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Psychiatry > Psychiatric Disorders in Children + Geriatrics + Cognitive Disorders > Flashcards

Psychiatric Disorders in Children + Geriatrics + Cognitive Disorders Flashcards

1
Q

Selective mutism

A

Usually 2-5 yo

Children have fear of situations that call for them to speak

Social phobia is often co-morbid condition

Criteria:

  • consistent failure to speak in some specific situations, but not others in which a person is expected to speak
  • duration > 1 mo
  • not attributable to lack of knowledge or comfort w/ spoken language
  • other communication or autism spectrum d/o or psychosis do not account for the presentation
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2
Q

Separation anxiety disorder

A

Usually > 6 years old

3 or more of following need to be present for >=4 wks:

excessive distress when separated from home

excessive worry about losing major attachment figures

refusal to go out because of fear of separation

nightmares about separation

physical complaints (HA, nausea, ab pain) when separation from attachment figure is anticipated

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3
Q

Stranger anxiety is normal finding until

A

age 3

After that, fear of strangers usually due to other causes

Autistic children lack this developmental marker

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4
Q

1 cause of suicide deaths in adolescents

A

Firearms

OD is #1 method of suicide ATTEMPT

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5
Q

When does sleep terror occur?

A

Stage 3-4 of sleep

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6
Q

1st line tx MDD in children

A

SSRI

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7
Q

Expressive language disorder

A

Interfere with academic functioning

Limited vocab
errors in tense
difficulty recalling words or making sentences

IQ test most helpful to confirm - need to r/p MR

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8
Q

Rumination disorder

A

Repeated regurg and rechewing of food for >= 1 mo following period of nl functioning

Often seen in infants w/ many caretakers in unstable environment

To confirm, need to r/o reflux via esophageal pH measurement

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9
Q

1 cause of visual hallucinations in child

A

substance induced psychotic disorder

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10
Q

1 psych emergency in kids and adolescents

A

Suicidal behavior

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11
Q

What is more commonly seen in kids w/ MDD compared to adoslecents w/ MDD

A

Psychomotor agitation

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12
Q

1 method CHILDREN use when attempting suicide

A

Substance ingestion

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13
Q

1 reason for MR

A

early alterations in embryo dev (eg chromosomal changes, prenatal damage 2/2 toxins)

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14
Q

What axis is MR?

A

2

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15
Q

Enuresis usually occurs in

A

Otherwise nl boys

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16
Q

Development milestones

A

2 yo - copy circle

3 yo - tell age and gender, ride tricycle

5 yo - copy square, ID L hand

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17
Q

ADHD children often suffer from

A

Low self esteem

Manic children more likely ot be euphoric

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18
Q

Children are what age when begin to understand irreversibility of death

A

7 or 8 yo

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19
Q

Delirium

- clinical features

A

Acute change from baseline

Impairment in cognition with fluctuating course

Change in level of consciousness

Inability to sustain attention

Can be hypo or hyperactive or mixed delirium

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20
Q

Highest risk factor for delirium

A

Amount of cognitive reserve you have (eg higher risk if you have dementia)

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21
Q

Highest risk surgery causing delirium

A

Cardio thoracic

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22
Q

Confusion assessment method

A

Acute onset, fluctuating course

In attention (serial 7s)

Disorganized thinking

Altered level of consciousness

+ if 3-4 of above are present

Do not use MMSE to dx delirium. Use this.

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23
Q

Tx delirium

A

Tx underlying condition

1:1

Antipsychotics (Haloperidol #1) prn

Benzo for withdrawal. Only time benzos used for delirium! Otherwise, can prolong/cause delirium

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24
Q

Dementia

A

Acquired persistent impairment in various cognitive domains

Deficit in memory in one or more of the following:
Language
Calculation
Visual spatial skills
Praxis
Recognition
Executive functioning

No impairment in consciousness

Orientation often impaired

Hallucinations less common vs delirium

Sx stable throughout day

Awareness clear

No EEG changes

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25
Q

Multi infarct dementia vs alzheimer’s disease - how do you tell the difference?

