Disorders of Childhood and Adolescence Flashcards Preview

Psychiatry pro +1700 > Disorders of Childhood and Adolescence > Flashcards

Flashcards in Disorders of Childhood and Adolescence Deck (96):
1

What percent of adolescents consider suicide?

20%

2

Does depression self resolve?

It can

3

True or false: brain structures can change with prolonged depression

True

4

Do most schools have suicide prevention programs?

Not most, but getting better

5

True or false: irritability as a symptom of depression is much more common in children

True

6

True or false: inattentiveness is not a common manifestation of depression in children

False--must r/o depression prior to diagnosing ADHD

7

What must always be r/o with suspected depression in children?

Substance abuse or medical condition

8

Can schizophrenia appear similar to depression or bipolar mania?

Yes

9

What are the criteria for MDD in children? (9)

-Fatigue
-Concentration difficulties
-Guilt
-Recurrent thoughts of death
-Anhedonia
-depressed Mood
-Psychomotor agitation
-Appetite changed
-Sleep disturbance

(FC GRAMPAS)

10

How many criteria are needed to diagnose MDD in children? How long must s/sx last?

Five symptoms for 2 weeks

11

Which is more common in MDD: weight loss or gain?

Weight loss

12

Which is more common in MDD: hypersomnia or hyposomnia

Hypersomnia

13

True or false: to meet the criteria for MDD, children can have irritability instead of depressed mood

True

14

What are the mood differences from adult MDD?

More irritable and labile

15

True or false: anhedonia is not a key marker in childhood MDD

False

16

Do children often verbalize feelings of sadness?

no

17

True or false: somatic complaints are common in childhood MDD

True

18

True or false: kids with MDD have an increased sensitivity to criticism, and poor focus

True

19

Why can a learning disability cause MDD?

Major part of self-worth at this age

20

What is the average length of depression?

7-9 months

21

What percent of childhood MDD remit by 2 years?

90%

22

What is the chance of recurrence of MDD in children at 2 and 5 years?

40% by 2 years
60-70% by 5 years

23

True or false: depression caught early is usually more treatable

False--usually more of a chronic, recurrent issue

24

What percent of children with MDD have one or more comorbid psychiatric conditions?

40-70%

25

Substance abuse is preceded by MDD by how many years on average?

5 years

26

What are the major mental health issues with marijuana use?

More anhedonia, apathy

27

What is double depression?

Dysthymia + MDD

28

What is the comorbidity of MDD + dysthymia?

Increased suicidality
Worse social impact

29

PTSD in the pediatric population often mimics what other psychiatric condition

ADHD

30

What is the common manifestation of trauma in kids?

Reenact the trauma

31

What is the key distinguishing factor for deciding therapy vs medical treatment for MDD?

Severity--psychotherapy first, add drugs if severe

32

What is the MOA of bupropion?

Increased NE and dopamine

33

What are the two SSRIs that are FDA approved in children, and are first line?

Lexapro (escitalopram) and prozac (fluoxetine)

34

Why is it that bupropion is useful for the treatment of ADHD and depression?

Increased NE and dopamine which is similar to amphetamine

35

What doses of SSRIs must be prescribed for OCD (high or lower than for MDD)? How long does this take to take effect for OCD?

Much higher

Takes months to take full effect

36

Neurovegetative s/sx benefit from what particular SSRI?

Fluoxetine

37

What antidepressant has an increased risk of seizures?

Bupropion

38

What is the major adverse effects of SSRIs?

-Disinhibition
-GI bleed

39

Disinhibition with SSRI use is suspicious for what?

Bipolar disorder

40

Which antidepressant has an increase in DBP?

Effexor (venlafaxine)

41

Which antidepressant has an increased risk of GI bleeding? MAO?

Cymbalta (duloxetine) (SNRI)

42

What are the s/sx of serotonin syndrome? (5)

-Fever
-Rigidity
-Autonomic instability
-Psychosis (visual)
-Myoclonic jerks

43

What are the s/sx of discontinuation of antidepressants?

-Dizziness
-HA
-n/v
-Electric shock sensations

44

What percent of MDD in children has severe suicidal ideation?

60%

45

What is the leading cause of disability in the world?

Depression

46

A child with one depressed parent is how many times more likely to have depression?

2x

47

A child with two depressed parent is how many times more likely to have depression?

4x

48

Why must you disclose the black box warning for SSRIs?

Malpractice o/w

49

What is the issue with the black box warning? What were the results of the study that led to this conclusion?

Correlation vs causation

(2% with placebo suicide vs 4% with)

50

What is the probability of having increased suicidal ideation with meds vs without?

