Psych Final Exam Kids

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Psych Final Exam Kids
2011-04-19 16:09:05
Nursing Psych

Children and Adolescents
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  1. Define Mental Health
    Successful performance of mental functions that results in productive activities, fulfilling relationships & the ability to adapt to change or cope with adversity
  2. Define Mental Disorder
    Health conditions marked by alterations in thinking, mood, or behavior that causes distress, impair ability to function or both
  3. Define Mental Illness
    A clinically significant, behavioral or psychological syndrome experienced by a person & marked by distress, disability, or the risk of suffering, disability, or loss of freedom
  4. Discuss Children's Mental Health
    • All SES
    • Determine Not developmentally normal
    • —Preventive programs and interventions can improve social & emotional development, reduce risks
  5. Discuss Developmental-Ecological Framework
    • Cicchetti
    • Looks at numerous developmental and genetic, biologic theories
    • Considers “nature” AND “nurture”
  6. Discuss the 4 levels of Developmental-Ecological Framework
    • Macro: Culture values beliefs
    • Exosystem: Community geographical
    • Micro: Family
    • Ontogenic: Individual: Genes, brain, biology, temperament,
  7. Discuss Developmental Theories in Developmental-Ecological Framework
    • —Critical Competencies
    • Must be achieved to meet challenges of later stages
    • Ex. Prosocial behaviors
    • Individual and environmental factors interact in a reciprocal manner
  8. Discuss Contextual Theories in Developmental-Ecological Framework
    • Cconsiders development & functioning
    • Informed by genetic & neurophysiological variables
    • Continuous exposure throughout life
  9. List Risk & Protective Factors
    • Risk Factors: Variables that impede development and cause hardship
    • Protective factors: Variables that serve as buffers and have a helpful influence
    • Proximal systems: variables with strongest influence/Closest
    • Distal systems: variables exert less effects
  10. Define Protective Factors and give examples
    Increase resilience to stress

    • Positive self-image
    • Family cohesion & absence of discord
    • Support from significant others
    • Positive relationship with at least one parent
    • —Positive early family experiences with development of social competence
    • —Family support
    • —Academic achievement
    • —Positive peer relationships
  11. List Risk Factors
    • Family history
    • Immature development of the brain
    • Brain abnormality
    • Family problems & dysfunction
    • Poverty
    • —Mentally ill or substance abusing parents
    • Teen parents
    • Abuse
    • Discrimination
    • Chronic parental conflict, divorce
    • Chronic illness or disability
  12. List Effects of childhood mental illness
    • Long-term mental disorders in adulthood
    • —Thwarted development
    • Diminished productivity
    • —Conflict within family and in community
    • Child welfare involvement
    • —Juvenile justice involvement
    • —Special education
    • Health
  13. List Current Theories r/t Child Dev
    • —Cognitive development theory: Piaget
    • Moral development: Kohlberg *
    • —Attachment
    • —Temperament
    • —Brain development
  14. Discuss Cognitive Development
    • —Piaget
    • —Intelligence: environmental adaptation
    • —Two major Components:
    • —Process of coming to know
    • Stages we move through as we gradually acquire ability to know/think
  15. Define Attachment
    a profound, reciprocal, physical and emotional relationship between a parent and a child that endures and sets the stage for all future intimate and trusting relationships.
