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545 > Week 7 mental health > Flashcards

Week 7 mental health Flashcards

1
Q

AAP recommends anticipatory guidance about discipline at every health visit between ages _____ and _____

A

9 months to 5 years

	○ "How does **** get along with friends and family?" 
	○ "Parents of kids around ***'s age frequently worry about discipline. I wonder if you have any questions or concerns" At age 5: starting discussion on shift towards parental monitoring
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2
Q

DISCIPLINE

time outs

Timer: ___ minutes per ___ of age

A

1 minute per year of age

* Child put in a neutral or boring environment after inappropriate behaviour
* Kids need to understand rules ahead of time and WHY behaviour is unacceptable
* Should use a timer: 1 minute per year of age
* Pick a boring area
* If child acts unacceptably in the middle of time out: reset timer
* Allowed to go to bathroom for one trip, but timer is reset
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3
Q

AUTISM

impairments in:

A
  • social communication

- restrictive, repetitive, stereotypic behaviours/interests

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4
Q

AUTISM

symptoms usually emerge between (age) _______

A

12-24 months old

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5
Q

AUTISM

risk factors

A
  • older parental age
  • preterm birth
  • low birth weight
  • jaundice
  • male
  • maternal obesity, DM, HTN
  • close spacing of pregnancies
  • rubella
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6
Q

AUTISM

when should standardized screening be done?

A

18 and 24 months

CPS recommendation: developmental surveillance at every scheduled health visit (ie well baby check) and any time parent/caregiver raises concerns re: language/skills development
***Ask at EVERY visit if parents have developmental concerns

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7
Q

AUTISM

4 domains of development to assess

ASD shows most significant delays in which 2 domains?

A

fine motor
gross motor
language
social development

ASD:

  • language
  • social development
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8
Q

AUTISM

common behaviours/red flags

A
  • decreased eye contact
  • limited convo/too much (only talk about things that interest them, not other people’s interest)
  • PHYSICAL INTERACTION on their own terms
  • PATTERNS, resist change
  • SOCIALLY insensitive
  • SENSORY processing
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9
Q

AUTISM

what is the major determinant of ultimate outcome?

A

2 years of early intervention before age 5

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10
Q

ADHD

3 domains

A

inattention
hyperactivity
impulsivity

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11
Q

ADHD

risk factors

A
  • family hx
  • in utero ETOH/nicotine exposure
  • extreme preterm birth
  • brain injury/stroke
  • severe early deprivation/neglect, maltreatment
  • comorbid MH
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12
Q

ADHD

symptoms

A
  • selective attention (over-focus on favourite activity)
  • easily distracted
  • inability to complete tasks
  • blurting out/interrupting others
  • social disinhibition
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13
Q

ADHD

symptoms must be present before age _____

must exist in _____ and for at least ______

A

age 12

at least 2 contexts (eg school, home)

at least 6 months

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14
Q

ADHD

rule out co-morbid conditions eg….

A
  • depression (PHQ-9)
  • anxiety (GAD-7)
  • substance (CRAFFT)
  • sleep disorder
  • mania

(SADSM)

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15
Q

ADHD

frequency of visits

A

2-4 visits over 1-2 months until stable

then
q3-4 months

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16
Q

ADHD

first line treatment

A

behaviour modification

eg change physical environment

  • clear boundaries re: behaviour
  • positive reward for target outcome
  • single step instructions
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17
Q

ADHD

first line
psychostimulants

common side effects

A

long acting stimulants

common s/e:

  • decreased appetite
  • abdo pain
  • headache
  • insomnia
  • jitteriness

at higher dose: growth suppression

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18
Q

ADHD psychostimulants

contraindications

A
  • untreated hyperthyroid
  • glaucoma
  • mod to severe HTN
  • pheochromocytoma
  • symptomatic CVS disease
  • hx mania psychosis
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19
Q

ADHD psychostimulants

caution with prescribing

A
  • tics
  • kids <5 or <20 kg
  • substance use disorder
  • renal impairment
  • epilepsy
  • Raynaud’s
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20
Q

ADHD

monitoring while on stimulants

A
  • wt
  • ht
  • BP and HR
  • priaprism
  • developmental milestones
  • Pharmanet
  • ADHD scales

*routine ECG not needed

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21
Q

ACE

3 categories

A
  • abuse (emotional, physical, sexual)
  • neglect (emotional, physical)
  • household dysfunction (domestic violence, incarcerated family member, mental illness, parent separation/divorce, substance/ETOH use)
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22
Q

Define social determinants of health

A

environmental conditions where kids are born, grow, live, play, work and age
• SDOH responsible for most health inequities (WHO)
“the unfair and avoidable difference in health status seen within and between countries”

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23
Q

Substance use during adolescent period of brain development adversely affects wiring of ________ cortex

A

prefrontal

-responsible for executive function (impulse control, attention, organization, planning, mood)

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24
Q

ACE

what is the biologic mechanism that ACE adversely impacts health?

A

excess activation of stress response (toxic stress response)

  • stress response chronically activated
  • no buffers to assure child they are safe
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25
Q

ACE

what are some protective factors?

