Term
| Describe the initial psychiatric diagnosis of a child. |
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Definition
uncertainty as child still evolving
**Psychiatric disorders in process of developing may be less “differentiated” than the final form
ex. Depressed children may show increased irritability instead of sadness and boredom instead of anhedonia |
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Term
| What do the anterior and posterior branch of the vagus nerve do? |
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Definition
anterior - parasympathetic
posterior - fight, flight, or freeze
**allows deep, intimate communication btw individuals |
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Term
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Definition
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Term
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Definition
arousal fluctuates in respnose to environemntal cues and organism's internal state (fatigue, hunger, etc.)
sympathetic/parasympathetic balance
people w/wider window can cope w/greater extremes of arousal and can process complex and stimulating info more readily |
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Term
| optimal functioning in window of tolerance (optimal arousal zone) |
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Definition
| threshold should be high enough to tolerate the stimulation from the environment and within, yet low enough to allow us to perveive subtle changes and novelty in the environment and ourselves |
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Term
| most commonly diagnosed psychiatric disorder of childhood |
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Definition
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Term
| Children w/ADHD frequently experience what? |
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Definition
| peer rejection-->leads to self esteem problems and adaptive coping |
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Term
| 3 core symptoms clusters of ADHD (according to DSM-IV-TR 2000) |
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Definition
hyperactivity, inattention, impulsivity
**must last >6 mo for dx |
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Term
| Describe the impact of ADHD on socialization. |
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Definition
behaviors bcome stigmatizing-->child excluded from games, groups, etc.-->influences her viewpt on herself-->compensatory behaviors
**Young child who is not treated has much higher chance of not being in social groups, unable to hold a job, more divorces, etc.solution is medication as early as possible |
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Term
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Definition
-ODD or CD: 50%
-Learning Disabilities: 20 – 60%
-Anxiety Disorder: 25 – 33%
-Major Depression: 3 – 75%
-Bipolar Disorder: 10 - 20% of clinical samples. |
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Term
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Definition
hypodopaminergic state - current meds increase DA concentration in prefrontal cortex
**dopamine most affects nucleus accumbens (pleasure center) |
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Term
| distinctive feature of major depression NOT seen in ADHD |
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Definition
| anehedonia, sleep/appepite disturbance |
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Term
| distinctive feature of bipolar NOT seen in ADHD |
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Definition
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Term
| distinctive feature of generalized anxiety NOT seen in ADHD |
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Definition
| EXAGGERATED apprehension and worry |
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Term
| hyperactivity and inattentiveness: child vs adult |
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Definition
hyperactivity tends to diminish and changes to inner restlessness in adults
inattentiveness very persistent and intractable |
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Term
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Definition
| medication, parental guidance/counseling, psychoeducational interventions |
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Term
| 1st line ADHD Medication Tx |
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Definition
| methylphenidate (Ritalin), dextroamphetamine (dexadrine), amphetamine salts (adderall), atomoxetine (strattera - ONLY 1 that does NOT target nucleus accumbens, just pre-frontal cortex) |
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Term
| When can neuroleptics be helpful in ADHD? |
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Definition
| for comorbid agitation/agression (in combo w/other meds) - by itself, 3rd line |
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Term
| recent info on neuroanatomy of ADHD pts |
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Definition
| children had significant cortical thinning and decrease in total brain volume - deformations in basal ganglia are attenuated in ADHD subjects treated w/stimulate meds |
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Term
| leading cauase of morbidity in pediatric population |
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Definition
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Term
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Definition
| organism's response to a perceived risk (can lead to cardiovascular disease) |
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Term
| Major Depressive Episode criteria |
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Definition
either depressed mood or loss of interest and at least four of the following:
weight/appetite changes
insomnia or hypersomnia
psychomotor agitation or retardation
fatigue
feelings of guilt or worthlessness
executive dysfunction
suicidal ideation |
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Term
| symptom duration to diagnose MDD |
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Definition
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Term
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Definition
>1 yr in children/adolescents
**less severe, more chornic than MDD |
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Term
adjustment disorder w/depressed mood
1. time
2. clinical |
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Definition
1. <6 mo = acute, >6 mo = chronic
2. marked, excess distress/impairment in social, academic or occupational functioning
**symptoms usually resolve w/in 6 mo if stressor (or consequences) have terminated - don't medicate unless impairment of functioning |
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Term
| How might MDD present in children and adolescents? |
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Definition
| irritable (as opposed to depressed mood in adults) |
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Term
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Definition
| presentation of depressive disorders in infants - distress, withdrawal, wt loss, sleep disturbance, failure to thrive, developmental delay |
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Term
| Psychotic symptoms of depressive disorders are more likely to present in which age group? |
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Definition
