El jabón

32 y/o w/ no psychiatric history brought to ER with 2 days of memory loss, insomnia, poor appetite, and difficulty performing daily routines. Subjective sense of numbing, detachment, and anxiety. One week earlier pt witnessed her child being fatally injured in a motor vehicle accident. All labs and scans normal. Dx?

(4x)

ACUTE STRESS DISORDER

What symptom is more likely to occur in acute stress d/o than in PTSD? REDUCTION IN AWARENESS OF SURROUNDINGS

Important determinant factor to whether an individual who was exposed to trauma

will develop PTSD? SEVERITY AND PROXIMITY OF TRAUMA

Acute stress d/o differentiated from PTSD by DURATION OF SYMPTOMS

29 y/o pt reports having been robbed at knifepoint almost a month ago. Pt escaped unharmed, but has been experiencing a sense of unreality, detachment, and dampened emotions that is interspersed with periods of intense physiological arousal. These symptoms are causing difficulties at work. The most likely Dx?

ACUTE STRESS DISORDER

ADHD

7 y/o child BIB parents report he’s been hyperactive since age 4, talks constantly, interrupts, has trouble sitting still to do homework, will not play quietly outdoors.

What else do you need to make the Dx of ADHD? (4x)

TEACHER REPORT

Studies show effective intervention for children with ADHD is to involve their

parents in what part of Tx? (4x) BEHAVIORAL MANAGEMENT

Child w ADHD ineffective Tx with methylphenidate. Next step in management: (4x) DEXTROAMPHETAMINE Child w ADHD not respond to methylphenidate IR. What med to try next (3x) MIXED AMPHETAMINE SALTS What aspect of ADHD is most likely to improve as children age? (3x) HYPERACTIVITY

Atomoxetine’s principal mechanism of action exerts a therapeutic action because it: (2x)

IS A SELECTIVE NOREPINEPHRINE REUPTAKE INHIBITOR.

Atomoxetine is most likely to be considered as initial treatment in ADHD in

adolescents with: (2x) SUBSTANCE USE D/O

The multimodal Tx study of children w/ ADHD examined the comparative responses over 14 months of children to medication and intense psychosocial interventions. What did the findings of the study reveal w/ respect to ADHD symptom changes? (2x)

MEDICATION MANAGEMENT IS SUPERIOR TO COMMUNITY CARE TREATMENT

Which perinatal factor is specifically associated with development of ADHD? MATERNAL TOBACCO USE PRENATALLY

The component of ADHD that is most likely to remain in adulthood: INATTENTION

Which DSM-V diagnosis requires symptoms to be present in 2 or more settings? ATTENTION-DEFICIT HYPERACTIVITY DISORDER (ADHD)

Current thinking about relationship between ADHD in children and adults: SIGNIFICANT NUMBER OF CHILDREN WILL GO ON TO BECOME ADULTS WITH ADHD

8 y/o boy w/ ADHD, oppositional defiant disorder, and chronic motor tic disorder has worsening of his tics on a good dose of a stimulant that seems to control his ADHD. How do you manage this further in trying to improve the tics?

MONITOR THE TICS ONLY

Which comorbid diagnosis of childhood ADHD worsens the prognosis into

adolescence and adulthood to the greatest degree? CONDUCT DISORDER

32 y/o w/ ADHD mixed type as child. As adult still has Sx. Tx: METHYLPHENIDATE

Which med would you prescribe for 20 y/o college student being worried over his grades? He complains that he has not been able to focus on studying and that his mind wanders frequently during classes. His energy level is low. He sleeps well and his appetite is good. History indicates he was treated with stimulants since second grade.

METHYLPHENIDATE

10yo w ADHD and aggressive outburst is started on a moderate dose of a stimulant.

ADHD symptoms have improved, but aggression has not. In addition to behavioral intervention, what is the next best step to manage both the ADHD and aggression?

