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Rotation 1: Pediatrics > Psych/Behavioral Med (6%) > Flashcards

Psych/Behavioral Med (6%) Flashcards

1
Q

What is the principle therapy for mild-moderate depression?

A

Psychotherapy

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2
Q

Patients diagnosed with conduct d/o have a poor prognosis as 40% of them will go on to develop ________ d/o

Most commonly in (boys/girls)

A

Antisocial personality

boys

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3
Q

What social factor is considered a protective factor against attempting suicide?

A

Marriage

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4
Q

There are 4 main characteristics observed in a pt with conduct d/o, what are they?

A

Serious violations of laws

Aggressive/cruel to animals

Deceitfulness

Destruction of property

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5
Q

There are two types of anorexia nervosa, what are they?

A

Restrictive type: reduced calorie intake, dieting, fasting excessive exercise, diet pills

Purging type: primarily engages in self-induced vomiting, diuretic/laxative/enema abuse

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6
Q

What is the diagnostic criteria for panic disorder?

A

Recurrent, unexpected panic attacks (at least 2)

Panic attacks often followed by concern about future attacks

Worry about the implication of the attacks

Significant change in behavior related to the attacks

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7
Q

What age group/ethnicity has the highest suicide rate in the US?

A

Elderly white males

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8
Q

What is recommended for management of oppositional defiant d/o?

A

Psychotherapy

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9
Q

What are some examples of inattentiveness sx seen in patients with ADD/ADHD?

A

Easily distracted

Has difficulty maintaining focus on one task

Misses details

Forgets/loses things

Difficulty in completing assignments

Becomes bored with a task after a few minutes

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10
Q

What is the recommended management for an acute panic attack?

A

Benzodiazepines

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11
Q

T/F: In a pt with a specific phobia, the fear is in proportion to any real danger

A

FALSE, it is out of proportion!

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12
Q

What are some risk factors for developing major depressive disorder?

More common in males or females?

What is the age range that this dx is most commonly seen in?

A

FHx

female (2:1)

20-40 y/o with highest incidence

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13
Q

What is the recommended management for a pt with anorexia nervosa?

A

Medical stabilization: hospitalization for <75% expected body weight or pts who have medical complications; electrolyte imbalances may lead to cardiac abnormalities

Psychotherapy

Pharmacotherapy

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14
Q

What is savantism?

A

unusually talented

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15
Q

T/F: Physical abuse, sexual abuse, and child neglect are all three examples of child abuse and neglect

A

TRUE

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16
Q

What are options for the management of a pt’s phobia?

A

Exposure/desensitization therapy (tx of choice)

Short term BZDs and BBs can be used in some pts

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17
Q

What are some examples of hyperactivity/impulsivity sx seen in patients with ADD/ADHD?

A

Fidgets and squirms in their seat

Constantly in motion

Talks nonstop or excessively

Impatience

Dashes around, touching, or playing with everything

Has trouble sitting for long periods

Difficulty doing quiet tasks

Restlessness

Blurts out comments

Interrupts conversations/activities of others

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18
Q

Is there any association to psychosis if a pt has oppositional defiant d/o?

A

No

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19
Q

What is agoraphobia?

A

anxiety about being in places or situations from which escape may be difficult

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20
Q

Generalized anxiety d/o is associated with how many of the following sx?

fatigue, restlessness, difficulty concentrating, muscle tension, sleep disturbance, irritability, shakiness, HA

A

greater than or equal to 3

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21
Q

Obesity associated with increased risk for ______ dz, _______, and what two cancers?

A

coronary dz

DM

breast & colon

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22
Q

What are some lab findings that may be observed in a pt with bulimia nervosa?

A

± hypokalemia, hypomagnesemia; electrolyte imbalance may lead to cardiac arrhythmias

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23
Q

Persistent depressive d/o, or dysthymia, is defined as a chronic depressed mood for how long in children/adolescents?

