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Psych Block 2 > Pediatric Psychiatric Disorders > Flashcards

Pediatric Psychiatric Disorders Flashcards

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1
Q

What is the rate of mental disorder in pediatrics?

A

14-20%

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2
Q

What are common pediatric psychiatric disorders?

A
  • ADHD 4-8%
  • Depression 7%
  • Anxiety Disorders 8-15%
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3
Q

What is the 3rd leading cause of death amongst teens?

A

Suicide

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4
Q

What are risk factors associated with pediatric psychiatric disorders?

A
  • Chronic Health Problems
  • Brain Damage
  • Temperament (Aggression, Behavioral Inhibition)
  • Genetics/Epigenetic Factors
  • Family Factors
  • Psychosocial Factors/Stress
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5
Q

What is the prototypal internalizing disorder in children?

A

Depression

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6
Q

What are the characteristics of depressed mood in children?

A
  • Irritation
  • Depressed mood
  • Loss of interest
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7
Q

What is the prevalence of depressed mood in children?

A
  • Childhood rates: males same as females
    • Childhood onset predicts poor prognosis
  • Adolescent (and beyond): 2:1 (more in females)
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8
Q

Currently what are the best treatments for childhood depression?

A
  • CBT

- SSRIs

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9
Q

What is the prevalence of MDD in adolescents?

A

MDD in adolescence is common; 1 in 20;

2.6 million 6-17 yr. old

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10
Q

What is the association between MDD and suicide in adolescents?

A
  • 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
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11
Q

What is the prevalence of suicide amongst adolescents?

A

9% (12% females, 5% males) of adolescents make suicide attempts/year
- 50% of them are depressed

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12
Q

Which SRIs are preferred in childhood treatment of depression?

A

FDA Label for Pedi-MDD
Prozac>8yrs

  • often side effects will occur before relief
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13
Q

What are the preferred medications for childhood OCD?

A 
FDA Label for Pedi-OCD
Zoloft(Sertraline)  >6yrs
Luvox (Fluvoxamine) >8yrs
Prozac (Fluoxetine)>7yrs
Anafranil>12yrs
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14
Q

In the Treatment of Adolescent Depression Study, which was the best form of treatment for participants (over 12 weeks)?

A
  • Fluoxetine =60.6% (improvement)
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15
Q

What was the important conclusion from analyses done on the Treatment of Adolescent Depression Study?

A
  • Risk of suicide/completion is higher in untreated patients than those on medication
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16
Q

What are the risk factors for pediatric anxiety?

A
  • TEMPERAMENT
  • GENETICS/EPIGENTICS
  • ATTACHMENT
  • PARENT FACTORS
  • ANXIETY/DEPRESSION
  • PARENTING STYLE (Anxious, Hostile)
  • TRAUMA/ENVIRONMENTAL STRESS
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17
Q

Describe the temperament of a child with anxiety.

A
  • Shy, Fearful, Novelty Avoidant
  • Consistent Over Time
  • Long Latency/Low Frequency of Verbal Response
  • Over arousal/Sympathetic Activation
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18
Q

Describe the attachment of a child with anxiety.

A
  • Irritation/anger

- Ambivalence

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19
Q

What is the relationship between parental psychiatric disorder and similar disorders in their children?

A
  • 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
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20
Q

What percentage of children attribute anxiety to a negative life event?

A

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

21
Q

What percentage of US children suffer from anxiety/meet criteria for anxiety disorder?

A

10-20%

22
Q

What is the most common psychiatric disorder?

A

Anxiety is the most common psychiatric disorder in children

- Least Likely to be Diagnosed

23
Q

What is the prevalence of comorbidities in pediatric anxiety?

A
  • 50-70% have 1 Comorbid Disorder
  • 40-70% with Depression have Anxiety D.O.
    • Comorbid Depression , Greater Morbidity
24
Q

What are normal developmental fears from birth -6 months?

A

Loud noises, loss of physical support, rapid position changes, rapidly approaching /unfamiliar objects

25
Q

What are normal developmental fears from 7-12 months?

A

Strangers, looming objects, sudden confrontation, unexpected objects or unfamiliar people

26
Q

What are the normal developmental fears from 1-5 years?

