Lange - Chapter 2: Child And Adolescent Psychiatry

Front 1

Approximately what % of adolescents have attempted suicide at least once in their lives?

Back 1

9%

Front 2

Has the adolescent suicide rate increased or decreased or remained the same in the past few decades?

Back 2

Substantially increased.

Front 3

What is the MC method by which adolescents DIE by suicide?

Back 3

- firearms

- drug overdose is the MC method of suicide ATTEMPTS, but accounts for fewer completed suicides

Front 4

What stages of sleep does episodes of sleep terror and sleepwalking occur?

Back 4

3 and 4

Front 5

What is the first-line agent for MDD in children and adolescents?

Back 5

Fluoxetine (Prozac) is FDA approved for children ages 8-18y.o.

Sertraline [Zoloft] is a first-line agent for MDD in children and adolescents.

Front 6

What kind of therapy is bulumia nervosa most effectively treated with?

Back 6

Cognitive-behavioral therapy (CBT) is the most effective type of therapy for Bulimia Nervosa.

Front 7

What are Sxs of expressive language disorder?

Back 7

- markedly limited vocabulary
- making errors in tense
- having difficulty recalling words or producing sentences with developmentally appropriate length or complexity

Front 8

What kind of test would be most helpful in confirming a Dx of expressive language disorder?

Back 8

An IQ test would be helpful b/c a Dx of MR must be R/O.

Front 9

What is rumination disorder?

Back 9

- repeated regurgitation and rechewing of food
- at least 1 month following a period of nL functioning
- often seen in infants with a variety of caretakers in an unstable environment
- can see drooling
- lack of weight gain can also be seen if baby does not reswallow the milk/food

Front 10

What kind of test would be most helpful in confirming a Dx of rumination disorder?

Back 10

An esophageal pH measurement so that esophageal reflux can be R/O.

Front 11

What is reactive attachment disorder of infancy or early childhood?

Back 11

- social circumstances have prevented the child from forming a normal reciprocal attachment to a caregiver resulting in abnL behavior

Front 12

What are the 2 types of reactive attachment disorder of infancy or early childhood?

Back 12

1. inhibited type
- the child is withdrawn and unresponsive (like Spitz's orphanage children)

2. disinhibited type
- the child approaches and cuddles up indiscriminately to strangers and familiar people

Front 13

Somatization?

Back 13

- a defense mechanism in which emotional concerns are manifested as physical Sxs

Front 14

Coprolalia?

Back 14

- the repetitive speaking of obscene words
- seen in severe cases of Tourette disorder

Front 15

Reaction formation?

Back 15

- a defense mechanism in which unacceptable impulse is transformed into its opposit

Front 16

Coprophagia?

Back 16

- the eating of feces

Front 17

What is the MC cause of visual hallucinations in a child?

Back 17

- substanced-induced psychotic disorder
- child may have ingested prescription drugs, illicit drugs, OTC meds, or household agents

Front 18

What is the MC psychiatric emergency in children and adolescents?

Back 18

- suicidal behavior

Front 19

Axis I?

Back 19

- all Dx of mental illness (including substance abuse and developmental disorders)

- NOT personality disorders & MR

Front 20

Axis II?

Back 20

- personality disorders & mental retardatio

Front 21

Axis III ?

Back 21

- medical (physical) disorders

Front 22

Axis IV ?

Back 22

- psychosocial and environmental problems that may affect the Dx, Tx't, and prognosis of her Axis I disorder

Front 23

Axis V ?

Back 23

- the Global Assessment of Functioning (GAF)

- the clinician's judgement of the individual's overall level of functioning

Front 24

What Sxs are MC'ly seen in children with MDD compared to adolescents with MDD?

Back 24

- psychomotor agitation

Front 25

What is the MC method used by children when attempting suicide?

Back 25

- substance ingestion

Other frequently used methods include:
- stabbing
- cutting
- jumping from buildings
- hanging
- running in front of vehicles
- gas inhalation

Front 26

What are common SEs of DDAVP?

Back 26

- HAs
- nausea

Front 27

What are lab findings that could be found with use of DDAVP?

Back 27

- mild hyponatremia


(hypocalcemia / hypokalemia / hypomagnesemia / hypophosphatemia = are NOT SEs of DDAVP)

Front 28

The approximate comorbidity of childhood anxiety disorders and MDD is?

Back 28

50%

Front 29

What are the MC SEs of fluoxetine [Prozac]?

