BH E3- Childhood & Adolescence

He said nothing past elimination disorders was on the exam so I did not include them <3

The following criteria if associated with what condition?

• ≥ 4 sx exhibited during interactions w/ atleast 1 individual who is not a sibling; lasting at least 6 mos

  • loses temper

  • touchy or easily annoyed

  • angry & resentful

  • argues w authority figures or adults

  • actively defies or refuses to comply w requests from authority figures or rules

  • deliberately annoys others

  • blamers others for their mistakes/ behaviors

  • spiteful or vindictive at least twice

• children under 5: behavior occurs most days for ≥ 6 mos

• children 5 & older: at least once per week for ≥ 6 mos

ODD

What is the MC population & age of onset for ODD?

Boys until puberty; first sx appear in preschool years

What can more serious forms of ODD evolve into?

Conduct disorder

ODD or conduct disorder?

• more severe, has aggressive or cruelty towards people or animals, destruction of property or patterns of theft

Conduct disorder

Language disorder of ODD?

• failure to follow directions id due to impaired language comprehension

Language disorder

Social anxiety disorder of ODD?

• defiance is due to negative evaluation

Social anxiety disorder

What environment often contributes to ODD?

Harsh, inconsistent, or neglected child-rearing practices

What is the treatment for oppositional defiant disorder (ODD)?

Refer to pediatric psychiatrist

The following criteria if associated with what condition?

• ≥3 in the past 12 mos, w/ atleast 1 in the last 6 mos:

  • aggression to people & animals

    • bullies, initiates fights, uses weapon, cruelty, steals while confronting victim, etc

  • destruction of property

    • deliberately set fire or destroy

  • deceitfulness or theft

    • breaking & entering, cons others, shoplifting or forgery

  • serious violation of rules

    • before age 13: staying out past parental curfew, truancy

    • ran away at least twice

Conduct disorder

What condition?

• develops as result of biological risk & childhood experiences (opportunities for early intervention)

  • child-hood onset- sx before age 10

  • adult onset- sx after age 10

• ODD common precursor

• individuals lack remorse or guilt for actions, are callous or lack empathy about feelings of others

Conduct disorder

What do individuals with conduct disorder have a high risk of developing as an adult?

*even higher risk of comorbid ADHD

Antisocial personality disorder

The following RF are for what condition?

• parental: rejection, conflict, alcoholism, substance abuse

• maternal depression

• inconsistent parental figures

• harsh punishment, inconsistent child rearing practices

• abuse, neglect

• institutional living

• fetal alcohol syndrome, prenatal drug exposure

Conduct disorder

What is the treatment for Conduct disorder?

Refer to pediatric psychiatrist → family therapy, behavior management training, social skills group, teaching problem solving skills

What is the etiology of pediatric anxiety disorders?

Genetic, environmental (rejection, assault), temperament (shy, inhibited)

The following criteria is associated with what condition?

• Excessive anxiety & worry about numerous activities

  • work, health, school, everyday responsibilities, etc

  • out of potion to actual likelihood

• difficult to control worry

• ≥ 3 sx occurring more days than not for ≥ 6 mos:

  • restlessness, feeling keyed up, on edge

  • easily fatigued

  • difficulty concentrating, mind going blank

  • irritability

  • sleep disturbances

GAD

What clinical features are associated with GAD?

Muscle tension, trembling, muscle aches, HA, exaggerated startle response, somatic sx (N, D, sweating), autonomic sx (SOB, palpitations, dizzy)

If a child has the following symptoms, what should you consider?

• HA, stomachache, other physical complaints

• insomnia, nighttime awakening

• overeating (mild) or under eating (severe)

• avoiding outside activities or social events

• poor school performance

• inattention, distracted

• excessive need for reassurance

GAD

What worry themes are seen in pediatric GAD?

Academics, natural disasters, social life, physical assault

What is the average age of onset of pediatric GAD?

10-15 y/o

What is the treatment for pediatric GAD?

Refer to psych → behavioral, cognitive & family therapy

The following criteria is associated with what condition?

• marked fear or anxiety of social situations where person has to perform, be observed eating or drinking, or exposed to scrutiny by unfamiliar people

• fears they will act or show anxiety sx that will be negatively evaluated, humiliated, rejected

• social situations almost always provoke fear & are avoided

• fear/ anxiety out of proportion

• sx ≥ 6 mos

• significant impact on functioning

Social anxiety disorder

Social anxiety disorder or normal shyness?

• lacks clinically significant impact on work, social or other areas of function

Normal shyness

Agoraphobia or social anxiety disorder?

• avoidance of social situations is d/t lack of escape or help not available

Agoraphobia

The following criteria is associated with what condition?

• inappropriate & excessive fear concerning separation from attached individual; ≥3 sx:

  • recurrent excessive distress anticipating or experiencing separation

  • worry about losing attachment figure or harm

  • worry about untoward event (getting lost, kidnapped) causing separation

  • reluctance or refusal to go out d/t fear of separation

  • fear or reluctance about being alone

  • refusal to sleep away from figure

  • repeated nightmares of separation

  • repeated physical sx - HA, N, V - when separated

• sx persistent ≥ 6 mos

Separation anxiety disorder

What is the treatment for separation anxiety disorder?

Refer pediatric behavioral health → CBT, group or family therapy

The following criteria is associated with what condition?

