Peds | ADHD | Pharm | Personality Disorders | Eating Disorders |
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What is ODD
sxs first seen around 3-4 yrs, dx made around 6-8yrs; defiant, angry, spiteful, mean, w/ CD 6% of the time, says “no” instinctively, enjoys conflict, intense need to win; all of these outweigh normal drives to please or avoid consequence; do not violate the basic rights of others; some genetic component; symptoms worse at home
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What is inattention
Sx category including careless mistakes, trouble attending to details, problems with sustained attention, not attentive when directly addressed
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What is Methylphenidate
MOA: Inhibition of norepinephrine and dopamine reuptake
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What is cluster A
Schizo, schizotypal and paranoid; odd and eccentric
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What is Bulimia nervosa
Recurrent episodes of binge eating characterized by:
- Eating, in a discrete period of time, an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances - A sense of lack of control over eating during the episode Recurrent inappropriate compensatory behaviors in order to prevent weight gain such as self induced vomiting, misuse of laxatives or other meds, fasting or excessive exercise The binge eating and inappropriate compensatory behavior both occur, on average, at least once a week for 3 months Self evaluation is unduly influenced by body shape and weight The disturbance does not occur exclusively during episodes of anorexia nervosa |
What is Conduct Disorder
usually appears around 8-12 yrs; lying, stealing, breaking rules; precursor to antisocial personality disorder in adulthood (10%); violate social norms and the basic rights of others; leads to arrest; harm towards animals, cruelty for the sake of it
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What is hyperactivity/impulsivity
Sx category include fidgets or squirms, leaves seat often, restless, difficulty playing quietly
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What is Dextroamphetamine
MOA: Blocks the reuptake of dopamine, NE and serotonin & increased release of monoamines within the synapse
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What is Cluster C
Avoidant, Dependent, obsessive compulsive; anxious and fearful
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What is binge eating disorder
Recurrent and persistent episodes of binge eating
Binge eating episodes are associated with three or more of the following: - Eating much more rapidly than normal - Eating until feeling uncomfortably full - Eating large amounts of food when not feeling physically hungry - Eating alone because of being embarrassed by how much one is eating - Feeling disgusted with oneself, depressed or very guilty after overeating Marked distress regarding binge eating Absence of regular compensatory behaviors (such as purging) |
What is Antisocial personality disorder
>18yrs; adult version of pediatric disruptive disorder; low empathy, high risk tolerance, narcissism, SUD is high, most have impulse control issues and broken attachment
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What is Methyl/Ritalin and dextroamph/Adderall
1st line ADHD tx in kids... in adults....
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What is wellbutrin
non stimulant (NDRI), not abusable, antidepressant (helps depression, bipolar, smoking cessation); take once a day; takes 4 weeks to work; suicide warning; do not use on pts with seizures or eating disorders
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What is cluster B
Antisocial, borderline, histrionic, narcissistic; dramatic, emotional and erratic
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What is ARFID
An eating or feeding disturbance (i.e. apparent lack of interest in eating or food; avoidance based on sensory characteristics of the food; concern about the consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one or more of the following:
- Significant weight loss or failure to achieve expected weight gain or weight falter - Significant nutritional deficiency - Dependence on enteral feeding or oral nutrition supplements - Marked interference with psychosocial functioning The disturbance is not better explained by lack of available food or an associated culturally sanctioned practice The eating disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa and there is no disturbance in the way in which one’s body shape or weight is experienced The eating disturbance is not attributable to a concurrent medical condition or ot better explained by another mental disorder. When it is in the context of another condition the severity of the eating disturbance exceeds that routinely associated with the condition and warrants additional clinical attention |
What is DMDD
irritable at baseline, abnormal intense rage response every few days, depression or sustained mood disturbance, often replaces inaccurate bipolar disorder; normal empathy, not distracted, good impulse control when not angry; may refuse to go to school, get out of bed or comply with authority figure
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What is 6+ sx of the following for at least 6 mo that negatively affects social and academic/occupational activities; several symptoms before age 12, symptoms present in at least 2 settings, clear evidence they interfere with life, not explain by another disorder
Diagnostic criteria of ADHD
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What is Strattera/atomoxetine
may treat anxiety too but takes 4 weeks to work; not abusable and non stimulant; do not use with MAOI’s; causes sedation and weight loss
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What is avoidant
Extreme shyness, low self esteem and fear of rejection
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What is Anorexia nervosa
Restriction of energy intake requirements leading to a significantly low body weight in the context of age, sex and developmental trajectory, and physical health. Significantly low weight is defined by less than minimally normal or expected (i.e. falling off the curve)
Intense fear of gaining weight or of becoming fat or persistent behavior that interferes with weight gain even though at a significantly low weight. Restricting type: during the last 3 mo, the individual has not engaged in recurrent episodes of binge eating or purging behavior. Weight loss due to dieting, fating and/or excessive exercise Binging/purging type: during the last 3 mo the individual has engaged in recurrent episodes of binge eating or purging behavior such as induced vomiting, misuse of laxatives, diuretics or enemas |
What is ADHD
hyperactive, impulsive, attention deficit, distracted, irritability
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What is sense of underachievement, difficulty with organization, chronic procrastination, many projects at once, few completions, impulsive voicing, frequent search for high stimulation, intolerance of boredom, involuntary distraction, often very creative and intelligent, trouble following proper procedure
Bothersome symptoms
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What is Lisdexamphetamine/Vyvanse
Prodrug to dextroamphetamine; less abusable
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What is schizotypal
Discomfort in close relationships combined with eccentric behaviors and thoughts
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What is CBC, ESR, urine pregnancy test, urine analysis, thyroid function, LFT, Mg Ca Phos, labs to r/o medical conditions of differential diagnosis
W/U
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