children and adolescents-mental health

most common ego defense mechanism for children

regression

in order, most common causes of death for adolescents

automobile accidents, unintentional accidents, suicide

behavioral therapy is goof for

those with self-destructive behaviors

systematic habit training

for severe intellectual disabilities. perform skills repetitively

nurse diagnosis for patients with intellectual disability

risk for injury and self-care deficit

what is autism spectrum disorder

a withdrawal of the child into the self and into a fantasy world

prevalence for autism

1 in 88 children

self injurious behaviors for autism

head banging and scratching

nurse diagnosis for autism

risk for injury

What is Asperger's disorder?

Mild form of autism characterized by impaired social interaction and restricted or stereotyped interests/actions/behaviors.

child is developing normally then there is a sudden decline

rhett disorder

characteristics of rhett disorder

loss of purposeful hand movement and coordination, distinctive hand movements, loss of ability to speak, problems with walking

what population is rhett disorder associated with

girls

most disabling feature with rhett disorder

apraxia

severe sudden regression

childhood disintegrative disorder

population associated with childhood disintegrative disorder

boyds

another name for childhood disintegrative disorder

heller's syndrome

childhood disintegrative disorder: when does normal development stop

at least the age of two

childhood disintegrative disorder is characterized by

a dramatic loss of previously acquired skills in language, social skills, motor skills, GI control

stereotypic movement disorder

a disorder in which the individual voluntarily repeats nonfunctional behaviors, such as rocking or head banging, that can be damaging to his or her physical well-being

reactive attachment disorder

occurs before the age of 5; attachment difficulties

emotionally withdrawn/ inhibited reactive attachment disorder characteristics

poor connections, lack of eye contact, lack of responsiveness, dont seek comfort, sudden outbursts, anger/aggression, rage

indiscriminant/uninhibited reactive attachment disorder characteristics

cling to anyone, seek comfort from anyone, wander away from caregiver, does not seek meaningful relationships

does adhd have a genetic component

yes

combined adhd

inattentive, hyperactive, impulsive

Predominantly inattentive adhd

6 symptoms of inattention and less than 6 symptoms of hyperactive

predominantly hyperactive/impulsive adhd

less than 6 symptoms of inattention and 6 symptoms of hyperactivity

weird environmental influence for adhd

lead

Co-occurrence

adhd with a conduct disorder/depression/anxiety

adhd in toddlers

unable to sit still, impulsive, trail of destruction

adhd in children

intrusive, limited attention, impacts learning, poor academic performance, peer rejection, high risk behaviors

evaluate childhood adhd

can they participate in groups, less impulsive, age-appropriate behaviors, delay gratification, self-regulation

amphetamine

adderall

adderall mechanism of action

release of dopamine and norepinephrine. inhibits MAO enzyme

methylphenidate

Ritalin, concerta

methylphenidate Mechanism of action

stimulates release and selectively blocks reuptake of dopamine and norepinephrine

Dextroamphetamine

Dexedrine

mechanism of action for Dextroamphetamine

causes release of dopamine and norepinephrine and inhibits MAO enzyme

Lisdexamfetamine Dimesylate

Vyvanse

population for Vyvanse

adults and peds

adverse affects of Vyvanse

loss of appetite, weight loss, and growth inhibition

dexmathylphenidate methylphenidate

focalin

Focalin mechanism of action

selectively inhibits reuptake of dopamine and norepinephrine

magnesium pemoline

cylert, pemoline

mechanism of action for magnesium pemoline

inhibits reuptake dopamine and norepinehprine

black box warning for magnesium pemoline

liver failure

non-stimulant adhd meds

Straterra, INtuniv, bupropion, impramine

can cns stimulants build tolerance

yes

what do you assess for while taking stimulants

hypertension, dysrhythmias, and liver disorders

dosing of stimulants

2/3 in the morning, 1/3 in the afternoon

side effects of stimulants

HA, insomnia, hyperactivity, paranoia, restlessness, cardiovascular disturbances, appetite suppression, weight loss

long term side effects of stimulants

Decreased growth, seizures, tics, altered liver function

no ... while taking stimulants

caffeine

why can stimulants be fatal

arrhythmia

what happens if stimulant dose is increased too quickly

increased irritability/anger, tachycardia, insomnia

stimulant dose too high

agression and tics

rebound effect with stimulants

occurs late in afternoon. med wears off and return to original behaviors

abrupt discontinuation of stimulants

n/v, abdominal cramps, ha, fatigue, depression, suicidal ideation, psychotic behavior

is straterra a stimulant or non stimulant

non-stimulant

mechanism of action for straterra

selective norepinephrine reuptake inhibitor

how long until you see benefits of straterra

up to 30 days

straterra dosing is ... based

weight

watch for ... with straterra

cardiovascular and liver functioning

what can happen to a person with cardiovascular disease taking straterra

sudden cardiac death

side effects of straterra

palpations, tachycardia, anorexia, weight loss, n/v, constipation, liver damage

bad side effect of straterra

new or worsened psychiatric symptoms

do you take Straterra with meals

yes

intuniv is the .... of guanfacine

extended release

Tenex is the ... of guanfacine

immediate release

Is Guanfacine a stimulant?

no

mechanism of action for guanfacine

blood pressure med: alpha 2A adrenergic receptor agonist

ages for guanfacine

6-17

what NOT to do with Guanfacine

crush, chew or break the tablet or eat with high fat meal

what do you check frequently with guanfacine

HR and BP

common side effects of Guanfacine

somnolence, sedation, hypotension, bradycardia

what to avoid with guanfacine

overheated or dehydration

Wellbutrin is an ...

antidepressant

who takes wellbutrin

adults

who should not take wellbutrin

Any person with a seizure disorder or eating disorder

what should you never take with wellbutrin

mao inhibitor

behavioral modifications for adhd kids

consistent schedules

give ... for activities to help with attention/retention (adhd)

breaks

nurse interventions adhd

watch for side effects of meds, monitor for signs of addiction/abuse, monitor hydration, assess for lowering the seizure threshold

dyslexia is ... in origin

biological

conduct disorder

the "bad kid". the rights of others and society norms are violated

when does conduct disorder occur

up to age 18; over 18 may be antisocial personality disorder

manifestations of conduct disorder

aggressive to people and animals, destroys property, deceitful or theft, violation of rules, no remorse or shame

nurse diagnosis for conduct disorder

risk for other-directed violence

nurse care for conduct disorder

coping skills, enforce rules, set limits

treatment for conduct disorder

individual psychotherapy, family therapy, stress reduction, environmental structure

meds for conduct disorder

treat symptoms. antipsychotics!!

oppositional defiant disorder

persistent patterns of behaviors that are negativistic, defiant, and hostile towards authority

what is the oppositional defiant disorder child like?

angry, power struggle, consistently argumentative, resistant to rules, and tests the limits, argues with adults, annoys people, vindictive

when is oppositional defiant disorder evident

before 8 years old but no later than early adolescence

etiologies of oppositional defiant disorder

rejection or abuse by parents, harsh or inconsistent discipline

assess for ... with oppositional defiant disorder

suicidal ideation

nurse diagnosis for oppositional defiant disorder

noncompliance

nurse care for ODD

assist with anger management, modeling, reinforce positive behaviors, state expectations, set limits, avoid why questions, dont give attention to negative behavior

Disruptive Mood Dysregulation Disorder

mood disorder: not argumentative. rages when triggered

when is dmdd diagnoses

between ages 6-18