• ≥5 sx for most of the day, nearly everyday, for at least 2 weeks (must have #1 or 2)

  • depressed or irritable mood

  • anhedonia

  • significant wt loss or gain, change in appetite

  • insomnia or hypersomnia

  • psychomotor agitation or retardation

  • fatigue or loss of energy

  • worthlessness or guilt

  • diminished ability to think, concentrate or indecisiveness

  • recurrent thoughts of SI or death

MDD

What are the key manifestations of childhood/adolescence MDD?

Somatic sx (MC abdominal pain), sudden decline in school performance, withdrawal from social activities or friends, frequent irritability, sleep problems, conduct problems

*MC irritable mood rather than depressed

What population is MDD MC in?

F > M

Are the following MDD sx more likely to be seen in older or younger adolescents?

• Anhedonia - “im bored”

• psychomotor retardation

• hopelessness

• delusions

Older

Are the following MDD sx more likely to be seen in older or younger adolescents?

• somatic complaints - abd pain

• sleep or appetite changes

• fatigue

Younger

What is the treatment for pediatric MDD?

Refer to psychiatrist → cognitive, interpersonal, group or family therapy

Mod-severe → fluoxetine or citalopram

What SSRI is first line for pediatric MDD can be used in children > 8 y/o?

Fluoxetine

What SSRI can be used for pediatric MDD in children > 7 years old/o, but is usually not effective to help with depression?

Citalopram

What features are suicidal children more likely to have?

Hx of impulsive or aggressive behavior, taller & physically more mature, conflict with parents, disciplinary crisis

The following warning sides are for what condition?

• past suicide attempts or threats

• past violent or aggressive behavior

• mental illness or alcohol use

• bringing weapons to school

• recent experience of humiliation, shame, or loss

• bullying- victim or perpetrator

• victim of abuse or neglect

• vandalism, animal cruelty, setting fires

• poor peer relationships, cults, no supervision

Pediatric suicide

The following criteria is associated with what condition?

• persistent eating of nonnutritive, nonfood substances ≥ 1 mo

• inappropriate to developmental level

• not part of culturally supported normative practice or other mental disorder

• ex: paper, soap. hair, chalk, etc

Pica

What should be r/o when evaluating pica?

Iron or zinc deficiency, anemia, celiacs, renal dialysis, starvation

The following criteria is associated with what condition?

• repeated regurgitation of food ≥ 1 mo

  • may be re-chewed, re-swallowed, or spit out

• Not attributable to GI or medical conditions, eating disorders, or other mental disorder

Rumination disorder

What are RF for rumination disorder?

Neglect, stressful life, parent-child relationship issues

The following criteria is associated with what condition?

• lack of interest in eating + ≥1:

  • significant wt loss or lack of growth

  • significant nutritional def

  • dependence on PO nutritional supplements

  • marked interference with funcitoning

• not d/t lack of food, eating d/o, mental condition

Avoidant / restrictive food intake disorder

The following criteria is associated with what condition?

• restriction of energy intake relative to requirements leading to low body wt (BMI < 18.5)

• intense fear of gaining weight; significant behavior that interferes with gaining wt even though low BMI

• disturbance in way body wt/ shape is perceived; persistent lack of recognition of seriousness of low BMI

Anorexia Nervosa

What subtype of anorexia is classified as no binge eating or purging in the last 3 months, just refusal to ingest appropriate amount of calories?

Restrictive type

What subtype of anorexia is classified as binge eating then purging in the last 3 months (vomiting, laxatives, diuretics, enemas, exercising)?

Binge-eating / purging type

What BMI is mild anorexia?

17-18.5

What BMI is moderate anorexia?

16-16.99

What BMI is severe anorexia?

15-15.99

What BMI is extreme anorexia?

< 15

What is the treatment for all pediatric eating disorder?

Refer psych & registered dietitian

The following criteria is associated with what condition?

• recurrent episodes of binge eating

  • eating in discrete period of time (2 hrs) an amt of foot larger than normal

  • sense of lack of control

• recurrent inappropriate compensatory behaviors to prevent wt gain

• normal BMI

• average once per week for 3 months

Bulimia nervosa

What is considered mild bulimia nervosa?

1-3 episodes/wk

What is considered moderate bulimia nervosa?

4-7 episodes/wk

What is considered severe bulimia nervosa?

8-13 episodes/wk

What is considered extreme bulimia nervosa?

>14 episodes/wk

The following criteria is associated with what condition?

• recurrent episodes of binge eating

  • eating in discrete period of time (2 hrs) an amt of food larger than normal

  • sense of lack of control

• ≥3 sx:

  • eating more rapidly, until uncomfortably full, large amounts when not hungry, eating alone bc embarrassed, feeling disgusted or depressed or guilty

• at least once a week for 3 mos

• normal wt, overweight, or obese

Binge-eating disorder

The following criteria is associated with what condition?

• repeated voiding of urine into bed or clothes- involuntary or intentional

• significant frequency- at least twice per week for ≥ 3 mos OR impaired functioning

• at least 5 y/o

• not d/t medical condition or substances

• *refer psychiatrist

Enuresis

The following criteria is associated with what condition?

• repeated passage of feces into inappropriate places (clothes, floor)- involuntary or intentional

• at least 1 event each month for ≥ 3 mos

• at least 4 y/o

• not d/t medical condition or substance

• *refer psychiatrist

Encopresis

What are RF for encopresis?

Painful defecation → leads to holding behavior