  16. Discuss Internal Working Model
    • Set of expectations about self & relationships
    • —Availability of attachment figure
    • —Likelihood of receiving support during times of stress
    • Ongoing interactions
    • Become basis for all future relationships
  17. List qualities of Parents of securely attached children
    • —Sensitive to the child’s needs and emotional states: Attunement
    • —Responsive to the child’s needs and emotional states
    • Accessible to the child
    • Cooperative with the child
  18. Discuss the Child's Role
    • —The Child seeks proximity
    • —Communicates needs clearly
    • —“any form of behavior that results in a person attaining or maintaining proximity to some other clearly defined individual who is conceived as better able to cope with the world”
  19. List Sx of Poor Child attachment
    • Avoidant
    • —Ambivalent/Anxious
    • Difficult to soothe
  20. List the 4 Types of Attachment
    • Secure Attachment
    • Insecure Avoidant
    • Insecure Ambivalent
    • Disorganized: A 4th response described more recently in children of abuse & neglect
  21. List Benefits of Secure Attachment
    • Self confidence
    • —Competence
    • —Loved
    • —Lovable
    • —World is predictable
    • —I can deal
  22. List Outcomes of Avoidant Attached Infants by 6th Grade
    • Emotionally insulated
    • —Hostile
    • —Antisocial
    • —Unduly seeking attention
  23. List Outcomes of Ambivalently Attached Infants by 6th Grade
    • —Tense
    • —Impulsive
    • —Easily frustrated
    • —Passive
    • Helpless
  24. List Parental Factors that inhibit secure attachment
    • —Depression & other mental illnesses
    • —Stress
    • —Substance abuse
    • —Childhood experiences
    • Limited parenting knowledge
    • —Abuse & Neglect
    • —Domestic conflict
    • —“Out-of –Synch” responses
    • Anything that prevents parent from meeting the social, emotional and physical needs of their child in a sensitive responsive way
  25. List Child Factors that inhibit secure attachment
    • —Medical, developmental issues
    • Difficult temperament
    • Inability to communicate needs clearly
    • —Pushing parent away
    • Being difficult to soothe
  26. Discuss/ Define Tempermant
    • How or style of behavior as opposed to why (motivation)
    • —Easy
    • —Difficult
    • Slow to warm
    • —Predictability to early school years
  27. Define Brain Development
    The brain develops and organizes as a reflection of developmental experience, organizing in response to the pattern, intensity and nature of the sensory and perceptual experience
  28. Discuss Early Brain Development
    • Synaptic Connections “The Wiring”
    • Birth --> 50 trillion Synapses
    • 1 year --> 1000 trillion Synapses
    • —20 years --> 500 trillion Synapses
    • How they connect is driven by experiences and emotional experience plays a crucial role in the minds architecture
  29. Discuss the Effects of Maltreatment
    • Areas of brain r/t fear are activated
    • Other areas of brain are not activated
  30. Discuss Neglect/ Abuse Brain Changes
    • Brains are 20-30 % smaller
    • —Speech Delays
    • —Hearing Problems
    • Gross and Fine Motor Problems
  31. Discuss Cortisol
    • Stress hormone
    • Increased cortisol destroys synapses
    • Maltreated kids have less cortisol after stress
  32. Define Hyper-arousal
    • —Chronic Fear leads to state of hyper-arousal.
    • This appears as hyper-vigilance and exaggerated autonomic responses
    • —Heart Rate does not return to normal after startle.
    • Reminders of trauma evokes fear response
  33. List Impairments r/t Maltreatment
    • —Difficulty with self-regulation
    • —Irritability in the limbic system can lead to panic disorder
    • Smaller growth of the hippocampus and limbic system can increase the risk for dissociative disorders and memory impairments
    • Children deprived of touch, movement, sound may be at risk for Sensory Integration Disorder.
  34. List Psych Nurses role
    • —Assessment
    • —Family needs
    • Promoting children’s rights in treatment settings
    • Avoiding seclusion & Restraint
  35. Discuss Assessment for Kids
    • —Children need simple phrases (more concrete)
    • —Corroborate information with adult
    • Direct questions, rather than open-ended
    • May use play media
    • May not be able to provide accurate time
  36. Discuss Data Collection/ Interview
    • —Clinical interview: primary tool
    • —Depends on developmental level of each child
    • Establish a treatment alliance
    • Assess interactions between child and parent
  37. Discuss Interviewing Techniques
    • Interview child and parent separately
    • Children provide better information about internalizing symptoms (mood, sleep, suicide ideation)
    • Parents provide better information about externalizing symptoms (behavior, relationships)
  38. Discuss Assessment: Family Functioning
    • Family assessment: usually done before assess’t of child/ teen
    • Reinforce that everyone is involved and expected to work on problem how child is viewed : realistic or unrealistic
  39. Discuss Assessment: Current Problem
    • Nature, severity, length;
    • How upsetting?
    • Better/ worse?
    • Triggers/Events?
