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Psychiatry > Psychiatric Disorders in Children > Flashcards

Psychiatric Disorders in Children Flashcards

1
Q

What are the 4 sources to consult in child psychiatry?

What kind of information do they report?

A
  • The child
    • Report info in concrete terms
    • Give accurate details about emotional states
  • Parents
    • More reliable for info about conduct, school performance, problems w/ law
    • Child’s developmental hx & issues w/ other family members (medical/psychiatric conditions, problems in family function, etc)
  • Teachers
    • Child’s conduct, academic performance, peer relationships
  • Child welfare/juvenile justice
    • If applicable
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2
Q

What are 4 other methods of gathering information?

A
  • Play, stories, drawing
    • Help to assess conceptualization, internal states, experiences, etc.
  • Kaufman Assessment Battery for Children (K-ABC)
    • Intelligence for ages 2.5 to 12
  • Weschler Intelligence Scale for Children-Revised (WISC-R)
    • Determines intelligence quotient (IQ) for ages 6 to 16
  • Peabody Individual Achievement Test (PIAT)
    • Tests academic achievement
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3
Q

What is the DSM-IV criteria for mental retardation?

A
  • Significantly subaverage intellectual functioning w/ an IQ of 70 or below
  • Deficits in adaptive skills appropriate for the age group
  • Onset must be before the age of 18
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4
Q

Mental Retardation

  • Prevalence: ___%
  • Mild vs. Severe
  • Men vs. Women
A
  • Prevalence: 2.5%
  • 85% mild cases
  • Males 2x affected as females
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5
Q

What are the 4 subclassifications of mental retardation?

A
  • Profound
    • IQ <25
    • 1-2% of MR
  • Severe
    • IQ 25-40
    • 3-4% of MR
  • Moderate
    • IQ 40-50
    • 10% of MR
  • Mild
    • IQ 50-70
    • 80% of MR
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6
Q

What are 4 causes of mental retardation?

A
  • Genetic
  • Prenatal: infection & toxins (TORCH)
  • Perinatal
  • Postnatal
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7
Q

What are genetic causes of mental retardation?

A
  • Down’s syndrome
    • Trisomy 21 (1/700 live births)
  • Fragile X syndrome
    • 2nd most common cause of retardation
    • Involves mutation of X chromosome
    • Males >> females
  • Many others
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8
Q

What are prenatal causes of mental retardation?

A

TORCH

  • Toxoplasmosis
  • Other (syphilis, AIDS, alcohol/illicit drugs)
  • Rubella (German measles)
  • Cytomegalovirus (CMV)
  • Herpes simplex
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9
Q

What are perinatal causes of mental retardation?

A
  • Anoxia
  • Prematurity
  • Birth trauma
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10
Q

What are postnatal causes of mental retardation?

A
  • Hypothyroidism
  • Malnutrition
  • Toxin exposure
  • Trauma
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11
Q

Always rule out __________ in the workup before diagnosing learning disorders.

A

hearing or visual deficit

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12
Q

What is the DSM-IV criteria for a learning disorder?

A
  • Achievement in reading, mathematics, or written expression that is significantly lower than expected for chronological age, level of education & level of intelligence
  • Affect academic achievement or daily activities
  • Cannot be explained by sensory deficits, poor teaching, or cultural factors
  • Often due to deficits in cognitive processing (abnormal attention, memory, visual perception, etc.)
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13
Q

What are the 4 types of learning disorders?

A
  • Reading disorder
  • Mathematics disorder
  • Disorder of written expression
  • Learning disorder not otherwise specified (NOS)
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14
Q

Reading Disorder

  • ___% of school-age children
  • Boys vs. girls
A
  • 4% of school age children
  • Boys 3-4x as often as girls
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15
Q

Mathematics Disorder

  • ___% of school-age children
  • Boys vs. girls
A
  • 5% of school-age children
  • May be more common in girls
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16
Q

Disorder of Written Expression

  • ___% of school-age children
  • Boys vs. girls
A
  • 3-10% of school-age children
  • Male to female ratio unknown
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17
Q

What is the etiology and treatment of learning disorders?

