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exam 4 > Peds > Flashcards

Peds Flashcards

1
Q

kids are more at risk for what in psychiatry

A

kids have a higher risk of significant adverse effects from medications

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2
Q

What was a finding of GAO about kids and psychiatric conditions

A

kids in foster care are much more likely to receive psychotropic medications

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3
Q

how long should tics be present for diagnosis of tourettes disorder

A

must be present for over a year

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3
Q

what is the most well known tic disorder

A

tourette’s

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4
Q

what is the age onset of tourettes

A

before 18

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5
Q

what is a characteristic of tourettes tics

A

they may wax and wane in frequency

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6
Q

can tics be motor

A

yes,

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7
Q

what are the three kinds of tic disorders

A

tourette’s, persistent motor or vocal tic disorder, and provisional tic disorder

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8
Q

what is persistent motor or vocal tic disorder

A

must have EITHER vocal OR motor tics, both not present

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9
Q

what is provisional tic disorder

A

motor and or vocal, present for less than a year

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10
Q

what is the difference between provisional tic disorder and tourettes

A

how long the symptoms have been present, tourettes is over a year and ptd is less than a year

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11
Q

what is the demographics of tic disorders

A

male predominance

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12
Q

biting, jumping, repeating words are what kinds of tics

A

complex

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13
Q

blinking, shrugging, coughing are what kind of tics

A

simple

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14
Q

what are the two conditions common with tic disorders and what are their prevalences

A

75% have ADHD, 50% have OCD

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15
Q

what is the rule of thirds for tic disorders

A

1/3 resolve, 1/3 improve, 1/3 stay the same

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16
Q

what percent of adults have persistent tic symptoms after childhood

A

10%

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17
Q

what is the first line treatment of tics

A

alpha-2-agonists, clonidine, guanfacine,

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18
Q

by what percent are tics reduced by first line treatment

A

30%

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19
Q

what is the second line treatment for tics

A

atypical antipsychotics (aripiprazole and risperidone)

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20
Q

what percent reduction in tics is expected from second line therapy

A

30-60%

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21
Q

what is the third line treatment of tics

A

typical antipsychotics (haloperidol and pimozide)

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22
Q

what percent reduction can be expected from third line treatment of tics

A

80%

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23
Q

what antipsychotic is weight based dosing for children with tic disorders

A

aripiprazole

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24
Q

what age is aripiprazole approved for

A

6-17 years old

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25
Q

what weight should be kept in mind for dosing of aripiprazole

A

50 kg

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26
Q

What medication should be used in all tic disorders and why

A

stimulants should always be used, ADHD is a common co-morbidity

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27
Q

what is an effects of amphetamine based stimulants on tics

A

might exacerbate motor and vocal tic symptoms

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28
Q

what disorder is characterized by angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months

A

oppositional defiant disorder

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29
Q

how long must oppositional defiant disorder last

A

at least 6 months

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30
Q

what is the frequency for oppositional defiant disorder in children younger than 5 years old

A

most days for at least 6 months

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31
Q

what is the frequency for oppositional defiant disorder in children older than 5

A

at least once a week for 6 months

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32
Q

what are the three behaviors seen in oppositional defiant disorder

A

angry, argumentative, vindictive

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33
Q

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

A

conduct disorder

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34
Q

what are the 4 behaviors seen in conduct disorder

A

aggression, destruction, deceitfulness, serious violence

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35
Q

what defines childhood onset type conduct disorder

A

less than 10 years old

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36
Q

what defines adolescent onset type conduct disorder

A

onset over the age of 10

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37
Q

what type of onset of conduct disorder is defined by unclear information regarding age onset

A

unspecified onset

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38
Q

what two underlying conditions are really important to treat with ODD and CD

A

ADHD and depression/anxiety

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39
Q

what drugs should be used first before any others in ODD and CD

A

stimulants and guanfacine/clonidine

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40
Q

what antipsychotic should be used after treating underlying conditions of ODD and CD

A

atypical antipsychotics

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41
Q

atypical antipsychotics for ODD and CD my be used to treat 3 specific behaviors

A

persistent aggression, oppositional behaviors, and defiance

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42
Q

what drug combination is often seen for ODD and CD if patient has ADHD and also needs sleep

A

alpha agonist and stimulant

43
Q

when should pharmacotherapy be used for ODD and CD

A

adjunctive treatment when behaviors have been determined, other interventions have failed, and aggression has escalated to dangerous levels

44
Q

what disorder is characterized by developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached

A

separation anxiety disorder

45
Q

how long must separation anxiety disorder last in children

A

at least 4 weeks

46
Q

how long must separation anxiety disorder last in adults

A

6 months

47
Q

separation anxiety disorder is treated in a similar manner to what other disorder

A

anxiety

48
Q

what is the first line treatment for mild anxiety

A

psychotherapy

49
Q

what is the first line treatment for moderate to severe anxiety

A

combination therapy

50
Q

what drug is the first line for separation anxiety disorder

A

SSRIs

51
Q

what is important to consider during treatment of Separation anxiety disorder

A

treat co-morbidities like depression, ADHD, and screen for bipolar disorder

52
Q

what disorder is characterized by persistent deficits in social communication and social interaction across multiple contexts

