RUMINATION, PICA, ANXIETY DISORDERS, OCD & PTSD Flashcards
What is rumination disorder?
Rumination disorder is the repeated regurgitation of food, which may be rechewed, reswallowed, or spit out, for at least 1 month following a period of normal functioning. It is not caused by a gastrointestinal illness or other medical conditions.
What is the typical age of onset for rumination disorder in infants?
Rumination disorder in infants typically appears in the first year of life, generally between ages 3 and 12 months.
What are common complications of rumination disorder in infants?
Complications include growth delay, malnutrition, and negative effects on development and learning potential.
What are risk factors for rumination disorder in adolescents?
Risk factors include early childhood issues such as a disturbed relationship with primary caregivers, neglect, stressful life situations, and comorbid anxiety and depression.
What are some conditions in the differential diagnosis for rumination disorder?
Differential diagnoses include gastrointestinal system anomalies, pyloric stenosis, Sandifer syndrome, gastroparesis, hiatal hernia, increased intracranial pressure, diencephalic tumors, adrenal insufficiency, and inborn errors of metabolism.
What is the first step in treating rumination disorder?
The first step is a behavioral analysis to determine whether the disorder serves a self-stimulation purpose and/or is socially motivated.
What are some effective treatments for rumination disorder?
Effective treatments include reinforcing correct eating behavior, diaphragmatic breathing, postprandial gum chewing, and aversive conditioning techniques such as withdrawal of attention.
What is pica?
Pica is the persistent eating of nonnutritive, nonfood substances (e.g., paper, soap, clay, paint) for at least 1 month.
What is the suggested minimum age for diagnosing pica?
The suggested minimum age for diagnosing pica is 2 years, as it is inappropriate to the developmental level.
What are common substances ingested by individuals with pica?
Common substances ingested include paper, soap, plaster, charcoal, clay, wool, ashes, and paint.
What is the most common age group affected by pica?
Pica most frequently occurs in childhood.
Which group is pica more common in?
Pica is more common in individuals with intellectual disabilities and autism spectrum disorders.
What are some risks associated with pica?
Risks include lead poisoning, iron-deficiency anemia, mechanical bowel problems, intestinal obstruction, perforations, dental injury, and parasitic infections.
What are some proposed causes of pica?
Proposed causes include nutritional deficiencies, low socioeconomic factors, child abuse, family disorganization, mental disorders, and learned behavior.
What is the differential diagnosis for pica?
The differential diagnosis includes anorexia nervosa, factitious disorder, and nonsuicidal self-injury.
What are the main components of treatment for pica?
Treatment typically includes a combination of behavioral, social, and medical approaches, such as applied behavioral analysis, and addressing any underlying medical conditions like lead toxicity.
How can pica be treated in individuals with intellectual disabilities or autism spectrum disorders?
Behavioral interventions, particularly applied behavioral analysis, have been shown to be helpful in treating pica in these individuals.
What are some consequences of ingesting nonfood substances in pica?
Consequences can include lead toxicity, iron-deficiency anemia, parasitic infections, and, in some cases, require surgical intervention for a gastric bezoar.
What is the difference between normal anxiety and pathological anxiety?
“Normal anxiety can be adaptive and is a response to life-threatening situations. Pathological anxiety becomes disabling
What is the median age of onset for anxiety disorders?
“The median age of onset for anxiety disorders is 11 years.”
What factors contribute to the development of anxiety disorders?
“Genetic or temperamental factors contribute to some anxiety disorders
What are common physical manifestations of anxiety?
“Common physical manifestations of anxiety include weight loss
What is the typical onset age for obsessive-compulsive disorder (OCD)?
“OCD typically has its onset in the mid–school-aged years.”
What is the relationship between parental anxiety disorder and offspring?
“Parental anxiety disorder is associated with an increased risk of anxiety disorders in offspring.”
What are the key symptoms that distinguish major depressive disorder from anxiety disorders?
“Fatigue
How is anxiety commonly distinguished from obsessive-compulsive disorder (OCD)?
“OCD involves ritualistic
How is posttraumatic stress disorder (PTSD) differentiated from general anxiety disorders?
