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Pediatrics- Noelle > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

criteria for generalized anxiety disorder

A

excessive anxiety and worry occurring more days than not for at least 6 months
the individual finds it difficult to control the worry
1 or more out of 6 (TCHERS)

WATCHERS
Worry
Anxiety
Tension in muscles 
Concentration difficulty 
Hyperarousal (or irritability) 
Energy loss
Restlessness 
Sleep disturbance
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2
Q

Neuroleptic malignant syndrome

A 
FEVER
F- Fever
E- Encephalopathy
V- Vital sign instability
E- Elevated WBC/CPK
R- Rigidity (lead pipe rigidity)
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3
Q

Serotonin syndrome

A 
HARMED
H- hyperthermia, hyperreflexia
A- Autonomic instability (Increased HR, RR and decreased BP)
R- Restlessness
M- Myoclonus
E- Encephalopathy (decreased LOC)
D- Diaphoresis
*myoclonus is key
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4
Q

Major Depression

SIGECAPS

A

5 or more criteria out of 9 with depressed mood or loss of interest/pleasure for 2 week period

in children/adolescents mood can be irritable rather than depressed *

S- sleep
I- interest
G- guilt
E- energy
C- concentration
A- appetite
P- psychomotor changes (agitation or retardation)
S- suicidal thoughts
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5
Q

Manic episode

DIGFAST

A

elevated mood with 3/7 one week or irritable mood with 4 of 7 one week
the mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others

D- distractibility
I- indiscretion (excessive involvement in pleasures)
G- grandiosity
F- flight of ideas
A- activity increase
S- sleep deficit (decreased need)
T- talkativeness (pressured speech)
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6
Q

Post traumatic stress disorder criteria

A

Presence of one or more after event occurred

TRAUMA
T- traumatic event
R- re-experience (memories, nightmares, flashbacks)
A- avoidance
U- unable to function
M- month or more of symptoms
A- arousal increased (insomnia, hyper-vigilance)

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7
Q

Panic Attack

A 
>or =4 of PANNICCCSSS
Palpitations
Abdominal distress
Numbness, Nausea
Intense fear of death
Choking, chills, chest pain
Sweating, shaking, shortness of breath

Panic disorder- recurrent unexpected panic attacks.

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8
Q

Tourette disorder

A

Multiple motor tics and at least one vocal tic
onset before 18
>12 months
not due to drugs or other medical condition
Tx: Haldol, pimozide (only 2 FDA approved)
alpha agonists (clonidine), risperidone

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9
Q

ADHD Inattention

A

6 or more of the symptoms that have persisted for at least 6 months, inappropriate for developmental level
present in 2 or more settings
age<12
impairing functioning

a. fails to give close attention to details or makes careless mistakes
b. difficulty sustaining attention
c. does not listen when spoken to directly
d. does not follow through on instructions and fails to finish school work, chores, or duties in the workplace
e. difficulty organizing tasks and activities
f. avoids, dislikes or is reluctant to engage in tasks that require sustained mental effort

close attention/mistakes, sustaining attention, not listen, not follow through, poor organization, sustained mental effort, lose things, easily distracted, forgetful

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10
Q

ADHD hyperactivity

A

6 or more of the symptoms for at least 6 months
present in 2 or more settings, inappropriate for developmental level
age <12
impairing functioning

a. fidgets with or taps hands or feet
b. leaves seat in situations when remaining seated is expected
c. runs or climbs in situations where it is inappropriate
d. often unable to play or engage in leisure activities quietly
e. often “on the go” acting as if “driven by a motor”
f. talks excessively
g. blurts out an answer before a question has been completed
h. difficulty waiting his or her turn
i. often interrupts or intrudes on others

fidgets, leaves seat, runs/climbs, no quiet play, on the go/motor, talks excessively, blurts, not wait turn, interrupts/intrudes

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11
Q

side effects of SSRI’s

A 
7 S's
s- stomach upset
s- sexual dysfunction
s- serotonin syndrome
s- sleep difficulties (insomnia and headaches)
s- suicidal thoughts
s- stress (Agitation, anxiety)
s- size increase (weight gain)

stomach upset, headaches, dizziness, activation (Especially in younger children)

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12
Q

what is one risk associated with chronic administration of haloperidol

A

tardive dyskinesia

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13
Q

what are some side effects of atypical antipsychotics

A 
weight gain
metabolic syndrome
diabetes
extrapyramidal symptoms
hyperlipidemia
hyperprolactinemia
hematologic adverse effects- leukopenia, neutropenia
seizures
hepatotoxicity
NMS
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14
Q

what are some examples of atypical antipsychotics

A

risperidone
aripiprazole
olanzapine
quetiapine

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15
Q

what is an example of a typical antipsychotic

A

haloperidol

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16
Q

what are extrapyramidal symptoms

A

dystonia
rigidity
tremor
akathisia

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17
Q

what conditions are comorbid with depression?

