Peds Flashcards
kids are more at risk for what in psychiatry
kids have a higher risk of significant adverse effects from medications
What was a finding of GAO about kids and psychiatric conditions
kids in foster care are much more likely to receive psychotropic medications
how long should tics be present for diagnosis of tourettes disorder
must be present for over a year
what is the most well known tic disorder
tourette’s
what is the age onset of tourettes
before 18
what is a characteristic of tourettes tics
they may wax and wane in frequency
can tics be motor
yes,
what are the three kinds of tic disorders
tourette’s, persistent motor or vocal tic disorder, and provisional tic disorder
what is persistent motor or vocal tic disorder
must have EITHER vocal OR motor tics, both not present
what is provisional tic disorder
motor and or vocal, present for less than a year
what is the difference between provisional tic disorder and tourettes
how long the symptoms have been present, tourettes is over a year and ptd is less than a year
what is the demographics of tic disorders
male predominance
biting, jumping, repeating words are what kinds of tics
complex
blinking, shrugging, coughing are what kind of tics
simple
what are the two conditions common with tic disorders and what are their prevalences
75% have ADHD, 50% have OCD
what is the rule of thirds for tic disorders
1/3 resolve, 1/3 improve, 1/3 stay the same
what percent of adults have persistent tic symptoms after childhood
10%
what is the first line treatment of tics
alpha-2-agonists, clonidine, guanfacine,
by what percent are tics reduced by first line treatment
30%
what is the second line treatment for tics
atypical antipsychotics (aripiprazole and risperidone)
what percent reduction in tics is expected from second line therapy
30-60%
what is the third line treatment of tics
typical antipsychotics (haloperidol and pimozide)
what percent reduction can be expected from third line treatment of tics
80%
what antipsychotic is weight based dosing for children with tic disorders
aripiprazole
what age is aripiprazole approved for
6-17 years old
what weight should be kept in mind for dosing of aripiprazole
50 kg
What medication should be used in all tic disorders and why
stimulants should always be used, ADHD is a common co-morbidity
what is an effects of amphetamine based stimulants on tics
might exacerbate motor and vocal tic symptoms
what disorder is characterized by angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months
oppositional defiant disorder
how long must oppositional defiant disorder last
at least 6 months
what is the frequency for oppositional defiant disorder in children younger than 5 years old
most days for at least 6 months
what is the frequency for oppositional defiant disorder in children older than 5
at least once a week for 6 months
what are the three behaviors seen in oppositional defiant disorder
angry, argumentative, vindictive
what disorder is characterized by repetitive and persistent pattern of behavior in which the basic rights of others or societal norms or rules are violated
conduct disorder
what are the 4 behaviors seen in conduct disorder
aggression, destruction, deceitfulness, serious violence
what defines childhood onset type conduct disorder
less than 10 years old
what defines adolescent onset type conduct disorder
onset over the age of 10
what type of onset of conduct disorder is defined by unclear information regarding age onset
unspecified onset
what two underlying conditions are really important to treat with ODD and CD
ADHD and depression/anxiety
what drugs should be used first before any others in ODD and CD
stimulants and guanfacine/clonidine
what antipsychotic should be used after treating underlying conditions of ODD and CD
atypical antipsychotics
atypical antipsychotics for ODD and CD my be used to treat 3 specific behaviors
persistent aggression, oppositional behaviors, and defiance
what drug combination is often seen for ODD and CD if patient has ADHD and also needs sleep
alpha agonist and stimulant
when should pharmacotherapy be used for ODD and CD
adjunctive treatment when behaviors have been determined, other interventions have failed, and aggression has escalated to dangerous levels
what disorder is characterized by developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached
separation anxiety disorder
how long must separation anxiety disorder last in children
at least 4 weeks
how long must separation anxiety disorder last in adults
6 months
separation anxiety disorder is treated in a similar manner to what other disorder
anxiety
what is the first line treatment for mild anxiety
psychotherapy
what is the first line treatment for moderate to severe anxiety
combination therapy
what drug is the first line for separation anxiety disorder
SSRIs
what is important to consider during treatment of Separation anxiety disorder
treat co-morbidities like depression, ADHD, and screen for bipolar disorder
what disorder is characterized by persistent deficits in social communication and social interaction across multiple contexts
autism spectrum disorder
