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Peds 1 > Psych Disorders > Flashcards

Psych Disorders Flashcards

1
Q

Attention Deficit Hyperactivity Disorder (ADHD)

  • sx
  • MC in boys/girls?
  • comorbid psych disorders
  • pathogenesis
A

sx: manifests in childhood w/ sx of hyperactivity, impulsivity, and/or inattention

MC in boys (hyperactive type)

Comorbid disorders:

  • oppositional defiant disorder
  • conduct disorder
  • depression
  • anxiety disorder
  • learning disabilties

Patho: genetic imbalance of catecholamine metabolism in cerebral cortex causing sx.

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2
Q

ADHD:

-common influences/associations

A

Common influences/associations:

  • food additives
  • refined sugar intake
  • food sensitivity
  • iron/zinc deficiency
  • prenatal tobacco/alcohol exposure
  • prematurity/low birth weight
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3
Q

Criteria for ADHD sx must…?

A
  • be present in more than one setting
  • persists for at least 6 months
  • be present before the age of 12years
  • impair function in academic, social, or occupational activities
  • be excessive for the developmental elvel of the child
  • not be caused by other mental disorders.
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4
Q

Sx of Hyperactivity in ADHD

  • age at onset?
  • age at peak?
A
  • excessive fidgetiness (tapping hands and feet)
  • difficulty remaining seated when sitting is required
  • feeling restlessness/inappropriate running/climbing
  • difficulty playing quietly
  • always seem to be on the go

Age at onset: 4 yo
Age at peak: 7-8yo

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5
Q

Sx of Impulsivity in ADHD?

How long do sx persist?

A
  • excessive talking
  • difficulty waiting turns
  • blurting out answers too quickly
  • interruption

Sx persist throughout life.

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6
Q

Sx of inattention?

  • age at onset of sx?
  • how long do sx persist?
A

DAYDREAMER!

  • failure to provide close attention to detail, careless mistakes
  • difficulty maintaining attention in play, school, or home activities
  • seems not to listen, even when directly addressed
  • fails to follow through (eg homework, chores)
  • diff organizing tasks, activities
  • loses objects required for tasks/activities (eg school books, sports equp)
  • easily distracted
  • forgetfullness in routine activities

Age onset of sx: 8-9yo
Sx persist through life.

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7
Q

Evaluation of ADHD

A

-medical, developmental, educational, psychosocial

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8
Q

WHat is the DSM V requirements of ADHD Dx?

A

-greater than or equal to 6 sx of hyperactivity and impulsivity
OR greater than or equal to 6 sx of inattention

  • sx of hyperactivity/impulsivity or inattention must occur:
  • often
  • be present for more than one setting
  • persist for at least 6 mo
  • be present before age of 12 yrs
  • impair function in academic, social, or occupational activites
  • be excessive for the development level of the child.
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9
Q

What are the three subtypes of ADHD?

A

predominatntly inattentive

predominately hyperactive-impulsive

combined; greater than 6sx of inattention and greater than 6 sx of hyperactivity/impulsivity

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10
Q

Tx ADHD

Goals of ADHD tx

Indications for referral?

A

Tx:

  • behavioral interventions
  • medication
  • school-based interventions
  • psychological interventions alone or in combo

Goals:

  • relationships
  • academic performance
  • rule follwoing

Referral:

  • coexisting psychiatric, neurologic, or medical conditions
  • lack of response to stimulant therapy or atomoxetine
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11
Q

Medical Therapy for ADHD

  • when can you initiate medications?
  • what are the meds used?
  • when starting on medication what do you tell the pt as to the reason for RX?
A

begin when child is 6yrs or older, healthy, and dx w/ ADHD.

Meds:

  • stimulants;
  • -dextroamphetamine (Adderall)
  • -methylphenidate (Ritalin)
  • if stimulants dont work…refer!

explain the medication is being prescribed to help with self-control and ability to focus.

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12
Q

How do you prescribe ADHD meds?

BBX of stimulants?

Common SE of stimulants?

A
  • try short acting meds first
  • start low and titrate up

BBX: increased risk of sudden death, cardiovascular problems including heart attacks. Potential for drug dependency.

Common SE:

  • appetite suppression
  • abdominal pain
  • HA
  • insomnia
  • irritablity
  • tics
  • growth delay
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13
Q

Autism Spectrum Disorders

  • what are the three and list them in order of worsening severity.
  • etiologies
  • what are the 3 main areas of functioning affected?
A 
Mild = aspergers 
Med = Pervasive developmental disorder not otherwise specified 
Severe = autistic disorder

Etiologies:

  • unknown
  • could be environmental, biologic, or genetic
  • prenatal exposure to valproic acid or thalidomide
  • older maternal age

3 affected areas:

  • social interaction
  • communication
  • behaviors and interests
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14
Q

Aspergers:

  • MC affects which gender?
  • what is this?
  • IQ?
A

MC affects boys

What: become obsessively interested in a single object or topic. learn all about their subject and discuss it nonstop.
-impaired social interaction.

