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

Disorders of Childhood and Adolescence Flashcards

1
Q

What percent of adolescents consider suicide?

A

20%

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2
Q

Does depression self resolve?

A

It can

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3
Q

True or false: brain structures can change with prolonged depression

A

True

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4
Q

Do most schools have suicide prevention programs?

A

Not most, but getting better

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5
Q

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

A

True

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6
Q

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

A

False–must r/o depression prior to diagnosing ADHD

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7
Q

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

A

Substance abuse or medical condition

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8
Q

Can schizophrenia appear similar to depression or bipolar mania?

A

Yes

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9
Q

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

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

(FC GRAMPAS)

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10
Q

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

A

Five symptoms for 2 weeks

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11
Q

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

A

Weight loss

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12
Q

Which is more common in MDD: hypersomnia or hyposomnia

A

Hypersomnia

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13
Q

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

A

True

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14
Q

What are the mood differences from adult MDD?

A

More irritable and labile

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15
Q

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

A

False

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16
Q

Do children often verbalize feelings of sadness?

A

no

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17
Q

True or false: somatic complaints are common in childhood MDD

A

True

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18
Q

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

A

True

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19
Q

Why can a learning disability cause MDD?

A

Major part of self-worth at this age

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20
Q

What is the average length of depression?

A

7-9 months

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21
Q

What percent of childhood MDD remit by 2 years?

A

90%

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22
Q

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

A

40% by 2 years

60-70% by 5 years

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23
Q

True or false: depression caught early is usually more treatable

A

False–usually more of a chronic, recurrent issue

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24
Q

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

A

40-70%

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25
Q

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

A

5 years

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26
Q

What are the major mental health issues with marijuana use?

A

More anhedonia, apathy

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27
Q

What is double depression?

A

Dysthymia + MDD

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28
Q

What is the comorbidity of MDD + dysthymia?

A

Increased suicidality

Worse social impact

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29
Q

PTSD in the pediatric population often mimics what other psychiatric condition

A

ADHD

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30
Q

What is the common manifestation of trauma in kids?

A

Reenact the trauma

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31
Q

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

A

Severity–psychotherapy first, add drugs if severe

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32
Q

What is the MOA of bupropion?

A

Increased NE and dopamine

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33
Q

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

A

Lexapro (escitalopram) and prozac (fluoxetine)

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34
Q

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

A

Increased NE and dopamine which is similar to amphetamine

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35
Q

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?

A

Much higher

Takes months to take full effect

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36
Q

Neurovegetative s/sx benefit from what particular SSRI?

A

Fluoxetine

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37
Q

What antidepressant has an increased risk of seizures?

A

Bupropion

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38
Q

What is the major adverse effects of SSRIs?

A
  • Disinhibition

- GI bleed

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39
Q

Disinhibition with SSRI use is suspicious for what?

A

Bipolar disorder

40
Q

Which antidepressant has an increase in DBP?

A

Effexor (venlafaxine)

41
Q

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

A

Cymbalta (duloxetine) (SNRI)

42
Q

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

A
  • Fever
  • Rigidity
  • Autonomic instability
  • Psychosis (visual)
  • Myoclonic jerks
43
Q

What are the s/sx of discontinuation of antidepressants?

A
  • Dizziness
  • HA
  • n/v
  • Electric shock sensations
44
Q

What percent of MDD in children has severe suicidal ideation?

A

60%

45
Q

What is the leading cause of disability in the world?

A

Depression

46
Q

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

A

2x

47
Q

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

A

4x

48
Q

Why must you disclose the black box warning for SSRIs?

A

Malpractice o/w

49
Q

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

A

Correlation vs causation

2% with placebo suicide vs 4% with

50
Q

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

A 
With= 4%
Without = 15%
51
Q

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

A

First four weeks

52
Q

The black box warning goes up to what age?

