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112 Cards in this Set
- Front
- Back
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Q: At what age should children be expected to have abstract thought abilities?
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A: Age 12
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Q: Proverb Testing and Similarity Testing require what in children/adolescents?
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A: Prior exposure to concept, word choices, and ability to think abstractly
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Q: Conduct disorder is a persistent pattern of behavior in which ____ ______ _______ or ________ _________ or _______ are violated.
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A: Rights of others, societal norms, rules
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Q: Name 3 risk factors for conduct disorder.
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A: Genetic loading, dysfunctional family functioning, substance abuse
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Q: For conduct disorder, pt. must have three or more symptoms in the past year and at least one symptoms in the past 6 months. What are the four categories of behaviors in this disorder?
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A: Aggression toward people and animals, Destruction of property, Deceitfulness or theft, Serious violation of rules
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Q: Childhood onset of conduct disorder is for which age? Adolescent onset?
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A: Childhood onset: Before age 10
Adolescent onset: After age 10 |
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Q: What would be the thought content of someone with conduct disorder?
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A: Lack of empathy or concern for others
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A: How is aggression and agitation treated in conduct disorder pharmacologically?
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A: Antipsychotics, mood stabilizers, SSRIs, and alpha agonists (clonidine) Catapres
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Q: Before puberty, which are more prevalent to have oppositional defiant disorder, boys or girls? How about after puberty?
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A: Before puberty: boys more prevalent
After puberty: boy-to-girl ration equal |
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Q: What is the mainstay therapy for conduct disorder?
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A: Behavioral therapy
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Q: True or False: Conduct Disorder can be diagnosed in adults?
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A: True, if they don't meet all criteria for antisocial personality disorder
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Q: Oppositional Defiant Disorder is an enduring pattern of negativistic, defiant, disobedient, hostile, and defiant behaviors that is usually directed to whom?
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A: An authority figure
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Q: For a diagnosis of Oppositional Defiant Disorder, there needs to be four symptoms for at least 6 months. What are these symptoms? Name at least three.
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A: OFTEN:
Loses temper Argues with adults Actively defies or refuses to comply with adults' requests or rules Deliberately annoys people Blames others for his or her mistakes or misbehavior Is touchy or easily annoyed by others Is angry and resentful Is spiteful and vindictive |
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Q: What would be the primary thought content of someone with Oppositional Defiant Disorder?
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A: Low Frustration Tolerance
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Q: What is the mainstay therapy for Oppositional Defiant Disorder?
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A: Behavioral therapy
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Q: In ADHD, there are problems with executive functioning. Also there are abnormalities of the fronto-subcortical pathways and of the reticular activating system. Which brain structure is abnormal in inattention and impulsivity? Which brain structure is abnormal in hyperactivity?
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A: Frontal Cortex
Basal ganglia |
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Q: What two neurotransmitters are involved in ADHD?
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A: Dopamine and Norepinephrine
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Q: What is the average age of onset for ADHD? What is the mean age of diagnosis?
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A: Onset: age 3
Diagnosis: age 9 |
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Q: Which kind of symptoms are more persistent in ADHD, hyperactivity/impulsivity or inattention?
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A: Inattention symptoms more persistent than hyperactivity/impulsivity
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Q: Approximately what percent of pts. have symptoms of ADHD into adulthood?
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A: 60%
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Q: What are some inattention symptoms in clients with ADHD?
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A: Inattention to details, Careless mistakes, Difficulty sustaining attention, Seeming not to listen, Failure to Finish Tasks, Difficulty with organizing, Avoidance of tasks requiring sustained attention, Loss of things, Distractibility, Forgetfulness
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Q: What are some hyperactivity/impulsivity symptoms in ADHD?
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A: Blurting out answers before question is finished, Difficulty awaiting turn, Interrupting or intruding on others, Fidgeting, Inability to stay seated, Inappropriate running or climbing, General restlessness, Difficulty engaging in leisure activities, Always "on the go," Excessive talking
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Q: Name the 3 subtypes of ADHD?
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A: ADHD-Inattentive
ADHD-Hyperactive ADHD-Combined (criterion met for inattention and hyperactivity/impulsivity) |
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Q: Pts. with ADHD have some distinctive physical exam features. Name two.
