Pediatric Psychiatric Disorders Flashcards
What is the rate of mental disorder in pediatrics?
14-20%
What are common pediatric psychiatric disorders?
- ADHD 4-8%
- Depression 7%
- Anxiety Disorders 8-15%
What is the 3rd leading cause of death amongst teens?
Suicide
What are risk factors associated with pediatric psychiatric disorders?
- Chronic Health Problems
- Brain Damage
- Temperament (Aggression, Behavioral Inhibition)
- Genetics/Epigenetic Factors
- Family Factors
- Psychosocial Factors/Stress
What is the prototypal internalizing disorder in children?
Depression
What are the characteristics of depressed mood in children?
- Irritation
- Depressed mood
- Loss of interest
What is the prevalence of depressed mood in children?
- Childhood rates: males same as females
- Childhood onset predicts poor prognosis
- Adolescent (and beyond): 2:1 (more in females)
Currently what are the best treatments for childhood depression?
- CBT
- SSRIs
What is the prevalence of MDD in adolescents?
MDD in adolescence is common; 1 in 20;
2.6 million 6-17 yr. old
What is the association between MDD and suicide in adolescents?
- MDD associated with suicide
- MDD associated with long-term impairment
- Suicide associated with Serotonin
- Increase SSRI use linked with decreased suicide rate in depressed children
- Suicide associated with Serotonin
What is the prevalence of suicide amongst adolescents?
9% (12% females, 5% males) of adolescents make suicide attempts/year
- 50% of them are depressed
Which SRIs are preferred in childhood treatment of depression?
FDA Label for Pedi-MDD
Prozac>8yrs
- often side effects will occur before relief
What are the preferred medications for childhood OCD?
FDA Label for Pedi-OCD Zoloft(Sertraline) >6yrs Luvox (Fluvoxamine) >8yrs Prozac (Fluoxetine)>7yrs Anafranil>12yrs
In the Treatment of Adolescent Depression Study, which was the best form of treatment for participants (over 12 weeks)?
- Fluoxetine =60.6% (improvement)
What was the important conclusion from analyses done on the Treatment of Adolescent Depression Study?
- Risk of suicide/completion is higher in untreated patients than those on medication
What are the risk factors for pediatric anxiety?
- TEMPERAMENT
- GENETICS/EPIGENTICS
- ATTACHMENT
- PARENT FACTORS
- ANXIETY/DEPRESSION
- PARENTING STYLE (Anxious, Hostile)
- TRAUMA/ENVIRONMENTAL STRESS
Describe the temperament of a child with anxiety.
- Shy, Fearful, Novelty Avoidant
- Consistent Over Time
- Long Latency/Low Frequency of Verbal Response
- Over arousal/Sympathetic Activation
Describe the attachment of a child with anxiety.
- Irritation/anger
- Ambivalence
What is the relationship between parental psychiatric disorder and similar disorders in their children?
- Example of a bottom up study (look at child, then parent)
In children who are overanxious, GAD, SAD- Parents: 20-67% with Panic Disorder, 81% with Psychiatric Disorder
- Example of a top down study (look at parents, then children)
Of parents who have depression/Anxiety Disorder- Children: Increased rates SAD, Inhibition, School Phobia
Anxiety begets anxiety
- Children: Increased rates SAD, Inhibition, School Phobia
What percentage of children attribute anxiety to a negative life event?
54% of Children Attribute Anxiety to Negative Life Event
- HOWEVER: On their own, stressful life events do not provide a full explanation for the development of anxiety disorders
What percentage of US children suffer from anxiety/meet criteria for anxiety disorder?
10-20%
What is the most common psychiatric disorder?
Anxiety is the most common psychiatric disorder in children
- Least Likely to be Diagnosed
What is the prevalence of comorbidities in pediatric anxiety?
- 50-70% have 1 Comorbid Disorder
- 40-70% with Depression have Anxiety D.O.
- Comorbid Depression , Greater Morbidity
What are normal developmental fears from birth -6 months?
Loud noises, loss of physical support, rapid position changes, rapidly approaching /unfamiliar objects
