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211 Cards in this Set
- Front
- Back
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What sources should you consult when gathering information regarding a child?
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- Child
- Parent / caregiver - Teachers and coaches - Pediatrician - Child welfare / juvenile justice system (if relevant) |
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What are the methods of gathering information in child psychiatry?
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- Diagnostic play sessions
- Classroom observation - Formal neuropsychological testing - Kaufmann Assessment Battery for Children (K-ABC) - Wechsler Intelligence Scale for Children-Revised (WISC-R) |
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What happens in the method of diagnostic play sessions?
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Have the child reveal their internal states and experiences through the use of play, story-telling, or drawing
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What happens in the method of classroom observation?
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Can help provide greater insight into child's functioning in school
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What happens in the method of formal neuropsychological testing?
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Can help clarify diagnoses by quantitatively assessing a child's strengths and weaknesses by examination of intelligence quotient (IQ); language and visual-motor skills; and memory, attention, and organizational abilities
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What is the Kaufman Assessment Battery for Children (K-ABC) used for?
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Intelligence test for ages 2-12
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What is the Wechsler Intelligence Scale for Children-Revised (WISC-R) used for?
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Determines IQ for ages 6-16
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What is the preferred term for mental retardation?
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Intellectual Disability
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What is the DSM-IV criteria for intellectual disability / mental retardation?
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- Significantly sub-average intellectual functioning with an IQ ≤70
- Deficits in adaptive skills appropriate for the age group - Onset must be before the age of 18 |
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How common is intellectual disability / mental retardation?
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- 1-3% of population
- Approx. 85% of cases are "mild" |
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How does gender affect the incidence of intellectual disability / mental retardation?
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Males are affected 1.5x as often as females
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What is the definition of mild intellectual disability / mental retardation? Approximate % of MR?
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- IQ 55-70
- 85% |
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What is the definition of moderate intellectual disability / mental retardation? Approximate % of MR?
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- IQ 40-55
- 10% |
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What is the definition of severe intellectual disability / mental retardation? Approximate % of MR?
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- IQ 25-40
- 3-4% |
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What is the definition of profound intellectual disability / mental retardation? Approximate % of MR?
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- IQ <25
- 1-2% |
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Can you make a diagnosis of intellectual disability / mental retardation just based on low IQ?
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No, need to show deficits in adaptive skills also
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What are the genetic causes of intellectual disability / mental retardation?
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- Down syndrome (trisomy 21)
- Fragile X syndrome - Phenylketonuria, familial mental retardation, Prader-Willi syndrome, Williams syndrome, Angelman syndrome, tuberous sclerosis |
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What is the cause of Down syndrome? How common?
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Trisomy 21 (1/700 live births)
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What is the cause of Fragile X syndrome?
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Mutation of X chromosome, 2nd most common cause of mental retardation, M>F
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What are the prenatal causes of intellectual disability / mental retardation?
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Infection and toxins (TORCH):
- Toxoplasmosis - Other (syphilis, AIDS, alcohol / illicit drugs) - Rubella (German measles) - Cytomegalovirus (CMV) - Herpes simplex |
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What is the "T" of TORCH infections/toxins that causes prenatal intellectual disability / mental retardation?
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Toxoplasmosis
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What is the "O" of TORCH infections/toxins that causes prenatal intellectual disability / mental retardation?
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Other:
- Syphilis - AIDS - Alcohol / illicit drugs |
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What is the "R" of TORCH infections/toxins that causes prenatal intellectual disability / mental retardation?
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Rubella (German measles)
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What is the "C" of TORCH infections/toxins that causes prenatal intellectual disability / mental retardation?
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Cytomegalovirus (CMV)
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What is the "H" of TORCH infections/toxins that causes prenatal intellectual disability / mental retardation?
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Herpes simplex
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What are the perinatal causes of intellectual disability / mental retardation?
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- Anoxia
- Prematurity - Birth trauma - Meningitis - Hyperbilirubinemia |
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What are the postnatal causes of intellectual disability / mental retardation?