“PTSD involves anxiety specifically in response to psychological trauma
What are the DSM-5 criteria for diagnosing a specific phobia?
“A specific phobia is diagnosed when there is marked fear or anxiety about a specific object or situation
What are the core diagnostic features of obsessive-compulsive disorder (OCD)?
“OCD is characterized by recurrent
How is social anxiety disorder (social phobia) diagnosed according to DSM-5?
“Social anxiety disorder is diagnosed when there is marked fear of social situations due to the fear of being negatively evaluated
What are the key diagnostic criteria for generalized anxiety disorder?
“Generalized anxiety disorder is characterized by excessive anxiety and worry lasting for at least 6 months
What is the DSM-5 criteria for panic disorder?
“Panic disorder is diagnosed when there are recurrent
What is the clinical presentation of panic disorder?
“Panic disorder is marked by abrupt surges of intense fear
Which medical conditions can mimic the symptoms of anxiety disorders?
“Medical conditions such as cardiac disease
What environmental factors contribute to the development of separation anxiety disorder and PTSD?
“Environmental factors such as parent-infant attachment and exposure to trauma contribute more to the development of separation anxiety disorder and PTSD.”
What is the role of behavioral inhibition in anxiety disorders?
“Behavioral inhibition
What are common comorbid mental disorders with anxiety disorders?
“Common comorbid mental disorders include major depressive disorder
What is the diagnostic criterion for panic attacks?
“A panic attack is characterized by a sudden surge of intense fear or discomfort
What is the significance of insight in OCD diagnosis?
“In OCD
How does social anxiety manifest in children?
“In children
How are specific phobias classified?
“Specific phobias are classified based on the phobic stimulus: animals
What are common behaviors in individuals with obsessive-compulsive disorder (OCD)?
“Common behaviors in OCD include handwashing
Which medical tests should be considered when anxiety symptoms overlap with somatic disorders?
“Tests such as electrocardiograms for cardiac disease
What is the recommendation for routine screening of children and adolescents for anxiety disorders?
“There is no recommendation for routine screening of children and adolescents for anxiety disorders.”
Which screening instruments can be used to identify anxiety concerns in primary care and school settings?
“Freely available general screening instruments such as the Pediatric Symptom Checklist and Strengths and Difficulties Questionnaire can be used to identify anxiety concerns.”
Which anxiety rating scales are commonly used?
“Commonly used anxiety rating scales include the Screen for Child Anxiety Related Emotional Disorders (SCARED)
What methods are used to identify symptoms of anxiety?
“Symptoms of anxiety are typically identified through the clinical interview by asking questions about ‘worries
What should be considered when distinguishing normal anxiety from pathological anxiety?
“It is important to clarify when the symptom severity reaches the point of being pathologic and differentiate between the subtypes as per the DSM-5 criteria.”
What is the role of Cognitive-Behavioral Therapy (CBT) in treating anxiety?
“CBT targets the cognitions
Who is CBT specifically recommended for in the treatment of anxiety?
“CBT is specifically recommended to patients 6-18 years old with social anxiety
Which DSM-5 diagnostic criteria are used to diagnose agoraphobia?
“DSM-5 criteria for agoraphobia include marked fear of two or more situations like using public transportation
What is required for the diagnosis of agoraphobia in relation to fear and anxiety?
“The fear or anxiety must be out of proportion to the actual danger and cause clinically significant distress or impairment in functioning.”
What are the DSM-5 diagnostic criteria for posttraumatic stress disorder (PTSD)?
“The criteria include exposure to a traumatic event
How are PTSD symptoms different in children 6 years and younger?
“For children under 6
What are the specific dissociative symptoms of PTSD in children?
“The dissociative symptoms of PTSD in children can include depersonalization (feeling detached from oneself) or derealization (feeling that the world around them is unreal or distorted).”
What is the duration required for the diagnosis of PTSD?
“The symptoms must last for more than 1 month for a diagnosis of PTSD.”
What is the significance of dissociative symptoms in PTSD diagnosis?
“Dissociative symptoms such as depersonalization and derealization are considered in the diagnosis if they are persistent or recurrent and are not attributable to the effects of a substance or other medical conditions.”
