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Paediatrics > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Hospital admission criteria for eating disorders

A
  • Significant electrolyte disturbance (K < 3.0)

HR ≤ 50bpm

Postural HR increase ≥ 30bpm

Resting systolic BP ≤ 80mmHg

Postural systolic drop ≥ 20mmHg

Hypothermia < 35.5C

Dehydration

Arrhythmia or prolonged QTc > 0.45s

Weight <75% of their expected body weight or rapid weight loss (>10-15% in 3-6 months is significant)

Out of control ED compensatory behaviours e.g. prolonged fasting/ inability to eat at home/ uncontrolled purging and exercising

Admission may be appropriate in rare circumstances where community management is not effective

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2
Q

1st line treatment for anorexia nervosa

A
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3
Q

1st line treatment for bulimia nervosa

A
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4
Q

Does medication alter the outcome in anorexia nervosa

A
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5
Q

Definition of somatisation

A
  • Tendency to experience and communicate somatic distress
  • Psychological distress manifested in the form for physical symptoms
  • Seeks medical help
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6
Q

What condition is selective mutism MOST associated with?

A

Social phobia

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7
Q
A
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8
Q

What style of attachment is the highest risk for developing a psychopathology?

A
  • Disorganised attachment highest risk
  • Avoidant + resistant attachment are risk factors for psychopathology BUT low predictive value
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9
Q

What is the criteria for autism spectrum disorder?

A
  • Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays and manifests by ALL 3 of the following:
    • Deficits in social-emotional reciprocity
    • Deficits in nonverbal communication
    • Deficits in developing and maintaining relationships, appropriate to developmental level (beyond those with caregivers)
  • Restricted, repetitive patterns of behaviour, interests or activities as manifested by at least 2 of the following:
    • Stereotyped or repetitive speech, motor movements, or use of objects
    • Excessive adherence to routines, ritualised patterns of verbal or nonverbal behaviour, or excessive resistance to change
    • Highly restricted, fixated interests that are abnormal in intensity or focus
    • Hyper or hypo reactivitiy to sensory input or unusual interest in sensory aspects of environment
  • Symptoms must be present in early childhood (but may not become fully manifest until social demans exceed limited capacities)
  • Symptoms together limit and impair everyday functioning
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10
Q

What is the average age at diagnosis for autism spectrum disorder?

A

7-8yrs

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11
Q
A

10% for each sibling (x50 increased risk)

Monozygotic twin = 60% risk

Serum lead above normal in 44%- related to pica/ oral-motor stage

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12
Q

What are co-morbidities in autism spectrum disorder?

A
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13
Q

Who get picked up earlier with autism girls or boys?

A

Boys: usually noticed as they get in trouble

Girls: usually are better at masking their symptoms

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14
Q

Screening + assessment tools for autism?

A
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15
Q

What are the best predictors for outcome in autism?

A
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16
Q

What % of patients with autism develop seizures?

A

25% by 11-14yrs

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17
Q

What are the diagnostic criteria for ADHD?

A
  • Inattention
  • Hyperactivity
  • Impulsivity
  • Symptoms must be before 7yrs of age + in TWO settings or more (e.g. home + school)
  • Causes dysfunction
  • Subtypes:
    • Inattentive
    • Hyperactive
    • Combined (most common)
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18
Q

What is the prevalence of ADHD?

A
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19
Q

What are the common comorbidities in ADHD?

A
  • ODD / CD 50%
  • Learning problems 10-90%
  • Anxiety 33%
  • Depression 6%
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20
Q

What are the risk factors for ADHD?

A
21
Q

What is the treatment for ADHD?

A
  • Stimulant medication alone is as good or better than other treatment alone or in combination
  • Medications
    • Stimulants:
      • Methylphenidate
      • Dexamphetamine
    • Uncommonly used: atomoxetine (takes 1-2 weeks to work, may be more beneficial in families with history of substance use), clonidine (sleep difficult), imipramine, risperidone (used if behavioural concerns)
    • Not helpful for ADHD but can be used for comorbid anxiety: SSRI’s
  • Comorbid disorders may determine other treatment (in addition to stimulants)
    • Medication + behavioural treatment for comorbid anxiety
    • Parent management training if comorbid ODD/CD
    • Tourettes doesn’t preclude stimulants, but avoid high doses
22
Q
A
23
Q

What is the mechanism of action of:

  • Methylpenidate
  • Amphetamine
  • Atomoxetine
A
  • Methylpenidate (short acting 3-4hrs), slow release forms available
    • Block reuptake of dopamine
  • Amphetamine
    • Block reuptake of dopamine + increases dopamine release
  • Atomoxetine
    • Blocks transporter and blocks reuptake of noradrenaline
24
Q

Efficacy of stimulants + positive effects of stimulants in ADHD

A

Efficacy

Improvements in core symptoms range from 50-95%

60-70% of school age children respond to 1st agent, 80% to 2nd

Positive side effects

  • Improved sustained attention
  • Improved performance on memory, vigilance, attention
  • Improved academic productivity
  • Improved social interation
  • Reduced aggressive behaviour
25
Q

Negative effects of stimulants

A

Extremely rare: hypersensitivity, SJS, thromobocytopenia, alopecia, toxic psychosis

26
Q

What is the association between stimulant use + growth?

A
  • Associated with reductions in height of 1-2.5cm after 2-3.5 years of treatment
  • Weight 0-5kg less than expected
    • To overcome this:
      • Give medication morning + lunch
      • Give large dinner
      • Off medication on the weekends + feed
  • Height and weight growth rates increase after medication stopped
27
Q

What are the outcomes in ADHD?

