Glossary of Block 4 PSYCH Exam -- Childhood Disorders
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- How does MDD often present in children?
- Conduct problems and/or irritability
- Which typically has an earlier age of onset?
(Bipolar disorder vs. MDD)
- Bipolar Disorder
- How do manic episodes in kids differ than those in adults?
- 80% are "atypical" (20% in adults)
Irritable temper w/ outbursts
Chronic and continuous (intermittent and acute in adults)
NOTE: Up to 20% of kids w/ ADHD develop Bipolar disorder
- What is the first choice for treating childhood depression?
- What are the safest first choice meds for childhood depression?
- What potential side effect is dangerous when using TCAs in kids?
- Potential cardiac toxicity
- What is changed in the criteria for dysthymic disorder in kids?
(vs. criteria for adult diagnosis)
- Symptoms need only be of one year duration
- What proportion of OCD cases begin in childhood?
- 1/3 - 1/2
- How are OCD cases treated?
- Behavior therapy
- How are panic disorder cases treated?
- Psychotherapy augmented w/ BDZs, TCAs, or SSRIs
- Instead of having flashbacks, how do kids often present w/ PTSD?
- Reenactments of the trauma in symbolic play
- How is PTSD treated in kids?
- Therapy, including attempts at systematic desensitization
- What is the treatment strategy of GAD in younger children?
In older children?
- Younger -- Behavioral therapy
Older -- Cognitive therapy (emphasis on assertiveness training)
- What drugs are often used to treat GAD, despite lacking data of efficacy?
- How are phobias treated in kids?
- SSRIs/BDZs in combo w/ psychotherapy
- When do cases of schizophrenia usually have onset?
- Almost all cases have onset after puberty
BUT, some have been described as young as 5 y.o.
- Which sex accounts for the majority of child schizo cases?
- Primarily male patients
- Typically, how is the prognosis for childhood schizo?
- Overall outcome tends to be poor
Response to meds tends to be poor as well
- What 2 disorders does Separation Anxiety Disorder overlap w/?
- When does normal separation anxiety usually first appear?
When does it peak before subsiding?
- Appears at 6 - 7 months of age
Peaks at 13 - 18 months, before gradually subsiding
- By what age does separation anxiety disorder become more apparent?
- 7 - 8 years of age
- What 6 PSYCH disorders are commonly comorbid w/ sep. anx. disorder?
- Social Phobia
Cluster "C" Personality Disorders
- How does sep. anx. disorder affect eventual panic disorder in pts?
- Hx of Sep. Anx. Disorder --> earlier onset & more severe panic disorder
- What pharmacotherapy is used for separation anxiety disorder?
- SSRIs, Buspar
BDZs, beta-blockers for anxiety w/ exposure
- What is the definition of selective mutism?
- Failure to speak in specific situations, despite being able to in others
- When is selective mutism most commonly diagnosed?
- Between the ages of 5 and 8
- What other PSYCH disorders do most kids w/ selective mutism also show?
- Almost all have Social Phobia beyond mutism
About 1/3 have a language disorder
About 1/2 had delayed speech development
- What treatment is given for selective mutism?
- Behavioral therapy, along w/ SSRIs
- What is INHIBITED TYPE reactive attachment disorder?
- Failure to initiate/respond in an appropriate fashion to most interactions
- What is DISINHIBITED TYPE reactive attachment disorder?
- Indiscriminate sociability
Marked inability to exhibit appropriate selective attachments
- What 3 features are common in pervasive developmental disorders?
- Deficits in reciprocal social interaction
Deficits in communication
Presence of stereotyped behavior, interests, and activities
- What is the prototypical pervasive developmental disorder?
- 3 ways autisic disorder is different from childhood schizo
- Younger onset
NO loose associations
- Skin changes typical of tuberous sclerosis may be a sign of what?
(in addition to tuberous sclerosis itself)
- Autistic disorder
- ADHD places pt @ increased risk for what (4)?
- School failure/underachievement
- Of the symptoms of ADHD, what type persists into adulthood?
