NR606 / NR 606 Week 4 Midterm Exam | Latest 2026/2027 Edition | Diagnosis & Management in PMH II Practicum | Chamberlain | Practice Questions & Accurate Solutions

NR606 / NR 606 Week 4 Midterm Exam | Latest 2026/2027 Edition | Diagnosis & Management in PMH II Practicum | Chamberlain | Practice Questions & Accurate Solutions Children in the pre-operational stage think _____ and use what to represent objects? symbolically, use words or pictures In which stage of piaget's model does thinking become more logical and organized about events and children can reason inductively concrete operational (age 7-11) Which stage is defined by the ability to reason abstractly and consider hypothetical problems as well as moral, ethical, social, and political issues? formal operations (12+) Can a parent access information if the provider has concerns about parental abuse or neglect? the provider can decide whether or not to treat the parent as a personal representative If the parent is not the child's personal representative under HIPPA, do they have access to the health records? depending on state laws- if the state has a law against it then no, if the state does permit the provider to share health information then the provider is able to A challenge to prescribing psychoactive medications in the perinatal period is the paucity of evidence regarding the true risks for the pregnant client and developing fetus If a pregnant client is stable on their current medication regimen what should the PMHNP keep in mind keep them on current med rather than switching When should the PMHNP refer the patient to a perinatal psychiatrist when the patient is on a high-risk medication for pregnancy most common adverse effect associated with SSRIs and SNRIs neonatal withdrawal syndrome symptoms of neonatal withdrawal syndrome Symptoms include tremors, high-pitched crying, and disturbed sleep increase the risk of atrial septal defects. paroextine symptoms of newborn toxicity r/t benzodiazepine use during pregnancy Symptoms include sedation, floppy muscle tone, and potential breathing issues at birth bipolar medications that are considered teratogenic and should be avoided during pregnancy. valproic acid and carbamazepine Atypical antipsychotics that increase risk of gestational diabetes and large for gestational age infants olanzapine and quetiapine has also been found to increase the risk of musculoskeletal malformations in infants olanzapine the most used antipsychotics during pregnancy risperidone and quetiapine medications that are safe for breast feeding SSRIs, benzos, valproic acid, quetiapine medications that are safe for bottle feeding lithium, lamotrigine, clozapine smoking- related pregnancy complications ectopic pregnancy, placental abruption, placenta previa, fetal mortality, and stillbirth, as well as preterm birth and low birth weight infants Smoking-related effects on neonates include sudden infant death syndrome and birth malformations such as oral clefts and neural tube defects smoking effects on infants, children, and adolescents include asthma, cognitive impairment, lower respiratory illness, attention deficit hyperactivity disorder (ADHD), and central nervous system tumors Health problems associated with alcohol use disorder include increased risk for miscarriage, stillbirth, congenital anomalies, low birth weight, small for gestational age, and preterm delivery risk of using cannabis during the perinatal period including preterm labor, low birth weight and small for gestational age deliveries, and adverse effects on fetal and adolescent brain growth, executive functioning skills, behavioral problems, and academic achievement Cocaine use during pregnancy is linked with poor pregnancy-related outcomes including premature rupture of membranes, placental abruption, preterm birth, low birth weight, and small for gestational age deliveries, as well as long-term effects in children and adolescents including lower short-term memory, child and adolescent delinquent behavior, earlier age of sexual activity, and substance use complications of opioid use during the perinatal period eclampsia, heart attack or heart failure, and sepsis. Infants experience significant adverse effects, including neonatal abstinence syndrome, third trimester bleeding and mortality, postnatal growth deficiency, microcephaly, neurobehavioral problems, and sudden infant death syndrome includes policies, regulations, or laws that intentionally or unintentionally lead to discrimination structural stigma an example of structural stigma MAT encompasses the attitudes, beliefs, and behaviors of groups or individuals which form a stereotype that creates an emotional reaction or prejudice and results in discrimination. public stigma refers to the shame individuals internalize about negative stereotypes, may prevent themselves from seeking help self-stigma only validated behavioral health screening instrument designed specifically