A

Multi infarct dementia usually has focal neuro signs

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26
Q

1 finding in delirium

A

Impairment in recent memory

Visual hallucinations + short attention span are typical sx

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27
Q

Hallmark of delirium

A

Waxing + waning sx

Lucid intervals — then change in mental status

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28
Q

Delirium dx - dsm criteria

A
  • disturbance of consciousness + attention altered
  • change in cognition or dev of perceptual disturbance

Disturbance develops over short period of time, waxes and wanes

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29
Q

Delirium + hemiparesis or other focal neuro sign + sx

What could it be?
Confirm/dx tests?

A

CVA or mass lesion

Brain CT/MRI

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30
Q

Delirium + HTN + papilledema

What could it be?
Confirm/dx tests?

A

Hypertensive encephalopathy

Brain CT/MRI

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31
Q

Delirium + dilated pupils + tachy

What could it be?
Confirm/dx tests?

A

Drug intoxication

UDS

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32
Q

Delirium + fever + nuchal rigidity + photophobia

What could it be?
Confirm/dx tests?

A

Meningitis

LP

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33
Q

Delirium + tachy + tremor + thyromegaly

What could it be?
Confirm/dx tests?

A

Thyrotoxicosis

T4
TSH

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34
Q

1 dementia type

A

Alzheimers

Vascular (#2)

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35
Q

Pt presents with dementia

Nl CT

What do you do next?

A

CMP

MRI

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36
Q

Workup for reversible causes of dementia

A 
CBC
Electolytes
TFTs (HYPOthyroidism)
VDRL
B12 folate
Brain CT or MRI
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37
Q

Dementia + stepwise increase in severity + focal neuro signs

What could it be?
Confirm/dx tests?

A

Multi infarct dementia

CT/MRI

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38
Q

Dementia + cogwheel rigidity + resting tremor

What could it be?
Confirm/dx tests?

A

LBD
Parkinson disease

Clinical

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39
Q

Dementia + gait apraxia + urinary incontinence + dilated cerebral ventricles

What could it be?
Confirm/dx tests?

A

NPH

CT/MRI

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40
Q

Dementia + obesity + coarse hair + constipation + cold intolerance

What could it be?
Confirm/dx tests?

A

HYPOthyroidism

TSH
T4

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41
Q

Dementia + diminished position and vibration sensation + megaloblasts on CBC

What could it be?
Confirm/dx tests?

A

Vit B12 deficiency

Serum B12

42
Q

Dementia + tremor + abnormal LFTs + Kayser Fleischer rings

What could it be?
Confirm/dx tests?

A

Wilsons disease

Ceruloplasmin

43
Q

Dementia + diminished position and vibration sensation + argyll robertson pupils

What could it be?
Confirm/dx tests?

A

Neurosyphillia

CSF FTA-ABS or CSF VDRL

44
Q

Syphillis tests

  • sensitive
  • specific
A

Screen with VDRL (more sensitive)

Confirm with FTA ABS (more specific)

45
Q

Alzheimer’s disease

  • epi
  • pathophys
A

Women > men

Dec acethylcholine b/c loss of NE neurons in basal ceruleus and decreased choline acetyltransferase (need for Ach synthesis)

AB peptides excess

46
Q

Alzheimer genes

A

Presenelin I
Presenielin II
APP

Major susceptibility gene: APOe4

47
Q

AD autopsy

A

Diffuse arophy w/ large ventricles and flattened sulci

Senile plaques + neurofibrillary tangles

Neruritic plaques (not neurofibrillary tangles) correlate w/ severity of dementia

48
Q

Pharm tx Alzheimer’s disease

A

Cholinesterase inhibitors (want more ACh)

  • Tacrine
  • Donepezil
  • Rivastigmine
  • Galantamine

NMDA antagonists
- Memantine

49
Q

Classic finding with vascular dementia

A

2nd most common dementia

Stepwise loss of function as microinfarcts add up

Both this and AD can have similar neuropsych testing

50
Q

Lewy body dimentia

  • clinical manifestations
  • Vs parkinson
A

3rd most common dementia

caused by lewy bodies + lewy neurites in brain, esp basal ganglia

Waxing + waning of cognition is core feature
Visual hallucinations
Paranoid delusions
Parkinsomism is core feature
Sensitivity to neuroleptics

