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Behavioral Health > Pediatric Psychiatry > Flashcards

Pediatric Psychiatry Flashcards

1
Q

Impact on Primary Care: Advantage/Potential Roles of Primary Care Clinicians?
6

A
  1. Prevention
  2. Early identification / screening
  3. Early intervention / engagement
  4. Referral / collaborative care (with MH professionals)
  5. Monitoring progress in care
  6. Care coordination
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2
Q

Barriers to Enhancing MH Care in Primary Care Settings

8

A
  1. Ambivalence / variability
  2. Discomfort
  3. Time constraints
  4. Poor payment
  5. Variable access to MH specialty resources
  6. Administrative barriers to MH services
  7. Limited information exchange with MH specialists
  8. Stigma
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3
Q

Strategies: What Works for Families
-At the individual family level what can we educate on?
5

A
  1. Trusting relationship
  2. Understand emotional turmoil
  3. Teach how to access MH services
  4. Provide resources
  5. Family advocacy organization
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4
Q

Parenting a Child with a Disability

11

A
  1. Seek the assistance of other parents
  2. Know that you are not alone
  3. Rely on positive resources in your life (e.g., church, counselors)
  4. Take it one day at a time
  5. Seek information (e.g., internet, support groups, library)
  6. Do not be intimidated
  7. Maintain a positive outlook
  8. Find programs for your child
  9. Take care of yourself
  10. Keep daily routines as normal as possible
  11. Most importantly, keep your sense of humor
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5
Q

Approach to the Adolescent

Rules of confidentiality?

A
  1. outline the rules first
    1. not absolute
    2. ask them to explain confidentiality
    3. alone time with patient
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6
Q

HEADSSS assessment?

Describe each

A
  1. HOME: How are things going at home? Who lives at home? Do you get along with the other people in your house?
  2. EDUCATION: What school do you attend? How are your grades? What grades do you think you should be getting? How many days of school have you missed?
  3. ACTIVITIES: What do you do after school? Do you have a job? Who are your best friends?
  4. DRUGS: Do any of your friends smoke? Drink alcohol? Use drugs? Have you ever tried…? Does anyone in your family have trouble with alcohol? Drugs?
  5. SEX: Do you have a boyfriend/girlfriend? How long have you been going out? Are you getting along? Have you ever had sex? When you have sex, is it with men, women or both? Do you know how to protect yourself from pregnancy, STIs, and AIDS?
  6. 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 anyone who has committed suicide?
  7. SAFETY: Are things safe for you at home? At school? In your neighborhood? Has anyone ever hurt you? Physically? Sexually?
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7
Q

Definition of intellectual disability (ID)?

A

is a neurodevelopmental disorder with multiple etiologies that encompass a broad spectrum of functioning, disability, and strengths

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8
Q

Definition of Global developmental delay (GDD) ?

A

the term applied to children under 5 who fail to meet expected developmental milestones and have significant impairments in several areas of functioning.

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9
Q
  1. What two components make up intellectual disability?

2. Clinical features of intellectual disability? 3

A
  1. Two components include
    - Adaptive behavior
    - Intellectual functioning
  2. Clinical features
    - Parent concerns
    - Younger sibling overtake an older child
    - Fails to meet expected developmental milestones
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10
Q

Caues of Intellectual Disability? 5

A
  1. Genetic in more than 50% (down syndrome MOST common)
  2. Embryonic development
  3. prenatal causes include congenital infections, congenital hypothyroidism, and teratogens including alcohol, lead, and valproate
  4. Environmental deprivation
  5. Hereditary abnormalities
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11
Q

Intellectual Disability
Screening tools?
5

A
  1. Ages and Stages Questionnaires (ASQ)
  2. Bayley Infant Neurodevelopmental Screener (BINS)
  3. Brigance Screens-II
  4. Infant-Toddler Checklist for Language and Communications
  5. Parent’s Evaluation of Developmental Status (PEDS)
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12
Q

