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Peds EOR > Psychiatry/Behavioral Medicine > Flashcards

Psychiatry/Behavioral Medicine Flashcards

1
Q

What is general anxiety disorder?

A

involves persistent and excessive worry pertaining to multiple events or domains that continues for 6 months or more

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2
Q

What is the tx of general anxiety disorder?

A
  • SSRIs: paroxetine and escitalopram, SNRIs: venlafaxine
  • buspirone is also effective; the starting dose is 5 mg PO bid or did, however, buspirone can take at least 2 weeks before it begins to help
  • benzodiazepines (short-term use), beta-blocks
  • psychotherapy
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3
Q

What is panic disorder characterized by?

A

recurrent, unexpected panic attacks with at least a month or more of worry or avoidant behavior
-can occur with or without agoraphobia

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4
Q

What are the symptoms of panic disorder?

A

symptoms develop abruptly and reach a peak within 10 minutes
-palpitations, chest pain, sweating, SOB, etc.

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5
Q

What is the treatment of panic disorders?

A
  • SSRIs: paroxetine, sertraline, fluoxetine
  • benzodiazepines: for acute attack (watch for abuse)
  • CBT (relaxation, desensitization, examining behavior consequences)
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6
Q

What is phobias characteristics?

A

same as panic disorder - symptoms begin 10-15 minutes prior to stress even except in this case it is specific stress event (flying, blood, social situations, spiders etc.)

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7
Q

What is the treatment of phobias?

A
  • exposure therapy (first line), teach to relax and try to understand/overcome the fear
  • SSRI + CBT
  • benzodiazepines (prior to flying)
  • treat agoraphobia just as GAD with SSRIs and CBT
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8
Q

What are the characterized by attention-deficit/hyperactivity disorder?

A

problems paying attention, excessive activity, or difficulty controlling behavior with is not appropriate for a person’s age

  • hyperactivity, impulsivity, or inattentiveness manifesting prior to age 12 year
  • > 6 symptoms of inattention, hyperactivity-impulsivity, developmentally inappropriate and duration of symptoms > 6 months
  • symptoms must occur in more than one setting (example school and home)
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9
Q

What is the 1st line tx of attention-deficit/hyperactivity disorder?

A

caution: wt. loss and decrease growth with stimulants
- methylphenidate (ritalin, concerta, daytrana)
- dexmethylphenidate (Focalin)
- amphetamine/dextroamphetamine (adderall, dexedrine)
- atomexetine(Strattera) selective norepinephrine atomoxetine (strattera) selective norepinephrine reuptake inhibitor (non-stimulant)

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10
Q

What is the 2nd line tx of attention-deficit/hyperactivity disorder?

A
  • antidepressants (guanfacine, clonidine, imipramine, bupropion, venlafaxine)
  • behavior modification, family, educational management
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11
Q

What is autism spectrum disorder?

A

a range of conditions classified as neurodevelopment disorders
-individuals diagnosed with autism spectrum disorder present a developmental delay in socialization, language, and cognition

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12
Q

What does autism spectrum disorders encompass?

A
  • autistic disorder = disruption of social interaction and language at age 3 or earlier
  • childhood disintegrative disorder
  • pervasive developmental disorder - not otherwise specified
  • asperger disorder = a child has normal cognitive development, poor relationships and does not spontaneously seek activities with others
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13
Q

What is the DSM V criteria of autism spectrum disorder?

A
  • social communication and social interaction deficit in many contexts such as
  • lack of social-emotional reciprocity
  • lack of nonverbal communicative behaviors
  • impairment in developing, maintaining, and understanding relationships
  • restricted and repetitive patterns of behavior, interests, or activities such as
  • motor movements that are stereotyped or repetitive (flipping objects)
  • inflexibility to change
  • restricted and fixated interests - these are typical with abnormal intensity or focus
  • hyper-hyporactivity or unusual interest in a sensory stimulus (fascination with lights)
  • these symptoms must be present in the patient’s early developmental period in the absence of an organic etiology (hearing dysfunction)
  • these symptoms cannot be better explained by other conditions (intellectual developmental disorder)
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14
Q

What is the treatment of autism?