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- Hypothyroidism
- Malnutrition - Toxin exposure - Trauma - Psychosocial causes |
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What syndrome is associated with patients with mental retardation, obesity, hypogonadism, and almond-shaped eyes?
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Prader-Willi Syndrome
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What are the typical features of Prader-Willi syndrome?
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Genetic cause of intellectual disability / mental retardation:
- Obesity - Hypogonadism - Almond shaped eyes |
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50% of cases of intellectual disability / mental retardation have what cause?
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No identifiable cause!
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What is the most common inherited form of intellectual disability / mental retardation?
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Fragile X syndrome resulting from FMR-1 gene defect
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What are the characteristics of patients with Fragile X syndrome?
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- Autistic characteristics
- Delayed speech - Motor delay - Sensory deficits - Males have large testicles |
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What do you need to rule out before diagnosing a learning disorder?
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Sensory deficits
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What is the DSM-IV criteria for a learning disorder?
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Achievement in reading, mathematics, or written expression that is significantly lower than expected for chronological age, level of education, and level of intelligence
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What is the impact of learning disorders?
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Affect academic achievement or daily activities
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What must learning disorders not be explained by?
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- Sensory deficits
- Poor teaching - Cultural factors |
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What often causes learning disorders?
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- Deficits in cognitive processing (abnormal attention, memory, visual perception, etc)
- Genetic factors - Abnormal development - Perinatal injury - Neurological or medical conditions |
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What is the most common of learning disorders? How common?
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Reading disorder (4-10% of children); boys > girls
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What is the second most common learning disorder? How common?
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Disorder of written expression (6%)
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What is the least common learning disorder? How common?
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Mathematics disorder (1%); male=female
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How do you treat learning disorders?
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Remedial education tailored to the child's specific needs
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What is the difference between developmentally appropriate defiance and disruptive behavior disorders?
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- Some defiance is appropriate
- Disruptive behavior disorders include symptoms that result in impairment in social and/or academic function |
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What should you think of in kids who have no difficulties getting along with their peers but will not comply with expectations from parents or teachers?
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Oppositional Defiant Disorder (ODD)
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What are the types of disruptive behavior disorders?
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- Oppositional defiant disorder (ODD)
- Conduct disorder |
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What are the DSM-IV criteria for diagnosis of oppositional defiant disorder (ODD)?
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At least 6 months of negativistic, hostile, and defiant behavior during which at least 4 of the following are present:
1. Frequent loss of temper 2. Arguments with adults 3. Defying adults' rules 4. Deliberately annoying people 5. Easily annoyed 6. Anger and resentment 7. Spitefulness 8. Blaming others for mistakes or misbehaviors |
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How long do you need to have symptoms of oppositional defiant disorder (ODD) to make the diagnosis?
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6 months
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How do you distinguish Oppositional Defiant Disorder (ODD) from Conduct Disorder?
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ODD does not involve physical aggression or violation of the basic rights of others!
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How common is Oppositional Defiant Disorder (ODD)?
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2-16%
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When does Oppositional Defiant Disorder (ODD) begin?
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- As early as age 3, usually observed by age 8
- Onset before puberty is more common in boys, onset after puberty is equal in boys and girls |
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What is there increased incidence of in patients with Oppositional Defiant Disorder (ODD)?
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- Substance abuse
- Mood disorders - Attention deficit / hyperactivity disorder (ADHD) |
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What is the course/prognosis of Oppositional Defiant Disorder (ODD)?
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25% will no longer meet criteria in later years; in persistent cases, may progress to conduct disorder
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How should you treat Oppositional Defiant Disorder (ODD)?
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- Individual psychotherapy that focuses on behavior modification and problem-solving skills
- Include family involvement with a focus on parent management skills training |
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What should you think of in a child with cruelty towards animals?
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Conduct disorder
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What is the most serious disruptive behavior disorder?
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Conduct Disorder
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What are the DSM-IV criteria for Conduct Disorder?