A

autism spectrum disorder

53
Q

what is a characteristic of autism spectrum disorder

A

restricted, repetitive patterns of behaviors, interests, and activities

54
Q

what are two associated disorders of autism spectrum disorder

A

GI disorders and seizure disorder

55
Q

what percent of people on the spectrum have a seizure by the age of 20

A

30%

56
Q

What is the first line medication for autism spectrum disorder

A

HAHA PSYCH there are no medications used

57
Q

what behavioral symptoms are associated with ASD

A

aggression, hyperactivity, inattention, irritability, mood instability, poor frustration tolerance, self harm, severe temper tantrum, sleep disturbances, OCD symptoms, hypersensitivity of senses

58
Q

what is the first line treatment of disruptive behaviors in ASD

A

Applied Behavioral Analysis

59
Q

what age is risperidone approved for

A

5-16 yo

60
Q

what two drugs are approved for the management of irritability /aggression in ASD

A

aripiprazole and risperidone

61
Q

What two drugs are often prescribed for ASD but have no significant efficacy for irritability

A

lamotrigine and levetiracetam

62
Q

what drugs should be used for repetitive behaviors (3)

A

antipsychotics, haloperidol, aripiprazole, and risperidone

63
Q

what medication is preferred for the treatment of ADHD

A

methylphenidate

64
Q

what two drugs have modest effects on irritability and explosive behavior in ADHD

A

guanfacine and clonidine

65
Q

what is the treatment of sleep problems in children

A

melatonin, 1-6mg nightly

66
Q

what disorder is characterized by sever recurrent temper outbursts manifested verbally that are out of proportion with the intensity/duration of the situation

A

disruptive mood dysregulation disorder

67
Q

when should the diagnosis of disruptive mood dysregulation disorder (DMDD) be made

A

between the ages of 6 and 18

68
Q

what is the diagnostic criteria of disruptive mood dysregulation disorder (DMDD)

A

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

69
Q

three examples of settings for disruptive mood dysregulation disorder

A

home, school, and with peers

70
Q

what 3 conditions is disruptive mood dysregulation disorder similar to

A

anxiety, depression, ADHD

71
Q

what disorder must be differentiated from disruptive mood dysregulation disorder

A

bipolar disorder

72
Q

what is the first line treatment for disruptive mood dysregulation disorder

A

SSRIs and stimulants

73
Q

what symptoms are commonly complained about in children with pediatric depression

A

physical symptoms

74
Q

what are physical complaints of pediatric depression

A

headache is a good example

75
Q

what symptoms of depression do adolescents complain more about compared to younger children

A

suicidal behaviors and depression

76
Q

what is common in pediatric depression

A

instability in mood, more chronic than episodic

77
Q

what is the first line treatment of pediatric depression

A

nonpharm, get family/caregivers on board

78
Q

what is the only antidepressant approved for children

A

fluoxetine

79
Q

what age is fluoxetine approved for

A

down to 8 years old

80
Q

what depression treatment has the highest remission rate and what is the rate

A

CBT, 70%

81
Q

what are the black box warnings of antidepressants

A

suicidality

82
Q

when is suicidality highest in patients treated with antiddepressants

A

in the first 3 months of treatment

83
Q

what was the first antidepressant with suicidal thinking warning

A

paroxetine

84
Q

what antidepressant should definitely be avoided in kids

A

paroxetine

85
Q

what are the preferred drug options for bipolar 1 without psychosis (6)

A

lithium
valproate
carbamazepine
olanzapine
risperidone
quetiapine

86
Q

what is the preferred drug options for bipolar 1 with psychosis (3 with addition)

A

lithium
valproate
carbamazepine
WITH any atypical antipsychotic

87
Q

what is the first line treatment for depressed bipolar disorder

A

lithium, SSRI, bupropion

88
Q

what is the first line treatment for pediatric PTSD

A

trauma focused psychotherapy

89
Q

what is the first line drug for pediatric PTSD

A

SSRIs

90
Q

what pediatric disorder uses adult diagnostic criteria

A

schizophrenia

91
Q

what is a characteristic of childhood onset schizophrenia

A

hallucinations and delusions not explained by substance use or PDD/autism

92
Q

what age is escitalopram approved for

A

12-17

93
Q

what is the age of onset for childhood onset schizophrenia

A

before the age of 13

94
Q

what is more common in childhood onset schizophrenia compared to adulthood

A

visual hallucinations

95
Q

how common is childhood onset schizophrenia

A

rare

96
Q

what are the pediatric indications of aripiprazole

A

bipolar disorder, irritability with autism, schizophrenia, tourette’s

97
Q

what are the pediatric indications of asenapine

A

bipolar disorder

98
Q

what are the pediatric indications of brexpiprazole

A

schizophrenia

99
Q

what are the pediatric indications of lurasidone

A

schizophrenia and bipolar depression

100
Q

what are the pediatric indications of olanzapine

A

bipolar disorder and schizophrenia

101
Q

what are the pediatric indications of olanzapine/fluoxetine (symbyax)

A

bipolar 1 depression

102
Q

what is the pediatric indication for paliperidone

A

schizophrenia

103
Q

what is the pediatric indications for quetiapine

A

bipolar disorder and schizophrenia

104
Q

what are the pediatric indications for respiridone

A

bipolar disorder, irritability with autism, schizophrenia

105
Q

what two drugs are approved for irritability with autism

A

aripiprazole and risperisone

exam 4 (7 decks)

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