Psychiatric disorders in kids Flashcards
oppositional defiant disorder
6 mo of negative, hostile, or defiant behavior with 4 criteria: -loss of temper -arugments with adults -defying rules -being deliberately annoying -easily annoyed -anger/resentment -spitefulness -blaming others onset before puberty is more common in boys but gender ratios are even after puberty
What are common ODD comorbidities? what is the prognosis?
25% better in later years, but some go on to develop conduct disorder
many have substance abuse proble,s, mood DO, and ADHD
What are features of conduct disorder?
persistent patterno f behavior in which the basic right sof others or social norms are violated. behaviors must have been present for at least 1 yr. behaviors grouped into categories, including:
- aggression toward people or animals
- destruction of property
- deceitfulness or theft
- serious violation of rules
Comorbidities with conduct disorder, prognosis
40% develop antisocial personality DO
Great risk of substance abuse and suicide, ADHD, learning disorders, criminality
What are the key diagnostic criteria for ADHD?
6 sx for 6 months at the age of 6 or less
What are the second line tx for ADHD?
atomoxetine (SNRI)
clnoidine or guanfacine (tenex) are other second line possiblities
When must sx start in autism?
before the age of 3. must have problems with social interaction, communication and stereotypies/repetitive behavior
When is the age of onset for rett DO? What are associated risks? what is the responsible genetic defect?
onset age 5 mo- 48 months (48 mo =4 yr), most commonly before age of 1 yr
MECP gene on x chromosome
incr risk of seizure, sudden death
these kids have developmental arrest, arrest of head growth, and loss of previously learned skills
What are key features of childhood disintegrative DO?
- normal development for first 2 yrs
- loss of previously acquired skills before age 10 (but usually ages 2-4) in at least 2 areas (language, social skills, bowel/bladder control, play, motor skills)
- Many kids then have seizure DO and EEG changes
- No arrest of head growth, no hand wringing
What are the key features of tourrette’s?
onset before age 18
tics occuring many times per day, every day for >1 yr (no tic free period >3 mo)
motor and vocal tics present
symptoms do NOT have to cause distress
what are neurochemical changes in tourettes?
impaired regulation of DA in the caudate nucleus
What are the treatments for tourettes?
atypical neuroleptics like risperidone and alpha 2 agonists like clonidine and guanfacine.
OCD pts with tics have a good response to SSRI augmentation of antipsychotics
enuresis definition
after age 5, bed wetting >2x/wk for 3 months
encopresis defintion
at least 1/month for 3 monts after age 4
What are features that distinguish dissociative fugue from dissociative amnesia?
fugue- the patient travels far from home and is unaware that he has forgotten anything