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A: Hypertelorism: Abnormally increased distance between orbits (eyes)
Highly arched palate Low-set ears |
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Q: Kids with ADHD have higher than average what?
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A: Accidental injury rates
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Q: What are some differential diagnoses for ADHD?
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A: Substance abuse, MDD, BP Disorder, Stereotypic Movement Disorder, Understimulated home environment
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Q: Which agent for ADHD is not considered a controlled substance?
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A: Atomoxetine (Strattera)
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Q: Which schedule are stimulant agents used in ADHD?
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A: Schedule II
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Q: Which ADHD stimulant has less risk of abuse properties because it must be swallowed to be activated?
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A: Vyvanse (lisdexamfetamine)
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Q: Name three or four side effects of stimulants.
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A: GI upset, anorexia, weight loss, growth suppression, insomnia, headache, dizziness, irritability
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Q: What are 3 nonpharmacological management strategies for ADHD?
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A: Behavioral therapy, psychoeducation, treatment of learning disorders
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Q: What are some family educational needs for a child with ADHD?
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A: Environmental structuring, Psychiatric comorbidities, School issues/concerns, Peer relationship building, Smoking and substance abuse, Stress management
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Q: What is a standardized rating scale for ADHD that both the parent and teacher can fill out?
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A: Conner's Parent and Teacher Rating Scales
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Q: Asperger's Disorder is severe, sustained impairment in _________ _________, and restricted _________ ________ of ___________, __________, and ______________
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A: Impairment in social interactions
Restricted repetitive patterns of behavior, interests, and activities |
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Q: What things should you assess for in Asperger's Disorder?
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A: Impairments in social interaction
Restricted, repetitive, and stereotyped patterns of behavior, activities, or interests Significant impairment in social, occupational, or areas of functioning |
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Q: What symptoms are not present in Asperger's Disorder that is in Autism?
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A: No clinically significant delay in language, cognitive development, or adaptive behavior
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Q: What therapies are used in Asperger's Disorder?
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A: Behavior therapy, Occupational therapy, Physical therapy, speech therapy, appropriate school placement
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Q: Rett's Disorder is the development of specific deficits following a period of __________ ___________ after birth.
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A: Normal functioning
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Q: True or False: Rhett's Disorder is primarily in males.
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A: False, it is primarily in females
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Q: What major dysfunction is associated with Rhett's Disorder?
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A: Severe or profound mental retardation
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Q: What are risk factors for Rhett's Disorder?
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A: Mental retardation, seizure disorder
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Q: When assessing for Rhett's Disorder, what should you know the history of through the first 5 months after birth? What should you assess at the time of birth?
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A: Normal psychomotor development, normal head circumference
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Q: Also, what should you assess for in terms of abnormal development in Rhett's Disorder?
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A: Deceleration of head growth between age 5 and 48 months; Loss of hand skills between age 5 and 30 months with subsequent development of stereotypic hand movements, Early loss of social engagement, Appearance of poorly coordinated gait or trunk movements, Severely impaired expressive/receptive language development with severe psychomotor retardation
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Q: What would be some physical exam findings for those with Rhett's Disorder?
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A: Seizures, Irregular respirations, Scoliosis, Loss of Purposeful hand skills, Stereotypic hand movements
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Q: Autistic Spectrum Disorder involves the marked impairment of _______ and _________ abilities.
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A: Social and cognitive
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Q: Imbalances in which neurotransmitters are implicated in Autism?
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A: Glutamate, Serotonin, and GABA
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Q: Brain-imaging studies of children with autism reveal microscopic and macroscopic abnormalities of the ________, ___________, and ____________.
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A: Amygdala, Hippocampus, and cerebellum.
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Q: Decreased numbers of what in the cerebellum are thought to play a role in the development of Autism?
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A: Purkinje Cells
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Q: What percent of children with autism have mental retardation?
A. 50% B. 25% C. 75% D. 60% |
A: 60%
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Q: When does the onset of symptoms for Autism begin?
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A: Before age 3
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Q: In autism, there are impairments in which three areas?
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A: Social interaction, Communications, and Behavior
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Q: What happens to communication for those with Autism?