    • Describe behaviors at home, response to discipline, empathy violence, risks
  40. Discuss Assessment: History
    • Previous tx: Type length outcome; testing results & dx
    • Family history: Medical MH problems; symptom in immediate & Extended family
    • Developmental: Pregnancy HX ( Maternal health, stress, Substance use, physical abuse);Birth complications, developmental milestones,
    • Social history: Names ages relationships with whom child lives; relationships with parents,sibs, other relatives, peers; activities hobbies; legal charges/ involvement
    • Abuse history: Exposure to physical, sexual emotional abuse, CPS reporting/ involvement, treatment, exposure to family/ community services
    • Chemical history: Substance use in child, parent, other caretakers
    • Medical Hx: Seizure, head injuries, acute illnesses, injuries accidents, surgeries, loss of consciousness, asthma, et al chronic illnesses, vision hearing deficits, current medications, effects & S/E; names & effects of prior meds, Allergies
    • School History: Current grade, reg/special ed,learning difficulties, behavior problems, peer & Teacher relationships, LIKE? HATE about school
  41. Discuss Assessment: Mental Status Exam
    Conducted via observation, use of play & Questioning; Behavior, play, orientation, memory, Attention & Concentration, speech, thought content & process, Hallucinations, delusions, SI/HI, Self-harm, thinking or actions, judgment, insight.
  42. Discuss Discussion with Parents
    • —Ask for a detailed description of their view of problem
    • Allow parents to express frustration
    • Be nonjudgmental
  43. Discuss Interviewing Preschoolers
    • have difficulty putting feelings into words, thinking concretely
    • Use play; conduct assessment in play room
  44. Discuss Interviewing School-age
    • —able to use constructs, provide longer explanations
    • Establish rapport through competitive games
  45. Discuss Interviewing Adolescents
    • egocentric; have increased self-consciousness, fear of being shamed
    • —Let them know what information will be shared with parents; direct, candid approach
  46. Discuss Risk Assessment
    • Ask straight forward questions
    • —Have you thought about hurting yourself?
    • —Have you ever acted on these thoughts?
    • How would you hurt yourself?
    • What do you think would happen?
    • Have you ever hurt yourself?
    • When a child shares information regarding an intent to commit suicide or hurt others, it must be shared with parents
  47. List Basic Principle Interventions with Kids
    • Build a relationship!
    • Children want to behave and please those they care about
    • All behavior has meaning
    • —Children with mental health issues often cannot clearly communicate their needs
    • —Addressing the need behind the behavior is essential to successfully
  48. Discuss Intervention with Kids
    • Prevent & Early Intervention
    • Starts Prenatally
    • Screening
    • In-home visits
  49. List Psychosocial Modalities (Intervening)
    • Individual
    • Brief
    • Play therapy
    • Family therapy
    • Parent training
    • Group
    • Milieu
    • —Pharmacologic
  50. Discuss Psychosocial Modality: Individual
    • Cognitive or behaviorally based
    • Help children modify behavior
    • Behavioral: token economies, reinforcement of desired behaviors
    • —Teaching parents to use
    • —Behavioral contracts (teens)
    • Problem solving, stopping negative perceptions
  51. Discuss Play
    • Area for change, expression of feelings, trust, relationship building
    • How kids talk
    • Place to build rapport
  52. Discuss Parent Management Training
    • —Teaches family to alter children’s behavior in the home
    • —Maladaptive parent-child interactions
    • —Replace coercive behavior with pro-social behaviors
    • Solid supporting data
  53. Discuss Parent-Child Interaction Therapy (PCIT)
    • Strong evidence base for treatment of behavioral dysregulation
    • Adapted for use with traumatized and maltreated children
    • —Two treatment phases: Child-Directed Interaction (CDI) and Parent-Directed Interaction (PDI)
  54. Discuss Target Population for PCIT
    • initially for families with children ages 2-to-7 with oppositional, defiant, and other externalizing behavior problems.
    • —It has been adapted successfully to serve physically abusive parents with children ages 2-to-12.
