Psychiatry/Learning Issues Flashcards
First line treatment of depression in adolescents
- Fluoxetine (SSRI) - contraindicated in patients taking MAO inhibtors, caution in kids on diuretics and with liver/kidney disease
- Side effects: Headache, insomnia, GI upset, weight loss
- Inhibits CYP450 so concomitant drug levels can increase
Number 1 cause of preventable intellectual disability
Congenital hypothyroidism
Most common inherited cause of intellectual disability
Fragile X (uncles with learning problems)
Most common teratogen causing intellectual disability
Alcohol –> also at risk for neurobehavioral deficits even with a normal IQ
Best indicator of cognitive function in young children
Language development is better than motor development
Autism spectrum diagnosis
- Persistent deficits in social communication and social interaction across contexts (not accounted for by general developmental delays)
- Presence of restricted, repetitive, stereotyped behavior, interests, activities
- Lack of eye contact and lack of social engagement is key*
Learning disability red flags
- Inability to recognize letters and numbers by the end of kindergarten
- Speech delay in preschool
- Inability to read simple words by the end of first grade
Dyslexia can be normal until when
Age 7
Medications that can alter school performance
Anticonvulsants and antihistamines
Specific learning disability testing
Below normal scores on an achievement test but a normal IQ
Colic definition
- Between 3 weeks and 3 months
- Crying for more than 3 hours per day, more than 3 days per week, for more than 3 weeks
- Tend to draw up thier legs, tense their abdomens, and arch their backs
- Tx: use another caregiver to take over (no gas drops or meds)
- 5 S’s: swaddling, shushing, swinging, sucking, strolling
Normal baby crying amounts
Birth to 6 weeks: up to 2 hours a day
6 weeks and beyond: up to 3 hours a day
Breath holding spells
- Most common in ages 6-18 months
- Can be associated with iron deficiency anemia (not a cause but treating the anemia can improve them)
- Most severe form is hypoxic seizure with a postictal period
- Tx: behavioral modification
Head banging behaviors
- Neurologically intact and between 8 months to 4 years –> normal and no intervention is necessary
- If older than 4 and/or signs of developmental delay, then needs a workup
- If head banging plus other symptoms should consider neglect as well
Thumb sucking treatment
- Initial intervention: redirection, positive reinforcement when not sucking thumb
- No active measures until after age 4
- Prolonged thumb sucking can lead to dental problems (malocclusion)
Phobia definition
- Anxiety based on potential danger posed, must interfere with daily function for at least 6 months
- Tx: desensitization, cognitive behavioral techniques
ADHD symptoms
- Inattentiveness, impulsivity, hyperactivity
- Must be present before age 12 and in 2 or more settings
- Must impair functioning and be present for at least 6 months, not explained by another condition
ADHD hyperactivity vs inattentive types
Hyperactive more common in males, inattentive more common in girls
Risk factors for ADHD
- Maternal tobacco and/or alcohol use, lead exposure, low birthweight, prematurity, IUGR
ADHD neurochemical findings
- Areas of the brain rich in dopaminergic and noradrenergic pathways are less activated in kids with ADHD
Things to rule out instead of ADHD
- Absence seizures
- Depression, anxiety
- Substance abuse
- Visual/hearing deficits
- Lead toxicity
- Hyper/hypothyroidism
- Previous neuro damage (infection, trauma)
- Phenobarbital, antihistamines
ADHD Comorbidities
65% of kids with ADHD have a coexisting condition
- Oppositional defiant disorder, conduct disorder, mood disorder, anxiety disorder, learning disorder
Stimulants
- First line for ADHD
- Methylphenidate, amphetamine
- Caution in kids with heart conditions, psychiatric conditions, and seizures
- Can increase serum concentations of TCAs and seizure meds
Stimulant plus MAO inhibitor side effect
Hypertensive crisis
Stimulant side effects
- Insomnia, weight loss, anorexia, rash, tachycardia, GI issues, hypertension, palpitations, headaches, visual disturbances
- Less common: abnormal liver enzymes, hair loss
- Can unmask tics in kids with Tourettes but does not cause Tourette syndrome
- Isolated motor tics on stimulants is usually transient, not a contraindication
Nonstimulants for ADHD
- Atomoxetine (norepinephrine reuptake inhibitor) - use caution in patients with cardiac conditions or concurrent albuterol therapy, increased SI in teenage boys
- Clonidine, guanfacine (alpha adrenergic agonists)
Depression signs/symptoms
- Acting out can be a symptom
- Normal things - keep in mind if interfering with daily functioning and beyond the limits of normal, it’s often depression
- Increased risk: parental depression, chronic illness
Mania after starting antidepressant
Stop med right away and consider bipolar
Amitriptyline
- TCA
- Can’t be used in kids with seizures and severe cardiac disorders
- Metabolized in CYP450
- Can’t stop it abruptly
- Side effects: sedation, urinary retention, constipation, dry mouth, dizziness, drowsiness, arrhythmias
- Monitoring: EKG, BP, CBC at start of therapy and with dose changes
Escitalopram
- Can be used for depression in adolescents but requires QT monitoring
Oppositional defiant disorder
- Defiant, disobedient, hostile behaviors
- Little respect for authority
Conduct disorder
- Severe behavioral concerns (lying, stealing, cruelty to animals) that impinge on the basic rights of others or violate major age appropriate social rules
- For at least 6 months
Obsessive compulsive disorder
- Repetitive behaviors (compulsions) with recurrent thoughts and worries (obsessions)
- Can be a symptom of PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infection)
Bipolar disorder
- Major depressive episode can be presentation –> start med –> manic
- High rate of coexisting ADHD and psychiatric disorders
- Family history is biggest predictor
Conversion disorder
Symptoms incompatible with anatomical and medical logic
Hypochondriasis
Preoccupation with illness, frequently in the context of previous illness
Malingering
Presenting with false or exaggerated symptoms, often with a motive
Dysmorphic disorder
Patient perceives themselves as being ugly or undesirable
Somatic delusions
Belief that something is medically wrong and may take on psychotic dimensions
Factitious disorder/Munchausen by Proxy
- Usually the mom
- Consider if: unexplained persistance/recurrence of symptoms, child looks healthier than history/labs indicate, symptoms are unusual, symptoms don’t occur if they’re with someone else, mom refuses to leave kids side, negative work ups don’t reassure the mom, reported history is confusing, has seen multiple specialists
- Tx: CPS report, remove child from parent and see if symptoms occur
