Lecture 11: Pediatric Substance Use Flashcards
1
Q
Substance Abuse Diagnosis
A
- 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
2
Q
Diagnostic Testing Substance Use
A
- self-report
- lab testing
- UDS
- Blood
- Breath
- Hair
- saliva
- sweat
3
Q
Treatment Substance Use (6)
A
- treatment intensity should reflect severity of d/o
- often outpatient treatment
- family therapy is most researched-most comprehensive
- other psycollcial models
- pharmacologic
- relapse rates over 60% at 12 months after treatment
4
Q
Depressive D/O (8)
A
- consistently sad or depressed
- anhedonia
- changes in appetite or sleep
- irritability or agitation
- fatigue
- hopelessness/helplessness/worthlessness
- poor concentration
- SI
5
Q
DDX for Depressive D/O (5)
A
- anxiety
- untreated ADHD
- substance use
- bipolar
- medical conditions
6
Q
Diagnosis and treatment depressive d/o (5)
A
- full psych eval is most useful tool
- mood and feeling questionnaire
- tx approach varies with severity/duration/comorbidity
- SSRIs
- black box warning to increase suicide ideation in patients ages 24 and under - Psychotherapeutic interventions
7
Q
Separation Anxiety (6)
A
- developmentally inappropriate and excessive anxiety regarding separation from home or parent/caregiver
- 2%-4% of children and adolescents
- accounts for 50% of all anxiety referrals at this age
- linked to insecure attachments
- may be precipitated by loss separation
- actual or threatened - assoc. with parental anxiety and enmeshment
-enmeshment=parental/caregiver boundaries blurred
“icky” per lecturer
8
Q
Generalized anxiety d/o (5)*
A
- excessive anxiety and worry most of the time for 6+ months causing significant distress and impairment in functioning
- estimated 3% of children and 6%-7% adolescents
- assoc. with familial anxiety d/o
- also assoc. with parents who are anxious, hypercritical, have high expectations
- can manifest as children asking a lot of questions
9
Q
Avoidant Personality d/o
A
- pervasive social inhibition , a sense of inadequacy
- hypersensitivity to criticsm - leads to avoidance of involvement, preoccupation with rejection and low self-esteem
10
Q
Social Phobia (6)
A
- marked, persistent fear of situations that involve potential scrutiny
- fear is severe enough to interfere with normal functioning
- prevalence of avoidant PD and social phobia together
- 9% or 1.1%
- ratio to girls to boys is 7:3
- often precipitated by traumatic event
- strong familial basis
11
Q
Panic D/O
A
- recurrent, unexplained panic attacks followed by 1+ month changes in bx related to the panic attack
- can include agoraphobia
- not due to a substance
- base prevalence unknown
- 1st degree relatives of people with panic d/o meet criteria in 20-40% cases
12
Q
Selective Mutism (6)
A
- consistent failure to speak in specific social situations where there is an expectations of speaking despite speaking in other situations
- interferes with educations/occupation
- estimated prevalence 0.08%-0.7%
- more girls and boys
- 1-5 years AOO
- manipulative, passive aggressive, reactive, phobic
13
Q
Differential DX anxiety D.o (4)
A
- GI issues
- Chronic illness
- substance-induced anxiety
- ADHD
14
Q
Diagnosis and Treatment Anxiety d/o
A
- diagnosis by complete psych assessment
- behavioral treatments
- CBT
- Desensitization
- exposure - Pharmacologic
- SSRIs
- SNRIs
- TCAs
- Benzo
15
Q
Bipolar D/o (3)
A
- variable clinical presentation
- pediatric bipolar is mostly mild episodes, rapid cycling, or irritability
- can be difficult to differentiate from ADHD and other psychiatric d/o
16
Q
Signs/Sx Bipolar D/O (8)
A
- severe irritability
- moodiness
- temper tantrums
- depression/anxiety
- hyperactivity
- increased self esteem
- increased goal-directed behavior
- psychosis
17
Q
Hypothesized contributors bipolar d/o (2)
A
- biologic
- correlations between genetic and neuroimaging findings - family environment
- stress and abuse