A
  • refer - autism specialists, speech and language pathologist
  • audiology evaluation, +/- EEG
  • behavioral therapy
  • medications: second-generation antipsychotics (risperidone, aripiprazole) for aggression/hyperactivity, mood lability, can also use haloperidol, carbamazepine
  • SSRIs for stereotyped/repetitive behavior
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15
Q

What is child abuse and neglect?

A

deliberate action that is harmful to a child’s physical, emotional, or sexual well-being

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16
Q

What are the characteristics of child abuse and neglect?

A
  • injury not adequately explained or inconsistent with a history given
  • bruises/lacerations/soft-tissue swelling, dislocations/fractures, spiral fractures
  • burns (doughnut-shaped, stocking-glove, symmetrically round)
  • bruises or injuries with regular patterns on face, back, buttocks, thighs
  • internal hemorrhages, abdominal injuries, bite marks, injury with shape of instrument used
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17
Q

How else may child abuse and neglect manifest with?

A
  • anxiety
  • aggressive/violent behavior
  • PTSD
  • depression or suicide
  • substance abuse
  • poor self-esteem
  • dissociative disorders
  • paranoid ideation
  • failure to thrive
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18
Q

When can child abuse and neglect be considered?

A
  • minor allowed to engage in potentially harmful behavior (ETOH consumption)
  • child is unattended, in some states, leaving child age <13 home alone
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19
Q

What is the tx of child abuse and neglect?

A

the first thing to do is a care for any immediate injuries - like burns and fractures

  • it is also the healthcare provider’s responsibility to report any suspicion of child abuse to child protective services
  • oftentimes a social worker should be involved to help decide on the best next steps to ensure the child’s safety, like separating the child from the abuser and helping the family cope
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20
Q

What are the characteristics of major depressive disorder?

A

5 or more SIEGECAPS for > 2 weeks nearly every day and at least one of the symptoms is depressed mood or anhedonia

  • Sadness
  • Interest/anhedonia
  • Guilt
  • Energy
  • Concentration
  • Appetite
  • Psychomotor activity
  • Suicidal
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21
Q

What is the treatment of major depressive disorder?

A

SSRIs are the first-line treatment

  • continue to increase dosage q 3-4 weeks until symptoms in remission
  • the full medication effect is complete in 4-6 weeks
  • augmentation with 2nd medication may be necessary
  • see within 2-4 weeks of starting mediations and q2wek until improvement, then monthly to monitor medication changes
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22
Q

What is persistent depressive disorder (dysthymia)?

A

chronic depressions - depressive symptoms for >2 years

  • the individual has never been without the depressive symptoms in more than 2 months at a time
  • there has never been a manic episode or a hypomanic episode
23
Q

What is the tx of persistent depressive disorder (dysthymia)?

A
  • SSRIs and other antidepressants
  • Psychotherapy
  • Physical exercise
24
Q

What is premenstrual dysphoric disorder?

A

a disorder marked by repeated episodes of significant depression and related symptoms during the week before menstruation
-in the majority of menstrual cycles, at least five symptoms must be present in the final week before the onset of menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week post menses

25
Q

What are one (or more) of the following symptoms must be present for a dx of premenstrual dysphoric disorder?

A
  • marked affective lability (mood swings, feeling suddenly sad or tearful, or increased sensitivity to rejection)
  • marked irritability or anger or increased interpersonal conflicts
  • marked depressed mood, feelings of hopelessness, or self-deprecating thoughts
  • marked anxiety, tension, and/or feelings of being keyed up or on edge
26
Q

What are the following symptoms must additionally be present, to reach a total of fiver symptoms when cobbled with symptoms from above for dx of premenstrual dysphoric disorder?