Back 29

- GI Sxs
- insomnia
- agitation
- HAs


(weight gain / sedation = are NOT SEx)

Front 30

Treat lead toxicity with?

Back 30

CaEDTA
- chelating agent

Front 31

Treat benzo o/d with?

Back 31

- flumazenil

Front 32

Treat opiate o/d with?

Back 32

- naloxone [Narcan]

Front 33

Treat iron toxicity with?

Back 33

- deferoxamine

Front 34

Treat acetaminophen toxicity with?

Back 34

- N- acetylcysteine

Front 35

Treat aspirin toxicity with?

Back 35

- alkalinizing the urine

Front 36

Facts about Rett disorder.

Back 36

- the only DSM-IV-TR disorder that is seen ONLY in girls

- no clear char-tic lab findings associated with this disorder

- genetic testing is available

- no known familial clusters of this disorder

Front 37

What co-morbid disorder is a child with conduct disorder likely to have?

Back 37

- substance-related disorder and/or ADHD

Front 38

Following a Dx of DM-1, what % of children develop Sxs of adjustment disorder?

Back 38

33%

Front 39

What is the first-line Tx't for Tourette disorder?

Back 39

- Clonidine [Catapres]

- also haloperidol [Haldol]
- also pimozide [Orap]

Front 40

Why is clonidine first-line Tx't for Tourette disorder?

Back 40

- has a limited SE profile
- helps control Sxs of 2 frequently associated comorbid disorders: ADHD and OCD

Front 41

Is the DISC reliable in children aged 6 - 9?

Back 41

No.

Front 42

A child with a psychiatric illness and medical illness should be:

Back 42

- treated aggressively for psychiatric illness b/c it positively affect a medical illness with improvement of psychiatric Sxs

Front 43

What is the MC initial Sx of Tourette?

2nd MC?

Back 43

MC = eye tics (blinking, eye rolling)

2nd MC = facial tics (grimacing, licking movements) and vocal tics

Front 44

Dx of Tourette Disorder:

Back 44

- multiple motor tics and one or more vocal tics must be present at some time during illness
- need NOT be concurrently

- onset before age 18
- average age of onset = 7 y.o.
- tics must be present for over 1 year on nearly every day
- NO tic-free period for longer than 3 months

Front 45

What are the MC predisposing factors for MR?

Back 45

- early alterations in embryonic development (eg. chromosomal changes) and prenatal damage due to toxins

Front 46

If a child suffers from tics or has a family history of tics what kind of medications should be avoided?

Back 46

- stimulant medications

Front 47

Learning disorders are commonly associated with:

Back 47

- ADHD

Also
- conduct disorder
- oppositional defiant disorder
- MDD
- dysthymic disorder

Front 48

Approximately what % of students in public schools have a learning disorder?

What % of those students drop out of school?

Back 48

5% prev. of learning disorders in public schools.

~40% drop out

Front 49

MC'ly enuresis occurs in:

Back 49

Normal little boys

Front 50

What are the MC SEs of methylphenidate and other stimulant Rx?

Back 50

- insomnia
- decreased appetite
- weight loss
- dysphoria
- irritability

Front 51

Stimulant Rx are effective in reducing Sx of ADHD in approximately what % of patients?

Back 51

70%

Front 52

At what age can a child:

1. copy a circle

2. tell her age and gender and ride a tricycle

3. copy a square and identify her left hand

Back 52

1. Age 2

2. Age 3

3. Age 5

Front 53

Common lab findings in anorexia nervosa:

Back 53

- hypercholesterolemia
- mild normocytic normochromic anemia
- leukopenia
- hypokalemia, hypochloremia and metabolic alkalosis may be seen with vomiting

Front 54

Physiological findings in anorexia nervosa:

Back 54

- decreased energy expenditure
- low serum estrogen levels in girls
- low serum testosterone levels in boys
- increase in ventricular-brain ratios 2/2 starvation

Front 55

stranger anxiety:

Back 55

- usually at 7-8 months

Front 56

Bonding occurs in what period?

Back 56

- begins in the immediate postdelivery period

Front 57

Attachment occurs in what period?

