Hehi Test #2 - Mental Health Disorders First Diagnosed In Childhood And Adolescence

Front 1

Suicide risk assessment in children

Back 1

1. Suicidal thoughts, threats, or attempts
2. Circumstances and motivation at the time of suicidal thoughts and behaviors
3. Moods or feelings
4. Concepts about suicide and death
5. Experiences withsuicide and death

Front 2

Vulnerability to mental disorders

Back 2

1. Genetics
2. Perinatal exposure and/ or toxins
3. Biological - neurotransmitters and structural abnormalities (ADHD - deficiency in dopamine transport; left temporal lobe associated with autism)
4.Temperament

Front 3

Vulnerability risk factors to mental disorders

Back 3

1. Foster care placement
2. Large families
3. low economic status
4. maternal psychiatric disorders
5. Parental criminality
6. Severe marital discord
7. Traumatic life events
8. Emotional, physical, and sexual abuse

Front 4

Characteristics of a Resilient Child

Back 4

1. Adaptive temperament
2. Ability to form nurturing relationships with surrogate parental figures
3. Ability to distance self from emotional chaos in parents and family
4. Good social intelligence and problem-solving skills

Front 5

Essential assessment data

Back 5

1. History of present illness
2. Developmental history - pregnancy complications; milestones
3. Maturation level
4. Neurological status
5. Medical history
6. Family history - predisposition
7. Mental status
8. Characteristics of play

Front 6

Methods of collecting data

Back 6

1. Structures questionaires
2. Behavioral checklists
3. Genograms
4. Semistructured interview with child or adolescent
5. Play activities
6. Observation of interaction between child and family/ caregivers/ peers

Front 7

Pervasive Developmental Disorders

Back 7

PERVASIVE and severe impairment in:
a. communication skills
b. reciprocal relationships

types: Autistic, Asperger's, Rett's, Disintegrative

Front 8

Autistic Disorder: Standard Autism

Back 8

A behavioral syndrome resulting from abnormal brain function (onset usually before 3 years)

Presenting symptoms:
- Impairment in communication (none, very little, or repetitive) and imaginary activity
- Impairment in social interactions - in severe cases, cannot engage in play with other kids
- May lack nonverbal communication skills
- Markedly restricted stereotypical patterns of behavior and interest

Front 9

Asperger's Disorder: High functioning Autism

Back 9

1. Usually first observed after 2 years of age
2. Mild mental retardation is normal
3. No significant delays in cognitive and language development
4. Seizure disorder common
5. Outcome fair to poor
6. No significant delays in self-help skills
7. Severe and sustained impairment in social interactions
8. Development of restricted, repetitive patterns of bahavior
9. Interests and activities that resemble autistic disorder
10. Possible presence of delayed motor milestones, with clumsiness noted in preschool
11. Social interaction problems that become more noticeable when child enters school
12. Problems with empathy and modulating social relationships that may continue into adulthood

Front 10

Childhood disintegrative disorder

Back 10

1. Marked regression in multiple areas of function after at least 2 years of normal development
2. Loss of previously acquired skills in as least 2 of the following areas: communication, social relationships, paly, adaptive behavior, bowel/ bladder control, motor skills
3. Deficits in communication and social interactions (same as autism)
4. Stereotypical behaviors
5. Loss of skills reaching a plateau, which may be followed by limited improvement

Front 11

Rett's Syndrome

Back 11

1. Loss of acquired hand skills and development of sterotypical hand movements (hand wringing)
2. Problems with coordination and gait
3. Severe psychomotor retardation
4. Severe problems with expressive and receptive language
5. Loss of interest in social relationships
6. Only affects females
7. Thought to be associated with electroencephalographic abnormalities, seizure disorder, and severe or profound mental retardation
9. Onset before age 4
10. Outcome is very poor

Front 12

Pervasive developmental disorders: assessment guidelines

Back 12

1. Developmental assessment - spurts or lags, unevenness, loss of previously acquired abilities
2. Relationship assesesment - bonding, anxiety, tension

*HIGH RISK FOR ABUSE

Front 13

Interventions for children with pervasive developmental disorders

Back 13

1. School:
- Therapeutic nursery schools
- Special education classes in public schools

2. Parents taught how to:
- Modify child's behavior
- Foster development of skills

3. Pharmacological agents
- Haloperidol (Haldol) - blocks dopamine; discipline = behavior modification

Front 14

Attention Deficit Hyperactivity Disorder

Back 14

1. More frequent in males (4:1 ratio in general population; 9:1 in clinic population)
2. Firstborn boys most common
3. First-degree relative , particularly father
4. High prevalence of other familial disorders