MAXIMIZE DOSAGE OF LONG ACTING STIMULANT

Which psychiatric disorder is comorbid with ADHD? DISRUPTIVE BEHAVIOR DISORDERS

Which of the following side effects can result from stimulant medication treatment and warrants immediate discontinuation of the medication and a reassessment of the treatment plan?

HALLUCINATIONS

Abnormal LFTs would be most commonly associated w/ what medication used to

treat ADHD in children/adol? PEMOLINE

ADHD comorbid disorder DEPRESSION

These empirical non-stimulant meds have empirical support to treat ADHD: CLONIDINE, BUPROPION, IMIPRAMINE, ATOMOXETINE

What procedure is necessary to diagnose childhood ADHD? CLINICAL INTERVIEW OF PARENTS AND CHILD

Parents bring their 10 yo child for an eval due to concerns about child’s reported difficulty paying attention in a class and completing assignments in the expected time. Parents report that the child has trouble staying on task while doing homework and they are concerned that the child has an attention disorder. At the completion of the eval, the psychiatrist requests that both a parent and a teacher fill out a rating scale. The parent ratings fall into the clinical range but the teacher’s ratings do not meet criteria for a clinical problem. How should the psychiatrist account for the differences in observed ratings?

RATING DISCREPANCIES BY DIFFERENT OBSERVERS ARE COMMON IN CLINICAL PRACTICE.

Antidepressant for ADHD BUPROPION

With respect to ADHD symptoms, the 1999 multimodal treatment study of children with ADHD was most notable for demonstrating which of the following?

THE EQUIVALENCE OF COMBINED METHYLPHENIDATE AND PSYCHOSOCIAL TREATMENT COMPARED TO MEDICATION ALONE

Which of the following instruments is most helpful in the assessment of children

suspected of having ADHD? CONNERS TEACHER RATING SCALE

What med used for ADHD has been associated with liver damage? ATOMOXETINE (STRATTERA)

11 y/o with reading disability. Most likely comorbid dx: ADHD

Describes the relationship of stimulant treatment of children with ADHD and the emergence and/or presence of tic d/o:

TREATMENT WITH STIMULANTS HAS BEEN SHOWN TO REDUCE TICS IN CHILDREN WITH COMORBID ADHD AND TIC D/O.

What DSM-IV-TR disorder requires symptoms to be present in two or more settings? ADHD

12 yo comes in for worsening attention, impulsive, and hyperactive. He is snoring and hard to wake in the AM. Central adiposity, broad based neck and enlarged tonsils. exam is unremarkable. In child with ADHD and sleep problems, what is the most accurate about ADHD and sleep in this patient?

CORRECTING THE UNDERLYING SLEEP DISORDER CAN IMPROVE ADHD SYMPTOMS

5 y/o is evaluated for ADHD. Parents complain that the child has multiple symptoms of hyperactivity, impulsivity, inattention, and distractibility. Parents also bring teacher feedback reports that confirm these symptoms and state child is failing academically and having social problems. In psych MD office child is quiet, calm and cooperative, and very engaging . The difference in clinical presentation from parent and school reports is most likely because:

CHILDREN WITH ADHD CAN PRESENT WITH BRIEF PERIODS OF HEIGHTENED FOCUS AND CALM, ESPECIALLY IN A STRUCTURED SETTING.

Failing grades, poor organization, spending sprees, spontaneous trips ditching class, fidgety, euthymic. No change in sleep, appetite, no anhedonia. Dx? ADHD

When compared to the other subtypes of ADHD, children with the inattentive

subtype have higher rates of anxiety and somatic complaints and LEARNING DISORDERS

Evidence based therapy treatment for tic disorder in children HABIT REVERSAL THERAPY

DSM 5 prior age of presentation ADHD symptoms 12yo

Increased rate of comorbidity with ADHD? Anxiety or Oppositional defiant

30 10yr old child, 3 yr hx of involuntary movements and vocalizations, symptoms wax and wane but never disappeared, child is aware of symptoms and only mildly distressed, academic performance is below average, what is the co-occurring disorder most likely causing this functional impairment at school?

ADHD

What distinguishes ADHD in children vs adults? Hyperactivity