  55. List Contraindications for PCIT
    • Severe, untreated parental psychopathology
    • Severe marital discord
    • Children outside of the PCIT age range
    • Severe ADHD without medication consultation (Project SHAPE)
    • Parents/caregivers who are known perpetrators of sexual abuse
  56. List Essential Components of PCIT
    • —A two-stage approach aimed at relationship enhancement and child behavior management. (CDI & PDI)
    • —Skills are taught then coached
    • Assessment driven: progress charted on a graph
    • Parents are provided with immediate feedback
    • —Homework
  57. Discuss Psychosocial Modality: Group
    • —Especially effective with Adolescent
    • —Less threatening
    • Universality
    • —Windows of opportunity
    • —Avoid with conduct disordered kids
    • Social Cognitive group may be helpful in reducing aggressive behavior
  58. Discuss Psychosocial Modality: Family Therapy
    • —Behavior of one affects whole family
    • —Interventions focused on behavior patterns of entire family
    • —Promotes cohesion, addresses concerns conflicts
    • —Success necessitates modify family/ home environment
  59. Discuss Medication Education
    • —Few psychotropic meds have FDA Approval for use in children
    • Rx’d “off label”
    • —“black box” warnings with antidepressant use in children
    • Name, action, dose, time, side effects
    • Parents & Child
    • —Safety issues related to storage, administration
    • —Drug- drug interactions/ OTC drugs
  60. List Basic Guidelines
    • Always treat youngsters with respect and preserve their dignity.
    • Always do what is in the child’s best interests.
    • Seek solutions, not blame.
    • Model tolerant, patient, dignified, and respectful behavior.
    • Use the least intrusive intervention possible.
    • —Connect and build strong personal bonds with them.
    • —Instill hope for success
    • NEVER give up on a child. Be perturbed with the actions of a child but keep believing in his/her ability to change for the better.
  61. Discuss Mastering Feelings
    • Label feelings
    • Normalize and validate feelings
    • —Identify & connect triggers to feelings
    • —Identify & connect thoughts accompanying or preceding feelings
    • Address/ reframe thought distortions
    • Explore healthy expression of feelings
    • Use of play media is effective in helping
    • —Use of “some kids”, or third person helps
  62. Discuss ADHD
    • —Persistent pattern of inattention, hyperactivity, and impulsiveness that is pervasive and inappropriate for developmental level
    • Hyperactive type
    • Inattentive type
    • Combined type
    • No link to sugar, maybe food additives
  63. List Co-Morbidities of ADHD
    • ODD
    • Conduct DO
    • Depressive Do
    • —Early onset substance abuse
    • Learning DO
  64. Discuss Diagnosis of ADHD
    • No specific “tests”
    • Diagnostic tools include questionnaires such as Conner’s, for parents teachers and older kids
    • Symptoms appear early 3-6yo
    • R/O other possibilities
  65. List Tx for ADHD
    • AACAP, AAP:
    • —Behavioral< FDA approved meds
    • Stimualnts & amtomaxatine ( Strattera)
    • PMT
    • —Meds plus other treatment most effective
    • —Goals: Improve self- regulation & Social functioning
  66. List Meds for ADHD
    • Stimulants: Adderal, Concerta, Ritalin
    • Non stimulants: Strattera, ( watch closely for SI), Wellbutrin, clonidine, tricyclics
    • Side effects: (stimulants) Sleep disturbance, Decreased appetite, Tics : less common
  67. List Organization Tips for ADHD
    • Schedule
    • Organize everything
    • Use homework and notebook organizers
    • Be clear and consistent
    • Give praise and rewards when rules are followed
  68. Discuss Signs of Oppositional defiant disorder
    • Disobedience
    • Argumentativeness
    • Angry outbursts
    • —Low frustration tolerance
    • —Tendency to blame others
  69. Discuss Tx for Oppositional Defiant Disorder
    • —Behavior modification, parent training
    • Family therapy
    • —Medication used to treat co-morbidities
  70. Discuss Signs of Conduct Disorder
    • —Serious violations of social norms
    • Aggressive behavior
    • Destruction of property
    • Cruelty to animals
  71. List RF for Disruptive Behavior Disorders
    • Physical & Sexual abuse
    • Inconsistent Parenting with harsh discipline
    • Lack of supervision
    • —Early institutional living or out-of- home placement
