M2: psych diagnoses

Question 1

Depression: MDD

Answer 1

depressed/irritable mood or markedly diminished interest and pleasure in almost all usual activities for a period of 2+ weeks

Question 2

Dysthymic disorder

Answer 2

depressed/irritable mood majority of days in past 2 years that is less intense but more chronic

Question 3

Adjustment disorder with depressed mood occurs within 3 months of major life stressor, has less severe symptoms, and is relatively mild/brief

Question 4

Psychotic symptoms outcomes

Answer 4

greater incidence adverse long term outcomes, resistance to psychopharmacology, much higher risk of developing bipolar

Question 5

Atypical depression

Answer 5

hypersonic, increased appetite, psychomotor retardation, weight gain

Question 6

Depression s/s

Answer 6

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.

Question 7

Criteria for severe depression

Answer 7

suicidality and plan or attempt, psychotic, first degree relative with bipolar, significant impairment such as unable to leave home

Question 8

Meds that cause depressive symptoms

Answer 8

beta-blockers, benzos, NSAIDs, stimulants, clonidine, steroids, contraceptives, isotretinoin.

Question 9

Depression diagnostics

Answer 9

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.

Question 10

Warning signs for suicide

Answer 10

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

Question 11

Depression management

Answer 11

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.

Question 12

Depression treatment

Answer 12

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.

Question 13

Bipolar

Answer 13

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.

Question 14

bipolar management

Answer 14

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.

Question 15

Mild intellectual disability

Answer 15

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

Question 16

Moderate intellectual disability

Answer 16

presents earlier than mild; learning/language difficulties, deficits in social and communication, may function adaptively with training and support; 2nd grade level.

Question 17

Severe intellectual disability

Answer 17

limited ability to understand written language, numbers and time; need significant support; limited understanding of verbal/gestural communication; pre-K level

Question 18

Profound intellectual disability

Answer 18

use of objects in goal directed manner for self care or recreation; very limited communication and nonverbal; pervasive support and dependent

Question 19

ID diagnostics

Answer 19

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

Question 20

Screening tools for childhood aggression

Answer 20

child aggression scale 5-18 y/o. Modified Overt Aggression Scale. Buss-Perry Aggression Questionnaire 9years-adulthood.

Question 21

Conduct Disorder CD

Answer 21

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.

Question 22

Oppositional Defiant Disorder ODD

Answer 22

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.

Question 23

Autism spectrum disorder ASD

Answer 23

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.

Question 24

ASD s/s

Answer 24

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.

Question 25

asd red flags

Answer 25

lack of social smile/eye contact at 2-3 months, lack of joint attention at 9 mo, not responding to name by 1yr, not following a point to picture and look back at pointer by 1yr, not pointing at objects by 14mo, not pretending by 18mo, avoids eye contact, trouble understanding feelings, loss of social abilities at any age, delayed speech/language, echolalia, monotone intonation, speech scripted, lack of response to hearing name called, obsessive interests, upset by minor changes, flaps hands, unusual sensory issues, self-injuring behaviors. development is uneven.

Question 26

ASD screening

Answer 26

screen at 18 and 24 months: M-CHAT-R/F is most used tool. STAT 24-35mo, CAST 3+ years, SCQ 4+, ASSQ 7-16 years. gold standard ADOS-2 and ADI-R which are costly and require training. do full assessment for comorbidities and test for iron and lead. specialty assessment of DD, behavior, IQ, audiology, genetic testing. can do neuroimaging, EEG, metabolic testing. levels of severity change over time.

Question 27

anorexia

Answer 27

highest mortality rate of all mental health conditions. higher in females. higher risk athletes, weight division sports, middle-high socioeconomic class, divorced family, chronic disease, personality disorders, history of child abuse. often underweight, electrolyte misbalances, dental issues, high achieving, not eating much.

Question 28

bulimia

Answer 28

eating binging, then purging behavior once a week for 3 months. SCOFF questionnaire. menstrual irregularity, body dysmorphism.

Question 29

eating disorder red flags and s/s

Answer 29

reading diet books, regularly fasts, stops eating with friends, misses 2+ periods during weight loss, sudden desire to be vegetarian, sudden picky eating, visits bathroom after meals, showers multiple times a day, skip meals, excessive exercise, laxatives/diet pills, reports purging. weight fluctuation, guilt about weight, social isolation, s/s: highly structured schedule, cold intolerance, fatigue, myalgia, constipation/diarrhea/abdominal bloating, GI distress, sore throat, syncope, substance abuse, self harm, family history of stressors. altered growth, parotid gland enlargement, fluid retention, facial edema, thin body type, low body temp. hypotension, shallow respirations, dental enamel erosion, caries, Russell sign (knuckle issues), thinning hair, alopecia, abdominal distention, lanugo, muscle atrophy, mental torpor.

Question 30

eating disorder diagnostics

Answer 30

electrolyte issues, malnutrition, CBC, thyroid, liver function testing, LH, UA, ECG, bone density,