Vs Parkinson - onset of dementia within 12 months of parkinsonism sx. If dementia onset > 12 mo, that is more Parkinson disease dementia

51
Q

Tx lewy body dementia

A

Cholinesterase inhibitors for visual hallucinations

Levadopa/carbidopa, dopamine agonists for cognition, apathy, motor sx

Atypical neuroleptics to stop delusions and agitation

Clonazepam for REM sleep behavior disorder

52
Q

Pick Disease

  • clinical manifestations
  • path
A

Usually start 45-65 yo
Lots familial
4-6 years usually (rapidly progressive)

Lots of changes in personality and social conduct
Disinhibited
Echolalia, overeating, (frontal lobe signs)
NO emotional warmth, empathy
Poor insight
Cognitive deficits

Memory, language, and spatial functions usually OK

Path:

  • marked atrophy of frontal and temporal lobes
  • loss of cortical layer II
53
Q

Tx Pick Disease

A

Anticholinergic meds

Antidepressants

Improve behavior but not cognition

54
Q

HIV associated dementia

  • clinical manifestations
  • tx
A

Rapid decline cognition, behavior, memory, concentration
Apathy
Depression

Language OK

Tx - HAART as dec viral load often improves dementia

55
Q

Huntington disease

  • clinical
  • dx
  • path
  • tx
A

Autosomal dominant
trinucleotide repeat on short arm chromosome 4
30-50 years onset

Progressive dementia (1 year within onse of chorea)
Pts aware of deteriorating mentation
Choreiform mvmts
Muscular hypertonicity
Assoc w/ depression, psychosis, alcoholism
Inc rate of suicide

MRI –> caudate atrophy

56
Q

Parkinson disease

  • epi
  • clinical manifestations
  • path
A
  • Loss of neurons in substantia nigra (which gives dopamine to basal ganglia)
  • Senile plaques, neurofibrillary tangles, loss of neurons, decreased choline acetyltransferase
  • 30-40% ppl w/ PD get dementia
  • 50% suffer depression
  • Men > Women

Parkinsonism

  • bradykinesia
  • cogwheel rigidity
  • resting tremor
  • mask life facies
  • shuffling gait
  • dysarthria

Dementia 2/2 PD made worse by antipsychotics

57
Q

Crutzfeldt Jakob Disease

  • Clinical
  • Dx
A

Progressive, degen dz of CNS 2/2 abnormal prions
Small % got infected through corneal transplants!

  • Progressive dememtia – 6 - 12 mo after onset of sx
  • > 90% with myoclonus
  • basal ganglia + cerebellar dysfunction common
  • personality changes, paranoia

Dx:

  • path –> spongiform changes of brain tissue
  • Rapidly progressive dementia + periodic generalized sharp waves on EEG + 2 of the following:
  • myoclonus
  • cortical blindness
  • ataxia or EPS signs
  • muscle atrophy
  • mutism
58
Q

Normal pressure hydrocephalus

  • clinical
  • tx
A

Enlarged ventricles w/ increased CSF pressure

Etiology: idiopathic or 2/2 obstruction of CSF reabsorption sites

Gait disturbance
Urinary incontinence
Dementia

Tx:

  • relieve w/ shunt
  • dementia is least likely to improve out of the triad
59
Q

Suicide rate of elderly > 85

A

2x national average

60
Q

Pseudodementia

A

Cognitive deficits + major depression
Sx are 2/2 underlying depression

vs. dementia pts, pseudodementia more likely to say I don’t know and can actually answer questions; dementia pts more likely to confabulate when don’t know answer

61
Q

Tx Pseudodementia

A

Psychotherapy
Involve in senior groups

Low dose SSRI
If need to use TCA –> nortriptyline b/c least amt of antiCh SE

Mirtazapine
Methylphenidate for psychomotor retardation

ECT

62
Q

Dementia vs pseudodementia

A

Dementia

  • insidious onset
  • sundowning common
  • confabulation
  • unaware of problems
  • cognitive deficits don’t improve w/ antidepressants

Pseudodementia

  • acute onset
  • sundowning uncommon
  • answers I don’t know often
  • pt aware of problems
  • cognitive deficits improve w/ antidepressants
63
Q