DSM V Criteria for intellectual disability:
3 main
11 areas

A
  1. IQ ≈ 70 or below (deficits in intellectual fx)
  2. Concurrent deficits or impairments in adaptive functioning in at least 2 of the following areas:
    - communication
    - self-care
    - home living
    - social/interpersonal skills
    - use of community resources
    - self-direction
    - functional academic skills
    - work
    - leisure
    - health
    - safety
  3. Onset before age 18 years
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13
Q

Treatment for intellectual disability? 3

A

Early intervention program

Multidisciplinary team support

Family support and counseling

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14
Q

Typical learning difficulties include (what are the top three)?
6

A
  1. Dyslexia
  2. Dysgraphia
  3. Dyscalculia
  4. Ageometria (ageometresia)
  5. Anarithmia
  6. Anomic aphasia (dysnomia)
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15
Q

Dyslexia

  1. More often found in what gender?
  2. Genetic?
  3. Often occurs in people with what?
A
  1. More often found in boys than girls
  2. Tend to run in families
  3. Often occurs in people with ADHD
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16
Q

Dyslexia signs and symptoms?

4

A
  1. Delayed language production
  2. Speech articulation difficulties
  3. Difficulties remembering the names of letters, numbers, and colors
  4. Reversals or visual confusion can occur
    - d becomes b, m becomes w, h becomes n, was becomes saw, on becomes no
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17
Q

Individuals with dyslexia commonly have problems:

10

A
  1. Processing and understanding what they hear
  2. They may have difficulty comprehending rapid instructions
  3. Following more than one command at a time
  4. Remembering the sequence of things
  5. Reversals of letters (b for d)
  6. Reversal of words (saw for was) are typical among individuals who have dyslexia
  7. Individuals with dyslexia may also try to read from right to left
  8. May fail to see (and occasionally to hear) similarities and differences in letters and words
  9. May not recognize the spacing that organizes letters into separate words
  10. May be unable to sound out the pronunciation of an unfamiliar word
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18
Q

Dyslexia: Screening and diagnosis?

7

A 
There's no single test for dyslexia. 
Diagnosis involves an evaluation of:
1. medical
2. cognitive 
3. sensory processing
4. educational
5. psychological factors
  1. Vision, hearing, and neurologic examinations
    Other evaluations include:
  2. Psychological assessment
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19
Q

Treatment for dyslexia?

A

There’s no known way to correct the underlying brain malfunction that causes dyslexia.

Treatment is by remedial education.

Psychological testing will help identify the areas pts. need to work on.

May use techniques involving hearing, vision and touch to improve reading skills. Helping an individual to use several senses to learn — for example, by listening to a taped lesson and tracing with a finger the shape of the words spoken — can help them process the information.

The most important teaching approach may be frequent instruction by a reading specialist who uses these multisensory methods of teaching!!!!!

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20
Q

Dyslexia Prognosis?

2

A

Tutoring may involve several individual or small-group sessions each week
Progress may be slow

  1. Milder forms of dyslexia often eventually learn to read well enough to succeed in school.
  2. Severe dyslexia may never be able to read well and may need training for vocations that don’t require strong reading skills.
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21
Q

Dyscalculia is what?

A

(Math disability)

The word “dyscalculia” means difficulty performing math calculations.

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22
Q

Dyscalculia
signs and symtpoms?
3

A 
Signs and Symptoms
Difficulty understanding
1. Number lines
2. Carrying and borrowing numbers
3. Word problems
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23
Q

Dyscalculia
Strategies?
4

A
  1. Allow use of fingers and scratch paper
  2. Use diagrams and draw math concepts
  3. Provide peer assistance
  4. Suggest use of graph paper
24
Q

Dysgraphia is what?

A

(writing disability)-a learning disability resulting from the difficulty in expressing thoughts in writing

25
Q

Dysgraphia
Difficulties with what tasks?
4

A
  1. Handwriting (fine motor or graphomotor)
  2. Grammar and syntax
  3. Formulating, expressing, and organizing ideas in writing
  4. Spelling “encoding,” (which is the ability to use sound-letter relationships effectively)
26
Q

Dysgraphia results in what types of problems?