A 
anxiety *
disruptive behavior disorders *
substance use disorders *
ADHD
Eating disorder

*= most common Comorbidity conditons

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18
Q

what is required to diagnose Bipolar I disorder?

A

criteria must be met for at least 1 manic episode

lifetime risk of suicide in people with bipolar disorder is estimated to be at least 15 times that of the general population

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19
Q

what is required to diagnose Bipolar II disorder?

A

criteria for at least 1 hypomanic episode and at least 1 major depressive episode

hypomanic episode is shorter duration (4 days) and less severe (less functional impairment)

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20
Q

what is the treatment for bipolar disorder in kids?

A

lithium- only mood stabilizer approved in kids

atypical antipsychotics have good response and considered 1st line

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21
Q

Criteria for ODD

A

at least 4 symptoms
lasting at least 6 months

angry/irritable mood:

  1. often loses temper
  2. often touchy or easily annoyed
  3. often angry or resentful

Argumentative/Defiant Behavior

  1. argues with authority figures
  2. defies or refuses to comply with requests from authority figures
  3. deliberately annoys others
  4. blames others for his or her mistakes or misbehavior

Vindictiveness
8. has been spiteful or vindictive at least twice in the past 6 months

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22
Q

Criteria for conduct disorder

A

3 of the following 14 criteria in the past 12 months

  1. bullies, threatens or intimates others
  2. initiates physical fights
  3. used a weapon that can cause serious physical harm to others
  4. physically cruel to people
  5. physically cruel to animals
  6. has stolen while confronting a victim
  7. has forced someone into sexual activity
  8. deliberately engaged in fire setting with the intention of causing serious damage
  9. deliberately destroyed others property
  10. broken into someone else house, building or car
  11. lies to obtain goods or favors or to avoid obligations
  12. has stolen items
  13. stays out at night despite parental inhibitions
  14. has run away from home overnight at least twice
  15. is often truant from school
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23
Q

what often precedes the development of conduct disorder?

A

ODD

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24
Q

what condition is often comorbid with ODD

A

ADHD

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25
Q

what conditions are often comorbid with CD

A 
ADHD
ODD
anxiety
depression
learning disorder
substance related disorder
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26
Q

what is the main treatment for patients with personality disorders?

A

psychotherapy

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27
Q

what is the most common method used to complete suicide?

A

firearms

suicide attempts are more common in females but completed suicide is more common in males

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28
Q

what treatment combination has the best response rate for anxiety symptoms?

A

CBT + SSRIs

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29
Q

what is the criteria for brief psychotic disorder?

A

presence of 1 (or more) of the following symptoms for <1 month

  1. delusions
  2. hallucinations
  3. disorganized speech
  4. grossly disorganized or catatonic behavior

duration at least 1 day but less than 1 month, with eventual return to pre morbid level of functioning

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30
Q

what is schizophreniform disorder

A

2 or more of the following for 1-6 months

  1. delusions
  2. hallucinations
  3. disorganized speech
  4. grossly disorganized or catatonic behavior
  5. negative symptoms (diminished emotional expression or avolition)

the episode lasts at least 1 month but less than 6 months

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31
Q

what is the criteria for schizophrenia

A

2 or more of the following for AT LEAST 6 months

  1. delusions
  2. hallucinations
  3. disorganized speech
  4. grossly disorganized or catatonic behavior
  5. negative symptoms (diminished emotional expression or avolition)

typically develops between the late teens and mis 30s

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32
Q

what is the treatment for schizophrenia?

A

1st or 2nd generation antipsychotics

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33
Q

what are some common obsessions?

A 
contamination
thoughts of harming loved ones/oneself
washing/cleaning compulsions
checking
straightening
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34
Q

OCD can be associated with what type of infection?