A
  • Etiology
    • Genetic factors, abnormal development, perinatal injury, neurological or medical conditions
  • Treatment
    • Remedial education tailored to child’s specific needs
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18
Q

What are the disruptive behavioral disorders?

A
  • Conduct disorder
  • Oppositional defiant disorder
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19
Q

What is the DSM-IV criteria for conduct disorder?

A
  • Pattern of behavior that involves violation of the basic rights of others or of social norms & rules, with at least 3 acts w/i the following categories during the past year:
    • Aggression toward people & animals
    • Destruction of property
    • Deceitfulness
    • Serious violations of rules
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20
Q

_______ is the most common diagnosis in outpatient child psychiatry clinics.

A

Conduct disorder

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21
Q

Conduct Disorder

  • Prevalence: ___%
  • Etiology involves…?
  • ___% risk of developing antisocial personality disorder in adulthood
A
  • Prevalence
    • 6-16% boys
    • 2-9% girls
  • Etiology involves genetic & psychosocial factors
  • Up to 40% risk of developing antisocial personality disorder in adulthood
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22
Q

If a child has conduct disorder, they have increased incidence of what disorders/behavior?

A
  • Comorbid ADHD & learning disorders
  • Comorbid mood disorders, substance abuse, criminal behavior in adulthood
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23
Q

How is conduct disorder treated?

A
  • Multimodal treatment approach most effective
  • Structure child’s environment w/ firm rules that are consistently enforced
  • Individual psychotherapy that focuses on behavior modification & problem-solving skills
  • Adjunctive pharmacotherapy
    • Antipsychotics or lithium for aggression
    • SSRIs for impulsivity, irritability, mood lability
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24
Q

What is the DSM-IV criteria for Oppositional Defiant Disorder (ODD)?

A

At least 6 mo of negativistic, hostile & defiant behavior during which at least 4 of the following have been present:

  • Frequent loss of temper
  • Arguments w/ adults
  • Defying adults’ rules
  • Deliberately annoying people
  • Easily annoyed
  • Anger & resentment
  • Spiteful
  • Blaming others for mistakes or misbehaviors
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25
Q

Oppositional Defiant Disorder

  • Prevalence: ___%
  • Age of onset
  • Boys vs. girls
A
  • Prevalence: 16-22% in children >6 yo
  • Begins by age 8
  • Onset before puberty: boys >> girls
  • Onset after puberty: boys = girls
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26
Q

If a child has oppositional defiant disorder, they have increased incidence of what disorders/behavior?

How many children have remissions?

A
  • Increased incidence of comorbid substance abuse, mood disorders, ADHD
  • Remits in 25% of children
  • May progress to conduct disorder
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27
Q

How is ODD treated?

A
  • Individual psychotherapy that focuses on:
    • Behavior modification
    • Problem-solving skills
    • Parental skills training
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28
Q

2/3 of children with _____ also have conduct disorder or oppositional defiant disorder.

A

ADHD

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29
Q

What are the 3 subcategories of ADHD?

A
  • Predominantly inattentive type
  • Predominantly hyperactive-impulsive type
  • Combined type
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30
Q

What is the DSM-IV criteria for ADHD?

A
  • At least 6 symptoms involving inattentiveness, hyperactivity or both that have persisted for at least 6 months
    • Inattention - problems listening, concentrating, paying attention to details or organizing tasks; easily distracted, often forgetful
    • Hyperactivity-impulsivity - blurting out, interrupting, fidgeting, leaving seat, talking excessively, etc.
  • Onset before age 7
  • Behavior inconsistent w/ age & development
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31
Q

The etiology of ADHD is multifactorial, including….

A
  • Genetic factors
    • Monozygotic twins > dizygotic twins
  • Prenatal trauma/toxin exposure
    • Fetal alcohol syndrome
    • Lead poisoning
  • Neurochemical factors
    • Dysregulation of peripheral & central noradrenergic systems
  • Neurophysiological factors
    • Abnormal EEG patterns
    • Positron-emission tomography scans
  • Psychosocial factors
    • Emotional deprivation
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32
Q

How is ADHD treated?

