Kk&s Ch.54 Child Treatment

Front 1

A first task in therapy?

Back 1

stimulate child's motivation; i.e., often parent who perceives advantages in getting well

Front 2

What to think about if psychotherapy not effective with child?

Back 2

it is important to determine whether the therapist and patient are poorly matched,
whether the type of psychotherapy is inappropriate to the nature of the problems,
and whether the child is cognitively inappropriate for the treatment.

Front 3

Name Yalom's factors contributing to group effectiveness and describe

Back 3

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Hope: Hope may be generated by gathering with others who are experiencing similar difficulties and by observing others actively mastering the problems.
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Universality: Children and adolescents with psychiatric disorders often feel isolated and alienated from peers. Working together in groups may diffuse the isolation and help children and adolescents view their disorder as only a small part of their overall identity.
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Imparting Information: Children and adolescents are familiar with a format of gaining new information in a group setting, such as in school. The group therapy format provides an opportunity to reinforce learning when the child or adolescent “helps” or demonstrates what he or she has learned to peers.
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Altruism: Helping other peers in a group setting by supporting them and identifying with their struggles can improve a child or adolescent's self-esteem and help them gain a sense of mastery over their own issues.
P.1313

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Improved Social Skills: Group therapy is a safe format in which children and adolescents with poor social skills can improve their interpersonal and communication abilities under the supervision of a leader and with peers who also benefit from the practice scenarios

Front 4

Two biggest child studies?

Back 4

2004
POTS Pediatric OCD Tx Study
TADS: Treatment of Adolescents with Depression Study

Front 5

How is child pharmacokinetics different than adults?

Back 5

Children: >hepatic capacity; >GFR; <fatty tissue

Front 6

What kinds of drugs are eliminated more rapidly in kids than adults?

Back 6

Thus, stimulants, antipsychotics, and tricyclic drugs are eliminated more rapidly by children than by adults;

Front 7

Lithium: eliminated faster in kids or adults?

Back 7

kids; less fat to store tissue

Front 8

t 1/2; shorter in kids or adults

Back 8

kids shorter t/1/2 because of quick elimination

Front 9

What conditions and drugs are drug levels helpful?

Back 9

TCA for tx of enuresis
Lithium

Front 10

alternate way of getting lithium values?

Back 10

average 4 saliva concentrations

Front 11

ADHD: drugs and their approved age ranges

Back 11

Dextro-amphetamine for 3 and older
Methylphenidate: 6 and over

Front 12

Which rx combines dextroamphetamine and amphetamine?

Back 12

adderall

Front 13

Stimulants reduce hyperactivity, inattentiveness, and impulsivity in about ? percent of children with ADHD

Back 13

75%

Front 14

atomoxetine side fx?

Back 14

abdominal pain
loss of appetite

Front 15

Dextroamphetamine; amphetamine; methylphenidate side fx?

Back 15

Insomnia,
anorexia,
weight loss (possibly growth delay),

rebound hyperactivity,
headache,
tachycardia,
precipitation or exacerbation of tic disorders

Front 16

Side fx of clonidine?

Back 16

Bradycardia, arrhythmia, hypertension, withdrawal hypotension.

Front 17

Side fx of gaunfacine?

Back 17

Same as with clonidine plus headache, stomachache.

Front 18

Side fx of desmopressin

Back 18

Headache, nasal congestion, hyponatremic seizures (rare

Front 19

Atomoxetine metabolized by?

Back 19

2D^

Front 20

To date, ? and ? have shown promise in ending stereotypies and other behaviors in autistic children and adults.

Back 20

To date, clomipramine (Anafranil) and fluoxetine have shown promise in ending stereotypies and other behaviors in autistic children and adults.

Front 21

TRUE OR FALSE
The opioid antagonists naloxone (Narcan) and naltrexone have proved effective in diminishing self-injurious behavior in children with autistic disorde

Back 21

FALSE
THEY HAVE NOT

Front 22

Carbamazepine (Tegretol) has not been shown to be effective in controlling aggression in child and adolescent conduct disorders.

True or False?

Back 22

True

Front 23

Lithium has not been shown in multiple investigations to reduce aggression in conduct disorder
True or false?

Back 23

False
It has been helpful

Front 24

which child anxiety disorders tend to cluster?

Back 24

seperation anxiety
social phobia
GAD
in 30% of cases, all 3 comorbid

Front 25

Randomized clinical trials have provided evidence for the efficacy and safety of fluoxetine, ?, and ?in the treatment of major depression in children and adolescent

Back 25

Randomized clinical trials have provided evidence for the efficacy and safety of fluoxetine, sertraline, and citalopram (Celexa) in the treatment of major depression in children and adolescent

Front 26

Current literature has provided evidence from randomized clinical trials of efficacy and safety of fluoxetine, ?, and ? as first-line agents for children and adolescents with OCD

Back 26

fluvoxamine
sertraline

Front 27

Sleep terror disorder and sleepwalking disorder occur in the transition from ?sleep to ? sleep
Rx for these disorder? How do they work?

Back 27

Sleep terror disorder and sleepwalking disorder occur in the transition from deep delta-wave sleep (stages 3 and 4) to light sleep.

Benzodiazepines and tricyclics are effective in these disorders. They work by reducing both delta-wave sleep and arousals between sleep stages

Front 28

TCA and side fx versus adults: what is more common in kids?
toxic dose?

Back 28

kids> HTN and less hypotension than adults
fatal at 200 to 400mg

Front 29

Which class of drugs most impairs cognitive test perfomance?

Back 29

antipsychotics; almost every domain but IQ

Front 30

What is effect of antidepressants on cog testing?

Back 30

improve attention
neutral for all else

Front 31

Stimulant effect on cog fxn?

Back 31

improve all domains

Front 32

Up to what dose of chlorpromazine can you expect no TD?

Back 32

up to 400mg

Front 33

In the Mutimodal Treatment Study of Children with ADHD (MTA), psychosocial interventions did not add to the efficacy of the stimulant tx for the core sx of ADHD.

True or False?

Back 33

True, did not add

Front 34

ADHD+CBT studies show?

Back 34

not done; unclear

Front 35

Pubertal changes that occur ? years earlier or later than the average age are within the normal range.

Back 35

2.5

Front 36

Suicide is currently the ? leading cause of death among adolescents

Back 36

second after accidents

Front 37

Among adolescents who are not psychotic, the highest suicidal risks occur in those who

Back 37

have a history of parental suicide,
who are unable to form stable attachments,
who display impulsive behavior, and

who abuse alcohol or other substances