A

Group A Strep
PANDAS
pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection

35
Q

what is PANDAS

A

sudden onset or exacerbation of tic symptoms following a recent streptococcal infection

36
Q

what is the treatment for OCD

A

CBT +/- SSRI
CBT is the first-line treatment for children with mild to moderate OCD symptoms; SSRI’s are used when CBT is insufficient to address OCD symptoms, or when CBT is not accessible or the symptoms are severe.

37
Q

what is the definition of obsessions

A

Noelle’s- persistent thoughts that are distressing

recurrent and persistent thoughts, urges or images that are unwanted and that in most individuals cause marked anxiety or distress

the individual attempts to ignore or suppress such thoughts, urges or images or to neutralize them with some other thought or action (ie by performing a compulsion)

38
Q

what is the definition of a compulsion

A

repetitive behaviours (hand washing ordering, checking) or mental acts (praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly

39
Q

what is the diagnostic criteria for OCD

A

presence of obsessions, compulsions or both that are time consuming (>1h/day) or cause clinically significant distress/impairment

half experience remission by early adulthood

40
Q

what are some co-morbidities with OCD

A 
>50% HAVE A COMORBIDITY
ADHD
separation anxiety disorder
specific phobias
agroaphobia
multiple anxiety disorders
tics
41
Q

what is the name of the rating scale for OCD

A

Children’s Yale-Brown Obsessive Compulsive scale

42
Q

what is the rating scale for CD

A

Conners parent/teacher rating scale

43
Q

what is the rating scale for ADHD

A

SNAP IV, Conners

44
Q

What is the rating scale for anxiety?

A

MASC

multidimensional anxiety scale for children

45
Q

what are 3 options for treatment for ADHD

A
  1. psychoeducation and support (for all)
  2. behavioral management (for most)
    3, medications (for some)
46
Q

what are the medications recommended for treating ADHD

A

Stimulants: methylphenidate, amphetamine
atomoxetine- norepinephrine uptake inhibitor (mono therapy)
alpha 2 agonists- clonidine, guanfacine (mono therapy or adjunct to stimulant)

47
Q

atomoxetine is approved for what age group

A

age >6

takes weeks to months to see a response but will have a continuous response throughout the day

48
Q

what are the 2 main side effects of atomoxetine

A

sedation
stomach upset
small increased risk of suicide related events!

others:
decreased appetite
weight loss
insomnia
irritable mood
dizziness
increased HR and BP
dry mouth
49
Q

why do you have to alter the dose of atomoxetine if a patient is on fluoxetine

A

CYP2D6 substrate

fluoxetine is a 2D6 inhibitor and will therefore increase the levels of atomoxetine

50
Q

what are the 3 main side effects associated with alpha 2 agonists?

A

sedation
hypotension
bradycardia

others:
dizziness
rebound tachycardia and hypertension
headache
dry mouth
irritability and other emotional changes
modest increase in QT (guanfacine)
51
Q

should patients avoid taking guanfacine with a high fat meal?

A

yes!! because it increases its absorption considerably

52
Q

how is guanfacine metabolized?

A

by CYP3A4

- inform patients of drug and food interactions (ex: grapefruit)

53
Q

why do you have to taper a2 agonists gradually?

A

due to risk of
rebound tachycardia
hypertension
arrhythmias

54
Q

what conditions are comorbid with ADHD

A 
anxiety
OCD
Depression
tic disorders
learning disorders
substance use disorders
* almost 70% of children with ADHD had at least one comorbid condition
55
Q

do stimulate cause exacerbation or new onset of tics?

A

on AVERAGE stimulants do not cause exacerbation or new onset of tics but they can do so in certain individuals

56
Q

what psychosocial intervention is specific for conduct disorder?

A

multi systemic therapy

57
Q

ODD often precedes what 3 conditions

A

CD
substance use disorder
severely delinquent behavior

58
Q

what percentage of children will no longer meet the criteria for ODD after 3 years

A

2/3

most children with ODD do not go on to develop CD

59
Q

youth with conduct disorder may go on to develop what personality disorder in adulthood

A

antisocial personality disorder

60
Q

what percentage of youth with CD will experience improvement

A

> 50%

61
Q

what are 3 risk factors for worse outcomes associated with CD

A

early are of onset
increased severity
increased pervasiveness

62
Q

what is the first line treatment for children and adolescents with disruptive/aggressive behavior?