A
  • decreased interest in usual activities (work, school, friends, hobbies)
  • subjective difficulty in concentrations
  • lethargy, easy fatiguability, or marked lack of energy
  • marked change in appetite, overeating or specific food cravings
  • hypersomnia or insomnia
  • a sense of being overwhelmed or out of control
  • physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of “bloating” or “weight gain”
27
Q

What is the tx of premenstrual dysphoric disorder?

A

SSRIs are first-line treatment (fluoxetine, sertraline, paroxetine, escitalopram) and can be used continuously or instituted the week prior to menses

  • birth control, low-dose estrogen, and diuretics may also be beneficial
  • SNRIs such as venlafaxine may also be effective in women with predominantly psychological symptoms
  • gonadotropin-releasing hormone(GnRH) - SEs include accelerated bone loss and vasomotor symptoms
28
Q

What is conduct disorder?

A

a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated

29
Q

What is the dx criteria of conduct disorder?

A
  • manifested by the presence of at least three of the following 15 criteria in the past 12 months
  • from any of the categories below with at least one criterion present in the past 6 months
  • it is often seen as the precursor to antisocial personality disorder, which is per definition not diagnosed until the individual is 18 years old
30
Q

What is in the category of aggression to people and animals for conduct disorder?

A
  • often bullies, threatens, or intimidates others
  • often initiates physical fights
  • has used a weapon that can cause serious physical harm to others (a bat, brick, broken bottle, knife, gun)
  • has been physically cruel to people
  • has been physically cruel to animals
  • has stolen while confronting a victim (mugging, purse snatching, extortion, armed robbery)
  • has forced someone into sexual activity
31
Q

What is in the category of destruction of property for conduct disorder?

A
  • has deliberately engaged in fire setting with the intention of causing serious damage
  • has deliberately destroyed others’ property (other than by fire setting)
32
Q

What is in the category of deceitfulness or theft for conduct disorder?

A
  • has broken into someone else’s house, building, or car
  • often lies to obtain goods or favors or to avoid obligations (“cons” others)
  • has stolen items of nontrivial value without confronting a victim (shoplifting, but without breaking and entering, forgery)
33
Q

What is in the category of serious violations of rules for conduct disorder?

A
  • often stays out at night despite parental prohibitions, beginning before 13 years
  • has run away from home overnight at least twice while living in the parental or parental surrogate home, or once without returning for a lengthy period
  • is often truant from school, beginning before age 13 years
34
Q

What is the treatment of conduct disorder?

A
  • the most effective treatment for an individual with conduct disorder is one that seeks to integrate individual, school, and family settings
  • additionally, treatment should also seek to address familiar conflicts such as marital discord or maternal depression
35
Q

What is oppositional defiant disorder?

A

a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months as evidence by at least four symptoms from any of the following categories, and exhibited during interaction with at least one individual who is not a sibling

36
Q

What are the symptoms of oppositional defiant disorder?

A
  • frequent temper tantrums
  • arguments with adults and authority figures
  • does not conform to rules and regulation
  • intentional exasperation of others
  • easily annoyed by others
  • revenge-seeking and vindictiveness
  • angry attitude
  • harsh and unkind
37
Q

What is different between oppositional defiant disorder and conduct disorder?

A

unlike children with conduct disorder, children with oppositional defiant disorder are not aggressive towards people or animals, do not destroy property, and do not show a patten of theft or deceit

38
Q

What is the psychotherapy tx for oppositional defiant disorder?

A

is aimed at helping the child learn to express and control anger in more appropriate ways

  • cognitive-behavioral therapy aims to reshape the child’s thinking (cognition) to improve problem-solving skills, anger management, moral reasoning skills, and impulse control
  • family therapy may be used to help improve family interactions and communication among family members, peer group therapy might also be helpful
39
Q

What is the pharmacotherapy for the tx of oppositional defiant disorder?

A

mood stabilizers, antipsychotics, and stimulants
-other drugs seen include haloperidol, thioridazine, and methylphenidate which also is effective in treating ADHD, as it is a common comorbidity

40
Q

What is anorexia nervosa?

