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+--- Thread: Child Psychiatry - spartans1 (/showthread.php?tid=534616)
Child Psychiatry - spartans1 - ArchivalUser - 09-19-2010
USMLE CK 1:Child Psychiatry
Psychiatry Highlights for USMLE CK
Child Psychiatry
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Mental Retardation
Present before age 18
Consisting of below-average IQ less than 70 intellectual functioning with an impairment in adapting in school, work and other environment.
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Characteristics:
Mental Retardation
Degree IQ Range Characteristics
Mild 50- 70 6th gr level, can handle own affairs & live on his own
Moderate 35 - 50 2nd gr. level, benefit from vocational trainng, sheltered workshop
Severe 20 - 35 Can communicate, training not helpful, can be taught basic health habits.
Profound 6 months, < 7 years
Increased incidence among school age
Boys have a greater incidence than girls
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Clinical features:
ADHD
Symptoms must be present in at least 2 situations e.g., home, school or work
Symptoms may persist into adult life
Increased incidence of conduct disorders
Antisocial personality & substance-related disorders
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Management
ADHD
target symptoms defined before initiating tx. psychosocial and educational interventions : structure ansd stability to home and school.
Psychostimulants
o - methylphenidate
o - dextroamphetamine
o - consider antidepressant and clonidine
Methylphenidate side effect - GH suppression
Consider drug holiday
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Case Study
Johnny is an 8-year-old child being evaluated for various behaviors, such as staying to himself, as well as self-abusive and aggressive behaviors. He does not play with the other children and tends to act out aggressively when things are changed around at home. He has been in foster care since an early age and has not attended regular classes due to his behavior.
At the time of admission into foster care, he had an abnormal EEG but no seizures. When last given IQ tests, he scored 55, with comparable deficits in adaptive behavior. During the evaluation, Johnny spends most of his time reading a book he found in the waiting room. When asked about the book, he becomes angry and begins to rock back and forth. When called, he does not respond and does not make any eye contact.
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Characteristics:
Tourette's Disorder
Multiple motor and vocal tics present for over 1 year, must occur before age 18
Three times more common in boys than in girls
Association between ADHD (50%) & OCD (40%)
Abnormalities in the dopaminergic and adrenergic systems
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Clinical features: average 7
Tourette's Disorder
Initial tics are in the face & neck, progress down
Coprolalia
o - begins in early adolescence
o - ADHD and OCD occur in 1/3 of all cases
Chronic, with remissions and exacerbations
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Management
Tourette's Disorder
Antipsychotic drugs - haloperidol, resperidone & pimozide
Noradrenergic antagonist such as clonidine
Clonazepam
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AUTISTIC DISORDER
CONDUCT DISORDER
OPPOSITIONAL DEFIANT DISORDER
CHILDHOOD ENURESIS & ENCOPRESIS
CHILDHOOD ANXIETY
RETT & ASPERGER SYNDROME
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0 - ArchivalUser - 09-19-2010
bump
0 - ArchivalUser - 09-20-2010
A young mother brings in her 10-year-old son into your office. The mother tells you that she truly fed up with her son's behavior and is unable to control him. He always seems to be getting into fights with his siblings, neighbors, and classmates at school. When asked to help with the household work, he clearly refuses to do so. He is also very short tempered and argues frequently with his parents and teachers, as well. Few days ago, he got into an argument with an old lady staying next door, and in a fit of anger he œtook a pair of scissors and snapped off her hair. This child is suffering from which of the following disorders?
A. Conduct disorder
B. Attention deficit hyperactivity disorder
C. Tourette disorder
D. Oppositional defiant disorder
E. Antisocial personality disorder
0 - ArchivalUser - 09-20-2010
A 15-year-old male living in a group home for the developmentally challenged has an IQ of 73. He does not read or write, and communicates with one or two word utterances. He will not interact with other group
home members, and since birth he has "pulled back" and becomes agitated when others get physically close to him. In his room, everything is in a given place; if any of his belongings are moved, he becomes quite
disturbed. Which of the following is the most likely diagnosis?
A. Asperger's disorder
B. Autistic disorder
C. Childhood disintegrative disorder
D. Obsessive compulsive disorder
E. Schizophrenia, catatonic
0 - ArchivalUser - 09-20-2010
Nocturnal enuresis is due to a developmental disorder or maturational lag in bladder
control while asleep. Most cases spontaneously resolve before the patients are school
age. Reassurance of the parents is usually the first step in management, although some
physicians recommend bladder exercises and scheduled toileting.
Conditioning with “wet” alarms and waking the child in the middle of the night have also
helped.
For patients with persistent nocturnal enuresis, the drug of choice is DDAVP
(desmopressin). IMIPRAMINE
0 - ArchivalUser - 09-20-2010
Conduct disorder: at least 3 of these should be present to label it as conduct disorder 1-
aggression to ppl or animals 2- property destruction 3- theft or deceitfulness 4- serious
violation of rules
0 - ArchivalUser - 09-20-2010
-Nocturnal enuresis is due to a developmental disorder or maturational lag in bladder
control while asleep. Most cases spontaneously resolve before the patients are school
age. Reassurance of the parents is usually the first step in management, although some
physicians recommend bladder exercises and scheduled toileting.
Conditioning with “wet” alarms and waking the child in the middle of the night have also
helped.
For patients with persistent nocturnal enuresis, the drug of choice is DDAVP
(desmopressin). IMIPRAMINE
-)In Managemnt of Enuresis, urinalysis should always be the 1st step, then behavioral modification (pass urine right b4
going to bed, no drinks b4 going to bed, wake up the pt in the night to pass urine), n finally meds (Imipramine n
Desmopressin) r the DOC in refractory cases.
0 - ArchivalUser - 09-20-2010
Childhood disintegrative disorder is a rare pervasive developmental disorder that occurs more commonly in males. It is characterized by a period of normal development for at least 2 years!!! Followed by a loss of previously acquired skills in at least 2 of the following areas: expressive or receptive language, social skills, bowel or bladder control, or play and motor skills. They then develop autistic symptoms. Prognosis is poor and most children are severely disabled for life.
Vs. autism: in here the onset of symptoms is always LESS than 3 years of age.
Rett syndrome: it is also a pervasive developmental disorder. You have an initial
period of normal development (typically until 6 months of age) followed by the loss of
hand coordination and the development of peculiar stereotyped hand movements. Other
common features include a deceleration of head growth, poor coordination, ataxia,
retardation, seizures, and diminished social interactions. More in females.
0 - ArchivalUser - 09-20-2010
A 16-year-old male living in a group home for the developmentally challenged has an IQ of 50. He does not read or write, and communicates with one or two word utterances. He will not interact with other group home members, and since birth he has "pulled back" and becomes agitated when others get physically close to him. In his room, everything is in a given place; if any of his belongings are moved, he becomes quite disturbed. Which of the following is the most likely diagnosis?
A. Asperger's disorder
B. Autistic disorder
C. Childhood disintegrative disorder
D. Obsessive compulsive disorder
E. Schizophrenia, catatonic
0 - ArchivalUser - 09-20-2010
Attention deficit/hyperactivity disorder (ADHD) is characterized by impulsivity, hyperactivity, and inattention lasting at least 6 months and disorder must have started before age 7.