A

psychosocial interventions

63
Q

when disruptive/aggressive behavior occurs with ADHD what should be used to treat?

A

medication for ADHD should be used first

64
Q

what medication is supported for treating disruptive/aggressive behavior?

A

risperidone

65
Q

what guidelines are used for a patient on an antipsychotic medication

A

CAMESA Guidelines

Canadian Alliance for Monitoring Effectiveness and Safety of Antipsychotics in Children

66
Q

what are 3 treatment options for anxiety?

A
  1. psychoeducation and support (for all)
  2. psychotherapy (for most)- primarily CBT
  3. medication (for some)- primarily SSRIs
67
Q

what is the basic model for CBT

A

Feelings
thoughts
behaviours (relaxation/exposure)

way to address feelings is by modifying dysfunctional thoughts

68
Q

what is the CBT program for anxiety

A

Coping Cat

69
Q

what type of psychotherapy is recommended for PTSD

A

Trauma focused CBT

exposure to memories of the trauma to get desensitized to the memories

70
Q

what is the most effective psychotherapeutic approach in the treatment of pediatric OCD

A

exposure and response prevention

71
Q

what are 3 treatment options for OCD

A
  1. psychoeducation and support (for all)
  2. psychotherapy (for most)
    CBT with emphasis on exposure and response prevention (ERP)
  3. medication (for some)- primarily SSRIs
72
Q

up to what age have antidepressants been associated with an increased risk of suicide-related events

A

age 24

73
Q

what is the risk of later bipolar disorder in children with MDD

A

20-40%

cautious when treating with antidepressants, especially if family history of bipolar disorder

74
Q

what are some risk factors for suicide in children and adolescents?

A 
older age
male sex
MDD
substance abuse
impulsivity/aggression
history of suicide attempts
presence of suicidal plan/intent
stressful life events
exposure to abuse/violence
access to lethal means (ie firearms)
family history of suicide
75
Q

Name 4 treatment approaches for depression

A
  1. Risk assessment and safety planning (for all)
  2. psychoeducation and support (for all)
  3. psychotherapy (for most)- primarily CBT and IPT-A
  4. medication (for some)- primarily SSRIs but most evidence for fluoxetine
76
Q

what is IPT-A

A 
focus on >/= 1 of the following interpersonal areas:
grief
role transition
role disputes
interpersonal deficits
77
Q

SSRIs are most efficacious for what condition? least efficacious?

A

most- anxiety

least- MDD (most evidence for fluoxetine)

78
Q

escitalopram is approved for what ages and condition?

A

> 12 yo with MDD

79
Q

fluoxetine is approved for what ages with MDD

A

> 8 yo

80
Q

what is cannabinoid hyperemesis syndrome?

A

The cannabinoid hyperemesis syndrome is characterized by recurrent episodes of vomiting associated with abdominal pain and nausea; patients often find relief by taking a hot shower or bath. Cannabis use has been chronic (>1-2 yr) and frequent (multiple times per week). Treatment includes stopping marijuana use, antiemetics, and topical capsaicin.

81
Q

what is cannabis withdrawal syndrome?

A

CWS is defined by experiencing at least two of five psychological symptoms—irritability, anxiety, depressed mood, sleep disturbance, appetite changes
AADIS

and at least one of six physical symptoms—abdominal pain, shaking, fever, chills, headache, diaphoresis—after cessation of heavy cannabis use.
ACDFHS

Heavy cannabis use is defined as daily or near daily use for at least a few months.
Withdrawal symptoms commonly occur 24 h to 72 h after last use and persist for 1 to 2 weeks. Sleep disturbance is often reported for up to 1 month.

82
Q

Name 3 conditions associated with Tourettes

A
  1. OCD
  2. ODD
  3. ADHD
  4. LD
  5. ASD
  6. Anxiety
  7. Depression
83
Q 
Pt treated with prozac for 2 years.  What is the chance of recurrence of depression once she is taken off this medication?
10%
20%
40%
75%
90%
A

40%

84
Q

CUD

A

CUD is defined as a problematic pattern of cannabis use leading to clinically significant impairment in areas of function or distress within a 12-month period
Usually, adolescents experience the following functional impairments: reduced academic performance, truancy, reduced participation and interest in extracurricular activities, withdrawal from their usual peer groups and conflict with family.

Pediatrics- Noelle (28 decks)

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