Front 15

Presenting symptoms for ADHD

Back 15

1. Has difficulty paying attention
2. Does not seem to listen, follow through of finish tasks
3. Does not pay attention to details and makes careless mistakes
4. Is easily distracted, loses things, and is forgetfu in daily activities (symptoms worsen in situation requiring sustained attention)

Front 16

Hyperactivity - usually lost with age

Back 16

1. Fidgets, is unable to sit still or stay seated in school or at other times
2. Runs and climbs excessively in inappropriate situations
3. Has difficulty playing in leisure activities quietly
4. Talks excessively

Front 17

Impulsivity

Back 17

1. Blurts out answer before question has been completed
2. Hasdifficulty waiting for own turn
3. Interrupts intrudes in others' conversations and games

Front 18

Part 1 - Inattentive symptoms (must have 6 or more)

Back 18

1. Forgetful
2. Often loses things
3. Difficulty organizing
4. Often does not seem to listen
5. Distracted by extraneous stimuli
6. Fails to give attention to details
7. Difficulty staying on task
8. Fails to finish schoolwork or chores
9. Hesitant to engage in tasks that require sustained mental effort

Front 19

Part 2 - Hyperactivity/ Impulsivity (must have 6 or more)

Back 19

1. Fidgety
2. unable to sit still
3. Runs about or climbs excessively
4. "On the go"
5. Talks excessively (Professor Baird - according to Inott)
6. Difficulty engaging in leisure activities
7. Blurts out answers
8. Difficulty waiting turn
9. Interrupts and intrudes on others
10. Frequently has poot social boundaries - touching and comments
11. Outbursts/ aggression

Front 20

Comorbid diagnoses associated with ADHD

Back 20

1. Decreased self-esteem
2. Developmental delays
3. Depression
4. Learning disabilities
5. Conduct disorders
6. Substance abuse

Front 21

Course of ADHD

Back 21

1. Symptoms may be observed in infants and toddlers
2. Diagnosed during elementary school
3. Stable through early adolescence
4. Symptoms often dissipate late adolescence/ early adulthood
5. minority continue with full symptoms into mid-adulthood
6. Others may retain some symptoms (partial remission)

Front 22

Recommended System assessment tools for ADHD

Back 22

1. Conner's parent and teacher scales
2. Achenback child behavior checklist for ages 4-18
3. Vanderbilt ADHD diagnostic parent rating scale

Front 23

Assessment of ADHD

Back 23

1. Relationship between child and parents/ caregiver
2. Developmental competencies
3. Level of physical activity, attention span, talkativeness

Front 24

Nursing diagnoses for ADHD

Back 24

1. Risk for injury: self and/ or others
2. Ineffective individual coping
3. Impaired social interaction
4. Chronic low self-esteem

Front 25

Nursing interventions for ADHD

Back 25

1. Behavior modifications
2. Special education programs
3. Psychotherapy
4. Play therapy
5. Pharmaceutical agents - methylphenidate, mixed amphetimine, concerta

Front 26

Oppositional Defiant Disorder - think 8 year olds on Maury wearing halter tops and mini skirts and calling mom a bitch

Back 26

1. Enduring pattern of negative, hostile, and defiant behavior
2. Behavior is directed toward those well known to the individual
3. Absence of serious violation of other people's rights - distinguish from conduct disorders
4. Before puberty - boys > girls; after puberty boys = girls

Front 27

Influences of ODD

Back 27

1. temperamental predisposition
2. Parental patterns of control, power, struggles with autonomy (parents won't let them dress themself)
3. Family Hx: antisocial PDO, substance abuse

Front 28

Symptoms of ODD

Back 28

1, Refuses to comply with requests of others
2. Irritability and easily annoyed
3. Anger, resentful, often loses temper
4. Blames others
5. Deliberately annoys others
6. Spiteful and vidictive
7. Symptoms may not be evident outside home

Front 29

Nursing Interventions for ODD

Back 29

1. Outpatient treatment with individual , group, and family therapy
2. Focus therapy on parenting issues

Front 30

Conduct disorder - often child onset type is preceded by ODD

Back 30

1. Repetitive and persistent pattern of behavior in which:
- Basic rights of others are violated
- Major age-appropriate societal norms or rules are violated (ex. 10 yo leaves fri. at 10pm and returns sun. night)

