Tn: Psychiatry - 17

Front 1

What is temperament?

Back 1

Innate psycho-physiological and behavioural characteristics of a child (e.g. emotionality, activity, and sociability)

Front 2

Spectrum of temperament?

Back 2

• difficult
  
• slow to warm up
  
• easy
  

Front 3

What is parental fit?

Back 3

Congruence between parenting style (authoritative, authoritarian, permissive) and child's temperment

Front 4

What is attachment?

Back 4

Special relationship between child and primary caretaker(s)

Front 5

When does attachment develop?

Back 5

develops during first year, best predictor of a child's attachment style is their parent's attachment style

Front 6

What is separation anxiety?

Back 6

• 10-18 mo
  
• separation from attachment figure results in distress
  

Front 7

Parent: caregiver: loving, consistently available, sensitive and receptive?

Back 7

Secure attachment type

Front 8

Parent/caregiver: unavailable psychologically, insensitive responses

Back 8

Insecure (avoidant) attachment type

Front 9

Parent/caregiver: Inconsistent, insensitive responses, role reversal

Back 9

Insecure (ambivalent/resistant) attachment type

Front 10

Parent/caregiver: Frightening, dissociated, sexualized, or atypical?

Back 10

Disorganized attachment type

Front 11

Able to use caregiver to calm self (child)?

Back 11

Secure attachment type

Front 12

Not reliant on caregiver for soothing (child)?

Back 12

Insecure (avoidant) attachment type

Front 13

Epidemiology of MDD in children?

Back 13

pre-pubertal 1-2% (no gender differences)

post-pubertal 4-18% (F:M = 2:1)

Front 14

Clinical presentation of MDD in children?

Back 14

see adult mood disorders (DSIGECAPS)

Front 15

Physical factors in MDD (children)?

Back 15

• insomnia (children)
  
• hypersomnia (adolescents)
  
• somatic complaints
  
• substance abuse
  

Front 16

Physiological factors in MDD (children)?

Back 16

• irritability
  
• boredom
  
• anhedonia
  
• low self esteem
  
• deterioration in academics
  
• social withdrawal
  
• lack of motivation
  

Front 17

Comorbid diagnosis in MDD (children)?

Back 17

• ADHD
  
• conduct disorder
  
• eating disorders
  

Front 18

Treatment of MDD in children?

Back 18

• Majority never seek treatment
  
• individual (CBT, IPT)/family therapy and education, modified school program
  
• SSRIs (strongest evidence for fluoxetine)
  
• ECT: only in adolescents
  

Front 19

Prognosis of MDD in children?

Back 19

Prolonged episodes, up to 1-2 yr

adolescent onset predicts chronic mood disorder; up to 2/3 will have another depressive episode w/in5 yr

Front 20

Complications of MDD?

Back 20

• Negative impact on family and peer relationships
  
• School failure
  
• Significantly increased risk of suicide attempt (10%) or completion (suicide risk low for pre-pubertal children)
  
• substance abuse
  

Front 21

Biploar disorder presentation in children?

Back 21

• Mixed presentation and psychotic symptoms (hallucinations and delusions) more common in adolescents than adults
  
• unipolar depression may be early sign of adult bipolar disorder
  

Front 22

What percentage of psychotic depressed adolescents receive bipolar diagnosis?

Back 22

30% within 2 yrs of presentation

Front 23

What is unipolar depression in adolescents associated with?

Back 23

• rapid onset of depression
  
• psychomotor retardation
  
• mood-congruent psychosis
  
• affective illness in family
  
• pharm-induced mania
  

Front 24

Treatment of bipolar disorder in children?

Back 24

• 1st line: mood stabilizers and/or antipsychotics
  
• 2nd line: antidepressants, benzos (careful of disinhibiting effect)
  

Front 25

Prevalence of anxiety disorders in children?

Back 25

2-15%

F:M = 2:1

Front 26

Clinical presentation of anxiety disorders in children?

Back 26

• school problems
  
• recurrent physical symptoms (mornings)
  
• social/relationship issues
  
• social withdrawal/isolation
  
• family conflict
  
• irritability and mood
  
• alcohol/drug use in adolescent
  

Front 27

Three main forms of treatment in child psychiatry?

Back 27

• Family psychotherapy, predictive, supportive environment
  
• CBT
  
• pharmacotherapy
  

Front 28

CBT for anxiety in children?

Back 28

• child and parental education
  
• relaxation techniques (e.g. deep breathing)
  
• exposure/desensitization
  
• recognizing and correcting anxious thoughts
  

Front 29

Pharmacotherapy treatment for anxiety in children?

Back 29

• SSRIs (e.g. fluoxetine)
  
• Benzos (e.g. clonazepam - use with caution, may have dinhibiting effect)
  
• fluvoxamine and sertaline have good evidence, particularly for OCD
  

Front 30

Epidemiology of separation anxiety disorder in children?

Back 30

• Prevalence: 4% of children/adolescents
  
• Average onset: 7.5 YO; average age at presentation is 10 yr old
  
• Common for mother to have an anxiety or depressive disorder
  

Front 31

DDx of separation anxiety disorder in kids?

Back 31

simple/social phobia

depression

learning disorder

truancy

conduct disorder

school related problems (e.g. bullying)

Front 32

Clinical presentation of social anxiety disorder?

Back 32

• excessive/developmentally inappropriate anxiety on separation from primary caregiver with physical or emotional distress for at least 4 weeks
  
• school refusal (75%)
  
• persistent worry, refusal to sleep, nightmares, somatic symptoms
  
• comorbid major depression common
  
• worry about something happening to parent or themselves if separated
  

Front 33

Prognosis of separation anxiety disorder?

Back 33

• may present later on more severely if inadequately treated early on
  
• may develop in PD w/wo agoraphobia
  

Front 34

Social phobia in children?

Back 34

must distinguish shy child and child with social anxiety (interferes significantly with daily routine, social life, academic functioning, or if markedly distressed(

Front 35

Features of social phobia in children?

Back 35

temper tantrums

freezing, clining behaviour

mutism

excessively timid

stays on periphery

refuses to be involved in group play

Front 36

T/F: social phobia children cannot develop social relationships?

Back 36

FALSE

Front 37

T/F: social phobia is only present in presence of adults?

Back 37

FALSE; with peers

Front 38

What is selective mutism?

Back 38

• consistent failure to speak in social situations
  
• disturbance interferes with education/occupational achievement
  

Front 39

Panic disorder in children?

Back 39

Diagnostic criteria same as adults

Front 40

Potential causes of PD in childreN?

Back 40

• Genetic
  
• parental modeling
  

Front 41

T/F: children with PD often have a parent with panic or depressive disorder?

Back 41

TRUE

Front 42

What is GAD in children?

Back 42

• diagnostic criteria same as adults, but only 1 item required in children for criteria C
  
• often redo tasks, show dissatisfaction with work
  
• perfectionistic
  
• require reassurance and support in taking on new tasks
  

Front 43

Specific phobia in children?

Back 43

• heights
  
• small animals
  
• doctors
  
• dentists
  
• darkness
  
• loud noises
  
• thunder
  
• lightening