A
  • Pharmacotherapy
  • Individual psychotherapy
    • Behavior modification techniques
  • Parental counseling
    • Education & parental skills training
  • Group therapy
    • Help pt improve social skills, self-esteem
33
Q

What specific pharmacotherapy is used to treat ADHD?

A
  • CNS stimulants
    • First line: Methylphenidate (Ritalin)
    • Dextroamphetamine (Dexedrine)
    • Pemoline (Cylert)
  • SSRIs/TCAs
    • Adjunctive therapy
34
Q

What are pervasive developmental disorders (PDD)?

A
  • Group of conditions that involve problems with social skills, language & behaviors
  • Impairement noticeable at early age of life
  • Involves multiple areas of development
35
Q

What are examples of pervasive developmental disorders (PDD)?

A
  • Autistic disorder
  • Asperger’s disorder
  • Rett’s disorder
  • Childhood distintegrative disorder
36
Q

What is the DSM-IV criteria for Autistic Disorder?

A
  • Problems with social interaction (at least 2)
    • Impairement in nonverbal behaviors (facial expression, gestures, etc)
    • Failure to develop peer relationships
    • Failure to seek sharing of interests or enjoyment with others
    • Lack of social/emotional reciprocity
  • Impairments in communication (at least 1)
    • Lack of or delayed speech
    • Repetitive use of language
    • Lack of varied, spontaneous play, and so on
  • Repetitive & stereotyped patterns of behavior & activites (at least one)
    • Inflexible rituals
    • Preoccupation w/ parts of objects, and so on
37
Q

Autistic Disorder

  • Prevalence: ___%
  • Boys vs. Girls
  • Inheritence?
A
  • 0.02-0.05% in children under age 12
  • Boys 3-5x higher incidence than girls
  • Some familial inheritance
38
Q

What conditions are autistic disorder association with?

A
  • Fragile X syndrome
  • Tuberous sclerosis
  • Mental retardation
  • Seizures
39
Q

What is the age of onset for autism?

What percent of autistic pts have mental retardation?

A
  • May be apparent at an early age due to delayed developmental milestones (social smile, facial expression)
  • Almost always begins before age 3
  • 70% of pts are mentally retarded (IQ <70)
  • 1-2% can function completely independently as adults
40
Q

What is the etiology of autism?

A
  • Prenatal neurological insults (infections, drugs)
  • Genetic factors
    • 36% concordance rate in monozygotic twins
  • Immunological & biochemical factors
41
Q

How is autistic disorder treated?

A
  • Remedial education
  • Behavioral therapy
  • Neuroleptics
    • Help control aggression, hyperactivity, mood lability
  • SSRIs
    • Adjunctive therapy to help control stereotyped & repetitive behaviors
  • Some children benefit from stimulants
42
Q

What is the DSM-IV criteria for Asperger’s Disorder?

A
  • Impaired social interaction (at least 2)
    • Failure to develop peer relationships
    • Impaired use of nonverbal behaviors (facial expression, gestures, etc.)
    • Lack of seeking to share enjoyment or interests w/ others
    • Lack of social/emotional reciprocity
  • Restricted or stereotyped behaviors, interests or activities (inflexible routines, repetitive movements, preoccupations, etc.)
43
Q

Unlike autistic disorder, children with Asperger’s disorder have normal ________ & ________.

A

language

cognitive development

44
Q

Asperger’s disorder

  • What is the incidence?
  • Boys vs. Girls
A
  • Incidence unknown
  • Boys > girls
45
Q

What is the etiology of Asperger’s disorder?

A
  • Unknown etiology
  • May involve genetic, infectious or perinatal factors
46
Q

How is Asperger’s disorder treated?

A
  • Supportive treatment
  • Similar to autistic disorder
  • Social skills training & behavior modification techniques may be useful
47
Q

What is the typical patient population of Rett’s disorder?

What is the time course for cognitive development?

A
  • Seen only in girls
  • Early development appears normal
  • Diminished head circumference & stereotyped hand movements eventually ensue
  • Cognitive development never progresses beyond that of the first year of life
48
Q

What are the 9 things Rett’s disorder is characterized by?