A

close relationships

  • parental resilience
  • positive parenting
  • social connections
  • concrete support (reliable adult)
  • sense of purpose (faith, culture, identity)
  • individual competencies
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26
Q

ACE

difference between primary and secondary prevention

A

Primary prevention:
-prevent ACEs from happening

Secondary prevention:
-prevent complications

• Primary Prevention: reduce exposure to stressors and create buffers 
	○ Society, neighbourhood, school, family, caregiver, child
	○ Parenting programs
	○ Legal rights for family leave, poverty reduction strategies, neighbourhood safety programs
	○ Reach Out and Read literacy initiative
	○ Promote self regulation in child eg games that help kids make choices (Simon Says, Red Light Green Light)
• Secondary Prevention
	○ Screening for maternal depression, hostile parenting, food insecurity, developmental delays Providing links to community resources
27
Q

PHYSICAL ABUSE

sentinel injury definition

A

minor injury underappreciated by the parent or caretaker –> warning signs of future, more severe abuse
• Eg bruise in pre-mobile infant, subconjunctival hemorrhage, frenulum injury
• Crying or refusal to walk / move extremity

28
Q

PHYSICAL ABUSE

suspicious injuries

A

bruises in soft tissue areas

  • retinal hemorrhages in infants (most often head trauma)
  • damage to oral mucosa
  • long bone fractures
  • circumferential burns
  • fractures to rib/sternum/scapula

Increased index of suspicion:

- changing history or history inconsistent with injuries
- history that does not match developmental capabilities - unwitnessed injury in young kids
29
Q

what is most common trigger for head injuries?

A

crying

prevention: pre-emptive discussion re: challenging developmental stages

30
Q

common causes of labial adhesion

A
  • poor hygiene
  • recurrent vulvovaginitis
  • trauma
31
Q

Most common adverse birth outcome linked to IPV in pregnancy

A

low birth weight

32
Q

US preventative task force recommendation:

-who should be screened for IPV?

A

screen all women of childbearing age

-written self-administered screening more sensitive and preferred

33
Q

Child injuries

unusual areas for accidental injuries

A 
neck
ear
cheeks
medial thighs
genitals
34
Q

components of safety assessment

A
  • ESCALATING violence?
  • SEVERITY of abuse in the past
  • COMFORT with returning home?
  • CHILDREN
  • WEAPONS
  • SUBSTANCE/MENTAL health issues in perpetrator
  • SUPPORT network
35
Q

CRAFFT

how many YES answers suggest serious problem?

A

CAR (passenger or driver under influence)
RELAX (have you ever used substances to relax/feel better about self/fit in)
ALONE (do you use alone)
FORGET (do you ever forget things while using)
FAMILY or FRIENDS (do they tell you to cut down)
TROUBLE (have you ever gotten into trouble while using substances)

2+ YES is a positive screen

36
Q

CRAFFT

brief counselling 5 steps

A
  • REVIEW in detail
  • RECOMMEND not to use
  • RIDING/DRIVING risk counselling
  • RESPONSE: self-motivational statements
  • REINFORCE self-efficacy
37
Q

Phobia

definition

A

Overwhelming, intense, highly specific, and often irrational fears
-DSM criteria: “excessive anxiety accompanied by worry occurring more often than not for at least SIX MONTHS
AND
One or more of the following: restlessness, easy fatiguability, difficulty concentrating, irritability, tense muscles, disturbed sleep

38
Q

Anxiety

definition of anxiety problem vs disorder

A

fear without definable source

anxiety problem: significant but not severe distress

disorder:
-excessive, impairs functioning, lasts longer than 4 weeks

39
Q

ANXIETY

children between ages _____ is in age of anxiety

A

2 to 5 years old

  • strong imaginations
  • fear of medical environment, witches, monsters
40
Q

ANXIETY

pathophysiology
which neurotransmitters are elevated?

what areas of brain implicated in anxiety disorders?

A

GABA
norepinephrine
serotonin

amygdala
prefrontal cortex

41
Q

ANXIETY

what are two strategies parents can use to help kids who are fearful

A
  • do not trivialize fears (validate feelings even if unfounded fears)
  • provide physical comfort, make kids feel safe and secure

others:

  • try to recreate fear (eg noisy kettle) to show it is not scary
  • normalize fears with books about fear
  • empower them to conquer fear
  • create plan to deal with problem should fear actually happen
42
Q

SSRI

common side effects

A 
nausea
sleep: insomnia, sedation
headache
sexual dysfunction
tremor/agitation
appetite change
weight gain
43
Q

SSRI

serotonin syndrome

SHIVERS

A
  • onset: abrupt
  • myoclonus and tremor

SHIVERS

  • shivering
  • hyperreflexia / myoclonus
  • increased temp
  • vital sign instability
  • encephalopathy (delirium, obtunded)
  • restlessness
  • sweating
44
Q

OCD

define:
obsessions
compulsions

A

OBSESSIONS

  • recurrent disturbing, intrusive impulses or images
  • themes: contamination, aggression, taboo, exactness, safety