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Persistent pattern of behavior in which basic rights of others or social norms are violated, as evidenced by the presence of at least 3 out of 15 described behaviors during past year
Behaviors are grouped within the following categories: 1. Aggression toward people and animals 2. Destruction of property 3. Deceitfulness or theft 4. Serious violations of rules |
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What do children with Conduct Disorder have a higher rate of?
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- Substance abuse
- Making suicidal gestures and attempts - ADHD (up to 70%) - Learning disorders |
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What are the characteristics of boys with Conduct Disorder?
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Higher risk of fighting, stealing, fire-setting, or vandalism
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What are the characteristics of girls with Conduct Disorder?
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Higher risk of lying, running away, or sexually acting out
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How prevalent is Conduct Disorder?
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1-10%
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What does gender affect the prevalence of Conduct Disorder?
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4-12x higher in boys
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What are the risk factors for Conduct Disorder?
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- Punitive parenting
- Psychosocial adversity - History of being abused - Biological predisposition |
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What is the prognosis for Conduct Disorder?
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40% will go on to develop antisocial personality disorder in adulthood
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How should you treat patients with Conduct Disorder?
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- Multimodal treatment with family and community involvement
- Consistent rules and consequences are important to reduce problematic behaviors - Meds can be useful adjuncts if aggression is present (antipsychotics, mood stabilizers, SSRIs) |
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What meds can be useful for treating Conduct Disorder? Under what circumstances?
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Meds can be a useful adjunct if aggression is present:
- Anti-psychotics - Mood stabilizers - SSRIs |
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Case: 8yo is referred for eval because of academic and behavior problems at school and at home for about a year. Girl's mother reports when she is at home, she appears to be "driven by a motor." She is often forgetful and loses things regularly.
Teacher reports she has been making a lot of careless mistakes in her assignments and constantly fidgets in her seat, sometimes appearing restless during tests. Trouble waiting her turn and refraining from blurting out answers and interrupting the class. She believes the girl is generally intelligent and a "good girl." Soccer coach reports she doesn't always listen to directions and has problems paying attention during games. What diagnosis should come to mind? |
Attention Deficit / Hyperactivity Disorder (ADHD)
- She has enough symptoms (>6) from both the inattentive and hyperactive / impulsive categories to qualify for the "combined" type of ADHD |
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Case: 8yo is referred for eval because of academic and behavior problems at school and at home for about a year. Girl's mother reports when she is at home, she appears to be "driven by a motor." She is often forgetful and loses things regularly.
Teacher reports she has been making a lot of careless mistakes in her assignments and constantly fidgets in her seat, sometimes appearing restless during tests. Trouble waiting her turn and refraining from blurting out answers and interrupting the class. She believes the girl is generally intelligent and a "good girl." Soccer coach reports she doesn't always listen to directions and has problems paying attention during games. What treatment should be considered? |
Stimulant meds are generally considered to be the first line meds for ADHD
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How would you distinguish ADHD from learning disorders and mental retardation?
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- Though ADHD may affect academic performance, it is not defined by specific difficulty with an academic skill
- Learning disorders should be suspected when a child performs below expectation in one or more particular academic area, such as reading or math - A child's expected performance can be gauged in context of their age, intelligence, education level and performance in other academic areas |
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Do children with ADHD have lower IQs?
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No, but their ADHD symptoms may make it difficult for them to sit through neuropsychological testing, such as intelligence testing, long enough to obtain valid assessments
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What are the three sub-categories of ADHD?
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- Predominantly inattentive type
- Predominantly hyperactive impulsive type - Combined type |
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What are the DSM-IV criteria for ADHD?
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At least 6 symptoms of either inattentiveness, hyperactivity, or both, that:
- Have persisted for at least 6 months - Are present at a degree that is maladaptive - Have onset prior to age 7 |
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What are the timeline criteria for a diagnosis of ADHD?
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- Symptoms at least 6 months
- Onset prior to age 7 |
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What are inattentive symptoms for ADHD diagnosis?
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- Careless mistakes
- Difficulty sustaining attention - Difficulty listening - Does not follow instructions - Lack of organizational skills - Reluctant to do tasks that require a sustained effort - Losing things easily - Forgetful - Easily distracted |
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What are the hyperactivity-impulsivity symptoms for ADHD diagnosis?
