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90 Cards in this Set
- Front
- Back
Approximately what % of adolescents have attempted suicide at least once in their lives?
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9%
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Has the adolescent suicide rate increased or decreased or remained the same in the past few decades?
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Substantially increased.
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What is the MC method by which adolescents DIE by suicide?
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- firearms
- drug overdose is the MC method of suicide ATTEMPTS, but accounts for fewer completed suicides |
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What stages of sleep does episodes of sleep terror and sleepwalking occur?
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3 and 4
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What is the first-line agent for MDD in children and adolescents?
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Fluoxetine (Prozac) is FDA approved for children ages 8-18y.o.
Sertraline [Zoloft] is a first-line agent for MDD in children and adolescents. |
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What kind of therapy is bulumia nervosa most effectively treated with?
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Cognitive-behavioral therapy (CBT) is the most effective type of therapy for Bulimia Nervosa.
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What are Sxs of expressive language disorder?
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- markedly limited vocabulary
- making errors in tense - having difficulty recalling words or producing sentences with developmentally appropriate length or complexity |
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What kind of test would be most helpful in confirming a Dx of expressive language disorder?
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An IQ test would be helpful b/c a Dx of MR must be R/O.
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What is rumination disorder?
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- repeated regurgitation and rechewing of food
- at least 1 month following a period of nL functioning - often seen in infants with a variety of caretakers in an unstable environment - can see drooling - lack of weight gain can also be seen if baby does not reswallow the milk/food |
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What kind of test would be most helpful in confirming a Dx of rumination disorder?
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An esophageal pH measurement so that esophageal reflux can be R/O.
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What is reactive attachment disorder of infancy or early childhood?
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- social circumstances have prevented the child from forming a normal reciprocal attachment to a caregiver resulting in abnL behavior
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What are the 2 types of reactive attachment disorder of infancy or early childhood?
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1. inhibited type
- the child is withdrawn and unresponsive (like Spitz's orphanage children) 2. disinhibited type - the child approaches and cuddles up indiscriminately to strangers and familiar people |
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Somatization?
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- a defense mechanism in which emotional concerns are manifested as physical Sxs
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Coprolalia?
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- the repetitive speaking of obscene words
- seen in severe cases of Tourette disorder |
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Reaction formation?
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- a defense mechanism in which unacceptable impulse is transformed into its opposit
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Coprophagia?
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- the eating of feces
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What is the MC cause of visual hallucinations in a child?
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- substanced-induced psychotic disorder
- child may have ingested prescription drugs, illicit drugs, OTC meds, or household agents |
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What is the MC psychiatric emergency in children and adolescents?
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- suicidal behavior
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Axis I?
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- all Dx of mental illness (including substance abuse and developmental disorders)
- NOT personality disorders & MR |
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Axis II?
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- personality disorders & mental retardatio
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Axis III ?
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- medical (physical) disorders
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Axis IV ?
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- psychosocial and environmental problems that may affect the Dx, Tx't, and prognosis of her Axis I disorder
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Axis V ?
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- the Global Assessment of Functioning (GAF)
- the clinician's judgement of the individual's overall level of functioning |
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What Sxs are MC'ly seen in children with MDD compared to adolescents with MDD?
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- psychomotor agitation
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What is the MC method used by children when attempting suicide?
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- substance ingestion
Other frequently used methods include: - stabbing - cutting - jumping from buildings - hanging - running in front of vehicles - gas inhalation |
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What are common SEs of DDAVP?
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- HAs
- nausea |
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What are lab findings that could be found with use of DDAVP?
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- mild hyponatremia
(hypocalcemia / hypokalemia / hypomagnesemia / hypophosphatemia = are NOT SEs of DDAVP) |
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The approximate comorbidity of childhood anxiety disorders and MDD is?
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50%
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What are the MC SEs of fluoxetine [Prozac]?
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- GI Sxs
- insomnia - agitation - HAs (weight gain / sedation = are NOT SEx) |
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Treat lead toxicity with?
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CaEDTA
- chelating agent |
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Treat benzo o/d with?
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- flumazenil
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Treat opiate o/d with?
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- naloxone [Narcan]
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Treat iron toxicity with?
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- deferoxamine
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Treat acetaminophen toxicity with?
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- N- acetylcysteine
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Treat aspirin toxicity with?
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- alkalinizing the urine
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Facts about Rett disorder.
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- the only DSM-IV-TR disorder that is seen ONLY in girls
- no clear char-tic lab findings associated with this disorder - genetic testing is available - no known familial clusters of this disorder |
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What co-morbid disorder is a child with conduct disorder likely to have?
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- substance-related disorder and/or ADHD
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Following a Dx of DM-1, what % of children develop Sxs of adjustment disorder?
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33%
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What is the first-line Tx't for Tourette disorder?
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- Clonidine [Catapres]
- also haloperidol [Haldol] - also pimozide [Orap] |
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Why is clonidine first-line Tx't for Tourette disorder?
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- has a limited SE profile
- helps control Sxs of 2 frequently associated comorbid disorders: ADHD and OCD |
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Is the DISC reliable in children aged 6 - 9?
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No.
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A child with a psychiatric illness and medical illness should be:
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- treated aggressively for psychiatric illness b/c it positively affect a medical illness with improvement of psychiatric Sxs
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What is the MC initial Sx of Tourette?
2nd MC? |
MC = eye tics (blinking, eye rolling)
2nd MC = facial tics (grimacing, licking movements) and vocal tics |
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Dx of Tourette Disorder:
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- multiple motor tics and one or more vocal tics must be present at some time during illness
- need NOT be concurrently - onset before age 18 - average age of onset = 7 y.o. - tics must be present for over 1 year on nearly every day - NO tic-free period for longer than 3 months |
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What are the MC predisposing factors for MR?
