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Paediatrics RACP written exam > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Treatment of OCD?

A

CBT

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2
Q

Treatment of severe conduct disorder?

A

Multisystemic therapy.
MST recognises that in order to best deal with a youth in trouble, treatment must target the many “systems” that impact the youth, including the family, school environment, friendships, and peer pressures.

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3
Q

Which condition is most commonly co-morbid with ADHD in primary school children?

A

Specific learning disability - around 50%
Conduct disorder - 30%
Depression - 30%
Generalised anxiety disorder - 20-30%
Tic disorder - not usually associated but can be a side effect of medication.

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4
Q

Early onset (before age 10) conduct disorder most strongly predicts which adult mental health problem?

A

Antisocial personality disorder in 30-50%

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5
Q

What are the side effects of methylphenidate?

A
  • Decreased appetite 80%
  • Sleep disturbance 3-85%
  • Weight loss 10-15%
  • Transient motor tics 15 to 30%
  • Tachycardia, hypertension nervousness, irritability, moodiness, deceleration of linear growth may occur, but adult height is not affected.
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6
Q

What is the mechanism of action of methylphenidate?

A

Inhibition of noradrenaline and dopamine reuptake

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7
Q

What are the most common mental health disroders by age 15?

A
  • Anxiety (10%)
  • Mood disorders (7%)
  • Conduct/oppositional disorders (8-10%)
  • ADHD (3-4%)
  • Substance abuse (5-7%)
  • > 95% not seen by mental health services
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8
Q

Risks for developing mental health issues?

A
  • Long term physical conditions
  • Physical disability
  • Epilepsy
  • Parents with mental illness and addiction
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9
Q

What are the multiaxial diagnosis steps?

A
  • Axis I - primary psych
  • Axis II - personality, cognitive impairment
  • Axis III - medical conditions
  • Axis IV - acute and chronic stressors, strengths/resilience
  • Axis V - global assessment of function
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10
Q

Risk factors for attachment disorder

A
  • History of prolonged separation from primary caregivers, multiple placements
  • Neglect or FTT
  • Abuse
  • Parental psychopathology
  • Parental substance abuse
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11
Q

What are the two main domains for diagnosis of ASD?

A
  • Persistent deficits in social communication and social interaction across contexts (social-emotional reciprocity, nonverbal communication, developing and maintaining relationships)
  • Restricted, repetitive patterns of behaviour, interests, or activities (stereotyped or repetitive speech, motor movements, routines, excessive resistance to change, restricted and fixated interests, hypo or hyper-reactivity to sensory input)
  • Must be present in early childhood
  • Must limit and impair everyday functioning
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12
Q

Describe ASD incidence, recurrence rate, associated syndromes

A
  • 1%, 4:1 M>F
  • Average age diagnosis 6-7 years
  • Increasing awareness and change in classification causing rising incidence
  • Siblings 2-8% chance autism
  • Associated with fragile X and tuberous sclerosis, raised serum lead
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13
Q

What are the comorbidities with ASD?

A
  • Intellectual disability 75% have IQ less than 70
  • Epilepsy 7-14%
  • ADHD 50%
  • Anxiety disorders 50% (girls often present later with anxiety, eating disorders, when teenager)
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14
Q

What is the most commonly used assessment for ASD?

A

ADOS-G

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15
Q

What is the treatment of ASD?

A
  • Early SLT
  • Applied behavioural analysis
  • Sensory management
  • Early start Denver model
  • Limited role for meds: fluoxetine if excessive anxiety, low-dose risperidone and haloperidol for aggression and sterotypies
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16
Q

What are the outcomes of ASD?

A
  • 25% develop seizures
  • 10% adolescents lose skills/speech
  • Best predictors of outcome are IQ and speech by 5 uears (50% have good social outcome)
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17
Q

What is the definition of ADHD?

A
  • Inattention, hyperactivity, impulsivity
  • Symptoms before age 7
  • Two or more settings
  • Causes dysfunction
  • Subtypes: inattentive, hyperactive, or combined
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18
Q

What are the comorbidities for ADHD?

A
  • ODD, CD 50%
  • Depression 6%
  • Anxiety 33%
  • Learning problems up to 90%
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19
Q

Risk factors for developing ADHD?

