Child Psychiatry

Front 1

What % of children have clinically significant disorders?

Back 1

5 -15%

Front 2

Below the age of 12 years, what is the gender distribution of clinically significant psychiatric disorders? What is the distribution for ages 12 – 18 years?

Back 2

below age 12: boys>girls
12 to 18 years: girls > boys (higher rates of anxiety/affective disorders)

Front 3

What is the criteria for ADHD inattention?

Back 3

Six or more of the following for > 6 months
(Must be maladaptive and inconsistent with developmental level)
carelessness with details
cant’ keep on task
doesn’t seem to listen when spoken to
doesn’t follow through with instructions
difficulty organizing
reluctant to put effort into school or homework
often loses things necessary for activities
is easily distracted
is forgetful

Front 4

What is the criteria for ADHD hyperactivity-impulsivity?

Back 4

six or more of the following for > 6 months
(Must be maladaptive and inconsistent with developmental level)
Hyperactivity:
often fidgets with hands or feet or squirms in seat
often climbs or runs about … or feelings of restless
difficulty playing or engaging in leisure
often leaves seat when expected to remain in seat
often is “on the go” or acts as if “driven by a motor”

Front 5

Compare and contrast the signs and symptoms of early onset of bipolar disorder (mania) and ADHD?

Back 5

Mania:
irritability, increased energy, pressured speech, reckless behavior, grandiosity, distractibility, decreased sleep
ADHD:
grumpy, hyperactive, talking fast, reckless behavior, bragging, distractibility, restless sleeper

Front 6

Hallucinations are _____ in pre-adolescents until "proven" otherwise.

Back 6

anxiety phenomena

Front 7

What are some clinical features of depression in kids?

Back 7

Somatic complaints
irritability
guilt
low self-esteem
suicide attempts
oppositionality
withdrawal

Front 8

What percent of children with depression have 'comorbid dx'?

Back 8

40 to 70%

Front 9

What are the most common comorbid diagnosis in child depression?

Back 9

anxiety disorders (20 to 40%)
disruptive (incl. CD/ADHD) (10 to 80%)
substance abuse (20% to 30%)

Front 10

What % of teen deaths are suicide?

Back 10

12%

Front 11

What is the % of suicidal ideation in adolescents?

Back 11

20% per year

Front 12

What is the % of teens who attempt suicide per year?

Back 12

10%

Front 13

What is the gender distribution in teen suicide attempts?

Back 13

more common in females
more often completed by males

Front 14

What is anorexia nervosa?

Back 14

intense fear of gaining wt
disturbance in way body wt is experienced
absence of > 2 menstrual cycles

Front 15

What are some treatments for anorexia?

Back 15

meal support
activity restriction
monitor electrolytes
EKG

Front 16

What are the characteristics of bulimia nervosa?

Back 16

bingeing
sense of lose of control
at least twice a week
self-evaluation is unduly influence by body shape/weight

Front 17

What are the characteristics of asperger's disorder?

Back 17

impaired social interaction
- impaired nonverbal communication skills
- failure to develop appropriate peer relationships
- lack of social interests/reciprocity
Restricted repetitive and stereotyped patterns of behavior
- preoccupation with idiosyncratic interests
- inflexible adherence to routines/rules
- stereotypic motor mannerisms

Front 18

If a child is diagnosed with asperger's disorder and there are significant delays in cognitive development and or adaptive skills, what do we call it?

Back 18

pervasive developmental disorder

Front 19

What is the response rate for stimulants in ADHD?

Back 19

65 to 75% compared to 5 to 30% placebo response

short term results

Front 20

Which stimulants have been studied in the treatment of ADHD in children?

Back 20

methylphenidate
dextroamphetamine
pemoline
mixed amphetamine salts

Front 21

What drug is FDA approved usage of ADHD in children?

Back 21

amphetamine salts
age 6 for methylphenidate and age 3 for dextroamphetamine

Front 22

What is the black-box warning on amphetamine salts in children?

Back 22

cardiotoxicity

Front 23

What is atomoxetine?

Back 23

treatment for ADHD
noradrenergic-reuptake inhibitor
positive for randomized control trials for ADHD in children and adults
FDA approved for 6 y/o and older

Front 24

What is the black-box warning on atomoxetine?

Back 24

liver failure

Front 25

What are clonidine/guanfacine? What are they used for?

Back 25

alpha-adrenergic agonists
two small trials for usage in children with ADHD
Tourette's syndrome

Front 26

What is the indication of uses for antidepressants in kids?

Back 26

depression
dysthymia
bi-polar depression
generalized anxiety (incl. separation anxiety)
panic disorder
OCD
PTSD
enuresis
autism/aspergers
ADHD
headache/chronic pain

Front 27

Name 5 tricyclic antidepressants:

Back 27

imipramine
amitriptyline
nortriptyline
comipramine
desipramine

Front 28

What is the evidence that tricyclic antidepressants are effective in Rx of child depression?

Back 28

13 studies with > 300 subjects: none were superior to placebo (50 to 60% placebo response)

Front 29

What is the evidence that tricyclic antidepressants are effective in treating ADHD?

Back 29

several positive RCT's although not as effective as stimulants

Front 30

What is the evidence that tricyclic antidepressants are effective in the treatment of Enuresis?

Back 30

several positive RCT's for imipramine

Front 31

What is the evidence that tricyclic antidepressants are effective in the treatment of OCD?

Back 31

3 positive RCT's for clomipramine

Front 32

What is the evidence that tricyclic antidepressants are effective in the treatment of autism?

Back 32

1 RCT found clomipramine helpful for repetative behaviors in autism

Front 33

What are the best indications for using tricyclic antidepressants in children?

Back 33

Impramine for enuresis
Clomipramine for OCD
NOT indicated for anxiety of depression

Front 34

What have studies shown in the usage of fluoxetine (SSRI) in the treatment of adolescent depression?

Back 34

Emslie 1997: moderate to severe depression 58% vs 33% placebo response
Emslie 2002: significant improvement but 53% placebo response rate
Simeon 190: no difference, both groups had 66% response rate

Front 35

What is the only medication approved for the treatment of depression in children?

Back 35

fluoxetine

Front 36

Besides depression, what other indications are there for SSRI's in children?

Back 36

anxiety
OCD (studied fluvoxamine, sertaline, and fluoxetine)

Front 37

At what age is Lithium approved for the treatment of bipolar children?

Back 37

12 years and older

Front 38

What drugs have been utilized in the treatment of bipolar disorder in children?

Back 38

lithium
valproate
carbamazepine
anticonvulsant - trileptal, lamictal, topomax, neurotin, gabatril

Front 39

What drugs have been studied in the treatment of conduct disorder?

Back 39

risperiodone
haloperidol
molindone

Front 40

For the treatment of childhood schizophrenia, which antipsychotic has been shown to be superior?

Back 40

clozapine superior to haloperidol

Front 41

What do we use in children with aggressive and self-injurious behaviors in autism?

Back 41

risperidone

Front 42

What do we use in children with anxiety disorders?

Back 42

fluvoxamine

Front 43

What psychotherapy modalities have the best evidence for usage in children and adolescents?

Back 43

CBT for depression and anxiety
CBT/behavioral strategies for conduct problems
parent training for conduct problems
Multisystemic therapy for conduct problems