A
  • Normal prenatal & perinatal development
  • Normal psychomotor development during the first 5 mo after birth
  • Normal head circumference at birth, but decreasing rate of head growth btwn ages of 5 & 48 months
  • Loss of previously learned purposeful hand skills btwn ages 5 & 30 months, followed by development of stereotyped hand movements (hand wringing, hand washing, etc.)
  • Early loss of social interaction, usually followed by subsequent improvement
  • Problems w/ gait or trunk movements
  • Severely impaired language & psychomotor development
  • Seizures
  • Cyanotic spells
49
Q

Rett’s disorder

  • Age of onset
  • Boys vs. Girls
  • Prevalence
  • Genetic testing?
A
  • Onset btwn age 5-48 months
  • Girls predominantly
  • Boys have variable phenotype
    • Developmental delay
    • Many die in utero
  • Rare
  • Genetic testing available
50
Q

What is the etiology & treatment of Rett’s Disorder?

A
  • MECP2 gene mutation on X chromosome
  • Supportive treatment
51
Q

What is the DSM-IV criteria for Childhood Disintegrative Disorder?

A
  • Normal development in the first 2 yrs of life
  • Loss of previously acquired skills in at least 2 of the following areas:
    • Language
    • Social skills
    • Bowel or bladder control
    • Play
    • Motor skills
  • At least 2 of the following
    • Impaired social interaction
    • Impaired use of language
    • Restricted, repetitive & stereotyped behaviors & interests
52
Q

Childhood Disintegrative Disorder

  • Age of onset
  • Boys vs. Girls
  • Incidence
A
  • Onset age 2-10
  • Boys 4-8x higher than girls
  • Rare
53
Q

What is the etiology & treatment of Childhood Disintegrative Disorder?

A
  • Etiology unknown
  • Treatment supportive (similar to autistic disorder)
54
Q

What are tics?

What tics are Tourette’s disorder characterized by?

A
  • Tics: involuntary movements or vocalizations
  • Tourette’s disorder
    • Most severe tic disorder
    • Multiple daily motor/vocal tics w/ onset before age 18
  • Vocal tics may appear yrs after motor tics
55
Q

What are some examples of motor tics & vocal tics?

A
  • Motor tics
    • Involved the face & head
    • Example: blinking of the eyes
  • Vocal tics
    • Copralalia: repetitive speaking of obscene words (uncommon in children)
    • Echolalia: exact repetition of words
56
Q

True or False

Both motor & vocal tics must be present to diagnose Tourette’s disorder

A

True

The presence of exclusive motor or vocal tics suggests a diagnosis of motor tic disorder or vocal tic disorder

57
Q

What is the DSM-IV criteria for Tourette’s Disorder?

A
  • Multiple motor & vocal tics (both must be present)
  • Tics occur many times a day, almost every day for >1 year (no tic-free period >3 mo)
  • Onset prior to age 18
  • Distress or impairment in social/occupational functioning
58
Q

Tourette’s Disorder

  • Prevalence: ___%
  • Boys vs. Girls
  • Age of onset
  • High co-morbidity with what conditions?
A
  • 0.05% of children
  • Boys 3x more than girls
  • Onset btwn ages 7-8
  • High co-morbidity w/ OCD & ADHD
59
Q

What is the etiology of Tourette’s Disorder?

A
  • Genetic factors
    • 50% concordance rate in monozygotic vs. 8% in dizygotic twins
  • Neurochemical factors
    • Impaired regulation of dopamine in the caudate nucleus (possibly impaired recognition of endogenous opiates & the noradrenergic system)
60
Q

How is Tourette’s Disorder treated?

A
  • Pharmacotherapy
    • Dopamine receptor antagonists
      • Haloperidol
      • Pimozide
  • Supportive psychotherapy
61
Q

The great majority of cases of enuresis spontaneously remit by age ___.

A

7

62
Q

What is enuresis?

What should be ruled out before diagnosis?

A
  • Urinary continence established before age 4
  • Enuresis: involuntary voiding of urine
  • Rule out medical conditions
    • Urethritis
    • Diabetes
    • Seizures
63
Q

What are the 4 types of enuresis?