COMPULSIONS

  • repetitive behaviours/acts in response to obsession or rigid rules
  • reduce distress or prevent dreaded event but not connected to even realistically
    themes: cleaning, arranging, counting, hoarding, repeating activities
45
Q

OCD

criteria for diagnosis

A

-time consuming obsessions and compulsions that impair day to day functioning

over 1 hour/day

46
Q

ANOREXIA

diagnostic criteria

  • refusal
  • fear
  • disturbance/denial
  • amenorrhea
A
  • REFUSAL to maintain weight
  • intense FEAR of gaining weight
  • DISTURBANCE in way body weight/shape is experienced or DENIAL
  • AMENORRHEA x 3 consecutive menstrual cycles
47
Q

BULIMIA

diagnostic criteria
-two features that define episode of binge eating

compensatory behaviour

timeline

A

binge episode:

  • eating in discrete period of time unusual amount of food (compared to other people in similar period of time and similar circumstances)
  • lack of control over eating

compensatory behaviour: vomiting, laxative/diuretics/enema, fasting, exercise

occur on average minimum twice/week for 3 months

48
Q

BULIMIA

example of purging and non-purging compensatory behaviours

A

purging: laxatives, diuretics, enemas
nonpurging: fasting, excessive exercise

49
Q

what is a common co-morbid mental health diagnosis with restricting subtype anorexia?

bulimia?

A

personality disorder

cluster C (avoidant, OC, dependent) = restrictive anorexia

cluster B (narcissistic, histrionic, borderline) = bulimia

50
Q

EATING DISORDERS

SCOFF screening tool

what is a positive screen?

A

over last 3 months:
SICK - do you make yourself sick due to feeling uncomfortably full
-CONTROL - do you feel you have lost control on eating
-ONE STONE - have you recently lost >1 stone (14 lbs - 6.4 kg)
-FAT - do you feel you are too fat
-FOOD - does food dominate your life

positive answer to any question

51
Q

EATING DISORDER

what are some physical signs?

  • VS
  • CVS
  • hair
  • skin
  • ENT
  • Russell
A

VS: orthostatic drops, hypothermia

CVS: murmur (mitral valve), sinus bradycardia

HAIR: dull, thinning

SKIN: carotenemia, dry and sallow, lanugo

ENT: sialoadenitis (parotitis), angular stomatitis, oral ulcerations, dental enamel erosions

Russell sign: callous on knuckles from self-induced emesis

52
Q

EATING DISORDER

labwork

A 
○ ECG
		○ CBC
		○ Electrolytes
		○ Glucose
		○ Calcium
		○ MgSo4
		○ Phosphate
		○ TSH
		○ LFTs
		○ BUN, creatinine
		○ UA
53
Q

EATING DISORDER

-indications for hospitalizations in youth
weight:
HR:
orthostatic changes:
SBP:
CVS:
GI:

A

weight: <75% ideal body weight or ongoing weight loss
- body fat <10%

HR: <50 bpm daytime, <45 bpm nighttime

Orthostatic: HR increase >20 bpm or >10-20 mmHG drop in BP

SBP <90

CVS: cardiac arrhythmias, syncope

GI: intractable vomiting, hematemesis, dehydration

54
Q

EATING DISORDERS

chronic medical conditions associated with eating disorders

A
  • type 1 DM
  • IBD (Crohn’s, ulcerative colitis)
  • celiac
  • cystic fibrosis
  • illnesses requiring long term steroids
55
Q

EATING DISORDERS

what is the best way to assess risk in children and adolescents?

A

plot ht and wt on growth chart (compare previous measurements)

56
Q

EATING DISORDERS

most common cause of death?
most common medical cause?

A

suicide is most common cause of death for anorexia and bulimia
-highest mortality of any mental illness

medical cause: cardiac arrhythmias from electrolyte disturbance

57
Q

TICS

definition

A

brief, abrupt non-purposeful movement

-repetitive, involuntary, can be suppressed

58
Q

TICS

risk factors

A

OCD
self-conscious shy children
family hx
PANDAS

59
Q

TICS

characteristics

A

repetitive movement

  • worsened by stress and emotions
  • brief premonition indescribable and uncomfortable, relieved by tic
60
Q

TOURETTE SYNDROME

diagnostic criteria

A

multiple motor and vocal tics variably manifested over time

present for >1 year

onset before age 21

not caused by another condition

61
Q

TICS

first line pharmacotherapy and drug class?

A

clonidine

alpha adrenergic agonist
alternative: guanfacine

62
Q

are long-acting stimulants contraindicated in kids with Tourette’s?

A

no, not all patients with TS will have worsening tics

63
Q

FASD

diagnostic criteria (3 domains)

A

facial features (all 3)

  • short palpebral fissure
  • smooth philtrum
  • thin upper lip

Growth delay
-height or weight at 10th percentile or less

CNS abnormality

  • structural
  • neuro (eg seizure, motor delay)
  • functional (eg cognitive, developmental, social, sensory etc)

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