Recall Set 1 (unknown year w answers) Flashcards
Question stem was about anxiety, possibly selective mutism.
What are 3 negative prognostic factors?
no answer in recall documents
reviewing slides poor prognostic indicators include:
1. comorbid anxiety with other psychiatric disorders, like MDD–> poorer treatment outcomes
- family or personal history of anxiety or mood disorders–> more recurrent course, greater impairment, greater service use
- co-morbid medical condition–> worse outcomes for both medical and anxiety conditions
- ?lower educational attainment?
- ?adverse parenting experiences?
- ?low IQ?
Per slides: “longitudinally, comorbid depression is the best predictor of poor response”
Question stem was about anxiety, possibly selective mutism.
what are 2 developmental delays/disorders that they are at risk for?
no answer in the recall documents
reviewing the slides, they may be at risk of:
(not sure how the question was worded–is it that they may already have this disorder? or that they might develop this disorder?)
social communication disorder?
ASD?
specific learning disability?
Untreated childhood anxiety predisposes adolescents to:
Further anxiety disorders
Depression
Substance abuse esp. alcohol /marijuana
More severe social & academic impairment
list 5 criteria that are different for MDD vs grief
grief MAY INCLUDE:
-feelings of intense sadness
-rumination about the loss
-insomnia
-poor appetite
-weight loss
*predominant affect in grief is EMPTINESS and LOSS
-dysphoria likely DECREASES IN INTENSITY over days to weeks and occurs in WAVES, which tend to be associated with thoughts or reminders of the deceased
-pain of grief may also have positive emotions and humor
-thought content: thoughts, memories of the deceased
-self esteem: preserved usually in grief (may have feelings of guilt around perceived failings related to the deceased)
-thoughts about death and dying: usually thoughts about “joining” the deceased
consider individuals history and cultural context of grief expression
in MDD:
*predominant affect is PERSISTENT DEPRESSED MOOD and ANHEDONIA
-dysphoria is persisent and not tied to specific thoughts or preoccupations
-unlikely to have positive emotions and humor like you might have in grief
-thought content: self critical, pessimistic
-self esteem: feelings of worthlessness, self loathing
-thoughts about death and dying: focused around ending ones own life because of feeling worthless etc
so 5 criteria might be differences in:
1. thought content
2. self esteem
3. mood quality
4. thoughts around death and dying
5. time course (i.e waves of grief vs persistent dysphoria)
6. presence/absence of humor/positive emotions
what structural brain abnormalities are seen in those with ADHD
- reduced brain volumes–> posterior inferior vermis of cerebellum, cerebellar vermis, splenium, total cerebral volume, right cerebellum, left cerebellum, caudate
- NIMH MRI studies showed global cortical maturational delay for both surface area and thickness relative to controls
- less cortical surface area at entry to the NIMH study and reached peak surface area 2 years later than controls especially on right side
- pruned later than controls –> decreased pruning was associated with remission of ADHD sx in adulthood
- ?abnormalities in volume and activity in the prefrontal cortex, cerebellum, basal ganglia
what fMRI abnormalities are seen in those with ADHD
- reduced activation in response to inhibition tasks–> right IFC, supplemental motor area, ACC, striato-thalamic
- reduced activation in attention tasks–> right DLPFC, posterior basal ganglia, thalamic and parietal regions
- MPH tx enhanced right IFC/insula activation
- default mode network (“daydream circuitry”) may not be turned off effectively during attention tasks in people with ADHD
- ventral striatal HYPOresponsiveness and diminished dopamine release during reward anticipation
- abnormally increased limbic system influence on cortical functions (?amygdala activity)
You are prescribing fluoxetine and Risperidone together, what are possible side effects and how are pharmokinetics changed?
fluoxetine–> inhibits 2D6 and 3A4
risperidone–> metabolized by 2D6
thus, fluoxetine will increase risperidone levels and increase side effects associated with risperidone (i.e prolactinemia, sedation, EPS, weight gain)
4 yo with ADHD, would you prescribe medication and what would be the side effects? How different would your approach be for school aged-children?
CADDRA–> “you should only use meds in kids under 6 by the recommendation of a specialist”
one study showed smaller effect sizes in kids aged 3-5.5 compared to kids aged 7-9
with 4 year olds, try environmental and behavioural techniques prior to meds–> parent management training?
–> however in school aged you might implement this at the same time
side effects should be the same: delayed sleep phase syndrome, appetite suppression, height suppression (2cm if used continuously for 12 years), headache, nausea, anxiety, irritability
Name 3 medical indications for hospitalization for Anorexia Nervosa
less than 75%/85% of ideal body weight
HR below 40 or 50 bpm during the day (depending on guidelines), less than 45 at night
BP less than 80/55
orthostatic changes of more than 20bpm rise in HR, more than 10mmHG drop in BP
temp less than 36 celsius
electrolyte disturbances in K, Mg, phosphate
acute weight decline with food refusal, even if not below 85% of IBW
What are the physical finding and lab findings if you are suspecting NMS?
o 2 lab abnormalities and 2 signs on physical exam
Lab:
–increased CK
–metabolic acidosis
–electrolyte disturbances including K, Mg, Ca
physical exam:
–rigidity
–tachycardia
–hyperthermia
–autonomic dysfunction
–altered LOC
treatment:
consider ECT
consider dantrolene muscle relaxant
consider bromocriptine dopamine agonist or amantadine
What are phases of FBT for Anorexia?
3 phases
- weight restoration
–> focused on eating disorder symptoms and includes family meals
–> empower parents during meals - handing control over eating back to the adolescent
–> begins when the teen has agreed to the demands of the parents to increase their food intake and there is a positive change in the mood of the family
–> focus on ED sx is maintained
–> all other issues the family has had to postpone during the first phase can now be brought out for review - discussion of adolescent development
–> begins when teen has achieved and maintained a healthy weight and self-starvation has abated
–> central to this phase is the establishment of health relationship between teen and parents that isn’t revolving around illness
–> adolescent development issues are now brought forward for review
3 evidence based therapies in mild MDD
behavioural activation
CBT
IPT
exercise
Kid trying to be perfect and is seeking reassurance, what are school-based interventions for GAD?
-promote swift return to school at earliest signs of refusal
-psychoeducation
-ensure appropriate limits and do not reinforce maladaptive behavior (ie school refusal)
School accommodations
-individualized, examples:
-performance or test anxiety?testing in a private quiet room
-if anxiety interferes with HW completion??length of HW to meet child’s capacity
-if anxiety is overwhelming at school?identify an adult outside the classroom that can assist with
anxiety management
What are 3 comorbidities with reading disorder?
Other learning disorders (math, written expression), language disorders, ADHD, ODD, CD, depressive disorders
What are 3 symptoms of reading disorder?
An impairment of word reading accuracy, reading rate or fluency, or reading comprehension.
5 symptoms of Reactive Attachment Disorder?
DSM:
A. A consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers, manifested by both of the following:
1. The child rarely or minimally seeks comfort when distressed.
2. The child rarely or minimally responds to comfort when distressed.
B. A persistent social and emotional disturbance characterized by at least two of the following:
1. Minimal social and emotional responsiveness to others.
2. Limited positive affect
3. Episodes of unexplained irritability, sadness, or fearfulness that are evidence even during nonthreatening interactions with adult caregivers.