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Term
| suicide attempts and completions |
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Definition
| boys 2x more likely to complete, girls 2-3x more likely to attempt |
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Term
| for every depressive episode you have... |
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Definition
the more likely it is you'll have another one (bc neuronal pathways becoming wired)-->so treat agressively
**major episode avg = 7-9 mo in child/adolescent |
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Term
| biological factors of depressive disorder etiology |
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Definition
| genetic, dysregulation of central serotonergic and/or noraadrenergic systems, HPA axis dysfunction, hormonal influences |
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Term
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Definition
stress-->hopelessness-->depression
**personality factor of depressiv disorder etiology |
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Term
| DDx of depressive disorder for impaired concentration and sleep disturbances (3) |
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Definition
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Term
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Definition
CBT
others: psychoanalysis, supportive psychotherapy, interpersonal therapy |
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Term
| percent of children/adolescents w/MDD having comorbid disorders |
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Definition
| 40-70% (most common anxiety then disruptive behavior disorders then substance abuse) |
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Term
| MDD and substance abuse cormobidities |
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Definition
MDD - more likely to occur after the onset of other psychiatric problems
substance abuse - more likely to occur before MDD and increases risk |
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Term
| pharmacotherapy of MDD (3) |
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Definition
1. SSRIs 1st line
2. TCAs (more effective but worse side effects)
3. MAOi (when others don't wory - low tyramine diet required, can cause HTN crisis) |
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Term
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Definition
continue tx for at least 6 months after symptom remission
taper over several wks |
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Term
| 3 core features of anorexia nervosa |
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Definition
1. <85% ideal body wt for age/ht
2. fear of gaining wt/becoming fat
3. amenorrhea (3 consecutive missed cycles in post menarchal females)
**1 of most difficult disorders to treat |
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Term
| The typical anorexic is... |
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Definition
| "the perfect child" - she's neat, obedient, does cooking around house, etc. |
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Term
| chief discriminating factor btw AN and bulimia nervosa |
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Definition
| bulimia - absence of severe wt loss: >85% ideal body wt |
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Term
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Definition
binge eating/actions to prevent wt gain
***modeling, cancers, people exposed to pubblic, women in high society, etc. are prone to it |
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Term
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Definition
More than an average person would eat in a 2 hour period at least twice weekly for three months
**ass. w/loss of control |
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Term
| With anorexia nervosa, the younger the age of onset... |
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Definition
the better the prognosis for remission
**both AN and BN 10x more common in females |
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Term
| AN - onset, comorbidity, mortality |
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Definition
onset - 14-18
high comorbidity w/depression
mortality - 10% die of AN complications, 5% from suicide
**w/in 5 yrs, up to 50% of restricting type develop binge eating, developing BN if wt maintained >85% |
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Term
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Definition
onset late adolescence
mortality rare |
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Term
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Definition
70% concordance rate for monozygotic twins, 20% for dizygotic
1st degree relatives - more likely to have AN, increased prevalence of mood disorders |
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Term
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Definition
high concordance monozygotic twins
1st degree relatives - high degree substance abuse/dependence |
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Term
| ANs usually lie and their parents are usually unaware of their eating habits. What are some things to look for that may suggest AN? |
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Definition
-May wear multiple layers of bulky clothing
-Appear younger than chronological age
-Chronic anorexics appear older than age
-Cachexia and breast atrophy common
-Skin dry and frequent carotenemia
-Bradycardia, hypotension, hypokalemia
-Lanugo
-Dental enamel erosion, chipped teeth
-Vomiting types show Russell’s sign (callus on dorsum of fingers)
-Hypertrophic parotid and maxillary glands |
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Term
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Definition
-Do you make yourself Sick because you feel uncomfortably full?
-Do you worry that you have lost Control over what you eat?
-Have you lost more than One stone (14 lb) in a 3 month period? (Obviously, this diagnostic screen originated in the UK)
-Do you believe yourself Fat when others say you are thin?
-Would you say that Food dominates your life? |
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Term
| SCOFF questionnaire (for eating disorders) |
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Definition
-Do you make yourself Sick because you feel uncomfortably full?
-Do you worry that you have lost Control over what you eat?
-Have you lost more than One stone (14 lb) in a 3 month period? (Obviously, this diagnostic screen originated in the UK)
-Do you believe yourself Fat when others say you are thin?
-Would you say that Food dominates your life? |
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Term
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Definition
fluoxetine
**pharmacotherapy more effective in BN than AN |
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Term
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Definition
fluoxetine - to help maintain wt after normal wt achieved
neuroleptics - combat poor appetite, insomnia, body image disortions |
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Term
| psychosocial Tx AN and BN |
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Definition
AN - family therapy effective
BN - CBT effective and 1st line when no significant comorbid psychopathology |
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