessness
  7. poor concentration
  8. SI
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5
Q

DDX for Depressive D/O (5)

A
  1. anxiety
  2. untreated ADHD
  3. substance use
  4. bipolar
  5. medical conditions
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6
Q

Diagnosis and treatment depressive d/o (5)

A
  1. full psych eval is most useful tool
  2. mood and feeling questionnaire
  3. tx approach varies with severity/duration/comorbidity
  4. SSRIs
    - black box warning to increase suicide ideation in patients ages 24 and under
  5. Psychotherapeutic interventions
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7
Q

Separation Anxiety (6)

A
  1. developmentally inappropriate and excessive anxiety regarding separation from home or parent/caregiver
  2. 2%-4% of children and adolescents
  3. accounts for 50% of all anxiety referrals at this age
  4. linked to insecure attachments
  5. may be precipitated by loss separation
    - actual or threatened
  6. assoc. with parental anxiety and enmeshment
    -enmeshment=parental/caregiver boundaries blurred
    “icky” per lecturer
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8
Q

Generalized anxiety d/o (5)*

A
  1. excessive anxiety and worry most of the time for 6+ months causing significant distress and impairment in functioning
  2. estimated 3% of children and 6%-7% adolescents
  3. assoc. with familial anxiety d/o
  4. also assoc. with parents who are anxious, hypercritical, have high expectations
  5. can manifest as children asking a lot of questions
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9
Q

Avoidant Personality d/o

A
  1. pervasive social inhibition , a sense of inadequacy
    - hypersensitivity to criticsm
  2. leads to avoidance of involvement, preoccupation with rejection and low self-esteem
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10
Q

Social Phobia (6)

A
  1. marked, persistent fear of situations that involve potential scrutiny
  2. fear is severe enough to interfere with normal functioning
  3. prevalence of avoidant PD and social phobia together
  4. 9% or 1.1%
  5. ratio to girls to boys is 7:3
  6. often precipitated by traumatic event
  7. strong familial basis
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11
Q

Panic D/O

A
  1. recurrent, unexplained panic attacks followed by 1+ month changes in bx related to the panic attack
  2. can include agoraphobia
  3. not due to a substance
  4. base prevalence unknown
  5. 1st degree relatives of people with panic d/o meet criteria in 20-40% cases
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12
Q

Selective Mutism (6)

A
  1. consistent failure to speak in specific social situations where there is an expectations of speaking despite speaking in other situations
  2. interferes with educations/occupation
  3. estimated prevalence 0.08%-0.7%
  4. more girls and boys
  5. 1-5 years AOO
  6. manipulative, passive aggressive, reactive, phobic
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13
Q

Differential DX anxiety D.o (4)

A
  1. GI issues
  2. Chronic illness
  3. substance-induced anxiety
  4. ADHD
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14
Q

Diagnosis and Treatment Anxiety d/o

A
  1. diagnosis by complete psych assessment
  2. behavioral treatments
    - CBT
    - Desensitization
    - exposure
  3. Pharmacologic
    - SSRIs
    - SNRIs
    - TCAs
    - Benzo
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15
Q

Bipolar D/o (3)

A
  1. variable clinical presentation
  2. pediatric bipolar is mostly mild episodes, rapid cycling, or irritability
  3. can be difficult to differentiate from ADHD and other psychiatric d/o
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16
Q

Signs/Sx Bipolar D/O (8)

A
  1. severe irritability
  2. moodiness
  3. temper tantrums
  4. depression/anxiety
  5. hyperactivity
  6. increased self esteem
  7. increased goal-directed behavior
  8. psychosis
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17
Q

Hypothesized contributors bipolar d/o (2)

A
  1. biologic
    - correlations between genetic and neuroimaging findings
  2. family environment
    - stress and abuse
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18
Q

Differential DDX bipolar d.o (10)

A
  1. ADHD
  2. Schizophrenia
  3. child-abuse
  4. non-mood-related emotional and bx disturbances**
  5. developmental delays
  6. delirium
  7. tumors
  8. infections
  9. seizure d/o
  10. substance use
19
Q

Diagnostic testing bipolar d/o (4)

A
  1. comprehensive history
  2. consider developmental context
  3. psych testing may be beneficial
  4. possibly neuroimaging in the future
20
Q

Treatment Bipolar D/O (4)

A
  1. mood stabilizers or atypical antipsychotics
  2. official recommendation
    : lithium or depakote*
  3. atypicals are very effective
  4. psychotherapeutic interventions (CBT)
    * increased electrical activity, which also occurs in seizure d/o therefore, anticonvulsants can help
21
Q

Suicidal/Self-injurious behavior (4)

A
  1. suicidal ideation vs. suicide attempt
  2. non-suicidal self-injurious behavior
  3. consider severity of ideation
  4. consider lethality of attempt
22
Q

Epidemiology Suicidal/Self-injurious behavior (6)

A
  1. completion rare in children 5-14 yr.
  2. completed suicide in adolescents 15-19 years 3rd leading cause of mortality
  3. females attempt 2x more
  4. males complete 4x
  5. underlying psych d/o
  6. other rx
23
Q

