Mental Health + Development Flashcards

1
Q

Conditions assoc w disruptive behaviour

A

ADHD, ODD, conduct disorder, anxiety, mood disorders, cognitive and language disabilities

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2
Q

what age do temper tantrums peak?

A

3yo

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3
Q

First line for management of behaviour problems

A

Parent training programs

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4
Q

Treatment for depression

A

Fluoxetine

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5
Q

How frequently to monitor when start SSRI

A

weekly x 4 wk, then q2wk x 4wk; at 12 wk, then as clinically indicated

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6
Q

What SSRI has a concern for Prolonged QT?

A

Citalopram

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7
Q

Factors affecting child’s wellbeing when parents are separating

A

Quality of Parenting
Quality of parent-child interaction
Degree/frequency/intensity of hostile conflict

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8
Q

How to children react to diverse at
4-5 years
school age

A

At 4-5 yoa – blame themselves and become clingy with separation anxiety
School age – may take sides and have loyalty conflicts

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9
Q

Family risk factors during divorce

A
  • Ongoing conflict between parents (especially if it is abusive and/or focused on children)
  • Diminished capacity to parent or poor parenting
  • Lack of monitoring children’s activities
  • Multiple family transitions
  • Parent mental health problems
  • Chaotic, unstable household
  • Impaired parent-child relationships
  • Economic decline
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10
Q

Family protective factors during divorce

A
  • Protection from conflict between parents
  • Cooperative parenting (except in cases of domestic violence)
  • Healthy relationships between child and parents
  • Parents’ psychological well being
  • Quality, authoritative parenting
  • Household structure and stability
  • Supportive sibling relationships and extended family relationships
  • Economic stability
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11
Q

Risk factors to screen for on H&P before starting a stimulant

A
Personal or Fam Hx of:
Sudden death
FamHx non-ischemic heart disease
FamHx/Personal Hx Long QT or arrythmia
WPW
Cardiomyopathy
Heart transplant
Pulm HTN
Defibrillator

Personal History
SOB with exercise without explanation (asthma)
Poor exercise tolerance without other explanation
Fainting/Seizures with exercise, or fright
Palpitations with exercise

Exam:
Hypertension
Murmur
Sternotomy incision

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12
Q

Dx of global developmental delay

age

A

Significant delay (at least 2 SD below mean) in at least 2 developmental domains:

  • Gross of fine motor
  • Speech/Language
  • Cognition
  • Social/Personal
  • Activities of daily living

Age <5yo

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13
Q

Dx of intellectual disability

age

A

all 3:
1. deficits in INTELLECTUAL FUNCTIONING (reasoning, problem solving, planning, abstract thinking, judgement, academic learning and learning from experience) confirmed by both clinical assessment and individualized, standardized intelligence testing

  1. deficits in ADAPTIVE FUNCTIONING
    result in failure to meet developmental and socio-cultural standards for personal independence and social responsibility.
  2. Onset of intellectual and adaptive deficits DURING THE DEVELOPMENTAL PERIOD
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14
Q

Tier 1 blood work for investigation of GDD

A
Blood
Complete blood count 
Glucose
Blood gas 
Urea, creatinine 
Electrolytes (to calculate anion gap) 
AST, ALT 
TSH 
Creatine kinase 
Ammonia 
Lactate
Amino acids 
Acylcarnitine profile, carnitine (free and total) 
Homocysteine 
Copper, ceruloplasmin** 
Biotinidase*** 
Ferritin, vitamin B12 when dietary restriction or pica are present
Lead level when risk factors for exposure are present 
Urine
Organic acids 
Creatine metabolites 
Purines, pyrimidines 
Glycosaminoglycans
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15
Q

Conditions commonly misdiagnosed as ADHD

A
Learning disorder
Sleep disorder
Oppositional defiant disorder
Anxiety disorder
Intellectual disability
Language disorder, mood disorder, tic disorder, conduct disorder
Autism spectrum disorder
Developmental coordination disorder
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16
Q

DDX ADHD

A

Mood disorders – depression, anxiety, bipolar
Low or high IQ
ASD or Tourette movements
OSA, IBD (causing fatigue or pain)
Sensory (hearing, vision)
Chronic health conditions effecting school attendance
Neurological (seizures, concussion)
Higher prevalence of ADHD in epilepsy (more inattentive)
Genetic – turners, Fragile X, TS, BF, 22q11
Developmental coordination disorder
Specific learning disorder
Eating disorders

17
Q

Comorbidities of ADHD

A
Other neuropsychiatric disorders  
Disruptive behavioral disorders
OCD and CD; 90% comorbidity
Anxiety and OCD
May be difficult to participate in therapy, ADHD stimulant may worsen anxiety
Mood disorders – Bipolar
Substance use disorder
Tic disorder – association with stimulants may be incidental
18
Q

Non pharmacological management of ADHD

A
Organization skills training
Physical exercise
Behavioral interventions
- Daily report card
Classroom management 
Psychoeducation
Shared decision making
Parent Behaviour Training
First line for children < 6 yoa with ADHD
19
Q

First line mgmt of ADHD in <6yo

A

Parent Behaviour Training

20
Q

First line mgmt for ADHD

A

Extended release stimulant

Methylphenidate or Dextroamphetamine class

21
Q

Is tic d/o a c/I to stimulants?

A

no

22
Q

Second line treatment for ADHD

A

non stimulants

Strattera and Intuniv XR

23
Q

Concerning S/E of Intuniv

A

rebound hypertension and tachycardia if stopped suddenly

24
Q

Syndromes with features of ASD + ADHD

A

fragile X, Williams Syndrome, Tuberous Scleorosis, 22q11 deletion

25
Q

Wha comorbidities are more likely to be nonresponders in ADHD

A

ASD and ID