IQ: normal to above average intelligence

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15
Q

Pervasive Developmental disorder not otherwise specified (PPD-NOS)
-what is this?

A

What: between autism and aspergers in terms of severity of sx, impaired social interaction

Better language skills than kids with autistic disorder but not as good as those with aspergers.

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16
Q

Autism:

  • severe impairments in what?
  • sx
A

Severe impairments in social functioning, language, repetitive behaviors.

Sx: slow to develop words and talk, many are nonverbal.

-shaking hands constantly, tapping, lip smacking, oral fixation (putting things in their mouth)

17
Q

Risk factors for surveillance of ASD?

At what ages is routine screening done?

A
  • siblings with ASD
  • parent concern, inconsistent hearing, unusual responsiveness
  • pediatrician concern

-screen specifically for ASD at 18 and 24mo, MCHAT (16-48mo) & STAT screening tools.

18
Q

Red flags for ASD in 2nd year of life.

A
  • Regression
  • in his own world
  • lack of showing, sharing interest or enjoyment
  • using caregivers hands to obtain needs
  • repetative movements with objects
  • lack of approriate gaze
  • lack of response to name
  • talk in rhymes or sing-song way nonstop
  • repetitive movements or posturing of body
19
Q

Tx of ASD

A

-25hrs per week, 12 mo per year in systematically planned, developmentally appropriate educational activities.

  • speech and language therapy
  • social skill instruction
  • OT
20
Q

Common behavioral issues associated with ASD?

Associated medical conditions?

A
  • disruption/aggression
  • eating
  • sleeping (not normal circadian rhythm)
  • toileting
  • self injurious

Medical conditions:

  • GI: chronic constipation/diarrhea
  • seizures
  • sleep problems
21
Q

Oppositional Defiant Disorder

  • characterized by which two sets of problems?
  • definition
  • etiology
A

Characterized by aggressiveness, tendency to purposefully bother and irritate others.

Def:
negative, manipulative, hostile, and defiant behavior

Etiology:

  • family hx
  • if parent is alcoholic and has been in trouble with the law their children are 3x more likely to have ODD.
22
Q

ODD

-DSM V criteria

A

Criteria: must have 4 of the following 8 sx:

  • often loses temper
  • touchy or easily annoyed
  • angry/resentful
  • argues with authority figures
  • actively defies or refuses to comply with requests from authority figures
  • deliberately annoys others
  • blames others for mistakes
  • has been spiteful or vindictive at least twice in last 6 mo.
23
Q

ODD:

  • prognosis
  • tx
A

some will outgrow this, others will continue to have ODD and develop other disorders such as ADHDD, depressive disorder, etc. only 5% continue to have ODD without anything else.

Tx:

  • referral to pediatric psychiatrist
  • meds for comorbid disorders
  • behavioral therapy
  • parental therapy for setting clear boundaries.
24
Q

Conduct Disorder

  • what?
  • factors that contribute to this mental illness?
A

What: group of behavioral and emotional problems in children that have difficulty following rules and behaving in a socially acceptable way. “bad kids or delinquents”

Factors:

  • brain damage
  • child abuse
  • neglect
  • genetic vulnerability
  • school failure
  • traumatic life experience
25
Q

Differences between Conduct disorder and ODD?

A
  • ODD have worse social skills
  • ODD do better in school
  • Conduct disorder is the most serious childhood psychiatric disorder*
26
Q

Conduct Disorder is characterized by?

Tx

Prognosis

A

Characterized:

  • aggression to people and animals
  • bullies, physical fights, use of weapons to harm others
  • steals
  • forces others into sexual acts
  • destruction of property (arson)
  • lying

Tx:

  • referral to psychiatrist for
  • -behavioral therapy
  • -psychotherapy
  • -parental support and training
  • -medications for comorbid conditions such as ADHD, depression, or anxiety.

Prognosis:

  • substance abuse
  • 4x more likely to develop personality disorder when grown up
  • risky sexual behaviors
27
Q

Depression:

-Diagnostic criteria

A 
Dx criteria: 
at least 5 of the following sx during same 2wk period:
-depressed mood 
-anhedonia 
-sleep disturbance 
-weight change (up or down) 
-decreased concentration 
-suicidal ideation 
-fatigue or loss of energy 
-feelings of worthlessness 
-inappropriate guilt 
-sleeping all the time or insomnia 
-psychomotor agitation (figidity unintentional purposeless motions), retardation (neglecting appearance, showering, not taking care of yourself).
28
Q

Signs and Sx of Major Depression

A

SIGECAPS

Sleep disturbance

Interests (anhedonia)

Guilt

Energy

Concentration probs

Appetite change

Pleasure (decreased)

Suicidal thoughts or actions

29
Q

Tx for Depression

A

Psychotherapy
Medical therapy
Combination or both

Medical:

  • SSRI:
  • -prozac (fluoxetine)
  • -lexaproa (escitalopram)
  • These are only 2 FDA approved, use others off label.
30
Q

What are the SSRI black box warnings?

A

-increased suicidality risk

Peds 1 (12 decks)

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