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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

A

before 18

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
Q

autism spectrum disorder - manifestations

A
  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
Q

autism spectrum disorder - epidemiology of presentation / lab

A

must present in early childhood
More common in boys
–> increased head/brain size

27
Q

Rett syndrome - manifestations

A

regression characterized by loss of development, loss of verbal abilities, intellecutal disabilities, ataxia, stereotyped hand-wringing
SEIZURES

28
Q

Rett syndrome - epidemiology of presentation

A

X-linked disorder seen almost exclusively in girls (males die in utero or shortly after birth)
symptoms apparent around 1-4 age

29
Q

Pervasive developmental disorders - epidemiology

A
  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
Q

Pervasive developmental disorders - almost exclusively in girls - why

A

X-linked disorder seen almost exclusively in girls (males die in utero or shortly after birth)

31
Q

Child abuse - abuser?

A

Physical abuse - usually biological mother

Sexual abuse - known to victim, usually male

32
Q

vulnerable child syndrome?

A

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
Q

selective mutism

A

verbal at home but refuse to speak in specific social settings (commonly at school) for more than 1 month

34
Q

clinical diagnosis of autism - next step

A

further evaluation of social, language and intellectual development, in addition to hearing, vision and genetic (eg. Fragile X) testing

35
Q

an important tool for assessing behavior in the school environemtn for ADHD

A

teacher evaluation

36
Q

1st line treatment for OCD

A

SSRI and CBT (clomipramine is 2nd line)

37
Q

Reactive attachment disroder

A
  • emotional + social withdraw as well as lack of positive respones to attempts to confront
  • caused by early childhood abuse or neglect
38
Q

neonatal abstinence syndrome

A

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
Q

nonstimulant treatment of ADHD

A

atomoxetine (selective norepinephrine re-uptake inh)

40
Q

Landau-Kleffner syndrome

A

regression of language skills due to severe epileptic attacks –> language skills typically deteriorate at age 3-6

41
Q

most normal ages for imaginary friends

A

3-6

42
Q

neonatal abstinence syndrome

A

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
Q

Trichtotillomania (hair-pulling disorder)

A
  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
Q

sexual behaviour in preadolescents - normal in toddler (1-3)

A
  1. exploring own or others genitals
  2. masturbatory movements
  3. undressing self or others
45
Q

sexual behaviour in preadolescents - normal in school age

A
  1. increased interest in sex words + play
  2. asking questions about sex + reproduction
  3. masturbatory movemetns (may become more sophisticated)
46
Q

sexual behavior in preadolescents - abnormal

A
  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
Q

selective mutism - treatment

A

CBT, family therapy, SSRI

pediatrics (16 decks)

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