Child Psychiatry Disorders

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Author:
jknell
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196055
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Child Psychiatry Disorders
Updated:
2013-01-28 17:23:25
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MBB II
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Child Psych
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  1. Attention-deficit/hyperactivity disorder (ADHD)
    types, dx criteria
    • Inattentive type ADHD (6 or more of the following... persistent >6 months, problematic and inconsistent with development level)
    • -impairment in two or more settings (school, work, home...)
    • -Onset before the age of before the age of 7 years

    • 1. Fails to attend to details
    • 2. Fails to focus attention
    • 3. Fails to listen if spoken to
    • 4. Fails to follow through
    • 5. Fails to organize
    • 6. Avoids concentration
    • 7. Loses things
    • 8. Distracts easily
    • 9. Forgets

    • *Inattentive type is the most common
    • -leads to academic and social problems
    • -present at a later age (not disruptive, easier to miss)

    Hyperactive-impulsive type ADHD (6 or more... hyperactive 1-6, impulsive 7-9)

    • 1. Fidgets/squirms
    • 2. Leaves seat
    • 3. Runs/climbs
    • 4. Does not play quietly
    • 5. On the go
    • 6. Talk excessively
    • 7. Blurts answers
    • 8. Does not wait turn
    • 9. Interrupts

    -presents earlier (easier to see)

    • Combined type ADHD
    • -meets criteria for both (less common)
  2. ADHD
    epidemiology
    • Prevalence in young and school-aged children: 6%
    • Male>female (3:1)
    • Genetics contribute ~70% of the risk
    • -Dopamine transporter genes, dopamine receptor genes
    • Environmental risk factors: 
    • -Fetal alcohol syndrome
    • -prematurity
    • -Lead toxicity, nutritional deficiencies
  3. ADHD
    clinical course, evaluation and treatment
    • Clinical course:
    • -dx in grades 1 through 6
    • -hyperactivity decreases with age
    • -60% have some persistence of symptoms into adulthood

    • Evaluation:
    • -assess current situation/risk factors
    • -Rule out alternative causes (thyroid disorders, medications, absence epilepsy, hypoglycemia

    • Treatment: 
    • -Non-pharmacologic (education, behavior modification...)

    • Pharmacological Tx:
    • -Stimulants (know that AEs: decreased sleep, decreased appetite, irritability, anxiety, GI pain, headache, slow growth)
    • -ADHD does not predict risk for substance abuse (non-conduct disorder ADHD)
    • -Dose: dose only when needed (at school, not on the weekends); start low dose

    • Stimulants
    • -Methylphenidate (Ritalin)
    • -Dexmethylphenidate (Concerta)
    • -Mextroamphetamine (Dexedrine)
    • -Dextroamphetamine plus amphetamine (Adderall)

    • Non-stimulants:
    • -Atomoxetine (Strattera)
    • -Bupropion (Wellbutrin)
    • -Tricyclics such as nortriptyline (Pamelor)
    • -Clonidine (Catapres)
  4. Conduct disorder
    • -Repetitive and persistent pattern of violating rules or societal norms
    • - "Childhood form of Antisocial Personality Disorder"
    • - >3 of the following within the last year... that cause impairment

    • 1. Bully
    • 2. Fights
    • 3. Weapon
    • 4. Cruel
    • 5. Animal cruelty
    • 6. Steal/confront
    • 7. Forced sex
    • 8. Fires
    • 9. Vandalism
    • 10. Break-ins
    • 11. Lies
    • 12. Stealing 
    • 13. Curfew (onset <13 years)
    • 14. Runaway (more than once)
    • 15. Truant (onset <13 years)

    *Onset: prior to age of 10-13 (puberty)

    • Prevalence: ~6%
    • -Males > females (5:1)
    • -Genetic and environmental
    • -decreased function of the prefrontal cortex

    • Clinical course: 
    • -physical aggression often decreases with age
    • -puberty can bring on increased violence in some
    • -40% go on to develop ASPD
    • -80% develop substance abuse disorder
    • -individuals who have or had conduct disorder die earlier

    • Tx: 
    • mostly behavioral, education of family, structural changes
  5. Oppositional defiant disorder
    pattern of negative, hostile and defiant behavior lasting at least 6 months... >4 of the following

    • 1. Temper
    • 2. Argues
    • 3. Refusals
    • 4. Annoys
    • 5. Blames
    • 6. Annoyed
    • 7. Anger/resentful
    • 8. Vindictive

    • Prevalence and causes:
    • -~10% prevalence; Males = females
    • -etiology not well studied

    • Course and Treatment:
    • -onset in age is 6 to 8 years
    • -30% develop conduct disorder, 10% go on to develop ASPD
    • -60% improve within 3 years
    • -Tx: education, early, problem solving (worst first)
  6. Pervasive developmental disorders
    early onset of impaired communication, interaction, and interest:

    • Autism: impaired social interactions (>2 from group 1), impaired communication (>1 criteria from group 2), and restricted behavior or interests (>1 criteria from group 3). Total of  6 or more criteria.
    • -Pt has delays or abnormal functioning with onset before age 3 years in one of the following: social interaction, language as used in social communication, or symbolic or imaginative play

    • 1a. Decreased use of nonverbal cues (such as eye contact)
    • 1b. Decreased peer relationships
    • 1c. Decreased shared interests
    • 1d. Decreased social response
    • 2a. Decreased development of language
    • 2b. Decreased conversations
    • 2c. Idiosyncratic/repetitive
    • 2d. Decreased social play
    • 3a. Preoccupied, restricted interests
    • 3b. Nonfunctional routines, rituals
    • 3c. Repetitive movements
    • 3d. Preoccupied with objects

    • Asperger's disorder: impaired social interactions and restricted/repetitive behaviors or interests ( >2 group 1 and >1 group 3 symptoms - No group 2)
    • -No language delay, no delay in cognitive development
  7. Depressive disorders in childhood
    • Same criteria as for adults
    • Onset: rare before puberty
    • Incidence is increased if there is family hx of MDD or bipolar disorder
    • Males = females (incidence)
    • Clinical course is same as adult onset MDD
    • Evaluation/tx is same
  8. Anxiety disorders of childhood
    • 1. Separation anxiety: fear of leaving home and/or possible harm to parents
    • -seen in 4% of school aged children; onset is age 6 to 9
    • -disorder improves with age

    • 2. Post-traumatic stress disorder (PTSD):
    • -occurs in 8% of children
    • -improves with age
    • -tx is CBT and sometimes SSRIs

    3. Obsessive compulsive disorder, gerealized anxiety disorder, and social phobia MAY start in childhood

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