psychiatric disorders in children Flashcards
1
Q
intellectual disability/MR: dx
A
- IQ <= 70
- deficits in adaptive skills
- onset BEFORE age 18
2
Q
MR: epidem
A
- 1-3% of pop
- 85% of cases are mild
- males > females
3
Q
MR subtypes
A
- profound: IQ <70, 85% of MR
4
Q
causes of MR
A
- 50% unidentifiable
- genetic: Down, Fragile X, PKU, familial, Prader Willi/Angelman, Williams, tuberous sclerosis
- prenatal: TORCH
- perinatal: anoxia, prematurity, birth trauma, meningitis, hyperbili
- postnatal: hypothyroidism, malnutrition, toxins, trauma, psychosocial
5
Q
prader-willi
A
- MR
- obesity
- hypogonadism
- almond shaped eyes
6
Q
fragile X
A
- FMR1 defect
- autistic characteristics
- delayed speech
- motor delay
- sensory deficits
- males: large testicles
7
Q
learning dos: epidem
A
- reading: 4-10% of children, boys>girls
- math: 1% of children, boys=girls
- written dos: 6% of children
8
Q
oppositional defiant do: dx
A
- AT LEATS 6 MOS of negativistic, hostile, defiant behavior 4+ of: - frequent loss of temper - arguments with adults - defying adults' rules - deliberately annoying people - easily annoyed - anger and resentment - spitefulness - blaming others for mistakes or misbehaviors
9
Q
ODD: epidem
A
- 2-16% prevalence
- usually observed by age 8
- onset before puberty more common in boys
- increased inicdence of comorbid substance abuse, mood dos, ADHD
- 25% no longer meet criteria later on
- may progress to conduct do
10
Q
ODD: tx
A
- individual psychotherapy
- family involvement: parent management skills training
11
Q
conduct do: dx
A
- persistent pattern of behavior in which basic rights of others/social norms are violated during PAST YEAR 3+ behaviors in categories of: - aggression toward people and animals - destruction of property - deceitfulness or theft -serious violations of rules
boys: fighting, stealing, fire-setting, vandalism more common
girls: lying, running away, sexually acting out more common
12
Q
conduct do: epidem
A
- 1-10%
- boys»_space;> girls
- risk factors: punitive parenting, psychosocial adversity, hx of abuse, biological predisposition
- high incidence of comorbid ADHD and learning dos
- increased risk for mood dos, substance abuse, suicidal gestures/attempts, criminal behavior
- up to 40% develop antisocial personality do
13
Q
conduct do: tx
A
- family and community involvement
- consistent rules and conequences
- medications as adjunct if aggression present
14
Q
ADHD: dx
A
- 6+ sx of inattentiveness, hyperactivity or both
- persisted for AT LEAST 6 MOS
- present at a maladaptive degree
- onset prior to age 7
15
Q
ADHD: epidem
A
- 5-12%
- boys > girls
- up to 60% will have sx into adulthood
- high incidence of mood dos, anxiety dos, personality dos, conduct do, ODD
16
Q
ADHD: pathophys
A
- genetics
- environmental (emotional deprivation, malnutrition, abuse)
- noradrenergic dysregulation
- specific EEG patterns
- toxin exposure, head trauma, prenatal/perinatal factors
17
Q
ADHD: Tx
A
- 1st line: methylphenidate, dextroamphetamine, amphetamine salts –> significant improvement in 75% of pts
- atomoxetine: nonstimulant
- alpha2 agonists (clonidine, guanfacine) if 1st line can’t be used or as adjunct
- TREAT UNDERLYING MOOD/ANXIETY DO FIRST
- nonpharm tx
18
Q
pervasive developmental dos
A
- problems with social skills, language, behaviors
- notieceable at early age, involves multiple areas of devleopment
- autism, asperger, rett, childhood disintegrative do
19
Q
autism: dx
A
- at least 6 sx by age 3
- 2+ of: problems with social interaction
- 1+ of impairments in communication OR repetitive/sterotyped patterns
20
Q
autism: epidem
A
- range of incidence
- boys»_space;> girls
- 70% meet criteria for MR
- assoc with fragile X, tuberous sclerosis, sz
21
Q
autism: pathophys
A
- prenatal neurological insults
- genetics
- immunological, biochemical, increased head size, persistent primitive reflexes, EEG abnormalities
22
Q
autism: tx
A
- level of intellectual fn and communication skills are most impt prognostic factors
- remedial education, behavioral tehrapy
- antipsychotics to help control aggression, hyperactivity, mood lability
- antidepressants or stimulants if sx warrant
23
Q
asperger
A
- no clinically significant delay in spoken/receptive language, cognitive development, self-help skills, curiosity about environment
24
Q
Rett
A
- nl physical and pscyhomotor dvlpmt up to 5 mos
- 5-30 mos: decreasing rate of head growth, loss of milestones
- development of stereotyped hand movements
- girls»_space;> boys
- MECP2 gene (X-linked)
- increased risk of sudden death
- sz common
25
Q
childhood disintegrative disorder
A
- nl dvlpmt in first two yrs
- loss of milestones before age 10 in AT LEAST TWO of: language, social skills, bowel/bladder control, play, motor skills
- loss in AT LEAST TWO of: social interaction, communication, behaviors, interests
- onset after age 2
- boys»_space;> girls
- assoc with many GMCs
26
Q
tourette: dx
A
- multiple motor AND 1+ vocal tics NOT attributable to CNS dz (motor usually occur long before vocal)
- onset before age 18
- many times a day, almost every day for > 1year, no tic free period > 3 months
- change in location and character of tics over time
27
Q
tourette: epidem
A
- boys > girls
- waxing/waning
- sx peak in severity bw ages 8-12
- 1/3-1/2 become asymptomatic in adulthood
- high comorbidity with OCD and ADHD
28
Q
tourette: pathophys
A
- genetic
- perinatal
- impaired DA regulation in caudate nucleus
- GABHS infection?
- psychological - exacerbated by stressful life events
29
Q
tourette: tx
A
- educational and supportive interventions
- supportive therapy, behavioral therapy
- atypical neuroleptics, alpha2 agonists when tics are source of impairment
- typical neuroleptics if severe
30
Q
enuresis: tx
A
- most spontaneously resolve by age 7
- psychoeducation, psychotherapy, family therapy, behavioral therapy
- bell and pad, DDAVP, imipramine
31
Q
selective mutism
A
- refusal to speak in certain situations for > 1 month
- onset ~ 2-5 yo
- tx: psychotherapy, behavior therapy, management of anxiety
32
Q
separation anxiety
A
- appropriate from 7 mos to 6yo
33
Q
stranger anxiety
A
- peaks 8-12 mos
34
Q
separation anxiety do
A
- excessive fear for 4+ weeks of leaving parents/other major figure
- extreme distress when forced to separate
- may be preceded by stressful life event
- up to 4% of children
- parents often have anxiety dos
- tx: family tx, CBT, low-dose SSRIs
- may be risk factor for development of panic disorder