5

A
  1. resultss in irregular letter sizes and shapes, a mixture of upper and lower case letters or print and cursive letters.
  2. Contributes to difficulties in using writing as a communication tool
  3. Causes writing fatigue
  4. Interferes with communication iof ideas in writing
  5. results in unfinished letters and letter inconsistencies
27
Q

Dysgraphia Dx?

Treatment? 3

A
  1. Diagnosed
    by licensed psychologist who specialize in learning disabilities
  2. Treatment
    - Accommodations
    - Modifications
    - remediation
28
Q

Elimination Disorders? 2

Describe them

A

Enuresis
Repeated voiding of urine during the day or night into bed or clothes

Encopresis
Repeated passage of feces into inappropriate places

29
Q

Enuresis
1. Normally controlled by what age?

  1. common causes? 3
A
  1. Usual control ages 4-5
    - Primary or Secondary
  2. Common causes
    - Failure to arouse
    - Increase production of urine while asleep
    - Overactive bladder
30
Q

Enuresis
1. Psychiatry/Psychology symtpoms? 2

  1. Daytime occurance? 2
A

Psychiatry/Psychology

  1. Stressors
  2. Become withdrawn and anxious

Daytime incontinence

  1. Bladder overactive
  2. Constipation
31
Q

Enuresis Dx?

A
  1. History
  2. Physical exam
  3. Voiding diary
  4. UA with PVR
  5. Abdominal X-ray
32
Q

What should the child and parent put in their voiding diary? 3

A
  1. Timing of daytime voids
  2. Volume of voided urine
  3. Lower urinary tract symptoms
33
Q

Enuresis tx?

4

A
  1. Stop fluids before bedtime
  2. Scheduled night waking
  3. Alarms
  4. Medication
34
Q

Medications for enuresis?

A
  1. Desmopressin acetate (DDAVP)
  2. Oxybutynin
  3. Imipramine
35
Q

Encopresis

2 types?

A

Primary and secondary

36
Q

Encopresis physical aspects? 4

A
  1. Stool retention in the colon
  2. Intestinal walls and nerves stretch
  3. Retained stool becomes harder
  4. Liquid stool passes around retained hard feces
37
Q

Encopresis
1. Clincial presentation? 2

  1. Psychological effects? 2
  2. Dx?
A
  1. Clinical presentation
    - Repeated soiling of their underwear
    - Child denies both the visible and olfactory signs of soiling
  2. Psychological effects
    - Struggle within the family
    - Conflict in other areas of child’s life
  3. Diagnostics
    - Abdominal X-ray
38
Q

Encopresis
1. Management? 3

  1. 4 goals of treatment?
A
  1. Management
    - Educate child on bowel function
    - Behavior or reward systems
    - Psychological counseling
  2. Treatment goals
    - Establish regular bowel habits
    - Reduce stool retention
    - Restore normal physiological control over bowel function
    - Defuse conflicts and reduce concerns
39
Q

Initial phase of treatment with Encopresis? 2

Maintenance phase? 3

A

Initial phase

  1. Enemas/
  2. strong laxatives

Maintenance phase

  1. Scheduled regular toilet times
  2. Daily laxatives
  3. Proper diet
40
Q
  1. Autism is more common in what gender?
A

4 X more common in males

41
Q

Widely recognized as a what disorder that affects the functioning of the brain?

A

neurodevelopmental

42
Q

Classic autistic disorder characteristics?

4

A
  1. Very limited emotional connection with anyone, and they are very into their own world.
  2. They want everything to be the same all of the time
  3. Can be deeply effected by noises, bright lights and smells.
  4. Generally considered to be low functioning.
43
Q

Key diagnostic factors of autism

5 (whats the most important one?)

