other DO

Question 1

CD RF

Answer 1

• Harsh parents, chaotic environment, divorce
• Parental psychopathology, child abuse, negligence
• Parental sociopathy, substance abuse
• Parental psychosis
• Deprivation
• Urban environment
• Unemployed parents, lack of community participation
• Low levels of dopamine beta hydroxylase (converts DA to NE)
• High blood serotinin, low CSF 5HIAA
• Greater right frontal EEG activity at rest

•

Question 2

expressive langauage DO

Answer 2

• Selective deficit in expressive language development relative to receptive skills and nonverbal intelligence
• In IQ testing verbal level may appear depressed compared to IQ
• Below expected levels of vocabulary, tense usage, sentence construction, and word recall
• Often present as younger than age
• Can be developmental (majority) or acquired; usually congenital without an obvious cause
• Expressive deficits often occur without receptive, though receptive dysfunction often causes expressive problems
• Two to three times more common in boys, and children with fam history of communication issues
• High comorbidities:
o ADHD (19%)
o Anxiety Disorder (10%)
o ODD and CD (7%)
o Higher risk for speech disorder, receptive d/o, learning d/o
o Associated with reading d/o, developmental coordination d/o
o Other communication d/o
• Delayed motor skills and enuresis are common
• Soft neuro signs, depressed vestibular response, EEG abnormalities
Boys with severe behaviour issues have high levels of undiagnosed language dysfunction
• 50% of children with mild difficulties recover spontaneously without signs of impairment. Children with more sever impairment may continue to display features.

•

Question 3

tourette’s

Answer 3

Motor component usually emerges by age 7, while vocal by age 11.

• M:F = 3:1
• Natural history is a reduction or complete resolution by adolescence
• Initially occur in face and neck and over time travel downwards
• Up to 50% have ADHD (appears before tics) and 40% OCD (after tics)
• OCD is more common in high IQ, and tends to be more symmetry/counting/repetition
• Head and neck is most common area. Most frequent initial symptom is eye-blink, then head tic or facial grimace.
• Corporlalia occurs in 1/3 of patients, often in adolescence
• Older children, ados, and adults often report a “premonitory urge” (unpleasant sensation)

Question 4

adol depressiondiffers how?

Answer 4

children tend to have fewer melancholic symptoms,
delusions, and suicide attempts than depressed adults
Hypersomnia and hyperphagia more likely in younger

Question 5

ADHD comorbidities

Answer 5

ADHD comorbidities 
As per Dr. Hechtman:
Children: 	40% ODD
30% anxiety
30% none
20% learning disability
language DO
enuresis

Adults: 50% GAD

Question 6

PANDAS

Answer 6

PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections), this subgroup of patients is characterized by five clinical criteria: (1) the presence of OCD and/or tics; (2) pre-pubertal symptom onset; (3) abrupt onset and episodic course; (4) presence of neurologic signs, such as choreiform movements; and (5) evidence of a temporal relationship between symptom exacerbations and group A β-hemolytic

Question 7

POTS effect sizes

Answer 7

CBT=1
sertraline=0.7
combo= 1.4

Question 8

CBT or meds in pediatric OCD?

Answer 8

mild-moderate: try CBT
mod-severe, or family Hx or no expert CBT: go for combo
combo has larger effect size
tic disorder: not meds alone, CBT or combo
tic DO with OCD, augmentinf with AA has large ES

Question 9

augmenting strategies in pediatric OCD

Answer 9

add clomipramine (nice with Luvox), add SGA, treat with venlafaxine or duloxetine (kind of like TCAs), 
treat acc to CB, if tics: try clonidine or guanfacine, if ADHD, try atomoxetine

Question 10

tic DO has a better response to Clonidine when there is comorbid…

Answer 10

tic DO has better response to clonidine (ES=0.65) when there is comorbid ADHD (0.15 if tic DO with out ADHD)
So: the presence of ADHD predicts a better response to clonidine in tic DO

Question 11

OCD has a better response to AA when there is CB..

Answer 11

tic DO

The presence of tic DO predicts a better response to AA in OCD

NNT=2, vs 6 for OCD alone

Question 12

Anx DO CBT or meds?

Answer 12

CBT plus or minus meds
like OCD
depends on severity

group CBT= individual, but if severe social phobia, ADHD, OCD, trauma, individual better

Question 13

CBT manuals for kids

Answer 13

Meeky mouse for selective mutism

coping cat for SAD, sep anx, GAD

Question 14

how long do you treat child anx , OCD?

Answer 14

1 year. ssri r first line

Question 15

CAMS study

Answer 15

GAD, social phobia, sep anxiety
Combo vs CBT vs sertraline vs palcebo
combo> CBT=sertraline> placebo

Question 16

early and childhood onset schiz?
late onset schiz?
peak age?

Answer 16

45

15-30

Question 17

suicide and accidental death rate in Early onset schiz?

Answer 17

5%

Question 18

% of kids who are depressed who haver SI? attempt?

Answer 18

60%, 30%

Question 19

mild to moderate depression in adolescents with no red flags. how do you treat?

Answer 19

supportive= CBT= IPT

you could try this first

Question 20

moderate-severe depression?

severe?

Answer 20

CBT or IPT

meds in addition to above

Question 21

talka bout therapy, meds, combiination in adolescent deptression

Answer 21

According to 2007 American child GL:
Therapy:
Modest effect size
one metananlysis showed CBT=IPT= behavioral probelm solving= other types of therapy
they recommend CBT and IPT more due to more studies
individual and group are good

Meds: 
NNT=10
RR=40-70%
Placebo 30-60%
SSRI are first line. Prozac FDA approved. -ve studies with TCAs, Mirtazapine, Venlafaxine, and they have side effects anyway

Combination: slightly superior than either modality alone.
Some studies say CBT is equal but slower.
TADS and TORDIA support this.

Question 22

antidepressants with possible short half lives in kids

Answer 22

celexa
paxil
wellbutrin
zoloft

Question 23

des anxiety or depression in kids respond more to SSRIs?

Answer 23

anxiety