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pediatrics > psychiatry > Flashcards

psychiatry Flashcards

1
Q

Long term infant deprivation of affection results in

A
  1. Failure to thrive
  2. Poor language/socialization skills
  3. Lack of basic trust
  4. Reactive attachment disorder (infant withdrawal/unresponsive to comfort)
  5. infant death (if severe deprivation)
  6. irreversible changes (if more than six weaks)
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2
Q

Child abuse - evidence of sexual abuse

A
  1. Genital, anal, or oral trauma
  2. STDs
  3. UTIs
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3
Q

Child abuse - evidence of physical abuse

A
  1. spiral fractures (or multiple fractures at different stages of healing)
  2. burns (cigarette, buttocks/thighs)
  3. Subdural hematomas
  4. Posterior rib fructures
  5. retinal detachment
  6. during exam children avoid eye contact
  7. bruises (eg. trank ear neck –> in pattern of implement)
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4
Q

Evidence of child neglect

A
  1. poor hygiene
  2. malnutrition
  3. withdrawal
  4. impaired social/emotional development
  5. failure to thrive
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5
Q

Childhood and early onset disorders - types

A
  1. Attention-deficit hyperactivity disorder
  2. Conduct disorder
  3. Oppositional defiant disorder
  4. Separation anxiety disorder
  5. Tourette syndrome
  6. Rett syndrome
  7. Autism spectrum disorder
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6
Q

Attention-deficit hyperactivity disorder - onset

A

before 12 –> continues in adulthood in as many as 50% individuals

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7
Q

Attention-deficit hyperactivity disorder - manifestations

A

Limited attention span and poor impulse control –> characterized by hyperactivity, impulsivity and/or inattention in multiple settings (school, home, places of worship etc).

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8
Q

Attention-deficit hyperactivity disorder - intelligence

A

normal intelligence but commonly coexists with difficulties in school.

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9
Q

Attention-deficit hyperactivity disorder - treatment

A

stimulants (eg. methylphenidate) +/- cognitive behavioural therapy (CBT)
atomoxetine, clonidine, guanfacine may be alternative stimulants in selected patients

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10
Q

Conduct behaviour - definition

A

repetitive and pervasive behavior violating the basic rights of others (physical aggression, destruction of property, theft)

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11
Q

Conduct behaviour - association

A

after age eighteen, many of these patients will meet criteria for diagnosis of antisocial personality disorder

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12
Q

Conduct behaviour - treatment

A

CBT

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13
Q

oppositional defiant disorder - definition

A

Enduring pattern of hostile, defiant behaviour toward authority figures in the absence of serious violation of social norms

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14
Q

oppositional defiant disorder - treatment

A

CBT

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15
Q

Separation anxiety disorder - age

A

7-9

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16
Q

Separation anxiety disorder - definition

A

overwhelming fear of separation from home or loss of attachment figure for MORE THAN 4 WEEKS

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17
Q

Separation anxiety disorder may lead to

A

factitious physical complaints to avoid going to or staying at school

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18
Q

Separation anxiety disorder - treatment

A
  1. cognitive behavioural therapy (CBT)
  2. play therapy
  3. family therapy
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19
Q

Tourette syndrome - age

20
Q

Tourette syndrome - manifestation

A
  • sudden, rapid, recurrent, nonrhythmic, stereotyped motor and vocal tics that persist for MORE THAN 1 YEAR
  • coprolalia - involuntary obscene speech (only in 10-20 patients)
21
Q

Tourette syndrome is associated with

A
  1. Attention-deficit hyperactivity disorder (ADHD)

2. Obsessive–compulsive disorder (OCD)

22
Q

Tourette syndrome - treatment

A
  1. psychoeducation
  2. behavioral therapy
  3. for intractable tics –> a. low dose high potency antipsycotics (flyphenazine, pimozide) b. tetrabenazine
    c. clonidine D. guanfacine
  4. if mild: a2 agonists (clonidine, guanfancine)
23
Q