Treatment Suicidal/Self-injurious behavior (4)

A
  1. rx assessment
  2. focus on underlying d/o
  3. CBT or IPT
  4. pharmacologic
24
Q

Child Maltreatment Dx

2
4 forms maltreatment

A
  1. legal definitions vary by state
  2. forms of maltreatment
    a. neglect
    - educational, physical, medical

b. physical abuse
c. sexual abuse
d. emotional abuse

25
Q

Epidemiology child maltreatment

A
  1. 3 million CPS reports annually
  2. 60% neglect
    - 20% physical abuse
    - 10% sexual
  3. 1,500 children die every year related to maltreatment
26
Q

Factors assoc. with child maltreatment (4)**

A
  1. poverty
  2. financial stress
  3. poor housing
  4. social isolation
27
Q

Dx Child maltreatment (3)

A
  1. interviews of child and patient
  2. explore credibility
  3. psych testing
28
Q

Treatment Child Maltreatment (3)

A
  1. maintain safety
  2. psychiatric tx for significant psych or bx symptoms
  3. trauma-focused CBT
29
Q

PTSD Dx (8)

Infants-School aged children

A

infants-schoolchildren present as behavioral changes

  1. ease of feeding
  2. sleeping
  3. general settling
  4. regressed behavior
  5. unwillingness to explore
  6. increased aggression
  7. clinginess
  8. increased stranger danger
30
Q

PTSD Dx

Primary-High school children (8)

A

similar to adult symptoms

  1. fear of death
  2. separation anxiety
  3. fear of the traumatic event
  4. nightmares
  5. sleep disturbances
  6. flashbacks
  7. fear of stimuli leading to event
  8. hyperarousal
31
Q

DDX PTSD (2)

A
  1. depression

2. anxiety/ panic

32
Q

Diagnosis & treatment PTSD (5)

A
  1. psych testing
  2. history
  3. SSRIs
  4. Alpha agonists
  5. psychological first aid
  • *Does not depend on the event itself, dependent on child’s PERCEPTION of the event
  • 2 children can go through the same event: one can get PTSD while one cannot
33
Q

Tourette’s Dx (5)

A
  1. TIC: sudden rapid, recurrent, nonrhythmic, stereotyped, movement of vocalization
  2. tics occur many times a day ( usually in bouts) nearly every day for more than 1 year
  3. never tic free for more than 3 consecutive months
  4. onset before age 18
  5. not due to substance or medical condition
34
Q

Epidemilology/etiology Tourette’s (7)

A
  1. transient tics comon in school aged children
  2. chronic motor tics 1/4
  3. 2x likely in boys
  4. seemingly strong heritability
  5. stress-sensitive
  6. increasingly aware of urges and exercise some control as they get older
  7. evidence implicates basal ganglia and corticosteroid thalamocortical abnormalities
35
Q

DDX tourette’s (3)

A
  1. distinguish from movement d/o caused by medical conditions
    - MS, Head injury, huntington’s
  2. r/o PDD
  3. r/o OCD
  4. r/o extrapyramidal side effects from antipsychotics
36
Q

DX Tourette’s (2)

A
  1. clinical rating scales
    - Yale global tic severity scale
    - preferred for assessing initial severity and measuring changes
  2. direct observation
    - most objective measure of severity
37
Q

Treatment Tourette’s (8)

A
  1. goal is to diminish sx, not eliminate
  2. best to treat overall, long-term severity over exacerbation
  3. treat comorbidities first
  4. education and support
  5. D2(dopamine) antagonists (atypical)*best
  6. alpha agonists
  7. habit reversal training
  8. surgical intervention for adults with intractable tics (DBS)
38
Q

OCD DX (6)

A
  1. obsessions
  2. compulsions
  3. time consuming and interfere with normal routine (1+ hour/day)
  4. often kept hidden by children
  5. in young children, parental observation of compulsive bx may be only definite sign of d/o
  6. content of obsessions/compulsions is not due to another axis I dx
39
Q

Obsessions

A

intrusive thoughts, images, impulses that cause anxiety of distress

40
Q

Compulsions

A

repetitive behavioral or mental rituals that the person feels driven to perform due to the obsession

41
Q

epidemiology/etiology OCD (4)

A
  1. adolescent prevalence between 1.9%-3.3%
  2. seems to come from abnormalities of serotonin
  3. some heritability
  4. high prevalence of comorbidities
42
Q

DDX OCD (6)

A
  1. MDD
  2. GAD
  3. body dysmorphia
  4. specific phobia
  5. hypochondria
  6. autism/PDD
43
Q

Dx and treatment OCD (4)

A
  1. observation
  2. children’s yale-brwon obsessive compulsive scale
    - CY-BOCS
  3. CBT
  4. SSRIs
    - fluoxetine
    - sertraline
    - fluvoxamine
    - paroxetine
    - citalopram
44
Q

Possible indicators of sexual abuse

A
  1. bedwetting
  2. accidents
    - check for patterns of accidents, or time frame where accidents are happening

Psychosocial Medicine (19 decks)

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