MRCPsych Paper B - Child Flashcards
Heritability of ADHD (%)
70-80%
*risk of ADHD in siblings is 2-3x increased
At what age are 99% of children dry by day
5yo
Blockade of this receptor leads to reduction of vocal and motor tics in Tourette’s
D2
Pediatric manic episodes typically presents as…
mixed or atypical features - irritability, labile mood, and behavioral problems
drug treatment of choice for uncomplicated Tourette syndrome in the pediatric age group
clonidine
most common psychiatric emergency seen in child and adolescent population
suicidal behavior
NICE recommendations for stepped care treatment to pediatric depression
First line: fluoxetine, only when psychological therapy is ineffective
Second line: sertraline and citalopram.
AVOID: paroxetine, venlafaxine, TCA
Rett Syndrome inheritance
x-linked dominant
almost exclusively female
initially normal development
progressive loss of acquired skills starting 1-4yo
> purposeful hand movements, spoken language, gait disturbance
stereotypical hand movements, autism, ataxia, facial grimacing, teeth-grinding, irregular respiration (apnea, breath holding, hyperventilation), scoliosis, seizures, initial/ intermediate insomnia, excessive daytime sleep
most common psychiatric comorbidity associated with Asperger’s syndrome
depression
Pica typically occurs at what age group
2-3yo
Pedia patient + uncoordinated movement of limbs + history of fever and sore throat
Sydenham chorea
*rheumatic fever, group A strep
most common cause of comorbidity in pediatric bipolar disorder
53% ADHD
*
42% ODD
27% conduct disorder
23% anxiety disorder
09% substance use disorder
most common comorbidity in Tourette syndrome
ADHD 55% and OCD 50%
*ASD 20%
First line treatment for adolescent inhalant abuse
multimodal - psychotherapy and programs. No known pharmacotherapy
First line treatment for OCD in children
CBT
First line medication in pediatric ADHD
methylphenidate
most common age for school refusal
11yo
percentage of school-aged children affected by developmental dyslexia
4%
most important predictors of delinquency (Cambridge study)
antisocial child behavior
ADHD
low IQ and poor school attainment
family criminality
family poverty
poor parental child rearing behaviour
Pediatric age group where prevalence of depression in males and females are euqivalent
prepubertal
genetic aetiology most increases risk of parents having a second child with Down syndrome
translocation
rate of self-harm in teenagers who identify as Goth
50%
child with developmental disturbance + MRI hypoplasia of cerebellar vermis
autism spectrum disorder
most common inherited cause of ID
fragile X syndrome
most common positive symptoms found in childhood onset schizophrenia
auditory hallucination 95%
*visual hallucinations 80%, delusions 60%
most common comorbidities with ASD
80% ID
40-84% anxiety disorders
30-50% ADHD
OCD
tics
most common comorbidities in pediatric ADHD
70% learning disorders
59% ASD
55% tics/ Tourette
50% ODD
50% depression
47% bipolar
35% anxiety disorders
10% conduct disorders
very early onset schizophrenia or childhood onset schizophrenia occurs before what age
13yo
Heller syndrome - how many years of normal development before marked regression in several areas of functioning
2y
*aka Childhood disintegrative
scale for epidemiological study as a screening tool of caseness among school children before further diagnostic procedure
Strengths and difficulties questionnaire
what part of the sleep cycle does sleep-related bruxism commonly occur
transition to sleep
stage 2 sleep
during REM sleep
most common blood abnormality in adolescents with anorexia nervosa
normocytic normochromic anaemia
ASD symptom that tend not to improve over time
ritualistic and repetitive behaviours
medication of choice for pediatric ADHD with tics
NE reuptake inhibitor/ atomoxetine
best treatment option for pediatric ADHD with substance abuse
NE reuptake inhibitor/ atomoxetine
*less abuse potential
Medications licensed in the UK for OCD treatment in pediatric population
sertraline (starting age 6y)
fluvoxamine (starting age 8y)
chief differential medical problem to be excluded in children with encopresis
Hirschsprung disease, aka aganglionic megacolon
pediatric ADHD with frequent aggressive outbursts + unresponsive to methylphenidate or gaunfacine
risperidone
*
psychosocial interventions →
add stimulant methylphenidate →
atomoxetine/ guanfacine/ clonidine →
risperidone (no other antipsychotics are indicated)