Front 31

Environmental risk factors for developing conduct disorder

Back 31

1. Psychopathology
2. Substance dependence
3. neglectful and abusive
4. Chaotic conditions

Front 32

Prognosis

Back 32

Dependent on age of onset (earlier the onset, the worse the symptoms, the worse the prognosis), intellectual ability, conmorbid conditions

Front 33

Symptoms of Conduct Disorder

Back 33

1. Bullies and threatens others
2. Lying, cheating, and stealing - with or without weapons
3. Truancy and runaway behaviors
4. Poor academic achievement
5. Use of tobacco, ETOH or other drugs
6. Lack of guilt, empathy, or remorse
7. Physical cruelty to animals and people

*May have one person hey trust and latch onto - this is hopeful

Front 34

Diagnostic Criteria for Conduct Disorder

Back 34

A.) Three or more criteria in past 12 months, at least one present in past 6 months
- Aggression toward people or animals
- Destruction of property
- Deceitfulness or theft
- Serious violation of rules

Front 35

Nursing Assessment of Conduct Disorder

Back 35

1. Disruptive behavior
2. Level of anxiety, aggression , anger, hostility, impulsivity/ ability to understand impact of behavior
3. Inability to empathize with others

Front 36

Interventions for Conduct Disorders

Back 36

1. Inpatient hospitalization for crisis intervention - usually legally mandated after some offense
2. Transfer to therapeutic foster home

Front 37

Disruptive Behavior Disorders - general treatment focus

Back 37

1. Individual - self-esteem, peer relationships, self-control, empowerment
2. Parenting - education, developmental tasks, child advocate
3. School involvement - "team" approach, assessment tools, teacher education

Front 38

Interventions for Aggressive behavior

Back 38

1. Pharmacological agents
2. Cognitive-behavioral therapy
3. Behavior modification
4. Assess parents' knowledge of disorder
5. Provide information as needed
6. Assess impact of patient's behavior on family life
7. Discuss setting realistic behavioral goals
8. Refer parents to local self-help group - caregiver role strain, frustration

Front 39

Techniques for managing Disruptive behaviors

Back 39

1. Planned ignoring
2. Use of signals or gestures - to let child know when they are being disruptive without being interruptive to someone
3. Physical distance and touch control
4. Redirect child's attention to an activity
5. Give additional affection - use appropriate times, avoid embarrassment
6. Use humor as diversion
7. Appeal to child's developing self-control
8. Give early help to a child who is easily frustrated
9. Clarify situation and motivation for behavior
10. Change activity to decrease stimulationor frustration
11. Remove child from situation - appropriately, don't embarrass
12. Set limits
13. Safety of others

Front 40

General Psychosocial Interventions

Back 40

1. Play therapies: behavioral, mutual story telling, structured and nondirective play
2. Cognitive therapies: beliefs
3. Behavioral therapies: behaviors
4. Self-care management: empowerment
5. Group therapies: esteem, social interaction
6. Family therapies/ couseling: education

Front 41

4 S's of Inpatient Milieu

Back 41

Security & Safety
Structure
Support
Symptom Management

Front 42

TEST QUESTION - psychostimulants

Back 42

Found to be effective over placebo in approximately 90% of patients

Increases: vigilance and attention, short term memory; makes dopamine more available (& NE)

Decreases:motor activity, mpulsiveness, emotional lability

ADHD: activates arousal centers, so it's difficult to ignore something

Front 43

Other medication considerations for treating ADHD

Back 43

1. TCA's :
- If stimulants ineffective or not tolerated
- Coexisting enxiety or depressive disorder
- Family History of mood disorder
- Most common: Nortriptyline, Imipramine and Desipramine

2. Clonidine:
- Decreases excessive hyperactivity, has calming effect (does not improve inattention symptoms)
- May be useful in insomnia - monitor BP

Front 44

Suicide in Kids

Back 44

- Third leading cause of death among 15-24 year olds
- Sixth leading cause of death in 5-15 year olds
- For every kid who takes their life, there are 100-200 who commit suicide

Front 45

Assessing suicide risk in children

Back 45

1. Suicidal thoughts, threats, or attempts
2. Circumstances and motivation at the time of suicidal thoughts and behaviors
3. Moods or feelings
4. Concepts about suicide and death
5. Experience with suicide and death

Front 46

Risk factors for developing a psychiatric disorder

Back 46

1. severe marital discord
2. low socioeconomic status
3. large families and overcrowding
4. paternal criminality
5. Maternal psychiatric disorders
6. Foster care placement
7. traumatic life events
8. emotional, physical, sexual abuse