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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/?
Social Phobia
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
Panic disorder
Dysthymic disorder
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?
(what years)
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
NO hallucinations/delusions
Skin changes typical of tuberous sclerosis may be a sign of what?
(in addition to tuberous sclerosis itself)
Autistic disorder
Of the symptoms of ADHD, what type persists into adulthood?
Hyperactivity declines
Inattention persists
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)
Pemoline (pulled)
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
Mechanism of action for atomoxiten (strattera)
Selective NE re-uptake inhibitor
Drugs often used for ADHD (7)
(in addition to stimulants)
Clonidine, Guanfacine
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.)
Comorbid ADHD
More interpersonal aggression
Lower IQ
Poorer social skills
What 4 types of conduct problems are seen in conduct disorder?
Aggressive conduct
Non-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
Communication disorders
What is the treatment approach for conduct disorder?
Treat comorbid PSYCH issues
Behavioral management
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)
Language disorders
Communication disorders
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
Behavioral therapy
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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