- Hyperactivity declines
- Proportion of ADHD pts. in which disorder persists into adulthood
- About 1/2
- By what age must symptoms present to qualify as ADHD?
- Before the age of 7
- What are the two major categories of ADHD symptoms?
- What types of behavior is DA thought to be involved in?
(context of ADHD)
- Attention and novelty seeking
- What genetic defects are often seen in families w/ Hx of ADHD?
- Defects in the dopamine transporter gene
Defects in the D4 receptor gene
- What are the two mainstays of treatment for ADHD?
- Stimulant medications
- 3 major stimulants used for ADHD?
(one has been pulled from market)
- Comparison of onset and DOA between stimulants used for ADHD
- Dextroamphetamine & Methylphenidate have rapid onset and short DOA
Pemoline has slower onset and a longer DOA
NOTE: Pemoline would take several weeks to have effects
- Why was Pemoline pulled off of the market?
- Assoc. w/ acute liver failure in some cases
- % of pts. w/ ADHD that respond to stimulants
- Side effects of stimulant therapy for ADHD (3)
- Decreased appetite
Sedation or psychotic symptoms (often @ high doses)
Development or exacerbation of tics
- Mechanism of action for atomoxiten (strattera)
- Selective NE re-uptake inhibitor
- Drugs often used for ADHD (7)
(in addition to stimulants)
SSRIs (little effect on core attention deficits)
- What is the limitation of SSRI use for ADHD?
- Can help treat impulsiveness and aggression
BUT, little effect on core attention deficits
- In what scenario is Clonidine especially helpful?
(context of ADHD)
How is Guanfacine even better?
- When ADHD is combined w/ a tic disorder
Guanfacine is longer lasting and less sedating
- 50% of conduct disorder pts go on to what disorder?
- Anti-social personality disorder
- Which sex is conduct disorder more prevalent in?
16% of boys, and 9% of girls display symptoms of it
- What are poor prognostic factors for conduct disorder progressing (5)?
- Earlier onset (< 10 y.o.)
More interpersonal aggression
Poorer social skills
- What 4 types of conduct problems are seen in conduct disorder?
- Aggressive conduct
Deceitfulness or theft
Serious violations of rules
- What is aggressive conduct?
(context of conduct disorder)
- Causes/threatens physical harm to other people/animals
- What is non-aggressive conduct?
(context of conduct disorder)
- Causes property loss or damage
- What disorders commonly predate onset of conduct problems (3)?
- Learning disorders
- What is the treatment approach for conduct disorder?
- Treat comorbid PSYCH issues
- Oppositional defiant disorder
What type of behavior is seen?
How long does behavior have to persist to qualify?
- Negative, hostile, defiant behavior
At least 6 months
- What other disorders are common comorbidities?
(context of oppositional defiant disorder)
- What is Pica?
- Persistent eating of non-nutritive substances for at least 1 month
- How is Pica treated?
- Addressing of medical issues and psychosocial stressors
- What is rumination disorder?
- Repeated regurgitation and rechewing of food
Food is either ejected from mouth or re-swallowed
- What age group is rumination disorder most common in?
- What medical issues can rumination disorder lead to?
Failure to thrive
- How is rumination disorder often treated?
- Aversive behavioral therapy
- What is encopresis?
- Repeated passage of feces into inappropriate places
- At what age does encopresis usually get diagnosed?
- Actual or mental age of 4
- What medical condition(s) is encopresis often related to?
- Constipation, impaction or retention w/ overflow incontinence
- How is encopresis treated?
- Treatment of constipation
Behavioral and family therapy
- What is enuresis?
- Repeated voiding of urine during the day or at night
(either involuntarily or unintentionally)
At least 2x per week for 3 months w/ age of at least 5
- What is the prevalence of enuresis at age 5?
At age 18?
- Age 5 -- 7% males, 3% females
Age 18 -- 1% males, < 1% females
- What pharmacotherapy is used against enuresis?
What limits effectiveness?
- TCAs (esp imipramine)
Desmopressin nasal spray
Relapse rate is very high
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