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- Restlessness (leaves the classroom, runs or climbs excessively)
- Difficulty engaging in quiet activities - Appears as though "driven by a motor" - Excessive talking - Blurts out answers - Difficulty waiting their turn - Often interrupts |
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How prevalent is ADHD? Boys vs girls?
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5-12% in school aged children; more prevalent in boys
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How commonly does ADHD persist into adulthood?
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Up to 60% of childhood cases will have symptoms into adulthood (impulsive > hyperactive)
Up to 50% of children with ADHD go on to adulthood untreated |
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What is often comorbid with ADHD?
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More than 50% o children with ADHD have a comorbid psychiatric diagnosis - Mood disorders- Anxiety disorders - Personality disorders - Conduct disorders (30-50%) - Oppositional defiance disorder (30-40%) |
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What contributes to the etiology of ADHD?
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- Genetic factors
- Environmental factors - Neurochemical factors - Neurophysiological factors - Toxin exposures, head trauma, prenatal and perinatal factors |
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How do genetics relate to ADHD etiology?
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Higher concordance rate in monozygotic twins than dizygotic twins
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How do environmental factors relate to ADHD etiology?
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- Emotional deprivation
- Malnutrition - Abuse |
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How do neurochemical factors relate to ADHD etiology?
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Dysregulation of noradrenergic systems
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How do neurophysiological factors relate to ADHD etiology?
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Neurophysiological factors can be demonstrated in certain patients with abnormal EEG pattern or PET scans
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What prenatal and perinatal factors relate to ADHD etiology?
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- Maternal smoking
- Maternal stress - Prenatal substance exposure - Lead poisoning |
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What is the most effective treatment for decreasing core symptoms of ADHD?
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Medications
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What are the first line pharmacological treatments for ADHD?
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CNS stimulants:
- Methylphenidate (Ritalin, Concerta, Metadate, Focalin) - Dextroamphetamine (Dexedrine, DextroStat) - Amphetamine salts (Adderall) |
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What are the trade names for methylphenidate?
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- Ritalin
- Concerta - Metadate - Focalin |
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What is the trade name for dextroamphetamine?
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- Dexedrine
- DextroStat |
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What is the trade name for amphetamine salts?
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Adderall
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What is the name of the non-stimulant that has been FDA approved for ADHD?
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Atomoxetine
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What medications can be used for ADHD if first-line treatment cannot be used (d/t intolerable side effects or ineffectiveness) or as adjunctive therapy to stimulants?
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Alpha-2 agonists (Clonidine, Guanfacine)
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If someone had ADHD and an underlying mood or anxiety disorder, what should be the approach to treatment?
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Treat the underlying mood or anxiety disorder first
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What are the non-pharmacological treatments for ADHD?
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- Family, individual, and group psychotherapy - with focus on behavior modification techniques and social skills training
- Parent psychoeducation - Educational interventions (i.e., teacher and classroom modifications) |
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How effective are CNS stimulants for the treatment of ADHD?
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Significant early improvement is seen in 75% of patients, but long-term efficacy is controversial
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What is required for the diagnosis of encopresis (involuntary defecation, especially associated with emotional disturbance or psychiatric disorder)?
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Must be greater than 5 years old and already been toilet trained
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What are pervasive developmental disorders?
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Group of conditions that involve problems with social skills, language, and behaviors
Impairment is noticeable at an early age of life and involves multiple areas of development (social, communicative, and cognitive) |
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What are the pervasive developmental disorders included in DSM-IV?
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- Autistic disorder
- Asperger disorder - Rett disorder - Childhood disintegrative disorder - PDD not otherwise specified (NOS) |
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What are the DSM-IV diagnostic criteria for autistic disorder?