A

Strangers, storms, animals, the dark, separation from parents, objects, machines, loud noises, the toilet, monsters, ghosts, insects, bodily harm

27
Q

What are the normal developmental fears from 6-12 years of age?

A

Supernatural beings, bodily injury, disease (AIDS, Cancer), burglars, staying alone, failure, criticism, punishment

28
Q

What are the normal developmental fears from 12-18 years of age?

A

Tests and exams in school, bodily injury, scrutiny, appearance, body image, performance

29
Q

What is the most important consideration in pediatric anxiety?

A
  • Content of anxiety is less important than frequency/intensity
30
Q

How is pediatric anxiety characterized?

A
  • Pervasiveness
  • Intensity
  • Time Consuming
  • Debility
31
Q

What psychotherapy should be used in pediatric anxiety?

A 
Psycho-education
Cognitive
Behavioral
CBT
Family
Psychodynamic
Play-based
32
Q

What pharmacologic treatments are used in pediatric anxiety?

A

Classical Anxiolytics

Broad Spectrum Agents

33
Q

When is combined therapy best used in anxiety?

A
  • Best in mod-severe anxiety
34
Q

What is the biggest concern with benzodiazepine use in pediatric anxiety?

A

CLONAZEPAM (Klonipin), LORAZEPAM (Ativan)

BEWARE DISNIHIBITION

35
Q

What are the main SSRIs used in pediatric anxiety?

A

1) Fluoxetine (Prozac)
2) Fluvoxamine (Luvox)
3) Sertraline (Zoloft)

36
Q

What percentage of primary pediatric disorders remit over time?

A

80%

- but >1/3 develop new disorders

37
Q

Which type of childhood anxiety has an increased risk for other psychiatric disorders?

A

GAD has the greatest risk for => Soc Phobia, MDD, GAD, Panic Disorder

38
Q

What are the three types of ADHD?

A

Inattentive, Hyperactive/Impulsive, Combined

39
Q

What is the most common neurodevelopmental disorder in childhood?

A

ADHD

  • 4-8% of children
  • 60% will continue into adulthood
40
Q

What is the gender prevalence of ADHD?

A

4:1 (male»female)

41
Q

What are the major consequences of ADHD?

A 
Motoric hyperactivity
Aggressiveness
Low frustration tolerance
Impulsiveness
--
Easily distracted
Inattentiveness
Shifts activities
Easily bored
Impatient
Restlessness
 * second half seen more in adulthood
42
Q

What are common co-morbidities of ADHD?

A
  • Higher school suspension rate
  • Higher high school drop out rate
  • Lower GPA and less likely to graduate college
  • Increased likelihood of teenage pregnancy
  • Increase risk of STI and sexual partners
  • Increased risk of motor vehicle violations/crashes
  • Increase risk of substance abuse when not medicated
  • Increase risk of anxiety disorders
43
Q

What is positive reinforcement?

A
  • Any reinforcement increases the desired activity

- Positive reinforcement is giving a pleasurable reward when the stimulus/desired action is “on”

44
Q

What is negative reinforcement?

A
  • Any reinforcement increases the desired activity

- Negative reinforcement is giving an aversive stimulus when the desired action stops

45
Q

What are the most common/powerful treatments for ADHD?

A

Stimulants Most Common/Powerful Tx

- Methylphenidate & Dextro-amphetamine

46
Q

What are the side effects of Methylphenidate & Dextro-amphetamine?

A

Insomnia
Tics
Appetite Suppression/Decreased Growth

47
Q

What neurotransmitters do ADHD meds increase?

A

ADHD meds increase monoamines

48
Q

What are the benefits of extended release stimulants for ADHD?

A 
Effective for the treatment of core symptoms
Hyperactivity
Impulsivity
Inattentiveness
Academic efficiency and accuracy
No school-time dosing
Improved compliance 
Improved tolerability
49
Q

What are the limitations of extended release stimulants for ADHD?

A

Interrupted symptom relief
- Limited activity in evening/early morning hours
Controlled substances
- Diversion and abuse potential
- Prescribing inconvenience
Tolerability and safety
- Insomnia and decreased appetite
- Potential adverse height and weight effects
- Potential to exacerbate tics and anxiety

Psych Block 2 (22 decks)

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