Pervasive developmental disorders -characterized by

A

difficulties with language and failure to acquire or early loss of social skills

24
Q

Pervasive developmental disorders - types

A
  1. autism spectrum disorder

2. Rett syndrome

25
autism spectrum disorder - manifestations
1. poor social interactions 2. communication deficits 3. repetitive/ritualized behaviors 4. restricted interest 5. intellectual disability (may or may not) 6. unusual abilities - savants (rare)
26
autism spectrum disorder - epidemiology of presentation / lab
must present in early childhood More common in boys --> increased head/brain size
27
Rett syndrome - manifestations
regression characterized by loss of development, loss of verbal abilities, intellecutal disabilities, ataxia, stereotyped hand-wringing SEIZURES
28
Rett syndrome - epidemiology of presentation
X-linked disorder seen almost exclusively in girls (males die in utero or shortly after birth) symptoms apparent around 1-4 age
29
Pervasive developmental disorders - epidemiology
1. autism spectrum disorder --> must present in early childhood. More common in boys 2. Rett syndrome --> almost exclusively in girls symptoms apparent around 1-4 age
30
Pervasive developmental disorders - almost exclusively in girls - why
X-linked disorder seen almost exclusively in girls (males die in utero or shortly after birth)
31
Child abuse - abuser?
Physical abuse - usually biological mother | Sexual abuse - known to victim, usually male
32
vulnerable child syndrome?
parents perceive the child as especially susceptible to illness or injury --> usually follows a serious illness or life-threatening events --> can result in missed school or overuse of medical services
33
selective mutism
verbal at home but refuse to speak in specific social settings (commonly at school) for more than 1 month
34
clinical diagnosis of autism - next step
further evaluation of social, language and intellectual development, in addition to hearing, vision and genetic (eg. Fragile X) testing
35
an important tool for assessing behavior in the school environemtn for ADHD
teacher evaluation
36
1st line treatment for OCD
SSRI and CBT (clomipramine is 2nd line)
37
Reactive attachment disroder
- emotional + social withdraw as well as lack of positive respones to attempts to confront - caused by early childhood abuse or neglect
38
neonatal abstinence syndrome
by withdrawal to opiates and usually presents in the first few days of life --> irritbility,, high pitched cry, poor seeping, tremors, seizures, sweating, SNEEZING, tachypnea, poor deeding, vomiting, diarrhea treatment: symptomatic care, if refractory: morphine, methadone, buprenorphine
39
nonstimulant treatment of ADHD
atomoxetine (selective norepinephrine re-uptake inh)
40
Landau-Kleffner syndrome
regression of language skills due to severe epileptic attacks --> language skills typically deteriorate at age 3-6
41
most normal ages for imaginary friends
3-6
42
neonatal abstinence syndrome
infant withdrawal to opiates and usually presenets in 1st days --> higg pitched cry, tremors, seizures, SNEEZING, poor feeding, gi (vomiting, diarrhea) poor sleeping, irritability)
43
Trichtotillomania (hair-pulling disorder)
1. Recurrent hair pulling (hair loss) 2. repeated aatempts to decrease/stop it 3. significant distress 4. not due to a medical/dermatological condtition 5. not due to another mental disorder (eg. body dysmorphic disorder)
44
sexual behaviour in preadolescents - normal in toddler (1-3)
1. exploring own or others genitals 2. masturbatory movements 3. undressing self or others
45
sexual behaviour in preadolescents - normal in school age
1. increased interest in sex words + play 2. asking questions about sex + reproduction 3. masturbatory movemetns (may become more sophisticated)
46
sexual behavior in preadolescents - abnormal
1. repeated objext insertion into vagina or anus 2. sex play involving genital genital, oral genital, anal-genital contacts 3. use of force, threats, or bribes in sex play 4. age-inappropriate sexual knowledge
47
selective mutism - treatment
CBT, family therapy, SSRI

pediatrics (16 decks)

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