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At least 6 symptoms must be present by age 3, with at least 2 from (1) and at least one from (2) and (3):
1. Problems with social interaction 2. Impairments in communication 3. Repetitive and stereotyped patterns of behavior and activities Abnormalities in functioning must be present by age 3. The condition cannot be better accounted for by Rett disorder or childhood disintegrative disorder. |
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What are the problems with social interaction that can characterize autistic disorder? How many needed for diagnosis?
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At least 2 (6 total):
- Impairment in non-verbal behavior - Lack of peer relationships - Lack of interest in sharing enjoyment with others - Lack of social / emotional reciprocity |
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What are the impairments in communication that can characterize autistic disorder? How many needed for diagnosis?
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At least 1 (6 total):
- Delayed speech - Inability to hold conversations - Repetitive or stereotyped use of language - Lack of make-believe and imitative play |
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What are the repetitive and stereotyped patterns of behavior and activities that can characterize autistic disorder? How many needed for diagnosis?
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At least 1 (6 total):
- Narrowed interests - Inflexible adherence to rituals - Repetitive motor mannerisms (handflapping) - Preoccupation with parts of objects |
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What test should you get first for a toddler who shows no interest or does not speak less spoken to directly?
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Hearing test (before considering autism)
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How common is autism? How does gender affect prevalence?
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1 in 1000 to 1 in 100
Boys are affected 3-4x more than girls |
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How common is mental retardation in autism?
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70% of individuals with autism meet criteria for mental retardation (IQ <70)
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What is autism associated with?
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- Fragile X syndrome
- Tuberous sclerosis - Seizures |
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What are the contributing factors to autism etiology?
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- Prenatal neurological insults
- Genetic factors - Immunological and biochemical factors |
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What are the prenatal neurological insults that can predispose to autism?
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Infections, drugs, etc
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How do genetics relate to the incidence of autism?
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Siblings of affected persons are at a greater than 22-fold higher risk for autism than the general population
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What immunological and biochemical factors may be involved in the etiology of autism?
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Individuals with autism may have higher peripheral serotonin levels
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What is the prognosis for autism?
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Variable; no cure
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What are the two most important predictors of adult outcome in autism?
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- Level of intellectual functioning
- Communicative competence |
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What treatments for autism can be used to help manage symptoms and improve basic social, communicative, and cognitive skills?
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- Remedial education (ideally on an intensive and continuous basis)
- Behavioral therapy - Anti-psychotic meds (to help control aggression, hyperactivity, and mood lability) - Consider antidepressants or stimulants if other symptoms warrant them |
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What medications can be used in autism? When?
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- Anti-psychotics: to help control aggression, hyperactivity, and mood lability- Consider anti-depressants or stimulants if other symptoms warrant them
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What are the DSM-IV criteria for Asperger Disorder?
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- This condition is characterized by the same impairments seen in autism involving social interaction and restricted or stereotyped interests and behaviors
- Differs from autism in that there is no clinically significant delay in spoken or receptive language, cognitive development, self-help skills, or curiosity about the environment |
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What are the differences between Asperger Disorder and Autism?
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Children with Asperger disorder have normal language acquisition and cognitive development
(but impairments in social interactions and restricted or stereotyped interests and behaviors, similar to Autism) |
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How do you characterize the social interaction of Asperger Disorder?
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- Professorial
- Pedantic |
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What leads to increased risk for depression in adolescent patients with Asperger Disorder?
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Social difficulties lead to chronic frustration
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How do you treat Asperger Disorder?
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- Supportive treatment as used with autism
- Preservation of verbal abilities will allow for more benefit from social skills training and behavioral modification techniques |
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What disorder is characterized by normal physical and psychomotor development during the first 5 months after birth, followed by a decreasing rate of head growth and loss of previously learned purposeful hand skills between ages 5 and 30 months?
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Rett Disorder
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What are the characteristics of Rett Disorder?
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- Normal physical and psychomotor development during first 5 months
- Decreasing rate of head growth and loss of previously learned hand skills between ages 5 and 30 months |
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What do kids with Rett Disorder develop?
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Stereotyped hand movements (hand wringing, hand washing), impaired language and psychomotor retardation, and problems with gait or trunk movements
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Cognitive development never progresses beyond what level in kids with Rett Disorder?
