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74 Cards in this Set
- Front
- Back
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How does MDD often present in children? |
Conduct problems and/or irritability
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Which typically has an earlier age of onset?
(Bipolar disorder vs. MDD) |
Bipolar Disorder
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How do manic episodes in kids differ than those in adults?
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80% are "atypical" (20% in adults)
Irritable temper w/ outbursts Chronic and continuous (intermittent and acute in adults) NOTE: Up to 20% of kids w/ ADHD develop Bipolar disorder |
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What is the first choice for treating childhood depression?
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Psychotherapy
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What are the safest first choice meds for childhood depression?
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SSRIs
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What potential side effect is dangerous when using TCAs in kids?
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Potential cardiac toxicity
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What is changed in the criteria for dysthymic disorder in kids?
(vs. criteria for adult diagnosis) |
Symptoms need only be of one year duration
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What proportion of OCD cases begin in childhood?
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1/3 - 1/2
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How are OCD cases treated?
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Behavior therapy
Clomipramine SSRIs |
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How are panic disorder cases treated?
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Psychotherapy augmented w/ BDZs, TCAs, or SSRIs
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Instead of having flashbacks, how do kids often present w/ PTSD?
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Reenactments of the trauma in symbolic play
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How is PTSD treated in kids?
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Therapy, including attempts at systematic desensitization
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What is the treatment strategy of GAD in younger children?
In older children? |
Younger -- Behavioral therapy
Older -- Cognitive therapy (emphasis on assertiveness training) |
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What drugs are often used to treat GAD, despite lacking data of efficacy?
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Anti-histamines
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How are phobias treated in kids?
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SSRIs/BDZs in combo w/ psychotherapy
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When do cases of schizophrenia usually have onset?
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Almost all cases have onset after puberty
BUT, some have been described as young as 5 y.o. |
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Which sex accounts for the majority of child schizo cases?
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Primarily male patients
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Typically, how is the prognosis for childhood schizo?
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Overall outcome tends to be poor
Response to meds tends to be poor as well |
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What 2 disorders does Separation Anxiety Disorder overlap w/?
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GAD
Social Phobia |
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When does normal separation anxiety usually first appear?
When does it peak before subsiding? |
Appears at 6 - 7 months of age
Peaks at 13 - 18 months, before gradually subsiding |
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By what age does separation anxiety disorder become more apparent?
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7 - 8 years of age
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What 6 PSYCH disorders are commonly comorbid w/ sep. anx. disorder?
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Social Phobia
GAD Panic disorder MDD Dysthymic disorder Cluster "C" Personality Disorders |
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How does sep. anx. disorder affect eventual panic disorder in pts?
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Hx of Sep. Anx. Disorder --> earlier onset & more severe panic disorder
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What pharmacotherapy is used for separation anxiety disorder?
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SSRIs, Buspar
BDZs, beta-blockers for anxiety w/ exposure |
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What is the definition of selective mutism?
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Failure to speak in specific situations, despite being able to in others
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When is selective mutism most commonly diagnosed?
(what years) |
Between the ages of 5 and 8
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What other PSYCH disorders do most kids w/ selective mutism also show?
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Almost all have Social Phobia beyond mutism
About 1/3 have a language disorder About 1/2 had delayed speech development |
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What treatment is given for selective mutism?
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Behavioral therapy, along w/ SSRIs
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What is INHIBITED TYPE reactive attachment disorder?
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Failure to initiate/respond in an appropriate fashion to most interactions
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What is DISINHIBITED TYPE reactive attachment disorder?
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Indiscriminate sociability
Marked inability to exhibit appropriate selective attachments |
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What 3 features are common in pervasive developmental disorders?
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Deficits in reciprocal social interaction
Deficits in communication Presence of stereotyped behavior, interests, and activities |
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What is the prototypical pervasive developmental disorder?
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Autism
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3 ways autisic disorder is different from childhood schizo
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Younger onset
NO loose associations NO hallucinations/delusions |
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Skin changes typical of tuberous sclerosis may be a sign of what?
(in addition to tuberous sclerosis itself) |
Autistic disorder
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ADHD places pt @ increased risk for what (4)?
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School failure/underachievement
Conduct disorder Substance abuse Depression |
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Of the symptoms of ADHD, what type persists into adulthood?
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Hyperactivity declines
Inattention persists |
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Proportion of ADHD pts. in which disorder persists into adulthood
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About 1/2
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By what age must symptoms present to qualify as ADHD?