Back 57

- attachments occurs with ongoing interaction over time
- does not require contact in the perinatal period

Front 58

Schizophrenia: Paranoid type Sxs

Back 58

- delusions or frequent auditory hallucinations

- highest functioning type
- older age of onset

Front 59

Schizophrenia: Disorganized type Sxs

Back 59

- disorganized speech
- disorganized behavior
- flat or inappropriate behavior

- poor functioning type
- early onest

Front 60

Schizophrenia: Catatonic type Sxs

Back 60

- motor immobility
- excessive purposeless motor activity (automatisms)
- extreme negativism or mutism
- peculiar voluntary movements or posturing
- echolalia
- echopraxia

- rare

Front 61

Schizophrenia: Undifferentiated type Sxs

Back 61

- characteristic of more than one subtype or NONE of he subtypes

Front 62

Schizophrenia: Residual type Sxs

Back 62

- prominent negative Sxs with only minimal evidence of positive Sxs

Front 63

Dopamine Pathways Affected in Schizophrenia:

- prefrontal cortex
- mesolimbic

Back 63

Prefrontal cortex = negative Sxs

Mesolimbic = positive Sxs

Front 64

Other important pathways affected by neuroleptics:

- tuberoinfundibular
- nigrostriatal
- ventral-tegmentum

Back 64

Tuberoinfundibular
- blocked by Rx; causes hyperprolactinemia

Nigrostriatal:
- blocked by Rxs
- causes EPSEs

Ventral-Tegmentum
- reward/addictive pathway

Front 65

NT abnL-ties in Schizophrenia:

- 5-HT
- NE
- GABA

Back 65

- increased 5-HT

- increased NE

- decreased GABA ( loss of GABAergic neurons in the hippoocampus)

Front 66

A poor prognostic factor for childhood schizophrenia:

Back 66

- onset before age 10

Front 67

A better outcome for childhood schizophrenia is associated with:

Back 67

- more affective Sxs
- acute onset
- older age at onset
- good premorbid functioning
- well-differentiated Sxs
- lack of family Hx of schizophrenia

Front 68

Children with ADHD often suffer from __________ self-esteem.

Back 68

low

Front 69

At what age do children begin to understand the irreversibility of death?

Back 69

7-8 yrs

Front 70

What is a frequent adverse effect of clonidine?

Back 70

- sedation - but with continued Tx't, the sedation usually subsides

- dry mouth is a less common adverse effect
- hypotension is a RARE adverse effect

Front 71

Which month of pregnancy carries the highest risk of congenital defects with rubella infx?

Back 71

- first month (50%)

Front 72

Physical abuse of a child is under which Axis?

Back 72

Axis I Dx

Front 73

What lab findings are associated with anorexia nervosa?

Back 73

- hypercholesterolemia
- increased secretion of CRH
- hypoglycemia
- hypothyroidism
- leukopenia

Front 74

Alexia

Back 74

- inability to read

Front 75

Anomia

Back 75

- inability to name objects even though the object is recognizable and can be described by the patient

Front 76

Aphasia

Back 76

- more global
- abnL-ty in either the expression or comprehension of language

Front 77

Agnosia

Back 77

- inability to recognize objects

Front 78

Apraxia

Back 78

- inability to perform learned motor skills despite nL strength and coordination

Front 79

Group A beta hemolytic Streptococcus has been associated with?

Back 79

- OCD
- Tourette disorder

Front 80

Pica

Back 80

- disorder where inappropriate objects are eaten
- eg. soil, feces, ice

Front 81

What lab findings are associated with Bulimia Nervosa?

Back 81

- hypokalemia
- hyponatremia
- hypochloremia
- metabolic alkalosis

Front 82

An example of a presentation of stereotypic movement disorder:

Back 82

- self-inflicted bodily injury that is severe enough to require medical attention

Front 83

Asperger disorder

Back 83

- pervasive developmental disorder
- impairment in social interactions
- development of stereotyped or repetitive patterns of behaviors WITHOUT significant delay in language skills or cognitive function
- more common in males
- high-functioning autism

Front 84

DSM criteria for conduct disorder:

- need at least 3 out of the 4

Back 84

1. aggression towards people and animals

2. destruction or property

3. deceitfulness

4. serious violations of rules

Front 85

Oppositional defiant disorder:

Back 85

- at least 6 months

- negativistic, hostile, defiant behavior directed mostly at authority figures

Front 86

Borderline MR:

Back 86

IQ = 70-79

Front 87

Mild MR:

Back 87

IQ = 50 - 70

Front 88

Moderate MR:

Back 88

IQ = 35 - 50

Front 89

Severe MR:

Back 89

IQ = 25 - 35

Front 90

Profound MR:

Back 90

IQ = < 25