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First year of life
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When is the onset of Rett Disorder?
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5-48 months
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Who is most likely to be affected by Rett Disorder?
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Girls predominantly (boys have variable phenotype)
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Why is Rett Disorder less common in boys?
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Most likely lethal in utero in boys
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How common is Rett Disorder in females?
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1 in 15,000 to 1 in 22,000
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What testing can/should be done for patients with suspected Rett Disorder?
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- Genetic testing is available
- EEG is frequently abnormal, seizures are common |
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What genetic abnormality is associated with Rett Disorder?
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MECP2 gene mutation on X chromosome
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What is the prognosis for Rett Disorder?
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Patients may become non-ambulatory due to motor problems and scoliosis; increased risk of death
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How do you treat patients with Rett Disorder?
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Supportive
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What disorder has normal development in the first 2 years of life, including communication, social relationships, play, and adaptive behavior, but there is loss of previously acquired skills before age 10 years in at least two areas?
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Childhood Disintegrative Disorder
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What are the characteristics of Childhood Disintegrative Disorder?
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- Normal development during first 2 years of life, including communication, social relationships, play, and adaptive behavior
- Loss of previously acquired skills before age 10 years - At least two of these areas: language, social skills or adaptive behavior, bowel or bladder control, play, motor skills - At least two of these areas: impaired social interaction, impaired communication, restricted, repetitive, stereotyped behaviors, and interests |
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There is off of what previously acquired skills by age 10 to diagnose Childhood Disintegrative Disorder?
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- At least two of these areas: language, social skills or adaptive behavior, bowel or bladder control, play, motor skills
- At least two of these areas: impaired social interaction, impaired communication, restricted, repetitive, stereotyped behaviors, and interests |
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What age requirements are there for the diagnosis of Childhood Disintegrative Disorder?
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Onset after age 2 years, usually between ages 3-4 years, must be before 10 years
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How does the incidence of Childhood Disintegrative Disorder differ between boys and girls?
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4-8x higher in boys than girls
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How common is Childhood Disintegrative Disorder?
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Rare, maybe 1 in 100,000 children
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What brain abnormalities are associated with Childhood Disintegrative Disorder?
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High rates of EEG abnormalities and seizure disorders
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What medical conditions can be associated with Childhood Disintegrative Disorder?
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- Landau-Kleffner syndrome
- Neurolipidoses - Mitochondrial deficits - Metachromatic leukodystrophy - CNS infection |
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How do you treat Childhood Disintegrative Disorder?
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Supportive, with a focus on helping a child relearn basic skills
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How does Rett disorder compare to Childhood Disintegrative Disorder?
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In Childhood Disintegrative Disorder, head growth does not slow, and the unusual hand movements are not present
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What are "tics"?
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Sudden, repetitive, non-rhythmic, stereotyped involuntary movements or vocalizations
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What is the most severe tic disorder?
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Tourette disorder
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What are the characteristics of Tourette disorder?
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- Most severe tic disorder
- Multiple daily motor and one or more vocal tics - Onset before 18 years |
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Which type of tics typically appear first in Tourette disorder?
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Motor tics typically appear first, vocal tics may appear many years after motor tics
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What are the most common motor tics in Tourette disorder?
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Involve the face and head, such as blinking of the eyes
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What are examples of vocal tics?
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- Coprolalia
- Echolalia |
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What is Coprolalia?
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Repetitive speaking of obscene words (uncommon in children)
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What is Echolalia?
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Exact repetition of words
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What is the term for repetitive speaking of obscene words?
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Coprolalia
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What is the term for the exact repartition of words?
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Echolalia
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What are the DSM-IV criteria for Tourette disorder?
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- Multiple motor and one or more vocal tics that are not attributable to CNS disease
- Onset prior to 18 years - Tics occur any times a day, almost every day for >1 year (no tic-free period >3 months) - Change in anatomic location and character of tics over time - Both motor and vocal tics must be present to diagnose Tourette disorder |
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Do you need to have both motor and vocal tics for the diagnosis of Tourette disorder?
