Pediatric psychiatry

Question 1

What are the causes of Intellectual disability (mental retardation)?

Answer 1

50% are idiopathic
- Genetic: Down syndrome & Fragile X (most common inherited form of ID)
- Acquired: Hypothyroidism, TORCH infection, prematurity, jaundice, drinking in pregnancy

Question 2

Tx of mental retardation?

Answer 2

Special education & social care

Question 3

Diagnostic criteria of ADHD

Answer 3

• Impulsivity (answer before question is finished, interrupts people, cant wait their turn)
• Inattention (talk fast, easily distracted, fails to complete tasks, lose things)
• Must present in two settings (home & school), the onset between 7-12 ys*
• Symptoms > 6 months
• Impairment in kid’s function (learning, socializing, academically)

Question 4

Tx of ADHD?

Answer 4

• Stimulants (amphetamine)
• Special education
• Training parents
• Follow up for absence seizure (treat it with Ethosuximide)

Question 5

Diagnostic Criteria for Autism?

Answer 5

• Impaired social communication: social reciprocity (cant understand others emotions), social relationships, non-verbal communication, joint attending
• Restricted /repetitive behavior: restricted interest, rigid through pattern, change in sensory perception.
  ** R/O Learning disability and mental retardation

Question 6

Tx of Autism?

Answer 6

Special education
Social interaction

Question 7

Tic disorder management?

Answer 7

CBT (habit reversal therapy)
Medications (dopamine antagonist OR alpha2-agonist)

Question 8

Dx of Tic disorder?

Answer 8

• <18 ys diagnosis,
• symptoms > 1 years
• physical or vocal tic
• Echolalia (repeating other words)
• associated with OCD & ADHD

Question 9

Oppositional defiant disorder diagnostic criteria

Answer 9

• One individual involved (not sibling)
• > 4 symptoms for > 6 months:
  1- Anger-irritable mood (loses temper, easily annoyed, often angry)
  2- Defiant behavior (break rules, blames others)
  3- Vindictivene

Question 10

Oppositional defiant disorder diagnostic criteria

Answer 10

• One individual involved (not sibling)
• > 4 symptoms for > 6 months:
  1- Anger-irritable mood (loses temper, easily annoyed, often angry)
  2- Defiant behavior (break rules, blames others)
  3- Want-to-revenge (vindictiveness): at least 2 times in 6 months
• these are not involved in bullying or animal heart
• doesn’t involve physical aggression

Question 11

Tx of Oppositional defiant disorder (ODD) And Conduct disorder (anti-social kids)

Answer 11

Behavior modification
Parent management training

Question 12

Conduct disorder (Anti-social)

Answer 12

• Lack remorse for committing criems
• Lack empathy to their victims
• Theft: Broken into house or car
• Serious violation of rules: run away from home twice at night

Question 13

Enuresis diagnosis and Tx?

Answer 13

Dx:
- Recurrent urination into clothes (bed wetting) in > 5 years developmentally
- 2 times/week for 3 or more following months
- Nocturnal or diurnal or both
Tx:
1- Limited fluid and caffeine before bed
2- Urine alarm
3- Last option: Desmopressin

Question 14

Encopresis:

Answer 14

Recurrent defecation into inappropriate places
Tx:
1- Without constipation: behavioral program (bowel training)
2- Due to constipation: bowel cleaning followed by stool softeners & high fiber diet