With= 4%
Without = 15%

51

When in the course of the depression is the risk of suicidal ideation greatest post antidepressant prescription?

First four weeks

52

The black box warning goes up to what age?

24

53

What has happened to rates of suicide since the black box warning? What about the number of prescriptions?

Suicides have Gone up 20%

Number of prescriptions down 20%

54

What are the five questions that should be asked with suicidal ideation?

1. Plan
2. Means / access
3. Intent
4. Homicidal
5. Previous attempts

55

What is the issue with contracts for safety?

Still liable for anything that happens

56

What is the role of family history of suicide in determining the risk for suicide?

Risk factor

57

What is a major warning sign for suicidality?

Getting significantly better in a short period of time--may point to suicidal ideation

58

True or false: childhood bipolar disorders tend to be less severe than adult onset

False--more severe

59

What are the characteristics of childhood bipolar disorders as compared to adults? (2)

-Non-episodic course
-Mixed with *rapid* cycling

60

What is the usual initial episode of bipolar disorder in children: depression or mania?

Depression

61

What is the prevalence of bipolar disorder in adolescents?

1%

62

What is a rapid cycler for bipolar adults vs kids?

Adults = 4 times / year
Children = 4 times / day

63

What is the MOA of aripiprazole?

Atypical antipsychotic and mood stabilizer

64

What is the treatment for bipolar disorder?

antipsychotics (mood stabilizers)

65

What are the common side effects with antipsychotics? (3)

-Weight gain
-Tardive dyskinesia
-Increased prolactin

66

What are the two antipsychotics that cause weight gain? Are these typical or atypical antipsychotics?

-Olanzapine
-Clozapine
(both atypical antipsychotics)

67

Where is the weight gain located with antipsychotics?

Centrally

68

What is the major side effect of risperidone? MOA?

Increase prolactin
Atypical antipsychotic

69

What is akathisia? What is this commonly caused by?

Need to move
Bipolar

70

What is the major benefit of quetiapine over other psychotics?

Less EPS

71

What are the two antipsychotics that cause less weight gain?

Aripiprazole
Ziprasidone

72

What is the MOA of antipsychotics?

Reduce the dopamine in mesolimbic area of the brain

73

What are the typical antipsychotics? (4)

Chlorpromazine
Thioridazine
Fluphenazine
Haloperidol

74

What are the atypical antipsychotics? (6)

Clozapine (Clozaril)
Olanzapine (Zyprexa)
Risperidone (Risperdal)
Aripiprazole (Abilify)
Quetiapine (Seroquel)
Ziprasidone (Geodon)

("Old Quietly Risper from A to Z")

75

What are the major side effects of antipsychotics? (4)

-Sedation
-Akathisia
-Parkinsonian s/sx
-Orthostatic Hypotension

76

What is the treatment for dystonia use with antipsychotics?

Antihistamine

77

What is neuroleptics malignant syndrome? S/sx? Lab change?

-Adverse reaction to antipsychotics, and dopamine blockade
-presenting with fever, autonomic instability, and delirium.
-Increased CK

78

What is the treatment for neuroleptic malignant syndrome?

-Stop med
-Treat hyperthermia
-Dantrolene for muscle rigidity, and bromocriptine

79

What labs must be monitored with Li use? (3)

-TSH (hypothyroidism)
-Cr
-CBC

80

What must be monitored with Depakote (valproic acid) use? (3)

-LFTs
-CBC
-pCO

81

What is the major side effect of lamotrigine?

Steve-Johnson syndrome

82

What are the major side effect of tegretol (carbamazepine)?

Aplastic anemia

83

What is the major issue with Li?

Chronic renal insufficiency, and narrow therapeutic index

84

What are the only two drugs that have been proven to decrease suicidality?

Clozapine
Li

85

What are the skin side effects of Li?

Acne

86

What are the endocrine problems with Li?

Hypothyroidism

87

What happens to the tremor with Li?

Increase from fine to coarse as increased dose

88

What is the major cardiac issue with Li?

Cardiac arrhythmia

89

What is the only OTC analgesic that is appropriate with Li intake?

Acetaminophen

90

What is the major adverse reaction to (clozapine)?

Agranulocytosis

91

What is the major issue in benzos with children?

-cognitive clouding
-paradoxical excitation

92

What is the reversal agent for benzos?

Flumazenil

93

Is separation anxiety a symptom of depression in kids?

Can be

94

What type of hallucinations are seen with serotonin syndrome: visual or auditory?

Visual

95

What happens to bipolar kids or other psychotic kids when you put them on a stimulant for suspected ADHD?

-Worsens symptoms, and may cause hallucinations

96

What is the treatment for serotonin syndrome?

Cyproheptadine