A

>1 year

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24
Q

For dx of anorexia nervosa, one must have a BMI that is less than or equal to _______ or a body weight that is less than _____% of ideal weight

A

less than or qual to 17.5 kg/m2

< 85%

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25
To make the dx of major depressive d/o, which two sx must be ABSENT?
Mania and hypomania
26
What are three examples of clinical manifestations of a patient with autism spectrum disorder?
Social interaction difficulties: avoiding eye contact Impaired communication Restricted, repetitive, stereotyped behaviors and patterns of activities
27
What condition is described below? ## Footnote *REFUSAL TO MAINTAIN A MINIMALLY NORMAL BODY WEIGHT fueling a relentless desire for thinness with a morbid fear of fatness or gaining weight (even though they are underweight)*
Anorexia nervosa
28
Normal grief resolves within _____ year (s) Abnormal gried resolves in \> ______ year (s)
within 1 yr \> 1 year
29
In cases of sexual abuse, the abuser is often (male/female) and (is not/is) known to the victim
Male Is known
30
Patients with bulimia nervosa will ______ \_\_\_\_\_\_. They then partake in a compensatory behavior, which either includes ____ or not.
Binge eating purging
31
Among highly skilled workers, ______ are at an increased risk of suicide
Physicians
32
What are options for the management of a patient with ADD/ADHD?
Behavior modification **_Sympathomimetic medications_** (*Stimulants*): **Pharmacologic tx of choice** --\> _Methylphenidate_, _Amphetamine_/_dextroamphetamine_, _Dexmethylphenidate_ **Nonstimulants**: Atomoxetine (Strattera)
33
What is the major difference between a pt with anorexia nervosa and bulimia nervosa?
Their weight! Bulimia pts have a normal weight or are overweight
34
What d/o may oppositional defiant d/o progress to?
Conduct d/o
35
(males/females) attempt suicide more often, but (males/females) complete suicide more often
females males
36
What medications are often first line in patients with mild-moderate depression? How long should antidepressants be continued for to determine if they are efficacious?
SSRIs Should be continued for a minimum of 3- 6 weeks to determine efficacy
37
How to make the dx of MDD?
**_Depressed mood or anhedonia_** (loss of pleasure) or loss of interest in activities with **\>=5 associated sx** almost every day for most of the days for **at least 2 weeks**: *Fatigue almost all day, insomnia or hypersomnia, feelings of guilt or worthlessness, recurring thoughts of death or suicide, psychomotor agitation, significant weight change (gain or loss), decreased or increased appetite, decreased concentration/indecisiveness* The sx are not due to substance use, bereavement or medical conditions _Somatic_: constipation, HA, skin changes, CP, abd pain, cough, dyspnea
38
What d/o is described below? ## Footnote *Persistent pattern of behaviors that DEVIATE SHARPLY FROM THE AGE-APPROPRIATE NORMS & VIOLATE THE RIGHTS OF OTHERS*
Conduct disorder
39
What medications and otherwise can be used in the management of social anxiety d/o?
**_Antidepressants_** (SSRIs) Beta Blockers (for performance anxiety) BZDs (short term) **_Psychotherapy_** (CBT)
40
What condition is described below? ## Footnote *Neurodevelopmental d/o characterized by problems paying attention, difficulty controlling behaviors, and hyperactivity that is not age-appropriate*
ADD/ADHD
41
T/F: Substance abuse is associated with an increased risk of suicide
TRUE
42
What is 1st line tx for dysthymia (persistent depressive disorder)?
SSRIs
43
Panic d/o is more common in men or women?
Women (2-3x)
44
Major depressive d/o may be due to an alteration in _______ or a _______ dysregulation
neurotransmitters neuroendocrine
45
What are some examples of panic attack sx?
Dizziness, trembling, choking feeling, parasthesias, sweating, SOB, CP, chills, hot flashes, fear of losing control, fear of dying, palpitations, nausea, abd pain, depersonalization
46
There is a 60% of also being dx'd with _______ if a pt has anorexia nervosa
depression
47
Are males or females more afftected by autism spectrum disorder?
Males (4:1)
48
What comorbid d/o is seen in ~50% of pts with obesity?