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- early alterations in embryonic development (eg. chromosomal changes) and prenatal damage due to toxins
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If a child suffers from tics or has a family history of tics what kind of medications should be avoided?
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- stimulant medications
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Learning disorders are commonly associated with:
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- ADHD
Also - conduct disorder - oppositional defiant disorder - MDD - dysthymic disorder |
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Approximately what % of students in public schools have a learning disorder?
What % of those students drop out of school? |
5% prev. of learning disorders in public schools.
~40% drop out |
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MC'ly enuresis occurs in:
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Normal little boys
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What are the MC SEs of methylphenidate and other stimulant Rx?
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- insomnia
- decreased appetite - weight loss - dysphoria - irritability |
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Stimulant Rx are effective in reducing Sx of ADHD in approximately what % of patients?
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70%
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At what age can a child:
1. copy a circle 2. tell her age and gender and ride a tricycle 3. copy a square and identify her left hand |
1. Age 2
2. Age 3 3. Age 5 |
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Common lab findings in anorexia nervosa:
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- hypercholesterolemia
- mild normocytic normochromic anemia - leukopenia - hypokalemia, hypochloremia and metabolic alkalosis may be seen with vomiting |
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Physiological findings in anorexia nervosa:
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- decreased energy expenditure
- low serum estrogen levels in girls - low serum testosterone levels in boys - increase in ventricular-brain ratios 2/2 starvation |
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stranger anxiety:
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- usually at 7-8 months
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Bonding occurs in what period?
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- begins in the immediate postdelivery period
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Attachment occurs in what period?
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- attachments occurs with ongoing interaction over time
- does not require contact in the perinatal period |
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Schizophrenia: Paranoid type Sxs
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- delusions or frequent auditory hallucinations
- highest functioning type - older age of onset |
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Schizophrenia: Disorganized type Sxs
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- disorganized speech
- disorganized behavior - flat or inappropriate behavior - poor functioning type - early onest |
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Schizophrenia: Catatonic type Sxs
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- motor immobility
- excessive purposeless motor activity (automatisms) - extreme negativism or mutism - peculiar voluntary movements or posturing - echolalia - echopraxia - rare |
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Schizophrenia: Undifferentiated type Sxs
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- characteristic of more than one subtype or NONE of he subtypes
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Schizophrenia: Residual type Sxs
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- prominent negative Sxs with only minimal evidence of positive Sxs
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Dopamine Pathways Affected in Schizophrenia:
- prefrontal cortex - mesolimbic |
Prefrontal cortex = negative Sxs
Mesolimbic = positive Sxs |
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Other important pathways affected by neuroleptics:
- tuberoinfundibular - nigrostriatal - ventral-tegmentum |
Tuberoinfundibular
- blocked by Rx; causes hyperprolactinemia Nigrostriatal: - blocked by Rxs - causes EPSEs Ventral-Tegmentum - reward/addictive pathway |
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NT abnL-ties in Schizophrenia:
- 5-HT - NE - GABA |
- increased 5-HT
- increased NE - decreased GABA ( loss of GABAergic neurons in the hippoocampus) |
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A poor prognostic factor for childhood schizophrenia:
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- onset before age 10
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A better outcome for childhood schizophrenia is associated with:
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- more affective Sxs
- acute onset - older age at onset - good premorbid functioning - well-differentiated Sxs - lack of family Hx of schizophrenia |
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Children with ADHD often suffer from __________ self-esteem.
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low
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At what age do children begin to understand the irreversibility of death?
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7-8 yrs
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What is a frequent adverse effect of clonidine?
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- sedation - but with continued Tx't, the sedation usually subsides
- dry mouth is a less common adverse effect - hypotension is a RARE adverse effect |
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Which month of pregnancy carries the highest risk of congenital defects with rubella infx?
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- first month (50%)
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Physical abuse of a child is under which Axis?
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Axis I Dx
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What lab findings are associated with anorexia nervosa?
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- hypercholesterolemia
- increased secretion of CRH - hypoglycemia - hypothyroidism - leukopenia |
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Alexia
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- inability to read
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Anomia
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- inability to name objects even though the object is recognizable and can be described by the patient
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Aphasia
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- more global
- abnL-ty in either the expression or comprehension of language |
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Agnosia
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- inability to recognize objects
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Apraxia
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- inability to perform learned motor skills despite nL strength and coordination
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Group A beta hemolytic Streptococcus has been associated with?
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- OCD
- Tourette disorder |
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Pica
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- disorder where inappropriate objects are eaten
- eg. soil, feces, ice |
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What lab findings are associated with Bulimia Nervosa?
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- hypokalemia
- hyponatremia - hypochloremia - metabolic alkalosis |
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An example of a presentation of stereotypic movement disorder:
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- self-inflicted bodily injury that is severe enough to require medical attention
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Asperger disorder
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- pervasive developmental disorder
- impairment in social interactions - development of stereotyped or repetitive patterns of behaviors WITHOUT significant delay in language skills or cognitive function - more common in males - high-functioning autism |
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DSM criteria for conduct disorder:
- need at least 3 out of the 4 |
1. aggression towards people and animals
2. destruction or property 3. deceitfulness 4. serious violations of rules |
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Oppositional defiant disorder:
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- at least 6 months
- negativistic, hostile, defiant behavior directed mostly at authority figures |
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Borderline MR:
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IQ = 70-79
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Mild MR:
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IQ = 50 - 70
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Moderate MR:
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IQ = 35 - 50
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Severe MR:
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IQ = 25 - 35
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Profound MR:
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IQ = < 25
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