A
  • 2/3 of ADHD children continue to have one or more initial core symptoms of the syndrome later in life
  • 1/3 have full diagnosis at 18 yrs of age
  • ADHD + CD kids are at higher risk of antisocial personality disorder
28
Q

What is ODD

A

Oppositional defiant disorder

  • Pattern of negativisitic, hostile and defiant behaviour lasting at least 6 months during which at least 4 of OFTEN;
    • Loses temper
    • Argues with adults
    • Actively defies or refuses to comply with requests/ rules
    • Deliberately annoys eople
    • Blames others
    • Touchy, easily annoyed
    • Angry / resentful
    • Spiteful/ vindictive

At risk of developing CD, depression + other psychiatric illnesses

29
Q

What are effective interventions for ODD in 3-12yr olds?

A

Parent management training

  • Increase positive interactions with your child
  • Planned ignoring of unwanted behaviours
  • Limit setting
30
Q

Conduct disorder key features

  • Childhood onset VS
  • Adolescent onset
A

Childhood onset

  • One symptom present before 10yrs old
  • More likely male, aggressive, disturved peer relationships
  • Likely have ODD, ADHD
  • Likely develop antisocial personality disorder

Adolescent onset

  • No symptoms before 10yrs
  • F=M
  • Less aggression
  • Less likely to develop antisocial personality disorder
31
Q

What is the prevalence of conduct disorder?

A

3-5%

Increase in prevalence after age 12yrs

32
Q
A
33
Q

What are the anxiety disorders?

A
  • Separation anxiety
  • Generalised anxiety disorder
  • Specific phobia
  • Obsessive compulsive disorder
  • Post traumatic stress disorder
  • Social phobia
  • Panic disorder
34
Q

What is separation anxiety?

A

Developmentally inappropriate and excessibe anxiety concerning separation from parents and home

  • School refusal common
  • Often demanding, intrusive and in need of constant attention, especially when anxious
  • Often have somatic complaints especially on school days or when facing separation e.g. bed-time
35
Q

Separation anxiety

  • Prevalence
  • Long term
    • Management
A
  • Prevalence 4% of children / young adolescents
  • Increased symptoms after a stressor (e.g. death of pet, family member, changing school)
  • Long term: most children do not have ongoing anxiety disorders at end of extended follow up. Higher risk if family history of anxiety disorders.
  • Family history of anxiety, mood disorders and alcohol abuse common
  • Management:
    • Behavioural and cognitive strategies
    • Relaxation
    • Graduated exposure
36
Q

When do you use SSRI’s in anxiety?

A

SSRI’s useful if NOT responding to CBT alone

  • Fluoxetine (mainstay)

DO NOT use TCA’s: high risk in overdose

37
Q

What are the 3 key features of PTSD?

A
  • Re-experiencing: flashbacks, dreams, repetitive play
  • Avoidance: places, activities, people, thoughts
  • Hyper-arousal: hypervigilance, poor concentration, poor sleep
38
Q

What is the main treatment of PTSD?

A
  • Trauma focussed CBT
    • Relaxation + breathing, cognitive reframing
    • Traume narrative, mastery via play, talking, drawing
  • Group / individual therapy
  • Pharmacotherapy
    • No RCT evidence for SSRI’s clonidine or B blockers
39
Q

What is the definition of OCD?

A
  • Obsessions
    • ​Persistent ideas, thoughts, images or impulses that are experienced as intrusive and inappropriate and that cause marked anxiety and distress
  • Compusions
    • ​Repetitive behaviours or mental acts (praying, counting) the goal of which is to prevent or reduce the symptoms of anxiety
40
Q

What is the prevalence of OCD?

A

1%

Generlly gradual onset / progression

Most have a waxing / waning course

15% have progressive deterioration

Remember to think about PANDAS (Paed autoimmune neuropsychiatric disorder associated with strep infection) usually quicker onset

41
Q

What are the comorbid conditions in OCD?

80% have another comorbid disorder

A
  • ADHD 35-50%
  • Depression 33-40%
  • Tics 26%
  • ODD 17-51%
  • Developmental 24%
  • Other anxiety 16%
42
Q

What is the treatment for OCD?

A
  • 1st line = CBT exposure and response prevention
  • Medication: SSRI’s often require higher doses
43
Q

Social phobia

  • Key characteristics
  • Outcome
  • Treatment
A
  • Marked and persistent fear of social or performance situations leading to avoidance
  • May present as school refusal
  • May lead to substance abuse
  • Treatment: CBT, SSRI’s
44
Q

Difference between a panic attack + panic disorder:

A
45
Q

What sort of tics can you have?

When is the peak onset?

When do you outgrow them usually?

A
  • Motor, vocal or combined
  • Peak age of onset - primary school
  • Most outgrow them by - high school
46
Q

What are the features of Tourettes disorder?

A
  • Multiple motor tics, and one or more vocal tics
  • Occur multiple times / day, through a period of > 1 year
  • Onset BEFORE 18yrs
  • Simple tics- muscle twitch like eye blinking
  • Complex tics- touching, throwing movement, retracing steps
  • Vocal tics- grunts, yelps, snorts, clearing throat
  • Coprolalia- uttering obscenitis
47
Q

What are comorbid disorders in Tourette’s?

A

ADHD + OCD

Usually worse when stressed

M:F 3:1

48
Q

What is the treament of Tourette’s?

A
  • Psychoeducation, support, family work
  • CBT- habit reversal therapy
  • Medication: antipsychotics at low doses
    • Haloperidol + risperidone
    • Clonidine less effective
  • MOST patients with ADHD and Tourettes able to take methylphenidate, if problems can trial clonidine +/- antipsychotic
49
Q

What is the most common presentation of conversion disorder in children?

A

Motor impairment

Paediatrics (23 decks)

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