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A: Communication is impaired, such as a delay in or lack of development of spoken language, inability to initiate conversation, repetitive and stereotypic use of language, inability to play with others
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Q: In autism, there is a lack of?
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A: Peer relationships, Emotional reciprocity, and spontaneous seeking of enjoyment
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Q: Name some patterns of behavior, interests, and activities you would find in Autism.
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A: Restricted repetitive and stereotypic movements, inflexible adherence to routines, stereotypic motor mannerisms (e.g. hand or finger flapping, rocking, swaying)
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Q: There is a long list of specific behaviors that parents may report with their child who has Autism. Name some.
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A: Loss of language at any time, no single words by age 16 months, no 2-word phrases by 24 months, No imaginary play, Little interest in playing with other kids, Extremely short attention span, Little or no eye contact, No response when called by name, Intense tantrums, Fixations on certain objects, Oversensitivity to certain sounds, textures, or smells, Self-Injurious behavior, Appetite and/or sleep disturbance, Strong resistance to changes in routines
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Q: Are there specific pharmacological interventions for Autism?
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A: No, only symptomatic management
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Q: Name the class or type of drugs used for tantrums, aggressive or self-injurious behavior, hyperactivity, and repetitive, stereotypic behaviors.
What class or types of drugs used to diminish self-injurious and hyperactive and obsessive behaviors |
A: Antipsychotics
Antidepressants, naltrexone, clonidine, stimulants |
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Q: How are the following therapies used for pts. with Autism?
Behavioral Therapy Occupational Therapy Speech Therapy School Placement |
A: Behavioral Therapy: Improve cognitive functioning and reduce inappropriate behavior
Occupational Therapy: Improve sensory integration and motor skills Speech Therapy: Address communication and language barriers Appropriate school placement with a highly structured appproach |
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Q: What are some characteristics of Anorexia Nervosa?
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A: Clients refuse to maintain a normal body weight
Restrict caloric intake Have an intense fear of gaining weight because of a distorted body image |
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Q: What are some characteristics of Bulimia Nervosa?
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A: Binge eating
Combined with inappropriate ways of stopping weight gain |
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Q: What are some characteristics of Binge Eating Disorder?
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A: No purging or compensatory behaviors to lose weight
Recurrent episodes of binge eating with lack of control Occurs at least 2 days weekly for 6 months |
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Q: What are some biological or neurological factors in eating disorders?
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A: Decreased hypothalamic norepinephrine activation
Dysfunction of lateral hypothalamus Decreased Serotonin |
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Q: What should you assess for in anorexia nervosa?
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A: Weigh less than 85% of expected weight
Fear of gaining weight or becoming fat |
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Q: What are the two types of Anorexia Nervosa?
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A: Restricting Type: Person does not regularly engage in binge eating or purging behavior
Binge Eating/Purging Type: Person has engaged in binge eating or purging behavior |
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Q: How often does binge eating and inappropriate compensatory behaviors occur for a diagnosis of Bulimia Nervosa?
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A: At least twice a week for 3 months
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Q: What are some compensatory behaviors to prevent weight gain in bulimia?
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A: Self-induced vomiting, Laxative, Enemas, Diuretics, Stimulants, Abuse of diet pills, Fasting, Excessive Exercise
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Q: What are the two types of bulimia?
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A: Purging Type: Person has engaged in purging or the misuse of laxatives, enemas, or diuretics
Nonpurging Type: Person has used other compensatory behaviors such as fasting or excessive exercise, but has not engaged in purging or misuse of laxatives, enemas, or diuretics |
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Q: What are physical exam findings for a person with Anorexia Nervosa?
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A: Low BMI, Amenorrhea, Bradycardia, Hypotension, ECG changes (inversion of T waves, prolonged QT, ST segment depression), Hypothermia, Dry skin, Brittle hair and nails, LANUGO, Peripheral edema, Erosion of Dental Enamel, Russell's Sign: Scarring or calluses on the dorsum of the hand secondary to self-induced vomiting
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Q: What are some physical exam findings for Bulimia Nervosa?
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A: Weight is within NORMAL range, Erosion of dental enamel, Russell's sign, Hypertrophy of Salivary Glands, Rectal Prolapse
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Q: What are the major thought contents of a person with an eating disorder?