**binge eating** *recurrent episodes characterized by eating w/in a discrete time (ex. 2 hours) more than people normally would w/ lack of control during an eating episode* Binge eating occurs at least weekly for _3 months_
49
Obesity is defined as having a Body Mass Index (BMI) \>\_\_\_\_\_ or body weight \>/= ____ % over their ideal weight
\> 30 kg/m2 \>/= 20%
50
Patients with conduct disorder have both _____ and _____ difficutly
social and academic
51
What is seasonal affective d/o? Atypical depression? Melancholia? Catatonic depression?
1. **Seasonal affective d/o**: the presence of depressive sx at the same time each year (MC in winter due to reduction of sunlight & cold weather) Management: SSRls, light therapy, Bupropion 2. **Atypical depression**: shares many of the typical sx of major depression but pts experience mood reactivity (improved mood in response to positive events) Management: MAO inhibitors 3. **Melancholia**: characterized by anhedonia, lack of mood reactivity, depression, severe weight loss/loss of appetite, excessive guilt, psychomotor agitation or retardation & sleep disturbance (increased REM time & reduced sleep) 4. **Catatonic depression**: motor immobility, stupor & extreme withdrawal
52
What medications are used in the management of generalized anxiety d/o?
**_Antidepressants_** (SSRIs) **_Buspirone_** (does not cause drowsiness) BZDs for short term use only, BBs, TCAs **_Psychotherapy_** (CBT)
53
What age is the most common age of onset for anorexia nervosa?
Mid teens
54
What classic PE finding will be observed in a pt with bulimia nervosa?
Teeth pitting or enamel erosion
55
What is recommended management for a pt with autism spectrum disorder?
Referral to neuropsychologic testing Behavioral modification strategies Medications
56
In cases of physical abuse, the abuser is often (male/female) and (is not/is) usually the primary caregiver of the child
female is primary caregiver
57
What is 1st line medical treatment for long term management of panic disorder?
SSRIs 1st line Cognitive behavioral therapy
58
A majority of people who attempt suicide have what kind of underlying d/o?
Psychiatric
59
Which d/o is described below? ## Footnote *Persistent (\> 6 months), INTENSE FEAR OF SOCIAL OR PERFORMANCE SITUATIONS in which the person is exposed to the scrutiny of others for fear of embarrassment*
Social anxiety d/o
60
What are some options for management of a pt with bulimia nervosa?
**_Psychotherapy_** (CBT) **_Pharmacotherapy_**: **Fluoxetine** has been shown to reduce the binge purge cycle, but may have CV side effects especially if the patient has electrolyte abnormalities
61
What are components of normal grief vs abnormal grief?
**_Normal grief_**: sadness, irritability, intense yearning for a loved one, poor concentration, sleep disturbances, illusions/hallucinations (*hearing or seeing the dead*) but pt perceives the illusions/hallucinations as **not** being **real** *Normal responses include denial, shock, confusion, sadness, numbness or guilt, may develop depressive sx* **_Abnormal grief_**: SI, psychosis, psychomotor deficits, illusions/hallucinations (*hearing or seeing the dead*) but the pt perceives the illusions/hallucinations as **being** **real**
62
What is mania?
**_MANIA_**: abnormal & persistently elevated, expansive, or irritable mood at least 1 week (or less if hospitalization is required) with marked impairment of social/occupational function, \>=3: - _MOOD_: euphoria, irritable, labile or dysphoric - _THINKING_: racing, flight of ideas, disorganized, easily distracted, expansive or grandiose thoughts, judgment is impaired - _BEHAVIOR_: physical hyperactivity, pressured speech, decreased need for sleep, increased impulsivity and excessive involvement in pleasurable activities including risk-taking and hypersexuality, disinhibition, increased goal directed activity --\> *Psychotic sx (paranoia, delusions, hallucinations) may be seen in these pts*
63
What is child neglect?
The failure to provide the basic needs of a child ## Footnote *supervision, shelter, food, affection, education, etc*
64
Signs of sexual abuse may include \_\_\_\_/\_\_\_\_ trauma, _______ \_\_\_\_\_\_ dzs, and ______ \_\_\_\_\_\_ infections.
genital/anal trauma Sexually transmitted dzs Urinary tract infxns