what is a characteristic of autism spectrum disorder
restricted, repetitive patterns of behaviors, interests, and activities
what are two associated disorders of autism spectrum disorder
GI disorders and seizure disorder
what percent of people on the spectrum have a seizure by the age of 20
30%
What is the first line medication for autism spectrum disorder
HAHA PSYCH there are no medications used
what behavioral symptoms are associated with ASD
aggression, hyperactivity, inattention, irritability, mood instability, poor frustration tolerance, self harm, severe temper tantrum, sleep disturbances, OCD symptoms, hypersensitivity of senses
what is the first line treatment of disruptive behaviors in ASD
Applied Behavioral Analysis
what age is risperidone approved for
5-16 yo
what two drugs are approved for the management of irritability /aggression in ASD
aripiprazole and risperidone
What two drugs are often prescribed for ASD but have no significant efficacy for irritability
lamotrigine and levetiracetam
what drugs should be used for repetitive behaviors (3)
antipsychotics, haloperidol, aripiprazole, and risperidone
what medication is preferred for the treatment of ADHD
methylphenidate
what two drugs have modest effects on irritability and explosive behavior in ADHD
guanfacine and clonidine
what is the treatment of sleep problems in children
melatonin, 1-6mg nightly
what disorder is characterized by sever recurrent temper outbursts manifested verbally that are out of proportion with the intensity/duration of the situation
disruptive mood dysregulation disorder
when should the diagnosis of disruptive mood dysregulation disorder (DMDD) be made
between the ages of 6 and 18
what is the diagnostic criteria of disruptive mood dysregulation disorder (DMDD)
symptoms must be present in at least two of three settings (home, school, and with peers) and must be severe in at least one of these settings
three examples of settings for disruptive mood dysregulation disorder
home, school, and with peers
what 3 conditions is disruptive mood dysregulation disorder similar to
anxiety, depression, ADHD
what disorder must be differentiated from disruptive mood dysregulation disorder
bipolar disorder
what is the first line treatment for disruptive mood dysregulation disorder
SSRIs and stimulants
what symptoms are commonly complained about in children with pediatric depression
physical symptoms
what are physical complaints of pediatric depression
headache is a good example
what symptoms of depression do adolescents complain more about compared to younger children
suicidal behaviors and depression
what is common in pediatric depression
instability in mood, more chronic than episodic
what is the first line treatment of pediatric depression
nonpharm, get family/caregivers on board
what is the only antidepressant approved for children
fluoxetine
what age is fluoxetine approved for
down to 8 years old
what depression treatment has the highest remission rate and what is the rate
CBT, 70%
what are the black box warnings of antidepressants
suicidality
when is suicidality highest in patients treated with antiddepressants
in the first 3 months of treatment
what was the first antidepressant with suicidal thinking warning
paroxetine
what antidepressant should definitely be avoided in kids
paroxetine
what are the preferred drug options for bipolar 1 without psychosis (6)
lithium
valproate
carbamazepine
olanzapine
risperidone
quetiapine
what is the preferred drug options for bipolar 1 with psychosis (3 with addition)
lithium
valproate
carbamazepine
WITH any atypical antipsychotic
what is the first line treatment for depressed bipolar disorder
lithium, SSRI, bupropion
what is the first line treatment for pediatric PTSD
trauma focused psychotherapy
what is the first line drug for pediatric PTSD
SSRIs
what pediatric disorder uses adult diagnostic criteria
schizophrenia
what is a characteristic of childhood onset schizophrenia
hallucinations and delusions not explained by substance use or PDD/autism
what age is escitalopram approved for
12-17
what is the age of onset for childhood onset schizophrenia
before the age of 13
what is more common in childhood onset schizophrenia compared to adulthood
visual hallucinations
how common is childhood onset schizophrenia
rare
what are the pediatric indications of aripiprazole
bipolar disorder, irritability with autism, schizophrenia, tourette’s
what are the pediatric indications of asenapine
bipolar disorder
what are the pediatric indications of brexpiprazole
schizophrenia
what are the pediatric indications of lurasidone
schizophrenia and bipolar depression
what are the pediatric indications of olanzapine
bipolar disorder and schizophrenia
what are the pediatric indications of olanzapine/fluoxetine (symbyax)
bipolar 1 depression
what is the pediatric indication for paliperidone
schizophrenia
what is the pediatric indications for quetiapine
bipolar disorder and schizophrenia
what are the pediatric indications for respiridone
bipolar disorder, irritability with autism, schizophrenia
what two drugs are approved for irritability with autism
aripiprazole and risperisone
