STARS Flashcards
When is the peak age for bullying?
going INTO and transitioning OUT of middle school
Zero tolerance policies, conflict resolution/peer mediation, group treatment for bullies
school should NOT have these…sends mixed messages about bullying and makes kids less likely to report
Definition anorexia nervosa
restriction leading to clinically significant low weight, intense fear of gaining weight or behavior that interferes with gaining weight, lack of recognition of seirousness of low body weight.
two types: restricting or binge/purging
How to quantify severity of anorexia
BMI
mild 17-18..49
extreme
How is binge eating disorder different from bulima or anorexia?
No regular use of inappropriate compensatory behaviors
Other things to consider on differential when suspecting eating disorder
feeding disorder, inflammatory bowel disease, primary endocrine disorder, diabetes mellitus, Addison’s disease, depression/other psych, malignancy
How to quantify binge eating disorder severity
number of episodes of binge eating per week
mild 1-3
extreme 14
How to quantify bulima nervosa severity
Number of purging episodes weekly
mild 103
severe 14+
Common findings on physical for patient with eating disorder
cortical atrophy, prolonged QTc, sick euthyroid syndrome, Lanugo (fine soft hair), Russell’s sign *damage/calluses on knuckles from self induced vomiting), enamel erosion, parotid hypertrophy
When can ASD be detected?
as early as 18 months, but usually picked up by experienced clinician by 24 months
What is seen in typical infant at 9-12 months that isn’t seen in ASD infants?
Joint attention
Red flags for ASD
no response to name by 12 months, no pointing for interest by 14 months, no pretend play by 18 months, hyper/hypo sensitivity to certain senses
Medications for ASD
target symptom (anxiety, ADHD, etc) but no agent addresses the core features sadly
ASD boys vs girls
5x more common in boys
Concept of immanent justice (preoperational)
belief that a form of natural justice exists, leading to guilt and shame
ex: I got cancer because I didn’t tell my mom the truth
concepts of immanent justice can be abandoned earlier when appropriate explanations are given
Concept of temporal causality (preoperational)
ex: I fell down and that made me get a cough
Concept of contagion applied to things irrelevant to infection (preoperational)
I got cancer from a cold
What Piaget phase does one finally understand two unrelated symptoms can manifest from one condition?
Formal (11+)
Significant risk factor for emotional instability during illness
6 months - 5 years + early adolescence
The time of greatest vulnerability to physical deformity and or disability occurs…?
during early and middle adolescence
What age is a risk factor for pre-operative anxiety?
No Child Left Behind was correlated with a rise in what?
ADHD diagnosis
In elementary school children, what’s the presentation like for ADHD in boys vs girls
boys - tend to have hyperactive presentation
girls - tend to have inattentive presentation
How does ADHD evolve into adolescence?
Physical hyperactivity diminishes, but inattention/impulsivity stay (worse driving habits, accidents, speeding, increased consequences of sexuality, more difficult to gain teen’s cooperation with diagnosis)
What two substances are lethal in withdrawal?
Alcohol - delirium tremens
benzodiazepines - seizures
What is the final common pathway in the acute REINFORCING effects of many abused drugs
dopamine release in nucleus accumbens (VTA dopaminergic projects to nucleus accumbens)
What level of alcohol intoxication can result in coma/death?
> .4
Dangerous withdrawal syndrome; alcohol
delirium tremens, manage with BZDs like lorazepam
3 meds to treat alcohol dependence
- Naltrexone - opiod antagonist, first line drug; DOES reduce cravings
- acamprosate (GABA/NMDA antagonist)
- disulfiram (alcohol sensitizer, causes vomiting if alcohol ingested)
Are benzos lethal?
Not too much in overdose, but when taken with other sedative YES
Most commonly abused illicit drug/gateway drug? ;)
WEEEEEED NIGGA
How does cocaine alter brain’s dopamine receptors?
DOWN regulates the POST synaptic receptors (which don’t recover even over months of abstinence), UP regulates the PRE synaptic transporters….leads to hypodopaminergic state (Parkinsonism)…depressed without drug, and needing the drug more to achieve “normal” levels of dopamine
How do stimulants affect cerebral blood flow?
Abnormally adherent platelets + vasoconstriction = multi infarct dementia
affective/sensory dysregulation (can’t understand complex emotional events, can’t decide quickly to use relapse prevention cognitive skills when craving stimulated)
chronic perfusion defects even after abstinence
Mechanisms of opiates
bind receptors and cause INHIBITION of cAMP production…need only low dose to be agonist = low dependence, weaker withdrawal
Which patients respond best to naltrexone?
- complex and severely dependent patients
- patients with strong family history of alcholism
- patients with OPRM (hypersensitive opioid receptor, A/G allele more responsive)
B-endorphin levels in high risk alcoholic patients
B-endorphin levels are very low in high risk alcoholic patients, so if these guys consume alcohol it raises b-endorphin levels DRAMATICALLy. Naltrexone “normalizes” high risk patients response to alcohol and limits b-endorphin increase from alcohol
Which medications can be used to treat nicotine dependence?
VARENICLINE (partial nicotine agonist) > nicotine replacement therapy and buproprion (limited utility)
selegiline may improve abstinince
Things to take into account in pediatric presentations for mental illness
- children may present with more severe versions of symptoms that are milder in non-referred children (fears, tantrums, restlessness)
- presentations may differ from adult guided DSM crtieria
- childhood depression presents as IRRITABILITY rather than sadness (childhood PTSD is often sub-threshold and doesn’t always involve all criteria)
Implications for education (Vygotsky, socio cultural)
guided participations in which instructions are tailored to the child’s current abilities or cooperative learning exercises where students assist each other
zone of proximal development
gap between what you can do yourself and the skillfull learner
scaffodling
process by which an expert responds contingently to the novice so the novice increases understanding
Match these Erikson stages with their Freud stages
- infancy
- early childhood
- school age
- adolescence
- oral
- anal
- latency
- genital
Stranger anxiety
begins around 8 months, peaks at about 24 months
separation anxiety
begins 6-8 months; peaks 14-18 months
“goodness (or poorness) of fit
idea that development is both molded and optimized when parents’ child rearing practices are sensitively adapted to the child’s characteristics
tries to stay close to mom, but explores very little when she’s present; becomes very distressed when mom leaves and doesn’t calm down even when she’s there, wary of strangers
resistant ambivalent
shows LITTLE distress when separated from mom, ignores mom
avoidant
combo of resistant and avoidant, periods of being dazed/frozen, depressed mothers or abused infants, most associated with psychopathology
disorganized/disoriented
understandable to parents most of the time
2-3 years
understandable to strangers most of the time
3-4 years
Significant speech/language disorders during childhood predispose you to…
learning disabilities/written language disorders, and mental health issues
At 8 years old, self ratings are similar to teachers in all categories except….
behavioral conduct
Recommended TV at young age
2 yo 1-2 hrs per day
migration (neural movement)
occurs prenatally, damage in 2nd trimester = schizophrenia/other disorders
aborization
extension of dendritic arms of cells
pruning
neuronal loss; increases at 2 years old; “use it or lose it”; occurs with myelination to increase info processing
myelination
“insulation” of axons and neurons….cortical and frontal lobes myelinate later = less complex reasoning and less attention in childhood
What happens when there is damage to anterior cingulate gyrus?
decreased maternal behavior, empathy, expressiveness + increased response to stress, inappropriate social behavior, impulsiveness
At what age do you see gender conservation?
3-7 years old