65
For dx of oppositional defiant d/o, a pt must exhibit at least ___ months of the following 3 components: Angry/irritable mood (*often blames others for their misbehaviors, has negative attitudes and has anger/resentment*) Argumentative/defiant behavior Vindictiveness
6
66
What is the difference between bipolar I and bipolar II disorder? What is 1st line tx for each?
**_Bipolar I_**: \>=1 manic or mixed episode, which often cycles w/ occasional depressive episodes, but major depressive episodes are not required for dx **_Bipolar II_**: \>=1 hypomanic episode + \>=1 major depressive episode (***mania or mixed episodes are absent***) Tx: LITHIUM
67
What lab results are associated with anorexia nervosa?
Leukocytosis, leukopenia, anemia; hypokalemia, increased BUN (*dehydration*), hypothyroidism
68
What are some examples of signs of physical abuse? What kind of burn pattern is associated with physical abuse?
cigarette burns, **burns in a stocking glove pattern** *(seen when feet or hands are held in the water)*, lacerations, healed fractures on radiographs, subdural hematoma, multiple bruises or retinal hemorrhages *(seen in addition to hyphemia in shaken baby syndrome)*
69
What are some signs of child neglect?
malnutrition, withdrawal, poor hygiene, and failure to thrive
70
What is the single greatest predictive factor for attempting suicide?
Previous attempt or threat of suicide
71
If you suspect a pt of attempting suicide, what should you ask them about?
If they have a plan
72
In order to be dx'd with ADD/ADHD, a pt's sx of hyperactivity/impulsivity or inattentiveness leading to impairment must have an onset before ____ y/o and must be present for at least ____ months, and must occur in at least x\_\_\_\_ settings.
12 y/o 6 months x2 settings
73
(Teenagers/Older adults) attempt suicide more often than (teenagers/older adults)
teens attempt more than older adults
74
What d/o is described below? ## Footnote *Persistent pattern of negative, hostile & DEFIANT BEHAVIOR TOWARDS ADULTS*
Oppositional defiant disorder
75
What d/o is described below? ## Footnote *Spectrum of developmental d/o probably linked to a combo of prenatal viral exposure, immune system abnormalities, and/or genetic factors*
Autism spectrum disorder (ASD)
76
What is hypomania?
***Sx similar to manic sx***: period of elevated, expansive or irritably mood @ least 4 days that is clearly different from the usual nondepressed mood but does **NOT** cause **MARKED** impairment _No psychotic features_ and usually does not require hospitalization *Does not include racing thoughts or excessive psychomotor agitation*
77
What should be attempted for tx in pts who fail to respond to medical therapy?
Electroconvulsive therapy (ECT)
78
Childhood phobias may ______ with age
lessen
79
What is lanugo? What condition is it associated with?
soft, downy hair on their arms and legs, it is the body's strategy to protect itself against heat loss associated w/ extreme thinness Anorexia nervosa
80
Cyclothymic disorder is similar to what other condition, but less severe?
Bipolar II d/o
81
Is generalized anxiety d/o more common in males or females? When is the age range of anticipated onset of GAD?
Females Early 20s
82
\_\_\_\_\_ _____ must be impaired by distress or avoidance of the situation or object, for a pt's phobia to be diagnosed
Everyday activities
83
What is the diagnostic criteria for generalized anxiety?
Excessive anxiety or worry a majority of days \>6 month period about various aspects of life not episodic, situational, or focal
84
What condition is described below? ## Footnote *Persistent (\> 6 months}, intense fear/anxiety of a specific situation (ex. heights, flying), object (ex. pigeons, snakes, blood) or place (ex. hospital)*
Specific phobias
85
What are potential options for management of a patient who is obese?
B_ehavior modification_: exercise and dietary changes, therapy groups _Medical therapy_: antidepressants **_Anti-obese medications_**: Orlistat (*decreases GI fat digestion*), Lorcaserin (*serotonin antagonist*) _Surgical options_: gastric bypass, gastric sleeve, gastric banding, bariatric surgery

Rotation 1: Pediatrics (13 decks)

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