Recall Set 2 (2023) Flashcards
Question
1. Anxiety
? Selective mutism
what are 3 negative prognostic factors
o psychiatric comorbidity (ex. ASD, MDD)
o medical comorbidity (ex. Epilepsy)
o low IQ
o low SES
o family history
o neuroticism
o shyness
o social isolation
anxiety/SM
- What are 2 developmental delays/disorders that they are at risk for?
o receptive language disorder
o social communication disorder
o specific learning disorder
o childhood onset fluency disorder
Really unwell teen girl. Seizing a lot in ER. History of epilepsy but this is different. Orofacial movements.
* Most likely medical thing?
o NMS
o EPS
o serotonin syndrome
o epilepsy
o infectious cause
o encephalitis
o substance induced
o TBI/stroke
Really unwell teen girl. Seizing a lot in ER. History of epilepsy but this is different. Orofacial movements.
- If she had taken a lot of risperidone, what would this be
o NMS/EPS/Serotonin syndrome related
- What are 3 neuromuscular signs/symptoms of serotonin syndrome
o myoclonus/clonus–spontaneous or inducible
o ocular clonus
o hyper-reflexia
o agitation
o tremor
National Aboriginal Youth Suicide Prevention Strategy – official government document
* What can be done at a primary prevention level
o –increased number of trained gatekeeper in communities (i.e natural helpers, police, social service providers etc)
o –increased networks/social connections by youth
o –increase number of regional/community partnerships in place
o –increased suicide prevention training by local professionals and community members
o –available and accessible information tools, and resources on suicide
o –increased support amongst peers/development of supportive networks
DMDD:
* If someone meets criteria for bipolar disorder and DMDD, which do you diagnose
bipolar trumps DMDD
- If someone meets criteria for ODD and DMDD, which do you diagnose
- If someone meets criteria for IED and DMDD, which do you diagnose
DMDD trumps ODD and IED
Depression
* What do you assess/do in safety planning for SI. 5 things.
o previous attempts
o current SI
o intent, plan
o lethality, access, reasonableness of plan
o access to guns, substances/meds
o what are their supports?
o safety proofing home, planning
o timely follow up
o assess insight and judgment
o psychiatric diagnoses/comorbidities
Depression
* Kid on fluoxetine and CBT. Still has severe depression. What do you do next as per guidelines? What do you do after that?
o optimize med
o –change to another first line SSRI/med
o –trial third line agent like venlafaxine or TCA
o –consider with of therapy to IPT
o –consider ECT/rTMA “with significant caution”
o –augment with another agent
o –reassess diagnosis
o –cite TORDIA study, CANMAT special populations
Disruptive
* Name 5 principles of multisystemic therapy
o –finding the fit (identifying the problems and how they make sense in the context of the persons environment)
o –focusing on positives and strengths (family strengths as well–builds hope, IDs protective factors and decreases frustration)
o –increasing responsibility (promote responsible behavior by family members)
o –present focused, action oriented, and wellbeing defined (dealing with the here and now of a young persons life; tracks progress of treatment; provides clear criteria of success)
o –targeting sequences (what is sustaining the problems)
o –developmentally appropriate (emphasizes the person getting along well with peers, academic and vocational skills)
o –continuous effort (daily or weekly)
o –evaluation and accountability (no labeling of families as resistant, not ready for change, unmotivated–keeps team members accountable for finding ways to get over barriers)
o –generalization (to invest the parents or carers in the ability to address family needs after the intervention is over)
Eating
* Admission criteria for ED pt
o –severe malnutrition (<75% IBW)
o –Medical issues–Dehydration, Electrolyte abnormalities (low K, low Mg, low Phos), Acute complications e.g.pancreatitis, Cardiac dysrhythmias
o –Physiological instability–Bradycardia (<50 bpm daytime, <45bpm overnight), Hypotension (orthostasis or <90mmHG systolic), Hypothermia (<35.5), Orthostatic changes
o –Acute food refusal
o –Arrested growth and development
o –Uncontrollable binging/purging
o –Acute psychiatric emergencies e.g.suicidal attempt
o –Treatment for comorbid condition interfering with ED treatment
o –Failure of outpatient treatment
- ECT – psychotic youth who has failed medical management with catatonia. 5 arguments you would make to tell the family and the patient that it is safe. (not explaining how ECT works)
o –in BC, a second physician assessed for ECT appropriateness/indication/safety
o –two physicians are present for the treatment–psychiatrist and anesthesiologist plus nursing staff
o –we use a muscle relaxant/paralytic
o –general sedation monitored by anesthesia
o –performed in a monitored/surgical setting
o –mortality of anesthesia is higher than the mortality of ECT itself
o –80-90% effective in mood disorder–> getting ECT for a severe mood disorder/catatonia is likely safer than an untreated disorder
o –greatest risks: memory loss, status (which can be aborted with anti seizure meds)
o –most common Session: headache, muscle soreness, nausea, jaw pain
o –safer than suicide
o –use a short acting anesthestic agent
o –use lowest effective stimulus
o –closely monitored afterwards
o –life saving treatment
Elimination—Encopresis
* What % have constipation
o up to 80-90%
- 3 components treatment of encopresis
o –psychoeducation about encopresis
o –Bowel cleansing: Disimpaction, Stool softener
o –Bowel training: Behavior modification
o Sit on the toilet for 10 minutes after meals
o Gastrocolic reflex
o Create habit of using the toilet
o Foot stool (Valsalva ↑ abdominal pressure)
o Rewards
o –encouraging healthy bowel movements i.e dietary changes
o –Parents must understand there is no quick fix, relapses are common
o –Adding biofeedback questionable benefit
- Most likely psych comorbidity with encopresis
o –eneuresis
o –most likely medical is UTIs
Neurodev
* What academic psychological tests can be done on a 6 year old (3)
o California Verbal Learning Test
o Wide Range Assessment of Learning and Memory
o Stanford Binet Intelligence Scale (2+)
o Kauffman Assessment Battery for Children (2-12)
o **WIAT (Weschler individual Achievement Test) (4-19)
o **WISC (Weschler Intelligence Scale for Children) (6-16)
o **Weschler Preschool Primary Scale of Intelligence (2-7)
- What are 3 adaptive functioning domains
o –social
o –conceptual
o –practical
*rank severity based on adaptive functioning
“IQ tests are lousy when you get to the lower end of the scale, and also they are not culturally and linguistically validated”
Neurodev
? LD in reading.