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A: Preoccupation with food and body weight
Suicidal ideation Low self-esteem |
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Q: Are there definitive lab tests for Anorexia or Bulimia?
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A: No, but there will be general lab changes for each, they are just not diagnostic
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Q: What lab changes would be evident in a person with Anorexia Nervosa?
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A: Normochromic, normocytic anemia, Leukopenia, Neutropenia, Anemia, Thrombocytopenia, Hypokalemia, Hypomagnesemia, Hypoglycemia, Decreased LH and FSH
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Q: What labs will be evident with a person who has Bulimia Nervosa?
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A: Hypotension, Bradycardia, Hypo: kalemia, natremia, chloremia, magnesemia, Metabolic Acidosis or alkalosis, ELEVATED serum amylase
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Q: What medications are used for treatment of anorexia nervosa?
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A: Actually, there are no specific meds for anorexia
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Q: What medication is FDA-approved for Bulimia Nervosa?
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A: Fluoxetine (Prozac)
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Q: Which two medication groups are effective in reducing the frequency of bingeing and purging?
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A: SSRI's & TCA's
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Q: What are the medical and nutritional stabilization priorities with pts who have eating disorders?
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A: Weight restoration, Correction of electrolyte disturbances, Vitamin supplementation, Nutrition counseling
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Q: When must mental retardation occur to be diagnosed?
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A: Before age 18
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Q: What IQ level is considered to be indicative of mental retardation?
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A: IQ below 70
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Q: In mental retardation, impairment in adaptive functioning exists in at least two areas. What are these areas?
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A: Communication, Self-Care, Home living, Social or Interpersonal Skills
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Q: What are characteristics of Fetal Alcohol Syndrome?
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A: Epicanthal skin folds, Low nasal bridge, Short nose, Indistinct philtrum (divit under the nose), Small head circumference, Small eye openings, Wide-set eyes, Thin upper lip
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Q: Mild mental retardation is IQ range 50-55 to 70. What can they expect to accomplish in life functioning?
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A: Social and communication skills, Academic skills up to 6th grade, Achieve social and vocational skills for minimum self support, Live successfully in the community independently or in supervised settings, Has minimal sensorimotor abnormalities
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Q: Moderate mental retardation is IQ range 35-40 to 50-55. What can they expect to accomplish in life functioning?
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A: May benefit from vocational training, Seldom advances beyond 2nd grade level academically, Can be trained to care for most personal needs, Can perform unskilled or semiskilled work in sheltered job placements, Can live in the community but usually in a supervised setting such as a group home
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Q: Severe mental retardation is IQ range 20-25 to 35-40. What can they expect to accomplish in life functioning?
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A: Little or no communicative speech, May be able to learn some survival words such as stop and exit, May perform simple tasks in closely supervised settings, Can live in group homes
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Q: Profound mental retardation is IQ below 20-25. What can they expect to accomplish in life functioning?
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A: Poor cognitive and social capacities, Speech often absent, If appropriate training provided, may develop minimal motor skills, self-care skills, and communication skills, May live in group home or intermediate care facilities, May be able to perform simple tasks in closely supervised and sheltered settings
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Q: What are some mental status findings for persons with mental retardation?
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A: Communication deficits, Dependency, Passivity, Poor self-esteem, Low frustration tolerance, Aggressiveness, Stereotypic, repetitive motor movement, Self-Injurious Behavior
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Q: What are some differential diagnoses for mental retardation?
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A: Borderline intellectual functioning, Learning and communication disorders, Pervasive Developmental Disorder, ADHD, Stereotypic movement disorder, General medical condition
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Q: What percent of individuals with Pervasive Developmental Disorder have comorbid mental retardation?
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A: 75%
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Q: How are aggressive and self-injurious behaviors in mental retardation treated?
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A: With antipsychotics and mood stabilizers
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Q: Physical traits of mental retardation include what?
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A: Oblique eye folds, Small, flattened skull, Large tongue, Broad hands with stumpy fingers, Single transverse palm crease, Small height, Brushfield spots on iris, Cryptoorchidism, Congential heart defects, Hypothyroidism
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Q: What are the therapy goals in the child with Oppositional Defiant Disorder?