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Before the age of 7
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What are the two major categories of ADHD symptoms?
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Inattention
Hyperactivity-Impulsivity |
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What types of behavior is DA thought to be involved in?
(context of ADHD) |
Attention and novelty seeking
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What genetic defects are often seen in families w/ Hx of ADHD?
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Defects in the dopamine transporter gene
Defects in the D4 receptor gene |
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What are the two mainstays of treatment for ADHD?
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Stimulant medications
Psychotherapy/Education |
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3 major stimulants used for ADHD?
(one has been pulled from market) |
Dextroamphetamine
Methylphenidate Pemoline (pulled) |
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Comparison of onset and DOA between stimulants used for ADHD
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Dextroamphetamine & Methylphenidate have rapid onset and short DOA
Pemoline has slower onset and a longer DOA NOTE: Pemoline would take several weeks to have effects |
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Why was Pemoline pulled off of the market?
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Assoc. w/ acute liver failure in some cases
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% of pts. w/ ADHD that respond to stimulants
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~70%
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Side effects of stimulant therapy for ADHD (3)
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Decreased appetite
Sedation or psychotic symptoms (often @ high doses) Development or exacerbation of tics |
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Mechanism of action for atomoxiten (strattera)
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Selective NE re-uptake inhibitor
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Drugs often used for ADHD (7)
(in addition to stimulants) |
Atomoxiten
Buproprion TCAs Venlafaxine Clonidine, Guanfacine SSRIs (little effect on core attention deficits) |
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What is the limitation of SSRI use for ADHD?
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Can help treat impulsiveness and aggression
BUT, little effect on core attention deficits |
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In what scenario is Clonidine especially helpful?
(context of ADHD) How is Guanfacine even better? |
When ADHD is combined w/ a tic disorder
Guanfacine is longer lasting and less sedating |
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50% of conduct disorder pts go on to what disorder?
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Anti-social personality disorder
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Which sex is conduct disorder more prevalent in?
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Males
16% of boys, and 9% of girls display symptoms of it |
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What are poor prognostic factors for conduct disorder progressing (5)?
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Earlier onset (< 10 y.o.)
Comorbid ADHD More interpersonal aggression Lower IQ Poorer social skills |
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What 4 types of conduct problems are seen in conduct disorder?
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Aggressive conduct
Non-aggressive conduct Deceitfulness or theft Serious violations of rules |
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What is aggressive conduct?
(context of conduct disorder) |
Causes/threatens physical harm to other people/animals
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What is non-aggressive conduct?
(context of conduct disorder) |
Causes property loss or damage
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What disorders commonly predate onset of conduct problems (3)?
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Learning disorders
Communication disorders ADHD |
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What is the treatment approach for conduct disorder?
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Treat comorbid PSYCH issues
Psychotherapy Behavioral management |
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Oppositional defiant disorder
What type of behavior is seen? How long does behavior have to persist to qualify? |
Negative, hostile, defiant behavior
At least 6 months |
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What other disorders are common comorbidities?
(context of oppositional defiant disorder) |
ADHD
Language disorders Communication disorders |
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What is Pica?
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Persistent eating of non-nutritive substances for at least 1 month
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How is Pica treated?
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Addressing of medical issues and psychosocial stressors
Behavioral therapy |
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What is rumination disorder?
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Repeated regurgitation and rechewing of food
Food is either ejected from mouth or re-swallowed |
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What age group is rumination disorder most common in?
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Infants
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What medical issues can rumination disorder lead to?
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Malnutrition
Failure to thrive |
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How is rumination disorder often treated?
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Aversive behavioral therapy
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What is encopresis?
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Repeated passage of feces into inappropriate places
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At what age does encopresis usually get diagnosed?
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Actual or mental age of 4
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What medical condition(s) is encopresis often related to?
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Constipation, impaction or retention w/ overflow incontinence
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How is encopresis treated?
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Treatment of constipation
Behavioral and family therapy |
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What is enuresis?
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Repeated voiding of urine during the day or at night
(either involuntarily or unintentionally) At least 2x per week for 3 months w/ age of at least 5 |
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What is the prevalence of enuresis at age 5?
At age 18? |
Age 5 -- 7% males, 3% females
Age 18 -- 1% males, < 1% females |
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What pharmacotherapy is used against enuresis?
What limits effectiveness? |
TCAs (esp imipramine)
Desmopressin nasal spray Relapse rate is very high |