A
  • Heritability 80%
  • Fragile X, velocardiofacial, tuberous sclerosis
  • Antenatal ETOH, possibly smoking
  • Extreme adversity, poor mother-child relationship
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20
Q

What is the most commonly used assesment for ADHD?

A

Connors

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21
Q

What are the treatments for ADHD?

A
  • Psycho-eduction
  • Stimulants: methylphenidate, dexamphetamine (speed up frontal cortex to help regulate child’s behaviour)
  • Family focused - parent management training
  • School based interventions
  • Comorbid disorders may require other treatments
  • As get older, usually don’t need meds: caffeine, self-regulation, routines, diaries
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22
Q

Side effects of stimulants?

A
  • Loss of appetite, weight loss (0-5kg)
  • Abdo pain, headache
  • Sleep disturbance
  • Irritability, crying, mood changes
  • Decreased growth - normal end height. Take medication breaks eg over holidays. Reduction 1-2.5cm.
  • Tachycardia, inc BP
  • Can worsen or unmask tics or steroetyped behaviour, but don’t cause them. Avoid high doses in Tourettes
  • Rare: thrombocytopenia, SJS
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23
Q

What is the mechanism of action of amphetamine?

A

Increases dopamine release, blocks reuptake of dopamine

24
Q

What is the usual dose and duration of methylphenidate?

A
  • 0.3-0.5mg/kg/dose

- Short acting (3-4 hours)

25
Q

Children with ADHD and conduct disorder have a high risk of developing..?

A

Antisocial personality disorder (+ suicide attempts, more social isolation, lower self esteem)

26
Q

What is the definition of oppositional defiant disorder?

A
  • > 6m of losing temper, argues with adults, refuses to comply with requests/rules, annoys people, blames others, easily annoyed, angry/resentful, spiteful/vindictive
27
Q

Children with ODD are at risk of developing?

A

Conduct disorder, depression

28
Q

Management of ODD?

A
  • Parent management training
  • Incredible years, triple P, PCIT
  • Key: increasing positive interaction with child, planned ignoring of unwanted behaivours, setting limits, modelling behaviours, time-out 1 minute/year of age
29
Q

What is conduct disorder?

A
  • Cruelty to people and animals
  • Destruction of property
  • Deceitfulness or theft
  • Serious violations of rules
  • Present >12m
  • Childhood (<10) or adolescent onset (>10)
  • Repetitive and persistent pattern
30
Q

What are the differences between childhood and adolescent conduct disorder?

A
  • Childhood: <10, more likely male and aggressive, likely have ODD, ADH, likely develop antisocial personality disorder
  • Adolescent: >10, F=M, less aggression, less likely to develop ASPD
31
Q

What is the prevalence of conduct disorder?

A

3-5%, one of the commonest disorders, increased prevalence after age 12

32
Q

What is the treatment for conduct disorder?

A
  • Intervene as early as possible
  • Multi-systemic therapy, functional family therapy, treatment foster care, parents management training
  • Treat comorbidities (ADHD, depression, substance abuse, anxiety)
  • Meds rarely: stimulants if ADHD (but risk misuse), low dose risperidone, haloperidol, lithium in aggression - might be used to get control/calm while applying behavioural techniques
33
Q

40% of patients with Tourettes are diagnosed with what by the time of adulthood?

A

OCD

34
Q

Mangement of Tourettes

A
  • CBT - habit reversal therapy
  • haloperidol, risperidone, clonidine
  • if have ADHD then methylphenidate + clonidine +/- antipsychotic
35
Q

Treatment of dystonic reactions?

A

Benztropine

36
Q

How do typical antipsychotics affect prolactin, and what does high prolacitn cause?

A
  • Typical antipsychotics block dopamine inhibition of the pituitary, therefore causing a prolactin rise (normally dopamin inhibits prolactin)
  • Males: gynaecomastia, females: galactorrhea, ammenorrhea
  • Note: Opiates can stimulate prolactin release.
37
Q

Which antipsychotic medications have the highest and lowest risk of weight gain?

