Week 11 Developmental Disabilities and Pediatric/Adolescent Mental Health Flashcards
1
Q
adolescent depression is higher:
A
- females
- by age 14, it is 2x in girl
- having depressed parents have 3x the risk
- peak 15-20 yrs
2
Q
what framework gathers info about young person’s life and aids in gathering history:
A
- HEADSS
- Home
- Education, employment, eating, exercise
- Activities and peer relationships, social media
- Drug use, prescribed meds, cigarettes, vaping, alcohol and other drugs
- Sexuality and gender
- suicide, self harm, safety, and spirituality
3
Q
when to start MDD screening in adolescents? what tools?
A
- ALL adolescents beginning age 12-18
- pediatric symptoms checklist (PSC) - 4 yrs to 18 yrs
- Beck Depression inventory - adolescents
- PHQ-2 (if > 3, do PHQ-9) - 6 yrs and up
- CDRS-R
4
Q
depression in adolescents vs adult
A
- adolescents: don’t admit to “feeling sad” but have mood swings, irritability, short tempered, temper tantrum, social w/drawal, somatic complaints
- toddlers: lack energy, too eager to please others, clingy
5
Q
depression diagnosis criteria
A
- _>_5 symptoms below AND depressed mood or anhedonia x 2 weeks:
- SIGECAPS:
- Sleep changes/insomnia
- Interest (loss) - anhedonia, hopelessness
- guilt, worthlessness
- energy loss, fatigue
-
concentration/cognition (decreased)
- school/hw
-
appetite (changes)
- increase/weight gain
- psychomotor (agitation/retardation)
- suicide
6
Q
Management for adolescents with depression
A
- Cognitive behavioral therapy
- mild: CBT. if no response in 6-8 weeks, meds!
- complex: CBT + SSRI (1st line) [or SNRI/citalopram]
- fluoxetine (Prozac) for > 8 yrs
- escitalopram (Lexapro) > 12 yrs citalopram (Celexa) and sertraline (Zoloft)
- always CBT with meds (never alone)
- always assess suicide risk
- r/o underlying causes (CBC, TSH, CMP, B12, Folate)
7
Q
avoid what medication as treatment for adolescent depression?
A
- paroxetine (Paxil)
- a/s with increased suicide ideation
- TCA’s (-tyline/nortripyline) = no benefit either
8
Q
follow up interval for SSRI in adolescent
A
- EVERY week x 4 weeks, then every other for at least 2 visits
- again 12 wks later
-
Once remission of sx’s, f/u every 3 months
- continue meds for 6-12 months after remission WITH CBT
- always screen for SI/recurrent depression & document
- if stop meds, taper slowly over 1-2 months
9
Q
why follow up so quickly for adolescents on SSRI’s?
A
- slight increase in suicidal ideation when starting SSRI educate to look out for it
10
Q
if SSRI not helping adolescent depression and you maxed out the dose…
A
- switch to another SSRI!
- if 2nd SSRI no work → refer to psychiatrist (they will switch to another class, venlafaxine or bupropion)
11
Q
General screening q’s for youths about nutrition and body dissatisfaction
ask this T/F question for diabetic youths
A
- how do you feel about your weight?
- how much do you like to weigh?
- do you, ur friends, or ur fam have any concerns about your eating, exercise, or weight?
- “I sometimes take LESS INSULIN than I should”
12
Q
purging behavior (bulimia) can lead to
A
- loss of gastric acid
- hypokalemic hypochloremic
- metabolic alkalosis
- laxative abuse → hypokalemia
13
Q
DSM 5 diagnosis of ADHD
A
- < 17 yrs old:
- need 6 or more hyperactivity/impulsivity sx’s
- OR 6 or more of inattention sx’s
- > 17 yrs old, need 5 or more
- sx must:
- occur often, in 2 or more settings for at least > 6 months
- present before 12 months, impair work, school, home, severe
- inattention sx’s:
- fails to pay attention/careless mistakes
- difficulty paying attention
- doesn’t listen
- avoids tasks that require sustained mental effort
- loses things to complete tasks
- easily distracted
- often forgetful in daily activities
- hyperactivity/impulsivity sx’s:
- fidgets /squirms
- leaves seat when needed to be seated
- runs/climbs when inappropriate
- trouble playing quietly
- always on “go”
- talks excessively
- answers q’s before q is completed
- difficulty waiting for his or her turn
- interrups/intrudes others
14
Q
ADHD scales/screening
A
- Vanderbilt ADHD
- ADHD rating scale IV
- Connor Parent & Teacher rating scale
- Child attention profile
- CDC checklist
15
Q
types of ADHD
A
- primary inattentive (6 or more positive behaviors in inattentiveness category)
- primary hyperactive/impulsive (^)
- combined type (6 or more positive in each category)
ADD term no longer used
16
Q
ADHD treatment plan
A
- identify comorbid conditions & treat
- hearing/vision screening
- tutoring
- behavior management plan
- identify specific goals (2-3 behaviors)
- reward system for meeting goals
- online resources AAP, CDC< CHADD
- medication - stimulants + CBT
- NO meds for preschoolers unless severe/refractory to CBT
17
Q
challenges in diagnosing and treating ADHD in adults
A
- comorbidities (anxiety, depression, drug use)
- refer mental health
- childhood symptom recall (sx’ before age 7?)