    • —Association with delinquent peer group
    • —Parental substance abuse
  72. Discuss Tx for Disruptive Behavior Disorders
    • —Behavioral techniques: —MUST be very consistent
    • Medications for aggressive & Impulsive behavior: —Atypicals, mood stabilizers, lithium
    • —Parent management training: Greatest promise
  73. Discuss Adjustment Disorders
    • Clinically or behaviorally significant symptoms appear within 3 months of an identified stressor
    • Mood, anxiety, behavior or mixed
    • —Course may be acute or chronic
    • —May include regressed, fearful or acting out behavior
    • —Requires support, understanding and encouragement
    • —Adaptive coping skills
  74. List Anxiety Disorders
    • OCD
    • Phobias
    • Separation Anxiety
    • Social Anxiety disorder
    • —Generalized anxiety disorder
    • —Post traumatic stress disorder
  75. Discuss Separation Anxiety Disorder
    • Suffer great distress when faced with ordinary separations from major attachment figures: Panic
    • —Fear accidents befalling parents, cling or shadow parent, school refusal
    • Somatic complaints
    • Sleep disturbance
  76. List Tx for Separation Anxiety Disorder
    • Good response to SSRI’s
    • Imagery, self-talk Cognitive techniques
    • Teach parents helpful responses
  77. Discuss GAD
    • —Excessive unrealistic fears
    • Past & Future
    • Weather, school, health family finances
    • Buspar & Paxil effective
  78. Discuss PTSD
    • Response to trauma that person perceives as life threatening to self or other
    • Children do not present the same as adults
    • Adolescents may present with adult symptoms
    • Presence of risk/ protective factors play role in development
    • Ongoing or repetitive trauma
    • Co- morbidity: MDD
  79. Discuss PTSD in the Adolescent
    • Re-experiencing
    • Intrusive thoughts and nightmares
    • Avoidance of discussion of the traumatic event and places or people
    • —Amnesia important aspect of the trauma
    • withdrawal from friends or usual activities
    • detachment from others
    • sense of —foreshortened future
    • —Hyperarousal, such as sleep difficulties
    • —Hypervigilance
    • —increased startle response
  80. Discuss Chronic PTSD in the Adolescent
    • prolonged or repeated stressors
    • —may present with predominantly dissociative features,
    • including de-realization, depersonalization, self-injurious behavior, substance abuse, and intermittent angry or aggressive outbursts
  81. Discuss School-aged PTSD
    • —may not experience amnesia
    • may not have avoidantor numbing symptoms
    • —mayor may not have visual flashbacks
    • —may show frequent posttraumatic reenactment of trauma
    • —skewed sense of time during the traumatic event.
    • Sleep disturbances
    • —A high prevalence of "omen formation“ \questions about foreshortened future may be meaningless in this age group
  82. Discuss Infants, Toddlers and Preschool PTSD
    • May present with generalized anxiety symptoms (separation fears, —stranger anxiety, fears of monsters or animals)
    • —avoidance of situations that may or may not have an obvious link to original trauma

    • —Posttraumatic play
    • (which is compulsively repetitive, represents part of the trauma, and fails to
    • relieve anxiety)
    • play reenactment
    • social withdrawal
    • restricted range of affect
    • —loss of acquired developmental skills
  83. Discuss Tx of PTSD
    • direct exploration of the trauma,
    • —use of specific stress management techniques,
    • —inclusion of parents
    • Psychosocial: TF-CBT, —EMDR ( Adults only), —Psycho therapy
    • Psychopharmacology: Symptom treatment currently used to treat symptoms, SSRI’s& tricyclics, Propanol, Guanfacine, Carbamapezine
  84. List Tx of OCD
    • —Medications: Paxil & Luvox approved
    • —Behavior therapy: exposure and response prevention
    • —Cognitive Behavioral Therapy
  85. List Key Sx of Mood D/o
    • Depressed or irritable mood
    • Low frustration level
    • Over reaction
    • Loss of joy
    • Moodiness
    • —Changes in appetite, sleep
    • —Physical complaints
    • —Decreased ability to think, concentrate>>>> poor school functioning
    • —Acting out: Substance abuse, truancy, running away, self injury, promiscuity
    • —Thoughts or verbalizations about death
    • Stressors
  86. List Co-morbidities of Mood d/o
    • —Half have another psychiatric illness
    • —GAD