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A: Accept responsibility for own behavior, increase self-esteem, and improve social interactions
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Q: What are four characteristics of Autism?
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A: Lack of awareness of others or treats others as an object
Abnormal communication Repetitive behaviors Stereotypic movements: hand flapping, rocking |
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Q: Which treatment goal is most import in Autism?
A. Prevention of self-directed violence B. Improve social interactions C. Improve communication D. Improve sense of self |
A: Prevention of self-directed violence
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Q: What is the presentation or characteristics of Rett's Disorder? What is the management goal? Who does it primarily effect? ( Think sex)
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A: Presentation: Cease to gain developmental milestones
Loss of skills already acquired (speech, hand skills) Stereotypic hand movements Seizures, scoliosis, hypertoncity Management goal: Preserve functional abilities Primarily effects females at about 1 year old |
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Q: What disorder is the most commonly diagnosed behavioral problem in childhood?
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A: Attention-Deficit/Hyperactivity Disorder
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Q: When must symptoms start in ADHD? How many settings must the symptoms interfere with functioning?
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A: Before age 7
At least 2 settings (e.g. home, school) |
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Q: On which Axis is Mental retardation?
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A: Axis II
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Q: On which Axis is Fetal Alcohol Syndrome recorded?
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A: Axis III
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Q: In children, what is seen as anhedonia?
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A: Lack of enjoyment of play
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Q: Are suicidal behaviors most likely in anorexia or bulimia?
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A: Bulimia
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Q: What are some symptoms of depression in children and adolescents?
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A: Sudden decline in academic performance; Sudden outbursts and aggressiveness; Drug/ETOH use; Somatic complaints without physical causes; Social isolation; Boredom; Reckless Behavior; Irritable mood; Suicidal ideation
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Q: What neuroendocrine abnormalities may be present for eating disorders?
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A: Hypothalmic dysfunction in Anorexia, Increased Cortisol levels in CSF; Dopaminergic Dysregulation
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Q: Name some elements of power and control present in eating disorders.
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A: Passive father and domineering mother, overly dependent child, high value placed on perfectionism, dysfunctional eating behaviors viewed as rebellion against parents
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Q: What are the first line, second line, and third line medications for ADHD?
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A: First line: Stimulants (make more DA and NE available)
Second line: Antidepressants (make more 5HT, DA, and NE available) Third line: Antihypertensives (alpha 2 agonists): clonidine or guanfacine |
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Q: What may be first line medications for someone with ADHD and tics?
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A: Alpha 2 agonists: clonidine and guanfacine
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Q: What should be monitored for those on stimulants?
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A: BP, Weight, Height, CBC, Platelets, Liver function
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Q: What should the PMHNP include in parent teaching about ADHD stimulants?
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A: Give doses with or right after meals to minimize appetite suppression
Short acting stimulants may causes rebound hyperactivity Stimulants can increase motor or phonic tics or stereotypic behavior Stimulant can improve inattention, hyperactivity, and impulsiveness, but may not improve interpersonal relationships |
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Q: What must the PNHNP evaluate before starting stimulants for ADHD?
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A: Evaluate history of cardiac problems (Left Ventricular Hypertrophy, syncope), Family history of sudden death, Get EKG before starting
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Q: What are the three antidepressants that can be used for ADHD?
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A: Atomoxetine and Buproprion SR
Buproprion is useful in comorbid depression and ADHD, but may exacerbate tics Venlafaxine XR can be useful in ADHD with comorbid anxiety or depression |
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Q: What are antihypertensives such as clonidine (Catapres) and guafacine (Tenex, Intuniv) good for in ADHD?
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A: Effective for ADHD plus TICS, Hyperactivity, Impulsiveness, and Aggression, Hyperarousal
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Q: What side effects might the alpha 2 agonists for ADHD symptoms include?
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A: Sedation, Headaches, Depression, Potential Rebound Hypertension (especially if not tapered)
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Q: What medications or medication types are used in the management of aggressive behavior?
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A: Antipsychotics, Anticonvulsants, Antidepressants, Lithium, Benzo's, Propanolol
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