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
What are normal developmental fears from 7-12 months?
Strangers, looming objects, sudden confrontation, unexpected objects or unfamiliar people
What are the normal developmental fears from 1-5 years?
Strangers, storms, animals, the dark, separation from parents, objects, machines, loud noises, the toilet, monsters, ghosts, insects, bodily harm
What are the normal developmental fears from 6-12 years of age?
Supernatural beings, bodily injury, disease (AIDS, Cancer), burglars, staying alone, failure, criticism, punishment
What are the normal developmental fears from 12-18 years of age?
Tests and exams in school, bodily injury, scrutiny, appearance, body image, performance
What is the most important consideration in pediatric anxiety?
- Content of anxiety is less important than frequency/intensity
How is pediatric anxiety characterized?
- Pervasiveness
- Intensity
- Time Consuming
- Debility
What psychotherapy should be used in pediatric anxiety?
Psycho-education Cognitive Behavioral CBT Family Psychodynamic Play-based
What pharmacologic treatments are used in pediatric anxiety?
Classical Anxiolytics
Broad Spectrum Agents
When is combined therapy best used in anxiety?
- Best in mod-severe anxiety
What is the biggest concern with benzodiazepine use in pediatric anxiety?
CLONAZEPAM (Klonipin), LORAZEPAM (Ativan)
BEWARE DISNIHIBITION
What are the main SSRIs used in pediatric anxiety?
1) Fluoxetine (Prozac)
2) Fluvoxamine (Luvox)
3) Sertraline (Zoloft)
What percentage of primary pediatric disorders remit over time?
80%
- but >1/3 develop new disorders
Which type of childhood anxiety has an increased risk for other psychiatric disorders?
GAD has the greatest risk for => Soc Phobia, MDD, GAD, Panic Disorder
What are the three types of ADHD?
Inattentive, Hyperactive/Impulsive, Combined
What is the most common neurodevelopmental disorder in childhood?
ADHD
- 4-8% of children
- 60% will continue into adulthood
What is the gender prevalence of ADHD?
4:1 (male»female)
What are the major consequences of ADHD?
Motoric hyperactivity Aggressiveness Low frustration tolerance Impulsiveness -- Easily distracted Inattentiveness Shifts activities Easily bored Impatient Restlessness * second half seen more in adulthood
What are common co-morbidities of ADHD?
- 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
What is positive reinforcement?
- Any reinforcement increases the desired activity
- Positive reinforcement is giving a pleasurable reward when the stimulus/desired action is “on”
What is negative reinforcement?
- Any reinforcement increases the desired activity
- Negative reinforcement is giving an aversive stimulus when the desired action stops
What are the most common/powerful treatments for ADHD?
Stimulants Most Common/Powerful Tx
- Methylphenidate & Dextro-amphetamine
What are the side effects of Methylphenidate & Dextro-amphetamine?
Insomnia
Tics
Appetite Suppression/Decreased Growth
What neurotransmitters do ADHD meds increase?
ADHD meds increase monoamines
What are the benefits of extended release stimulants for ADHD?
Effective for the treatment of core symptoms Hyperactivity Impulsivity Inattentiveness Academic efficiency and accuracy No school-time dosing Improved compliance Improved tolerability
What are the limitations of extended release stimulants for ADHD?
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