    • OCD
    • ADHD
    • Conduct disorder
  87. List Tx for Mood D/o
    • —Cognitive-behavioral therapy: Positive Self-talk, Promote coping, Active participation in planning activities, —Self monitoring (Journaling about moods, feelings)
    • Play therapy for younger children
    • Family consultation: Help relatives understand, Develop more effective parenting skills, Communication, Teach about suicide risks
  88. List Meds for Mood d/o
    • —SSRIs: Low S/E: nausea, HA, Stomach ache, IMprovement1-2 weeks, Up to 12 weeks for full effect, Given for 6-24 months
    • TCA’s: —More S/E, —Dysrhythmias!, —Potential lethality in OD
    • Antipsychotics: Aggression, hallucinations delusions, Risperdal, Seroquel, Zyprexa, Sedating
    • —Typical A.P. not given due to increase risk for TDK
    • Discuss black box warnings with family
  89. List S&S of Bipolar D/o
    • Children: Delusions, hyper-sexuality, pressured speech, flight of ideas
    • Teens: resemble adults, Hallucinations, labile mood, —Determining cycling is still difficult
    • —“Affective storm”
    • Rages
    • Prone to violence
    • —Poor school performance
    • Sleep disturbance
    • —Rapid mood swings: q 1-2 hours
    • —Often symptoms seem to be chronic>>>> difficult to id cycling episodes
  90. List Bipolar Mood Stabilizers
    • Lithium: Serotonin norepinephrine and dopamine systems
    • Diminishes dopamine effectsduring mania
    • —Enhances serotonin effects during depression
    • —Strong suicide preventive properties
    • —Anti- convulsants: —Carbamazepine , Divaloprex, Rapid cycling and angry or depressed states
    • Antipsychotics: with psychosis
  91. Discuss Lithium Teaching
    • Watch for dehydration (Lithium)>>>>> lead to elevated lithium levels
    • —Child may need to carry water bottle @ School
  92. List Sx of Autistic D/o
    • Marked impairment of development in social interaction and communication
    • Delayed and deviant language, or concrete thinking
    • Pronoun reversals and abnormal intonation
    • Stereotypic behavior: Repetitive rocking, Hand flapping, Insistence on sameness, Self-injurious behavior
  93. List Autism Screening Tools
    • —Childhood Autism Rating Scale (CARS).
    • CHAT
    • Formal audiologic hearing evaluation and a lead screening
  94. Discuss Antipsychotics
    • For behavior
    • —2006 approved Risperdal (risperidone)irritability, and include aggression, deliberate self-injury and temper tantrums.
    • Off label: Zyprexa (olanzapine)
  95. Discuss Anxiety/ Depression: SSRIs
    • educate parents
    • —fluoxetine, (Prozac®) has been approved by the FDA for both OCD and depression in children age 7 and older
    • —(Luvox®), age 8 and older; sertraline (Zoloft®), age 6 and older; and clomipramine (Anafranil®), age 10 and older
    • —can be associated with decreased frequency of repetitive, ritualistic behavior and improvements in eye contact and social contact
  96. List other meds
    • Opioid antagonist: naltrexone for activity level and attention
    • Clonidine: reduces hyperactivity, self-stimulation, and irritability
    • Buspirone and trazodone: reduce agitation
    • Lithium, and some of the benzodiazepines such as diazepam (Valium) and lorazepam (Ativan). The safety and efficacy of these medications in children with autism has not been proven.
  97. Define/ Discuss Asperger's D/o
    • Severe and sustained impairment in social interaction and restricted, repetitive patterns of behavior, interests, and activities
    • Profound social deficits: Inappropriate initiation of social interactions, —Inability to respond to social cues, —Concrete in interpretation of language, Stereotypic behavior
    • Not associated with MR
    • —Normal intelligence, good verbal skills, low performance
  98. Discuss Tic Disorders and Tourette Disorder
    • Tourette disorder
    • Chronic motor or vocal tic disorder
    • Transient tic disorder
    • Tic disorder NOS: Can suppress tics for brief periods, —Treatment with antipsychotics ( Haldol) and clonidine, —Ritalin can trigger onset/worsen tics
  99. Discuss Death for Kids
    • Preschool-aged: —React more to others’ responses than to death itself, —Need reassurance, Avoid euphemisms (e.g., “he went to sleep”)
    • School-aged: Unable to express feelings in a grownup way, Express grief through somatic complaints, regression, behavior problems, withdrawal, hostility
    • —Adolescents: —Understand death as an abstract concept