Stages of bereavement

A 
Denial
Anger
Bargaining
Depression
Acceptance
64
Q

Normal grief

A 
intense feelings (guilt, sadness, sleep distrubances)
Usually stop within 6 mos
function is preserved
65
Q

Complicated/prolonged grief

A 
At least 6 mos
4/8 sx:
- difficult move on with life
- numbness/detachment
- bitterness
- feeling that life is empty
- trouble accepting the loss
- feeling the future holds no meaning without deceased
- agitation
- difficulty trusting others since loss
66
Q

Bereavement-associated depression

A

Major depression beginning with concrete death or loss in pt’s life

If have depressive sx for 2 wks, 6-8 weeks after precipitating loss, may need SSRIs

67
Q

Most common psych disorder in elderly

A

MDD

68
Q

Who has highest rate of successful suicide

A

White elderly males

69
Q

Meds and result of concurrent EtOH use

A

H2 blockers –> higher BAL

Benzos, TCAs, narcotics, barbs, anti-H –> inc sedation

ASA, NSAIDs –> long bleeding time, GI irrtation

Metronidazole, sulfas, long acting hypoglycemics –> N/V

Acetaminophen, INH, Phenylbutazone –> hepatotoxicity

Anti-HTN, anti-diabetes, ulcer drus, gout meds –> worsen underlying disease

70
Q

In setting of dementia, what kind of hallucinations do you get?

A

Visual

Suggest LBD –> don’t give antipsychotics!

71
Q

When do you tx w/ pharm for hallucinations?

A

If do not bother pt or interfere with caring for pt , pharm NOT necessary

72
Q

Normal sleep changes in geriatric pts

A

Dec REM latency and total REM sleep

Inc stage 1& 2 sleep
Dec stage 3&4 sleep

Freq nocturnal awakenings

Dec total amt of sleep

Earlier to bed, earlier to rise

73
Q

What can you use to help with sleep in elderly?

A

Hydroxyzine

Trazodone

74
Q

KAUFFMAN ASSESMENT Battery for children

A

Intelligence test ages 2-12

75
Q

Weschler Intelligence Scale for Children - Revivsed

A

IQ ages 6-16

76
Q

Mental retardation

A

IQ < 70, subaverage intellectual functioning

Deficits in adaptive skills ok for age group

Onset < 18 yo

Mild 55-70
Mod 40-55
Severe 25-40
Profound < 25

77
Q

Causes metnal retardation

A

Genetics - Down, Fragile X (MOST COMMON), Prader willi, Williams, angelman

Prenatal - TORCH (toxo, Other - syphilis, AIDS, EtOH, Rubella, CMV, Herpes)

Perinatal - anoxia, prematurity, meningitis

Postnatal - hypothyroid, malnutrition, toxins, trauma

78
Q

Prader Willi syndrome

A

MR
Obesity
Hypogonadism
Almond shaped eyes

79
Q

Fragile X syndrome

A

Most common inherited form of MR

FMR-1 gene defect

Autistic characteristics
Delayed speech
Motor delay
Sensory deficits

Males w/ large testicles

80
Q

What do you always want to r/o before diagnosing learning disorders?

A

Sensory deficits

81
Q

Oppositional defiant disorder

  • traits
  • tx
A

Usually onset age = 8

> = 6 mo negative, hostile, defiant behavior

No difficulties getting along with peers but won’t comply with authority figures

Vs. conduct disorder, ODD does not have physical aggression or violation of basic rights of others

Tx: psychotherapy

82
Q

Conuduct disorder

A

persistent behavior: basic rights of others or social norms violated

  • aggression towards ppl and animals
  • destruction of property
  • deceitfulness
  • serious violation of rules

Boys vs girls
- boys = high risk fighting, stealing, fires, vandals
- girls = higher risk lying, running away, sex acting out
Boys > girls

83
Q

ADHD

  • categories
  • criteria
A

Inattentiveness, hyperactivity or both that…

  • persist >=6 mo
  • maladaptive at age
  • onset < 7 yo

Inattentive sx: Careless mistakes, losing things, forgetful, easily distracted

Hperactivity-impulsivity sx: Restlessness, can’t keep quiet, lots of talking, blurt out answer, interrupts

84
Q

How many kids w/ ADHD have comorbid psych dx?