A
  1. Severe deficits in social responsiveness and interpersonal relationships*****
  2. Abnormal speech and language development
  3. Verbal and nonverbal communication impairment
  4. Repetitive, rigid, or stereotyped interests or behaviors
  5. Onset before age 3 years
44
Q

Severe deficits in ________social interaction (huge emotional toll on parents)

A

reciprocal

45
Q

Autism: (First year of life) manifestations? 3

Toddlers? 3

A
  1. Delayed or absent social smile
  2. Failure to anticipate interaction with parents
  3. Lack of attention to parent’s face
  4. Deficiencies in imitative play
  5. Lack of interest in interactions with others
  6. Language development delay
46
Q

Symptoms of children with autism spectrum disorder: Communication? 4

A
  1. Avoid eye contact
  2. Act as if deaf
  3. Develop language, then abruptly stop talking
  4. Fail to use spoken language, without compensating by gesture
47
Q

Symptoms of children with autism spectrum disorder: Social relationships? 6

A
  1. Act as if unaware of the coming and going of others
  2. Are inaccessible, as if in a shell
  3. Fail to seek comfort
  4. Fail to develop relationships with peers
  5. Have problems seeing things from another person’s perspective, leaving the child unable to predict or understand other people’s actions
  6. May physically attack and injure others without provocation
48
Q

Symptoms of children with autism spectrum disorder: Exploration of Environment?8

A
  1. Remain fixated on a single item or activity
  2. Repetitive actions like rocking or hand-flapping
  3. Sniff or lick toys or put unusual objects in mouth or need toys to chew on
    Well beyond the age of teething
  4. Show no sensitivity to burns or bruises, and engage in self-mutilation
  5. Are intensely preoccupied with a single subject, activity or gesture
  6. Show distress over change
  7. Insist on routine or rituals with no purpose
  8. Lack fear
49
Q

Complications with autism?

3

A
  1. 30% eventually develop seizure disorder
  2. Those with higher cognitive abilities may become depressed as they become aware of their deficits
  3. Some adults live in 24-hour care facilities or require immense community support
50
Q

DSM-5 Autism spectrum disorder
No longer has categories for Asperger’s or pervasive developmental disorder not otherwise specified
DSM-5 Autism Spectrum Disorder 299.0 and specify if the following: 5

A
  1. With or without accompanying intellectual impairment
  2. With or without accompanying language impairment
  3. Associated with a known medical or genetic condition
  4. Associated with another neurodevelopmental, mental or behavioral disorder
  5. With catatonia
51
Q

DSM-5 Autism spectrum disorder: Rank level of severity by how much support is needed in communication and behavior
3

A
  1. Level 1 “Requiring support”
  2. Level 2 “Requiring substantial support”
  3. Level 3 “Requiring very substantial support”
52
Q

Treatment for autism spectrum disorder?

3

A
  1. Autistic children require specialized therapy and special schooling or residential schooling although attempts of integrations are also started.
  2. Special techniques for teaching autistic children and special psychotherapeutic approaches were developed.
  3. Sometimes antipsychotic drugs and antidepressants are used to cope with aggressive behavior and depression or to treat co-morbid psychiatric diagnoses
53
Q

Treatment: Specialized therapeutic and teaching approaches?

7

A
  1. Applied behavior analysis (ABA)
  2. Picture exchange communication system (PECS)
  3. Early Start Denver Model (ESDM)
  4. More Than Words
  5. Treatment and Education of
  6. Autistic and Communication related handicapped Children (TEACCH)
  7. Child’s Talk
54
Q

Autism: Your job as a primary care provider is to screen and refer:
Very simple screening tools available. What are the two screening tools?

A
  1. M-CHAT (CHecklist for Autism in Toddlers)
    (18-24 months of age)
  2. STAT (Screening Tool for Autism in Toddlers and young children)
55
Q

Autism: Surveillance at every visit by asking three questions :

A
  1. Does your child look at you and point when he/she wants to show you something?
  2. Does your child look when you point to something?
  3. Does your child use imagination to pretend play?
56
Q

What are the 10 ACE items that can be scored?

A

Three forms of abuse.
Two forms of neglect
Five forms of family dysfunction

ABUSE
Emotional Abuse
Physical Abuse
Sexual Abuse

HOUSEHOLD CHALLENGES
Mother Treated Violently
Household Substance Abuse	
Household Mental Illness	Parental Separation or Divorce	
Incarcerated Household Member

NEGLECT
Emotional Neglect
Physical Neglect

Behavioral Health (20 decks)

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