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Yes, need multiple motor tics and one or more vocal tics (both must be present at some time during illness, but not necessary concurrently)
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What CNS diseases may cause tics?
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- Huntington disease
- Post-viral encephalopathies |
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By what age must the symptoms of Tourette disorder be present for it to be diagnosed?
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Before age 18 years
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Do the tics stay the same in Tourette disorder?
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No, they may change in anatomic location and character over time
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Does Tourette disorder have to cause distress to be diagnosed?
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No, it is one of the few disorders in psychiatry that can be given without symptoms causing significant distress
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How common are transient tic behaviors?
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Common in children, occurs in 4-24% of school-aged children
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How common is Tourette disorder? Boys vs girls?
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5-300 per 100,000
Boys > Girls |
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What is the course of Tourette disorder?
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Waxing / waning course, tic episodes occur in bouts, which also tend to cluster
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When do symptoms of Tourette disorder peak in severity?
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Between ages 8-12 years, then they decrease with puberty
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What is the prognosis of Tourette disorder?
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- 1/2 - 2/3 experience marked reduction of symptoms by their late teens
- 1/3 - 1/2 become virtually asymptomatic in adulthood |
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What disorders is there a high comorbidity with Tourette disorder?
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- OCD (40%)
- ADHD (50%) |
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What are the etiologic factors involved in Tourette disorder?
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- Genetic factors
- Perinatal factors - Neurochemical factors - Post-infectious auto-immune factors - Psychological factors |
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What is the relationship of genetics to Tourette disorder?
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50% concordance rate in monozygotic twins
10% concordance rate in dizygotic twins |
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What are the perinatal factors related to the etiology of Tourette disorder?
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Potential risk factors include:
- Severity of maternal life stress during pregnancy - Severe nausea and/or vomiting during first trimester - Prematurity - Low birth weight |
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What are the neurochemical factors involved in developing Tourette disorder?
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Impaired regulation of DOPAMINE in the caudate nucleus (and possibly impaired regulation of endogenous opiates and the noradrenergic system)
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What part of the brain is affected by Tourette disorder? How?
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Caudate nucleus (impaired regulation of dopamine)
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What are the post-infectious auto-immune factors involved in the development of Tourette disorder?
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Circumstantial evidence links group A beta-hemolytic streptococcal infection to development of some tic and OCDs
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What can cause symptom exacerbation in Tourette disorder?
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- Stressful life events
- Fatigue - Extremes of temperature - External stimuli |
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How do you treat Tourette disorder?
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- Educational and supportive interventions
- Psychological therapy - Pharmacological therapy |
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What are the components of educational and supportive interventions for treatment of Tourette disorder?
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- Create realistic expectations
- Supportive classroom environments |
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What psychological treatment should be involved in treating Tourette disorder?
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- Supportive therapy
- Behavioral therapy |
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When should you use pharmacological treatment for Tourette disorder?
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When tics become a source of impairment
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What pharmacological treatment can be used in Tourette disorder?
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- Atypical neuroleptics (risperidone)
- Alpha-2 agonists (clonidine, guanfacine) - Typical neuroleptics (haloperidol, pimozide) for severe cases |
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What medication for another psychological disorder can cause exacerbation of tics in Tourette disorder?
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Stimulants (for ADHD)
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OCD patients with comorbid tics have a good response to what medications?
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SSRI augmentation of anti-psychotics
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By what age is urinary continence normally established?
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Before age 4
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By what age is bowel continence normally established?
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By age 4
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What are the types of elimination disorders?
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- Enuresis
- Encopresis |
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What is enuresis?
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Involuntary voiding of urine (bed-wetting) after age 5 (at least twice a week for at least 3 consecutive months or with marked impairment)
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What do you need to rule out before diagnosing enuresis?
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- Infections
- Diabetes - Seizures |
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How long do bed-wetting symptoms need to be present to diagnose enuresis?
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Twice a week for at least 3 consecutive months (or with marked impairment)
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What is encopresis?