A

24

53
Q

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

A

Suicides have Gone up 20%

Number of prescriptions down 20%

54
Q

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

A
  1. Plan
  2. Means / access
  3. Intent
  4. Homicidal
  5. Previous attempts
55
Q

What is the issue with contracts for safety?

A

Still liable for anything that happens

56
Q

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

A

Risk factor

57
Q

What is a major warning sign for suicidality?

A

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

58
Q

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

A

False–more severe

59
Q

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

A
  • Non-episodic course

- Mixed with rapid cycling

60
Q

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

A

Depression

61
Q

What is the prevalence of bipolar disorder in adolescents?

A

1%

62
Q

What is a rapid cycler for bipolar adults vs kids?

A 
Adults = 4 times / year
Children = 4 times / day
63
Q

What is the MOA of aripiprazole?

A

Atypical antipsychotic and mood stabilizer

64
Q

What is the treatment for bipolar disorder?

A

antipsychotics (mood stabilizers)

65
Q

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

A
  • Weight gain
  • Tardive dyskinesia
  • Increased prolactin
66
Q

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

A

-Olanzapine
-Clozapine
(both atypical antipsychotics)

67
Q

Where is the weight gain located with antipsychotics?

A

Centrally

68
Q

What is the major side effect of risperidone? MOA?

A

Increase prolactin

Atypical antipsychotic

69
Q

What is akathisia? What is this commonly caused by?

A

Need to move

Bipolar

70
Q

What is the major benefit of quetiapine over other psychotics?

A

Less EPS

71
Q

What are the two antipsychotics that cause less weight gain?

A

Aripiprazole

Ziprasidone

72
Q

What is the MOA of antipsychotics?

A

Reduce the dopamine in mesolimbic area of the brain

73
Q

What are the typical antipsychotics? (4)

A

Chlorpromazine
Thioridazine
Fluphenazine
Haloperidol

74
Q

What are the atypical antipsychotics? (6)

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

(“Old Quietly Risper from A to Z”)

75
Q

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

A
  • Sedation
  • Akathisia
  • Parkinsonian s/sx
  • Orthostatic Hypotension
76
Q

What is the treatment for dystonia use with antipsychotics?

A

Antihistamine

77
Q

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

A
  • Adverse reaction to antipsychotics, and dopamine blockade
  • presenting with fever, autonomic instability, and delirium.
  • Increased CK
78
Q

What is the treatment for neuroleptic malignant syndrome?

A
  • Stop med
  • Treat hyperthermia
  • Dantrolene for muscle rigidity, and bromocriptine
79
Q

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

A
  • TSH (hypothyroidism)
  • Cr
  • CBC
80
Q

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

A
  • LFTs
  • CBC
  • pCO
81
Q

What is the major side effect of lamotrigine?

A

Steve-Johnson syndrome

82
Q

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

A

Aplastic anemia

83
Q

What is the major issue with Li?

A

Chronic renal insufficiency, and narrow therapeutic index

84
Q

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

A

Clozapine

Li

85
Q

What are the skin side effects of Li?

A

Acne

86
Q

What are the endocrine problems with Li?

A

Hypothyroidism

87
Q

What happens to the tremor with Li?

A

Increase from fine to coarse as increased dose

88
Q

What is the major cardiac issue with Li?

A

Cardiac arrhythmia

89
Q

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

A

Acetaminophen

90
Q

What is the major adverse reaction to (clozapine)?

A

Agranulocytosis

91
Q

What is the major issue in benzos with children?

A
  • cognitive clouding

- paradoxical excitation

92
Q

What is the reversal agent for benzos?

A

Flumazenil

93
Q

Is separation anxiety a symptom of depression in kids?

A

Can be

94
Q

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

A

Visual

95
Q

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

A

-Worsens symptoms, and may cause hallucinations

96
Q

What is the treatment for serotonin syndrome?

A

Cyproheptadine

Psychiatry pro +1700 (28 decks)

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