A

patient who refuses to eat due to fear or being overweight

  • intense fear of becoming fat, even though underweight, frequent weight checks and denial of emaciated state
  • weight <85% of ideal body weight
  • anorexia nervosa can be distinguished from bulimia nervosa by body mass index <17 or bodyweight <85% of ideal body weight
  • the highest suicide rate of eating disorders
41
Q

What are the two types of eating disorders?

A
  • binging/purging

- restricting

42
Q

What are the characteristics of binging/purging?

A
  • laxatives/diuretics abuse

- excessive exercise

43
Q

What are the characteristics of restricting?

A
  • eat very little

- exercise to excess

44
Q

What is the treatment of anorexia nervosa?

A
  • restore nutritional state
  • hospitalization - if weight is <75% expected body weight
  • psychotherapy - behavioral therapy
  • pharmacologic - SSRIs
  • have added benefit of causing weight gain
  • have not been proven to be effective in anorexia
  • have some efficacy in bulimia nervosa
45
Q

What is bulimia nervosa?

A

patient who has episodes of mass eating followed by self-induced vomiting or intense exercise

46
Q

What are the characteristics of bulimia nervosa?

A

frequent binge eating with or without purging

  • purging commonly performed by self-induced vomiting resulting in metabolic alkalosis, urinary chloride <20 mEq, and volume depletion
  • may abuse laxatives/diuretics
  • may exercise excessively
  • patients are disturbed by their behavior
  • binging and compensatory behaviors occur at least once a week for 3 months
47
Q

What are the classic physical findings for bulimia nervosa?

A

scars on knuckles, swollen parotid glands + dental erosions + normal weight + hypokalemia

48
Q

What is the treatment for bulimia nervosa?

A
  • first, you must restore the nutritional state
  • fluoxetine 60 mg PO once/day is recommended (this dose is higher than that typically used for depression)
  • SSRIs used alone often reduce the frequency of binge eating and vomiting
  • second-line medications: TCAs, MAOIs
  • behavioral/family/group therapy
49
Q

Suicide is what number leading cause of death?

A
  • 8th leading cause of death in the US

- second leading cause of death in ages 15-19 years

50
Q

What are the characteristics of suicide?

A
  • in all age groups, male deaths by suicide outnumber female deaths 4 to 1
  • women attempt suicide 2 to 3 times more often than men, among girls ages 15 to 19 years, there may be 100 attempts to every 1 attempt among boys of the same age
  • 13 percent of adolescents in the US planned a suicide attempt in the previous year and 8 percent attempted suicide
  • on average, primary care physicians encounter >6 potentially suicidal people in their practice each year
  • about 77% of people who die by suicide were seen by a medical practitioner within 1 year before killing themselves, and about 32% had been under the care of a mental health care practitioner during the preceding year
51
Q

What are the risk factors for suicide?

A
  • mental disorders (major depression, substance use disorders, or psychotic disorders)
  • previous suicide attempt
  • gay, lesbian, or bisexual orientation, or transgender or gender non-conforming identify
  • history of physical or sexual abuse
  • family history of suicidal behavior
52
Q

What is the tx for suicide behaviors?

A

consider referral to emergency services

  • crisis service, emergency department
  • psychotherapy = effective options include cognitive-bahvior therapy, dialectical behavior therapy, family therapy, and metallization-based therapy
  • the emergent administration of antidepressants has no role in the acute management of the suicidal adolescent or child
53
Q

What are the general principles for managing suicidal children and adolescents with psychotherapy?

A
  • address family interaction or increase non familial support
  • provide a sufficient number of treatment sessions
  • target alcohol and substance abuse when clinically indicated
  • discuss motivation for treatment
  • initiate treatment quickly and at a greater intensity when suicidal crises recur
  • coordinate treatment administered by multiple clinicians

Peds EOR (12 decks)

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