in children, ADHD medication SE of mild slowing of weight, height, and growth
methylphenidate
in children, ADHD medication SE of liver dysfunction
atomoxetine, rare - elevated hepatic enzymes, increased bilirubin with jaundice
in children, ADHD medication SE of suicidal ideations
atomoxetine
in children, ADHD medication SE of exacerbation of tics
methylphenidate
in children, ADHD medication SE of insomnia
methylphenidate
in children, ADHD medication SE of psychosis
methylphenidate
most important aetiological factor associated with school refusal
youngest child in the family
most important aetiological factor associated with adolescent depression
increased cortisol levels
most important aetiological factor associated with ADHD
maternal smoking during pregnancy
most important aetiological factor associated with conduct disorder
callous traits in parents
most important aetiological factor associated with anorexia nervosa
living in the western world
Scale helpful in the evaluation of a child with multiple behavioral problems, esp if the child presents with different symptoms in different settings
Child behavioral checklist (CBCL)
treatment for pediatric ADHD + tics
atomoxetine → clonidine
treatment for pediatric ADHD + depression
TCA - amitriptyline
treatment for ADHD + aggressive behavior
behavioural therapy
prevention strategies for conduct disorder
preschool child development programmme
community programme
therapy in which there is assessing and promoting the strengths of the young person and the system is paramount
multimodal systemic therapy
therapy that focuses on improving the communication between parent and young person
functional family therapy
therapy for conduct problems that includes social skills training and anger management
CBT
give 2 first line medications for OCD in children
sertraline, fluoxetine
first line management of aggressive and challenging behavior in ASD
risperidone, low dose
clinical features of depression in young children (0-5y)
poor feeding, failure to thrive, separation anxiety, tantrums, irritability, aggression, hyperactivity, regressed behavior
clinical features of depression in older children (6-10y)
somatisation, school refusal, poor school performance, acting out
clinical features of depression in adolescents (10-19y)
low self-esteem, melancholia, suicdal acts, substance misuse, psychotic symptoms
essential features of pediatric ASD
severe persistent impairment in social interactions, repetitive behavioral patterns and restricted interests, 70% have mild to moderate learning disability
essential features of pediatric Asperger’s syndrome
severe persistent impairment in social interactions, repetitive behavioral patterns and restricted interests, IQ and language are normal
essential features of pediatric Rett’s syndrome
almost exclusively females, abnormal hand movements, first 6mos of life are normal (decline starts at 2yo)
essential features of pediatric Heller’s syndrome
*aka childhood disintegrative disorder
normal development for 2-3 years, loss of acquired skills between 3-4years, disintegrative psychosis
essential features of pediatric reading disorder/ dyslexia
deficit in phonological processing skills, male predominance 4:1
essential features of pediatric disorders of written expression
difficulties with spelling, syntax, grammar, and composition, male predominance 3:1
essential features of pediatric mathematics disorder
often associated with visuospatial deficits (R parietal dysfunction), female predominance
stuttering
commonly struggles with initial syllables, treatment includes speech therapy
features of authoritarian parenting style
detached and unaffectionate, power imposed and autocratic, yields compliant but withdrawn and dependent children
features of permissive parenting style
indulgent and affectionate, associated with immature children who lack purpose, self-control, and self-direction, vulnerable to increased risk of future substance abuse
features of authoritative parenting style
uses parental authority and household rules/limits with some explanation, attends to child’s view and grant some responsibility to child, yields children who are independent assertive and friendly
investigations for the use of methylphenidate
height, weight, BP, HR - every 3mos, then 6mos
investigations for the use of atomoxetine
height and weight, BP, HR - every 3mos, then 6mos
investigations for the use of valproate
liver function tests - q 6mos, blood count, height and weight
