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Child Psychiatry Boards > Psychosis/Conduct > Flashcards

Psychosis/Conduct Flashcards

1
Q

Imaging studies in childhood-onset SZ consistently show the following:
(INC or DEC)

__ ventricular volume

__ cerebral gray matter

__ caudate volume

A

INC ventricular volume

DEC cerebral gray matter

INC caudate volume

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2
Q

Is this cold or hot aggression?

  • unplanned aggression
  • overt
  • outcomes negatively viewed
  • accompanying emotions are negative
  • associated with impulsive, mood and substance use disorders
A

HOT aggression (RAPI)

Reactive
Affective
Defensive
Impulsive

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3
Q

Is this cold or hot aggression?

  • planned aggression
  • covert
  • aggression and anticipated outcomes positively viewed
  • think conduct disorder and ASPD
A

COLD aggression (PIP)

Proactive
Instrumental
Planned

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4
Q

What NT has been found to be low in ppl with high levels of aggression/violence?

A

low 5-HT (Serotonin)
also low 5-HIAA in CSF (metabolite of serotonin)

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5
Q

ON imaging you see reduced volume and perfusion of the orbito-frontal lobe and anterior cingulate lobe, what might this person struggle with?

A

increased aggression and violence

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6
Q

Damage to the amygdala may __________ aggression.

DECREASE OR INCREASE

A

DECREASE

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7
Q

What is the most evidence based therapeutic treatment for juvenile offenders, conduct disorder, ODD and juvenile substance abuse disorders?

A

Multisystemic Therapy (MST)

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8
Q

What therapeutic modality has most evidence for treatment of those in foster care?

A

Multidimensional treatment foster care

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9
Q

What is the first line medication tx for IED?

A

Prozac (SSRI/SNRI but that one most supported)

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10
Q

What medication had been found to be effective in reducing urges to steal and stealing in those with kleptomania?

A

Naltrexone (opiate antagonist)

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10
Q

What biological correlate is found in those with pyromania?
LOW OR HIGH

_____ CSF level of 5-HIAA (metabolite of serotonin).

A

Low CSF level of 5-HIAA

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11
Q

Serotonergic abnormalities particularly in the anterior cingulate and orbitofrontal complex are found in what impulse-control disorder?

A

Intermittent explosive disorder

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12
Q

T/F: Hyperactivity of the amygdala is seen in DMDD.

A

True

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13
Q

Children with CD or ODD are found to have biological RF.
LOW OR HIGH
_____ levels of DHEAS (dehydroepiandosterone), related to chronic stress of HPA axia

A

HIGH
—thus will see high levels of cortisone & testosterone

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14
Q

What are the 4 good prognostic features for schizophrreniform disorder?

> 2 needed for specifier w/good prognostic features

w/out good prognostic features has < 2 good features

A
  1. 4 week or shorter prodrome
  2. presence of confusion/perplexity
  3. good pre-morbid function
  4. absence of blunted affect
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15
Q

T/F: Huntington’s chorea, lipid storage disorder and velocardiofacial syndrome can have presence of psychotic symptoms.

A

True

16
Q

No single gene can lead to SZ but what syndrome (due to deletion on 22q11) is associated with inheriting SZ?

A

Velocardiofacial syndrome

17
Q

What 2 chromosomes outside of velocardiofacial syndrome are risk genes for SZ?

A

6 & 13

18
Q

If I have SZ, what is the risk of inheritance that my ______ will get SZ?

  1. first cousin
  2. child
  3. dizygotic twin
  4. monozygotic twin
A
  1. first cousin: 2%
  2. child: 13%
  3. dizygotic twin: 17%
  4. monozygotic twin: 47%
19
Q

Enlargement of which part of the brain is indicative of SZ?

A

enlargement of lateral ventricles

20
Q

Fill in the blanks of the environmental risks for development of Schizophrenia?
A) Birth in the ________
B) _________ infection in mom during pregnancy
C) Obstetric __________
D) Maternal _________ during pregnancy
E) Advanced ______ age
F) Cannabis exposure
G) ____ expressed emotion within the family

A

A) Birth in the winter
B) Flu infection in mom during pregnancy
C) Obstetric complications
D) Maternal major stressor during pregnancy
E) Advanced paternal age
F) Cannabis exposure
G) High expressed emotion within the family

21
Q

In SZ patients, lower levels of _____ are associated with larger ventricular size.

A

HMA (homovanillic acid)
and 5-hydroxyindoleacetic acid (serotonin metabolite)

22
Q

SZ has decrease in total brain volume seen moreso in which 2 lobes?

A

frontal and temporal

23
Q

The PANSS (positive and negative symptom scale) and BPRS (brief psychiatry rating scale) and AIMS are good rating scales to dx which psychiatric disorder?

A

Schizophrenia

24
Q

What are the 4 drugs approved for SZ from 13-17y/o?

What is the one approved for 12-17y/o?

A

13-17: Olanzapine, Quetiapine, Risperidone, Abilify

12-17: Paliperidone

25
Q

What would you be worried about with someone on Antipsychotics who present with fever, elevated enzymes (creatinine phosphokinase, CPK), vitals unstable, encephalopathy and rigidity?

A

NMS

26
Q

What is tx of NMS?

A

stop AP
Dantrolene: antispasticity agents, works through calcium channels
bromocriptine: dopamine agonist

27
Q

What risk is more common from Seroquel in youth than adults?

A

hypertension

28
Q

CYP1A2 Inhibitors—-increase levels of most FGAs and clozapine, olanzapine

A

Cimetidine
Ciprofloxacin
Amiodarone
FLuvoxamine

29
Q

CYP1A2 Inducers—-decrease levels of most FGAs and clozapine

A

carbamezapine
phenytoin
rifampin
smoke

30
Q

CYP2D6 Inhibitors–increase levels of most FGAs and clozapine, olanzapine, risperidone, abilify, ilioperidone

A

Fluoxetine—KNOW
Paroxetine—KNOW
Duloxetine-KNOW
Cimetidine
diphenhydramine

31
Q

What mood stabilizer should be avoided in a patient on Haldol?

A

Lithium 2/2 risk of encephalopathic syndrome

32
Q

What should one worry about if they are on AP and OCP?

A

hyperprolactinemia 2/2 estrogen

33
Q

In patients with SZ, atrophy of the _____ is a prominent brain finding and contributes to the negative symptoms of SZ.

A

hippocampus

34
Q

The Massachusetts Youth Screening Instrument (MAYSI) is a 52-item self-report inventory that is administered to youths entering juvenile detention settings. It identifies mental illness and has been shown to decrease _____ if given in the first 24 hours of entering the facility.

A

suicide attempts

35
Q

The brain MRI scan of a pt with Wilson’s disease is most likely to show what?

A

Hypodense basal ganglia

36
Q

Downregulation of reelin gene during growth of the developing brain can put one at risk for developing what psychiatric disorder?

A

Schizophrenia

Child Psychiatry Boards (12 decks)

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