A
  • Highest: clozapine, olanzapine, quetiapine

- Lowest: risperidone

38
Q

What is the treatment for panic attacks caused by separation anxiety disorder?

A
  • 1st line: CBT, relaxation, graduated exposure

- 2nd line: SSRI eg fluoxetine

39
Q

What is the treatment of generalised anxiety disorder?

A
  • CBT
  • Family work
  • Medication if severe e.g. fluoxetine. Do not use tricyclics e.g. amitryptilline as risk in overdose
40
Q

What are the components of CBT?

A
  • Cognitive restructuring
  • Avitivty scheduling
  • Problem solving
  • Relaxation training
  • If anxiety: identification of stimuli, exposure, reducing avoidance
41
Q

PTSD vs. acute stress disorder?

A

PTDS needs symptoms weeks to >3m. ASD has shorter timeframe

42
Q

What are the criteria for PTSD?

A
  • Experienced or witnesses event involving actual or threatened death or serious injury
  • Re-experiencing - flashbacks, dreams
  • Avoidance - places, people, thoughts
  • Hyper-arousal - hyper-vigilance, poor concentration, poor sleep
43
Q

What is the treatment of PTSD?

A
  • Re-establish sense of safety and control
  • Trauma-focused CBT
  • No RCT evidence for SSRI, clonidine, B-blocker, but can be used short term
  • EMDR = eye movement desensitisation relaxation therapy, not as much evidence as CBT
44
Q

What are the criteria for OCD?

A
  • Obsessions: ideas, images, impulses. Cause marked anxiety and distress and take significant time
  • Compulsions: reptitive behaviours, goal of which is to reduce symptoms of anxiety
45
Q

What are the comorbidities of OCD?

A
  • ADHD
  • Depression
  • Tics
  • ODD
  • Developmental
  • Other anxiety
46
Q

What is the treatment of OCD?

A
  • CBT (exposure and response prevention)

- Meds: SSRIs, often require higher doses (c.f. lower doses in anxiety)

47
Q

Describe social phobia

A
  • Marked and persistent fear of social or performance situations, leading to avoidance e.g. school refusal
  • Can lead to substance abuse when older
  • Tx: CBT, SSRIs
48
Q

Describe panic disorder

A
  • Recurrent panic attacks
  • Worry about implications/ consequences or significant behavioural change
  • Affects function at school
  • Tx: controlled breathing, relaxation, CBT, SSRIs
49
Q

What are the criteria for Tourette’s disorder?

A
  • Multiple motor tics and one or more vocal tics
  • Multiple per day, >1 year
  • Onset before age 18
50
Q

What are the types of tics?

A
  • Simple - e.g. repetitive muscle twitch
  • Complex - e.g. touching, throwing, retracing steps
  • Vocal - grunts, yelps, clearing throat
  • Coprolalia - obscenities (10%)
51
Q

Medication for chronic pain/somatiform disorders

A
  • Low dose amitryptilline 10-20mg nocte
  • Neuropathic pain - gabapentin
  • Clonidine dermal patches
  • Avoid opiates
52
Q

What is conversion disorder?

A
  • Symptoms or deficits affecting voluntary motor or sensory function that suggest a neuro or other medical condition
  • Not intentional
  • Causes distress and impairment
  • Not limited to pain
  • Motor impairment most common presentation of conversion disorder in children
53
Q

Treatment of enuresis?

A
  • After age 7
  • Behavioural/alarm - 70% success, 30% relapse with bed alarm
  • DDAP - 24% remission but high relapse
  • Address social issues
54
Q

Discuss avoidant/restrictive food intake disorder (AFRID)

A
  • Previously known as selective eating disorder
  • Inability to eat certain foods (e.g. colour, taste, texture,
    sometimes entire food groups – i.e. fruit or vegetables)
    resulting in inability to maintain weight, or growth faltering
  • Dependence on supplements or enteral feeding
  • Typical onset in childhood
  • Does not occur in context of anorexia nervosa or bulimia
    nervosa, and no other medical explanation
55
Q

Discuss borderline personality disorder

A
  • Borderline personality disorder is defined as a pervasive of instability of interpersonal relationships, self image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts.

Paediatrics RACP written exam (18 decks)

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