- mostly primary inattentive bc not disruptive
- behavior scales
- ASRS scale with 18 behaviors, need to be in 2 settings
- tx difficult bc CVD, abuse,
18
Q
meds for ADHD
A
SNRI - Atomoxetine (Strattera) non stimulant
methylphenidate
19
Q
Down syndrome features
A
- most common: hypotonia (poor muscle tone) & short stature
- microcephaly
- flattened midface
- brachycephaly (flattened occiput), round face
- up slanting palpebral fissures “almond eyes”
- epicentral folds (vertical folds of skin b/t medial acanthi and bridge)
- brush field spots
- protruding tongue
- macroglossia
- short neck, skin folds
- broad shortened hands
- clinodactyly of little finger
- transverse palmar crease
- sandal toe deformity (inc spacing b/t 1st and 2nd toe)
20
Q
Causes and variations of Down syndrome
A
- nondisjunction of 21st chromosome [most common]
- translocation
- mosaicism
- increasing in rates and affects all racial/socio levels
21
Q
Down syndrome evaluation before discharge
A
- ECHO! (50% have congenital heart defects) even with no murmur
- TSH
- hearing screening
- CBC (hem abnormalities, myeloproliferative disorder, leukemia reaction, polycythemia)
22
Q
Down syndrome screening
A
- ECHO
- CBC
screen for:
- congenital heart disease
- childhood leukemia
- thyroid disease (hypo/hyper)
- autoimmune dz (celiac, diabetes, dermatological)
- seizure disorders
- decrease hearing/vision
- autism; behavior problems
- Atlantoaxial subluxation
- sleep apnea (eval by age 4)
- other:
- otitis media
- bronchitis
- GI illnesses
23
Q
what tendencies do Down syndrome have that’s normal?
A
- the “Groove” / OCD tendencies
- self talk / imaginary friends (esp when stressed)
24
Q
neuropsychiatric disorders in down syndrome and what to exclude?
A
- depression
- Alzheimer disease (1 gene of Alz on 21st chromosome)
- anxiety disorders
- compulsive disorders
- autism
- ADHD
- exclude treatable medical conditions:
- obstructive sleep apnea
- hypothyroidism
- celiac sprue
- atlantoaxial subluxation → behavioral changes
25
Q
screenings for adults with down syndrome
A
Screen TSH annually/yearly!
- testicular, ovarian, cervical, breast (routine), colon, leukemia (but would have found as child)
- celiac screen in children, not adults
- echo if haven’t already
- ophthalmologic and hearing q 2 years
- sleep study for OSA using polysomnography by age 4 (not routine)
- karyotype is used for diagnosis
26
Q
PE of Down syndrome that warrant special attention
A
- obesity
- HEENT: cerumen impact, hearing impairment, chronic sinusitis, allergies, reflux, cataracts, keratoconus, vision impair, airway compromise
- thyromegaly, thyroid nodules, atlantoaxial subluxation
- pneumonia
- murmur, cardiomegaly, cyanosis
- testicular masses, cryptochordism, Pap screen
- arthritic changes, hallux valgus (bony deformity on 1st MTP)
- cervical cord compression, nerve root compression, vertebrobasilar insufficiency, motor weakness, ankle conus
27
Q
dysthymic disorder criteria
A
- category of depression
- depressed mood for most days for at least 2 years
-
must not have gone more than 2 months w/o 2 or more of:
- poor appetite or over eating
- insomnia
- low energy
- low self esteem
- poor concentration
- difficulty making decisions
- feelings of hopelessness
45
Q
how is Fragile X inherited
A
-
X linked dominant inheritance (FMR1 gene mutation)
- females have XX
- milder sx’s bc have 2 X’s to compensate
- males have XY
- more sx’s
- females have XX
- 2nd common after Down syndrome
- women: 50% passing chance (carrier or syndromic)
- carrier men:
- pass premutation to ALL daughters (carriers only), none to sons
47
Q
Fragile X clinical findings
A
- (think elephant)
- prominent forehead & jaw
- long ears
- long narrow face
- epicanthal folds
- high arched palate
- increased head circumference
- large testes (macroorchidism)
- club foot/ples planus, hip dislocation, scoliosis
- OSA
- follow age appropriate health promo per AAP Bright futures
49
Q
Turner syndrome sx’s
A
- most common: short stature
- loss of ovarian function/immature ovaries/infertility
- no puberty
- heart defects
- webbing of neck (NB)
- lymphedema of hands/feet
- MOST INFERTILE
- normal IQ
52
Q
klinefelter syndrome sx’s
A
- tall with long arms
- reduced facial/body hair
- gynecomastia/boobies
- small testes
- less facial hair
- narrow shoulders, wider hips
- osteoporosis/weak bones
- infertility
- metabolic syndrome
- cryptocordism / undescended tests
- normal IQ but language/learning problem
55
Q
Marfan’s syndrome features
A
-
cardiac - monitor ~
- aortic root dilation
- Mitral valve prolapse, regurgitation
- tall, long limbs
- pectus deformities (pigeon)
- joint hyperextensibilities
- eyes: ectopic lentis, myopia, retinal detachment, esotropia/strabismus
- spontaneous pneumothorax
- normal IQ