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Involuntary or intentional passage of feces in inappropriate places by age 4 (at least once a month for at least 3 months)
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What do you need to rule out before diagnosing encopresis?
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- Metabolic abnormalities (hypothyroidism)
- Lower GI problems (anal fissure, inflammatory bowel disease) - Dietary factors |
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How long do abnormal passage of feces in children need to be present to diagnose encopresis?
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At least once a month for at least 3 months
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When diagnosing enuresis and encopresis what do you need to establish first?
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Distinguish between primary (never established continence) and secondary (continence achieved for a period and then lost)
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How common is enuresis in 5-year olds?
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5%
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How common is encopresis in 5-year olds?
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1%
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Are boys or girls more likely to have enuresis or encopresis?
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Boys > Girls
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Enruesis and encopresis may be associated with what?
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Other psychiatric conditions, such as conduct disorder
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What can predispose to enuresis and encopresis?
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- Genetic predisposition
- Psychosocial stressors (especially with secondary incontinence) - Enuresis: small bladder or low nocturnal levels of ADH) - Encopresis: lack of sphincter control, constipation with overflow incontinence (75% of cases) |
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What can cause enuresis?
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Small bladder or low nocturnal levels of ADH
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What can cause encopresis?
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- Lack of sphincter control
- Constipation with overflow incontinence (responsible for 75%) |
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The great majority of cases of enuresis spontaneously remit?
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By age 7
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How do you treat both enuresis / encopresis?
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- Take into account the high spontaneous remission rates
- Psychoeducation, psychotherapy, family therapy, and behavioral therapy |
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What are the treatment modalities specific to enuresis?
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Behavior modification
- Bell and pad method - buzzer that wakes child up when sensor detects wetness - Anti-diuretics (DDAVP) - Tricyclic antidepressants (imipramine) |
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What are the treatment modalities specific to encopresis?
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Initial bowel catharsis followed by stool softeners (if etiology is constipation)
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What is the definition of separation anxiety disorder?
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Excessive fear for ≥4 weeks of leaving one's parents or other major attachment figures
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When does stranger anxiety peak (distress children feel when faced with unfamiliar faces)?
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8-12 months of age
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Children with separation anxiety disorder may do what to avoid separation?
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Refuse (or complain of physical symptoms to avoid) going to school or sleeping alone, and they may report physical symptoms
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What happens when children with separation anxiety disorder are forced to separate?
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Become extremely distressed and may worry excessively about losing their parents forever
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How common is separation anxiety disorder?
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4% of school-aged children, boys = girls
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What is sometimes associated with separation anxiety disorder?
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- May be preceded by a stressful life event
- Parents are often afflicted with anxiety disorders and may express excessive concern about their children |
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How do you treat Tourette disorder?
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- Family therapy
- Cognitive behavioral therapy - Low-dose antidepressants |
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Childhood separation anxiety disorder may be a risk factor for the development of what?
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Panic disorder or agoraphobia as an adolescent or adult
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The majority of substantiated child abuse cases are what form?
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Neglect
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What do adults who were abused as children have an increased risk of developing?
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- Anxiety disorders
- Depressive disorders - Dissociative disorders - Self-destructive behaviors - Substance abuse disorders - PTSD - Increased risk of subsequently abusing their own children |
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What are the most common drugs of abuse in adolescents?
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- Alcohol
- Cannabis |
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What percentage of women and men report being sexually abused as children?
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- Women: 15-25%
- Men: 5-15% |
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The victim of sexual abuse is more commonly what gender? The perpetrator of sexual abuse is more commonly what gender?
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- Victim: female
- Perpetrator: male, usually someone who knows the child |
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From what ages are children at most risk of sexual abuse?
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Between ages of 7-13
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What are types of evidence of sexual abuse in children?
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- Sexually transmitted diseases
- Anal or genital trauma - Knowledge about specific sexual acts (inappropriate for age) - Initiation of sexual activity with others - Sexual play with dolls (inappropriate for age) |
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Who is the most common perpetrator in substantial child abuse cases?
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The child's parent
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