A

> 50%

85
Q

Encoporesis

A

voluntary or involuntary passage of stools in a child who has been toilet trained (typically over age 4), which causes the soiling of clothes

Therefore, person has to be > 5yo and toilet trained

86
Q

Tx ADHD

A

CNS stimulants 1st line
- methylphenidate (ritalin, concerta)
- dextroamphetamine
amphetamine esalts (adderal)

Atomoxetine = selective NE reuptake —|

Alpha 2 agonists (clonidine, guanfacine)

Non-pharm:

  • family, individual, group psychotherapy
  • edu interventions
87
Q

Autism spectrum disorder

A

Must be present by age 3

Problems with social interaction

Impairments in communication

Repetitive and stereotyped patterns of behavior and activities

ALWAYS GET HEARING TEST BEFORE DX AUTISM

Boys > girls

88
Q

Most important predictors of adult outcome in autistic children

A

Level of intellectual functioning

Communicative competence

89
Q

Tx autism

A

No cure

Help manage sx:

  • remedial ed
  • behavioral tx
  • antipsychotics
  • antidepressants
90
Q

Asperger Disorder

A

Impairment in social interaction

Restricted or stereotyped interests and behaviors

Vs. autism - NO clinically significant delay in spoken or receptive language, cognitive dev, curiosity about environment

Boys > girls

91
Q

Rett disorder

A

Nl physical + psychomotor development in first 5 months

Decrease rate of head growth, loss of prev learned purposeful hand skills between ages 5-30 months

Stereotyped hand mvmts (hand wringing), impaired language, psychomotor retardation

Coagnitive dev never progressed beyond that of the 1st yr of life

Only girls –> boys lethal in utero

Genetic testing available

Assoc w/ MECP2 gene mutation on X chromosome

Tx = supportive

92
Q

Childhood disintegrative disorder

A

Normal dev in 1st 2 yrs of life –>

loss of prev acquired skills before age 10 yrs in language, social skills, adaptive behaviors, bowel/bladder control, or play motor skills

Boys > girls

Vs Rett –> head growth does not slow and hand mvmts not present in CDD

93
Q

Out of Autism, Rett, and childhood disintegrative disorder, which has abnormal EEG?

A

ALL!

94
Q

Tourette disorder

A

Tics many times / day, every day for > 1 year (no tic free period > 3 mo)
–> will have change in anatomic location and character of tics over time

Need both motor + vocal tics to dx tourette

Onset < 18 yo, avg onset = 7yo

Motor tics usually before vocal tics

Motor tics that are most common = face and head, eg blinking eyes

Vocal tics

  • coprolalia = repetitive speaking of obscene words
  • echolalia = exact repeat of words
95
Q

Possible etiologies of Tourette

A

Genetics

Impaired regulation of dopamine

Group A beta hemolytic strep infection –> OCD or Tourette?

96
Q

Tx Tourette disorder

A

Education + supporive interventions

Pharm if tics impair life:

  • atypical neuroleptics (risperidone)
  • alpha 2 agonists (clonidine, guanfacine)
  • typical neuroleptics for severe

Stimulants can exacerbate tics

97
Q

Elimination disorders

A

Urinary continence usually est by age 4

Enuresis = involuntary wetting of bed after age 5; 2x/wk for 3 mo consecutive)
—> most resolve by age 7

Encopresis = involuntary passage feces by age 4 (1x/mo for at least 3 mo

Boys > girls

98
Q

Causes of elimination disorders

A

Eneuresis –> small bladder, low nocturnal levels ADH

Encopresis –> no sphincter control, constipation with overflow incontinence

99
Q

Tx enuresis

A

Behavior modification

DDAVP

TCAs (imipramine)

100
Q

Tx encopresis

A

Inital bowel catharsis, then stool softeners if etiology is constipation

101
Q

Most common drug of abuse by adolescents

A

EtOH

2 - Cannabis

102
Q

Most common reason to see kid in ER setting for psych reason

A

suicidal behavior

Psychiatry (9 decks)

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