Pediatric Therapies Flashcards
What is DMDD?
Disruptive mood dysregulation disorder
What, generally, is DMDD?
-Chronic, severe, persistent irritability
What is conduct disorder?
a psychological disorder diagnosed in childhood or adolescence that presents itself through a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate norms are violated
What is the prognosis for conduct disorder?
Early = leads to sociopathy Later = better prognosis
What is the boy:girl ratio of ADHD? Prevalence?
- 4:1 to 9:1
- 5%
What are the three domains of ADHD?
Inattention
Hyperactivity
Impulsivity
ADHD has an onset before what age? What is the duration that is needed to meet criteria? How many setting must this be seen in?
- before age 12
- Duration over 6 months
- At least 2 settings
There is a high comorbidity of ADHD with what other disorders?
- ODD
- CD
- learning disorder
What is the key difference between learning disability vs ADHD?
ADHD is a global problem vs disability is usually in one specific subject area
True or false: ADHD is overdiagnosed
Debateable
True or false: most kids will outgrow ADHD
True–frontal lobe grows, and learning strategies improve
True or false: TV causes ADHD
Possibly?– may be related to stimulus
True or false: ADHD is associated with eating preservatives and additives
Maybe?
True or false: ADHD is a clinical diagnosis
True
What must be true of ADHD symptoms in regards to setting?
must be preset at both home and school
What are the common side effects of ADHD stimulants?
- GI symptoms
- Decreased appetite
- Blunted affect
What is the thinking behind the stimulant prescription for ADHD?
Stimulate the frontal lobe
True or false: stimulants have a high efficacy for ADHD
True
What can happen to affect with stimulant use that should be monitored for? (3)
Blunts, with flat affect
BP and pulse
What may happen with stimulant use in a kid with an underlying psychiatric disorder? Why?
Hallucinations and other psychiatric symptoms–increases dopamine release
What are the first line drugs for ADHD?
Methylphenidate–Ritalin
Why should amphetamine products be avoided as a first line therapy for ADHD?
Much greater side effect profile
How fast do amphetamines work with ADHD?
Hours to days
What are the familial disorders of untreated ADHD?
Increased parental divorce and sibling fights
What are the societal consequences of untreated ADHD?
Increased Substance abuse
What can be done with rebounding off of ADHD meds? (2)
Short acting stimulants or alpha-2 agonists (apraclonidine)
What is the only nonstimulant used for ADHD? MOA? Benefit? Downside?
- Atomoxetine
- NE reuptake inhibitor
- No rebounding, but less efficacious
What are the major side effects of Atomoxetine?
Hepatotoxic
What is the MOA of clonidine? Why use in ADHD?
- Alpha-2 agonists
- treats impulsivity
What should be done prior to administering a stimulant for ADHD?
Cardiac exam and ECG if indicated
What ADHD get better with behavioral programs alone?
Mostly not
Will ADHD meds cause growth suppression?
Small evidence with little effect
Will children outgrow ADHD?
50% chance
Is ritalin a gateway drug?
No–less impulsivity and increased frontal lobe actually decrease drug use
Lining up toys = what mental disorder?
Autism
What is the M:F ratio of autism?
4:1
What are the three domains of autism?
- Impairment in social interactions
- Impairment in communication
- Restricted pattern of interest and stereotypical behavior
What are the qualifications of autism?
With or without:
- Intellectual impairment
- Language impairment
- Known medical conditions
What are the levels 1-3 of autism?
1 = high functioning 2 = Needs some support 3 = needs a lot of support
When should you refer for suspected autism? (4)
- Language delay
- Lack of nonverbal communication
- Lack of symbolic play
- Stereotypical or self stimulating behaviors
What is the trend of incidence of autism?
Increasing
What is the treatment for autism?
- PT/OT/speech
- Social skills training
- SSRI
What is the pharmacotherapy for autism? (3)
- NMDA antagonists (memantine)
- SSRIs
- Antipsychotics
What is the MOA and use of memantine?
- Alzheimer’s and maybe autism
- NMDA receptor blocker
Are negative or positive s/sx of schizophrenia seen first (usually)?
- Prodromal negative symptoms
- Acute s/sx are positive
What are schizophrenic patients often misdiagnosed as early on in the course of the disease? Why?
Depression, since negative s/sx usually come first
What type of hallucinations are usually had with schizophrenia: auditory or visual? Are these usually internal or external?
Auditory
External
What is the prevalence of schizophrenia?
1%
Who usually presents with schizophrenia earlier, men or women
Men
IQ can drop how much with psychosis?
Two SDs (30 points)
What happen to the brain with schizophrenic patients?
Shrinks
What happens to suicide rates post hospitalization for psychotic patients?
increase–thinking clearly leads to suicide
Does marijuana have an effect on schizophrenia?
Yes
What birth month more commonly has psychosis?
Winter months
True or false: schizophrenia is more common in males
False–no gender difference
What is the average length of time between the first psychotic break and treatment?
2-3 years
True or false: schizophrenia is more common in males
Fales–relatively equal
True or false: violence is more common in the schizophrenic population
False
True or false: paranoid schizophrenics have the worst prognosis
False–have the best prognosis
True or false: language delays can happen with schizophrenic patients
True
What happens to the ventricle with schizophrenia?
Enlarge
What is the male:female ratio of conduct disorder
5:1
What is the major comorbidity with conduct disorder?
ADHD (50% comorbidity)
What is the difference in the MOA of amphetamine derived products, compared to methylphenidate?
In addition to blocking reuptake of dopamine, they increase the release of it
What is the effect of untreated ADHD on ER visits?
33% increase
What is the effect of untreated ADHD on bike accidents?
50% increase
What is the effect of untreated ADHD on substance use?
2x risk
What is the effect of untreated ADHD on parental absenteeism?
Increased
Difficulty with symbolic play = what disease?
Autism
True or false: kids with autism often lack the theory of mind
true
Which gender appears later with schizophrenia?
Females
