Ped Psychiatry Flashcards
1
Q
What do ped mental illnesses result in? How can this be prevented?
A
- these are very common and results in sig. morbidity and mortality
- profound long term consequences
- early dx for kids with new onset mental illness essential in order to maximize clinical outcomes
2
Q
How can primary care clinicians help make an impact on ped mental illnesses?
A
They have a critical role:
- for prevention
- early ID/screening
- early intervention/engagement
- referral/collaborative care (w/ MH professionals)
- monitoring progress in care
- care coordination
3
Q
WHat are the barriers to enhancing MH care in primary care settings?
A
- ambivalence/variability
- discomfort
- time constraints
- poor payment
- variable access to MH speciality resources
- administrative barriers to MH services
- limited information exchange with MH specialists
- stigma
4
Q
How can we help with mental illnesses at the individual family level?
A
- form a trusting relationship
- understand the emotional turmoil
- teach how to access MH services
- provide resources
- family advocacy organization
5
Q
What advice can you give the parents with a child with a disability?
A
- seek the assistance of other parents
- know that you are not alone
- rely on positive resources in your life (church, counselors)
- take it one day at a time
- seek information (internet, support groups, bright futures book - set of prinicples and strategies that are theory-based, evidence-driven that can be used to improve health and well-being of all children)
- don’t be intimidated
- maintain a positive outlook
- find programs for your child
- take care of yourself
- keep daily routines as normal as possible
- most imptly - keep your sense of humor
6
Q
The child’s existence and emotional development depends on what?
A
- family or care givers - cooperation with family members…need written consent
- use of psych-pharmacotherapy is less common in comparison to adult psychiatry
- the developmental stages are very impt assessment of dx
7
Q
How do you approach an adolescent pt?
A
- no judgements or assumptions
- lay down rules of confidentiality:
outline rules
not absolute
ask them to explain what they think it means and have alone time with pt - HEADSSS assessment
8
Q
What does HEADSSS stand for?
A
- Home: how are things going at home, do you get along with everyone?
- Education: what school do you attend? How are your grades? How many days have you missed?
- Activities: what do you do after school? DO you have a job, best friends?
- Drugs: do any of your friends smoke, drink alcohol, use drugs? Have you ever tried? Any family troubles with alcohol or drugs?
- Sex: do you have a sig. other? how long have you been going out? Do you get along? Have you had sex? Do you know how to protect yourself from preg., STIs, AIDS?
- Suicide/depression: how have your moods been? Do you ever feel down or depressed? Have you ever felt like hurting yourself or suicide? Do you know of anyone who has committed suicide?
- Safety: are things safe in your home, at school, in neighborhood? Has anyone tried to hurt you? Physically, sexually?
9
Q
Define intellectual disability?
A
- neurodevelopmental disorder with multiple etiologies that encompass a broad spectrum of fxning, disability, and strengths
- usually presents b/f 18
10
Q
Define global developmental delay?
A
- term applied to kids under 5 who fail to meet expected developmental milestones and have significant impairments in several areas of fxning
- these kids may grow out of this
11
Q
2 components to intellectual disability? What are the clinical features?
A
- components:
adaptive behavior
intellectual fxning - clinical features:
parent concerns
younger sibling overtake an older child
fails to meet expected developmental milestones - difficulty with learning or immaturity, if severly affected - present b/f 2
12
Q
What are the causes of intellectual disability?
A
- genetic in more than 50% (down syndrome most common)
- embryonic development
- prenatal causes include congenital infections, congenital hypothyroidism, and teratogens including alcohol, lead and valproate
- envior deprivation ( hypoxia, trauma)
- heriditary abnormalities
13
Q
Screening tools for intellectual disability?
A
- ages and stages questionnaire
- bayley infant neurodevelopmental screener (BINS)
- brigance screens-II
- infant toddler checklist for language and communications
- parent’s eval of developmental status (PEDS)
- if any of the tools suggest developmental delay a multidisciplinary approach is recommended - refer on!
14
Q
DSM V criteria for intellectual disability?
A
- IQ = 70 or less (defecits in intellectual fx)
- concurrent deficits or impairments in adaptive fxning in at least 2 of the following areas:
communication
self-care
home living
social/interpersonal skills
use of community resources
self-direction
fxnl academic skills
work
leisure
health
safety - onset b/f 18
15
Q
Tx of intellectual disability?
A
- early intervention program
- multidisciplinary team support
- family support and counseling
16
Q
What are the typical learning disabilities?
A
- dyslexia
- dysgraphia
- dyscalculia
- ageometria
- anarithmia
- anomic aphasia
17
Q
How common is dyslexia? What pop does it affect the most?
A
- 15% of public shool kids
- more often found in boys than girls
- tends to run in families
- often occurs in people with ADHD
18
Q
Signs and sxs of dyslexia?
A
- delayed language production
- speech articulation difficulties
- difficulties remembering the names of letters, numbers and colors
- reversals or visual confusion can occur (was becomes saw, -on - no, m-w)
19
Q
Individuals with dyslexia commonly have what problems?
A
- processing and understanding what they hear
- they may have difficulty comprehending rapid instructions
- following more than one command at a time
- remembering the sequence of things
- reversals of letters (b-d)
- reversal of words (saw for was)
- may try to read from R to L
- may fail to see (and occasionally to hear) similarities and differences in letters and words
- may not recognize the spacing that organizes letters into separate words
- may be unable to sound out ponunciation of an unfamiliar word
20
Q
Screening and dx for dyslexia?
A
- no single test
- dx involves an eval of:
medical
cognitive
sensory processing
educational
psychological factors - vision, hearing, and neuor exams
- other evals: psychological assessment
