M2: psych diagnoses Flashcards
Depression: MDD
depressed/irritable mood or markedly diminished interest and pleasure in almost all usual activities for a period of 2+ weeks
Dysthymic disorder
depressed/irritable mood majority of days in past 2 years that is less intense but more chronic
Adjustment disorder with depressed mood occurs within 3 months of major life stressor, has less severe symptoms, and is relatively mild/brief
Psychotic symptoms outcomes
greater incidence adverse long term outcomes, resistance to psychopharmacology, much higher risk of developing bipolar
Atypical depression
hypersonic, increased appetite, psychomotor retardation, weight gain
Depression s/s
decreased mood, impaired concentration, inattention, irritability, fluctuating mood, temper tantrums, social withdrawal, somatic complaints, agitation, separation anxiety, behavioral problems. males more likely to externalize, females internalize. prepuberty rates equal, post puberty females higher. infants/young children may have failure to thrive, speech/motor delays, self-soothing behaviors, withdrawal, poor attachment, loss of developmental skills. toddlers/preschoolers: lack energy, too eager to please others, unusually clingy, developmentally inappropriate problems with separation, sad/grouchy mood, lack of pleasure in play, weight loss, poor appetite, sleep problems, low energy/activity, low self esteem, increased death play or talk. school age: irritable, angry, hyperactive, reckless, absence from school, poor performance, boredom, withdrawal, somatic complaints. adolescents: impulsive, fatigue, hopeless, antisocial, substance abuse, restless, aggression, hypersexuality.
Criteria for severe depression
suicidality and plan or attempt, psychotic, first degree relative with bipolar, significant impairment such as unable to leave home
Meds that cause depressive symptoms
beta-blockers, benzos, NSAIDs, stimulants, clonidine, steroids, contraceptives, isotretinoin.
Depression diagnostics
send CBC, vD, pregnancy test, EBV titer, thyroid panel, liver function, UA, drug screening. Diagnostic rating scales: CBCL for 1.5-18 year olds. CDRS-R for 6-12 year olds. CDI for 6-18 years. CES-D adolescents. depression self rating scale adolescents. PSC 4-adolescent. PHQ-9 6-10 and 11-adolescent.
Warning signs for suicide
risk taker, substance abuse, violent, no appetite, sudden alienation, worsening performance, putting affairs in order, loss of interest in personal affairs, disposal of possessions, writing letters, buying weapon, hopelessness, explosive rage, dramatic swings, crying spells, talking about suicide, preoccupation with death, difficulty concentrating, irrational speech, hearing voices, sudden interest in religion, major life changes had happened
Depression management
determine suicidal risk and intervene to prevent. risk greatest during first 4 weeks of episode. if acute suicidal intent with plan, psychosis, risk of abuse, and unstable behavior > immediate psych eval. cumulative risks require behavioral health intervention with immediate referral. establish safe environment. suicide risk highest during first week to month of treatment : emergence.
Depression treatment
CBT. older meds not helpful for children. SSRIs are firstling. NO paroxetine increased suicide risk. start low slowly increase, takes 4-6 weeks to see max response, but can adjust dose q2-4 weeks. activation/mania can occur. if psychosis too, often add antipsychotics like risperidone or olanzapine. f/u phone within 3 days and see them weekly until stable with first 4 weeks of treatment being critical; then maintenance q3months.
Bipolar
swings with depression and mania; high recurrence rate. common onset between 15-19 years of age. familial. caution when treating adhd/bipolar with meds. if develops in childhood, more severe: irritability, continuous rapid-cycling, mixed symptom state. late adolescent: classic manic episodes, patterns of mania/depression, relative stability between episodes. s/s: severe mood changes, inflated self esteem, increased energy and physical agitation, decreased need for sleep, talkative or compulsion, racing thoughts, distractibility, goal-directed activity but get stuck, risk taking, hyper sexuality, psychosis, suicidal thoughts. hallmark sign in kids is sleep difficulties with high activity levels before bed.
bipolar management
if treating ADHD kid and worsens or doesn’t improve, immediately refer because may have bipolar too. pharm: mood stabilizers like lithium, anti seizure meds like valproate, divalproex, and atypical antipsychotics. stress reduction, healthy diet, routine exercise, good sleep hygiene.
Mild intellectual disability
early school year presentation; difficulty in studies, more socially immature, concrete thinking, function adaptively but need support for complex daily living, reach 6th grade level
Moderate intellectual disability
presents earlier than mild; learning/language difficulties, deficits in social and communication, may function adaptively with training and support; 2nd grade level.
Severe intellectual disability
limited ability to understand written language, numbers and time; need significant support; limited understanding of verbal/gestural communication; pre-K level
Profound intellectual disability
use of objects in goal directed manner for self care or recreation; very limited communication and nonverbal; pervasive support and dependent
ID diagnostics
if suspecting syndrome: labs, chromosome studies, neuroimiging, referral to genetics specialist. if non syndromic: chromosomal microarray, fragile X testing, karyotyping as first line but referral to genetics is recommended. IQ < 70 is ID. 70-84 are slow learners. Wechsler intelligence scale or stanford-binet intelligence scales. adaptive functioning testing with Vineland adaptive behavior scales or adaptive behavior assessment system. impairment in one of three domains needs ongoing support in order to qualify as impairment
Screening tools for childhood aggression
child aggression scale 5-18 y/o. Modified Overt Aggression Scale. Buss-Perry Aggression Questionnaire 9years-adulthood.
Conduct Disorder CD
repetitive, persistent pattern of behavior in which basic rights of others or major societal norms and rules are violated. Early-onset around 4-6, formal diagnosis 7 years +. often associated with a history of harsh discipline, abuse, or neglect. more common in males. often apparent in change to middle school. s/s: severe physical aggression causing harm, damage to property, lying/stealing, serious violations of rules/laws.
Oppositional Defiant Disorder ODD
pattern of negative, hostile, defiant behavior that is excessive compared with other children of same age. often early childhood 3-7 y/o, disorder beginning 8 y/o.
Autism spectrum disorder ASD
restrictive, repetitive, stereotyped patterns of behaviors, interests, activities. familial inheritance patterns (male 4:1), increased prevalence siblings and twins, risk relatives). 2nd hit risk factors: preemie, meconium aspirate, breech delivery, low 5 min Apgar, maternal meds, advanced parental age, autoimmune and toxin exposure.
ASD s/s
infants: passive, non engaging, floppy/difficult, quiet, colicky, stiff, poor eye contact, fail to respond to name or gestures. early childhood: parents often become convinced that something is wrong with their child as language delays, lack of social relatedness, severe behavior problems common. echolalia, detachment, decreased eye contact, lack of reciprocity, lack of fear, poor creative play, invasion of others’ space, preference of being alone, lack of social awareness. School age: no reciprocal friendships have ritualistic behaviors, continue with language, social, behavioral problems. adolescents similar. rote learning possible, kutcomprehension lags.