* What to look for on developmental history (3)
o –language and fine motor delays
o –lower school achievement, avoidance of School, school related behavior problems
o –prematurity, very low birth weight
o –prenatal nicotine
o –family history of reading or math disabilities
- What are two building blocks in the skill of reading
o –phoenemic awareness (ability to identify and manipulate individual sounds)
o –phonics (process of systematically mapping the phonemes onto graphemes)
o –vocabulary
o –fluency
o –comprehension
Neurodev-ADHD
4 yo with ADHD
* Non med treatment
o –parent management training
o –psychoeducation
o –school support
o –behavioural approaches
o –skills based programs (social)
o –anger manegemtn and time management
o –relaxation techniques, mindfulness
o –family therapy to prevent scapegoating of the child
o –couples/marital therapy
- Stimulant side effects in 4 year old vs school age (2)
o Preschool children experience higher rates of side effects, especially irritability and moodiness, and, typically, better tolerate smaller doses of stimulant medications [55].
o ?greater impact on sleep and appetite
o ?more likely to reach 12 year threshold for difference in height?
o MORE LIKELY to have side effects like irritability, appetite suppression, activation, headache
o IRRITABILITY and moodiness specifically are likely to be worse in a younger child than an older child according to the Canadian Pediatric Society
- Effects of methylphenidate on 4 year old vs school age
o –there is not HC/FDA approval for mono therapy for stimulants under age 6 due to lack of data for efficacy and safety in this age group
o –8/9 studies supported efficacy of treatment of preschoolers with methylphenidate (AACAP paper) at a dose that is similar and comparable with respect for mg/kg that is used in school age children
o –those with significant developmental delays in preschoolers had more side effects like social withdrawal, irritability and crying
o –preschool group showed higher rate of emotional adverse events, crabiness, irritability, proneness to crying
o –MPH/any stimulant should be titrated more conservatively compared to school age patients and lower doses may be effective
o –preschoolers metabolized MPH MORE SLOWLY compared to school aged children
bonus Q: why is it important to treat ADHD with stimulants if indicated
Outcomes from well-designed, long-term trials to evaluate the effectiveness of stimulants for ADHD are under-researched [16] and, due to publication bias [17], may also be under-reported. Stimulants appear to improve parent-reported quality of life in children being treated for ADHD [18]–[21] and are associated with improved academic achievement and lower rates of comorbid anxiety and depression in young adulthood [22]. However, lasting impact on the core symptoms of ADHD has not been confirmed [23].
Short-term randomized control trials of stimulant use for ADHD have shown that these medications can improve function in multiple domains, including decision-making [21], handwriting [24], and school work productivity [25]. Among adolescents and young adults with ADHD, longer-acting preparations of extended-release (ER) stimulants have demonstrated improved evening driving performance [26]. Population-based observational studies have indicated that stimulant treatment is also associated with better math and reading scores [27], fewer injuries leading to emergency room visits [28][29] and reduced morbidity and mortality related to motor vehicle injuries [30].
Long-term cohort studies following children who were diagnosed in childhood with ADHD into adulthood, compared with children living without ADHD, have documented that individuals with ADHD who continue to experience higher rates of inattention, impulsiveness and hyperactivity than their typical peers will also have greater difficulties with educational and occupational adjustments, risky sexual behaviours, and psychiatric disorders than those for whom core ADHD symptoms diminished over time [31][32].
These studies suggest that when ADHD symptoms persist into young adulthood, there is reason to continue stimulant treatment to address them. Indeed population studies show that stimulant use is associated with better employment outcomes [31][32], and reduced morbidity and mortality related to motor vehicle injuries [30].