A
  • Primary
    • Child never established urinary continence
  • Secondary
    • Manifestation occurs after a period of urinary continence, most commonly btwn ages 5-8
  • Diurnal
    • Includes daytime episodes
  • Nocturnal
    • Includes nighttime episodes
64
Q

What is the DSM-IV criteria for Enuresis?

A
  • Involuntary voiding after age 5
  • Occurs at least 2x/wk for 3 mo or with marked impairment
65
Q

What is the prevalence of Enuresis?

A

7% of 5-year-olds

prevalence decreases w/ age

66
Q

What is the etiology of enuresis?

A
  • Genetic predisposition
  • Small bladder or low nocturnal levels of antidiuretic hormone
  • Psychological stress
67
Q

How is Enuresis treated?

A
  • Behavior modification
    • Example: buzzer that wakes child up when sensor detects wetness
  • Pharmacotherapy
    • Antidiuretics (DDAVP)
    • TCAs (imipramine)
68
Q

What is Encopresis?

What should be ruled out before diagnosis?

A
  • Bowel control normally achieved by age 4
  • Bowel incontinence can result in rejection by peers & impairement of social development
  • Rule out
    • Metabolic abnormalities (hypothyroid)
    • Lower GI problems (anal fissure, IBD)
    • Dietary factors
69
Q

What is the DSM-IV criteria for Encopresis?

A
  • Involuntary or intentional passage of feces in inappropriate palces
  • Must be at least 4 yo
  • Has occured at least 1x/mo for 3 mo
70
Q

Encopresis

  • Prevalence: ___%
  • (increases/decreases) w/ age
  • Associated w/ what psychiatric conditions
A
  • 1% of 5-year-old children
  • Incidence decreases w/ age
  • Associated w/ conduct disorder & ADHD
71
Q

What is the etiology of encopresis?

A
  • Psychosocial stressors
  • Lack of sphincter control
  • Constipation w/ overflow incontinence
72
Q

How is encopresis treated?

A
  • Psychotherapy, family therapy, behavioral therapy
  • Stool softeners (if etiology is constipation)
73
Q

What is selective mutism?

What is the epidemiology? How is it treated?

A
  • Rare condition, girls >> boys
  • Not speaking in certain situations (like school)
  • Onset age 5-6
  • May be preceded by a stressful life event
  • Treatment
    • Supportive psychotherapy
    • Behavior therapy
    • Family therapy
74
Q

What is the clinical presentation of separation anxiety disorder?

A
  • Excessive fear of leaving one’s parents or other major attachment figures
  • Children may…
    • Refuse to go to school or sleep alone
    • Complain of physical symptoms
  • When forced to separate, they become extremely distressed & may worry excessively about losing their parents forever
75
Q

Separation Anxiety Disorder

  • Prevalence: ___%
  • Age of onset
  • How do parents react?
  • Treatment
A
  • Up to 4% of school-age children
  • Boys = girls
  • Onset around age 7, may be preceded by stressful life event
  • Parents often afflicted w/ anxiety disorders & may ex
76
Q

What does child abuse include?

What should doctors do when they know abuse is occuring?

A
  • Physical abuse, emotional abuse, sexual abuse, neglect
  • Doctors are legally required to report all cases of suspected child abuse to appropriate social service agencies
  • Children may be admitted to the hospital w/o parental consent in order to protect them
77
Q

Adults who were abused as children have an increased risk of developing…..

A
  • Anxiety disorders
  • Depressive disorders
  • Dissociative disorders
  • Substance abuse disorders
  • Posttraumatic stress disorder
  • Increased risk of abusing their own children
78
Q

Who does child sexual abuse most commonly involve?

What is the most common age?

What is the prevalence?

A
  • Male who knows the child
    • Existence of true pedophilia in abuser rare
  • Most common btwn ages 9-12
  • Report being sexually abused as children
    • Women 25%
    • Men 12%
79
Q

What is evidence of sexual abuse in a child?

A
  • Sexually transmitted diseases
  • Anal or genital trauma
  • Knowledge about specific sexual acts (inappropriate for age)
  • Initiation of sexual activity w/ others
  • Sexualy play with dolls (inappropriate for age)

Psychiatry (18 decks)

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