How is PTSD with delayed expression characterized?
“PTSD with delayed expression is diagnosed when full criteria are met at least 6 months after the traumatic event
What is the differential diagnosis for anxiety disorders under the ‘general’ category?
Shyness
What are some psychiatric causes of anxiety disorders?
Substance use (including caffeine), substance use withdrawal, body dysmorphic disorder, ADHD, ASD, MDD, bipolar disorder, delusional disorder, learning disorders, ODD
What medical conditions can cause anxiety disorders?
Antihistamines, bronchodilators, nasal decongestants, steroids, dietary supplements, stimulants, hyperthyroidism, allergic reactions, asthma, cardiac conditions, autoimmune encephalitis, chronic pain, headaches, CNS disease, diabetes, dysmenorrhea, lead intoxication, hypoglycemia, hypoxia, pheochromocytoma, mast cell disorders, carcinoid syndrome, hereditary angioedema, systemic lupus erythematosus
What are common psychiatric comorbidities of anxiety disorders?
Depression, ADHD, bipolar disorder, eating disorders, learning disorders, language disorders, substance-related disorders
What are common medical comorbidities of anxiety disorders?
Somatic symptoms, headaches, GI disorders, asthma, allergies
What therapy has the most evidence for treating PTSD?
Trauma-focused cognitive-behavioral therapy (TF-CBT)
Why is trauma-focused CBT preferred for PTSD treatment?
It amplifies stress management techniques and prepares the patient for exposure-based interventions, aiming for mastery over trauma triggers.
What are the SSRIs commonly used for anxiety treatment?
Citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, vilazodone
Are SSRIs FDA-approved for anxiety in children?
No, SSRIs are not FDA-approved for anxiety in children.
What are some side effects of SSRIs?
Xerostomia, gastrointestinal upset, headache, somnolence or insomnia, dizziness, fatigue, changes in appetite
What is the first-line treatment for PTSD in children?
Trauma-focused CBT (TF-CBT)
What medication is FDA-approved for treating generalized anxiety disorder in children ages 7-17?
Duloxetine
Which SNRIs are used for anxiety disorders?
Duloxetine, venlafaxine, desvenlafaxine
What are the side effects of duloxetine?
Xerostomia, diaphoresis, abdominal discomfort, gastrointestinal distress, headache, tremor, sedation or insomnia, decreased appetite, weight loss
Which α-agonists can be used for PTSD?
Clonidine, guanfacine
What is the first-line pharmacological treatment for OCD?
SSRIs such as sertraline or fluoxetine
When should fluvoxamine or clomipramine be considered for OCD treatment?
When a patient has failed two or more SSRI trials
What nonpharmacologic treatment is important for OCD?
Habit reversal training
What condition is often associated with abrupt-onset OCD?
Pediatric acute-onset neuropsychiatric syndrome (PANS)
What infections can trigger pediatric acute-onset neuropsychiatric syndrome (PANS)?
Streptococcal infections, among others
What is required to diagnose pediatric acute-onset neuropsychiatric syndrome (PANS)?
Abrupt onset of OCD with additional psychiatric symptoms, and ruling out neurologic or medical disorders
How should PANS be evaluated?
MRI, EEG, and autoimmune encephalitis antibody testing
What are the components of PANS treatment?
Psychotherapeutic, antimicrobial, and immunomodulatory treatments
How are specific phobias typically treated?
Exposure response prevention therapies and premedicating with a β blocker before exposure
Is β blocker premedication recommended for needle phobia?
No, it is not recommended due to the risk of exacerbating the vasovagal response.
What is the diagnostic criterion for PANS related to OCD?
Abrupt, dramatic onset of obsessive-compulsive disorder or severely restricted food intake.
What are some neuropsychiatric symptoms of PANS?
Anxiety, emotional lability, irritability, regression, deterioration in school performance, sensory or motor abnormalities, somatic signs like sleep disturbances and enuresis.
What is required to rule out in the diagnosis of PANS?
Other known neurologic or medical disorders like Sydenham chorea, systemic lupus erythematosus, Tourette disorder, autoimmune encephalitis.