for pregnant women. It screens for alcohol, tobacco, marijuana, and illicit drug use. In addition, validated screening questions for depression and domestic violence can be included. The 4Ps Plus validated for use with adults to generate a risk level for each substance class. It can be self-administered or conducted via clinician interview and combines screening and brief assessment of past 90-day problematic use into one tool Tobacco, Alcohol, Prescription medication, and other Substance Use (TAPS) Tool assess substance use disorder risks among adolescents 12-17 years old. NIDAMED's Screening Tools for Adolescent Substance Use when is inpatient treatment recommended for alcohol use disorder in pregnant women? for clients at risk for moderate, severe, or complicated alcohol withdrawal as indicated by a score of more than 10 on the CIWA meds for tobacco use disorder that are safe in pregnancy nicotine replacement therapy (NRT), bupropion, or a combination why use IR over ER in pregnancy an help minimize infant exposure during pregnancy and breastfeeding. OUD meds that are safe during pregnancy methadone and buprenorphine OUD meds that are safe during breastfeeding methadone, buprenorphine, and naltrexone neurological condition characterized by persistent, uncontrollable worrying that causes emotional distress + symptoms on most days, for a period of at least six months. GAD mood disorder characterized by depressive symptoms that last longer than two weeks + 5 or more of the following: irritable mood, diminished interest in activities, significant weight or appetite changes, fatigue, feelings of worthlessness, sleep disturbances, and the diminished ability to concentrate MDD Untreated MMHDs can have long-term negative impact on mother including Have poor nutrition Use substances such as alcohol, tobacco, or drugs Experience physical, emotional, or sexual abuse Be less responsive to baby's cues Have fewer positive interactions with baby Experience breastfeeding challenges Question their competence as mothers Untreated MMHDs can have long-term negative impact on the child including Low birth weight or small head size Pre-term birth Longer stay in the NICU Excessive crying Impaired parent-child interactions Social-emotional, cognitive, language, motor, and adaptive behavior development Adverse Childhood Experience Risk Factors for MMHDs Smoking Lack of social support Poor relationship quality Pregnancy complications Personal or family history of depression History of physical or sexual abuse Unintended pregnancy Life stress Chronic physical conditions Prior pregnancy with fetal/infant loss History of mental illness pathophysiology of the baby blues The abrupt change in hormones that occurs when the placenta is delivered may contribute to the development of symptoms and may be exacerbated by fatigue, pain, overstimulation, lack of support, or insecurity baby blues symptoms Poor concentration Moody Feeling sad Fatigue Easily angered Insomnia Anxiety Crying without reason Poor concentration baby blues causes Drastic hormonal changes Fatigue after giving birth and breastfeeding Sudden changes in routine caring for baby Lack of support from partner or family Transition to being a mother the most common maternal mood disorder depression when can the specifier "with peripartum onset" be applied can be applied to depressive disorders if the onset of mood symptoms occurs during pregnancy or in the four weeks following childbirth. criteria for perinatal psychosis as a "brief psychotic disorder with peripartum onset" when symptoms present suddenly during pregnancy or within the first 4 weeks after birth and last at least one day but no more than one month. who has the highest risk of a postpartum psychotic episode preexisting bipolar disorder Current recommendations from the American College of Obstetricians and Gynecologists (ACOG) include screening how often? at least once during the perinatal period using a validated instrument, increasing the frequency of visits when symptoms are identified, and referring clients for appropriate pharmacotherapy and psychotherapy treatments The American Academy of Pediatrics (AAP) recommends incorporating the Edinburgh Postnatal Depression Scale (EPDS) how often into infants' 1, 2, 4, and 6-month well check visits using a cutoff score of 10 as an indicator that maternal depression may be present what must be ruled out before starting SSRIs for perinatal depression bipolar II Medications for perinatal bipolar disorder lithium, lamotrigine First line therapy for perinatal PTSD first line= psychotherapy SSRIs may be used for comorbid depression screening tool used for bipolar disorder MDQ Screening tool used for depression PHQ-9 tool used to monitor symptoms of bipolar disorder after diagnosis young mania rating scale tool used to assess clients who present with symptoms of psychosis brief psychiatric rating scale how can maternal depression and anxiety can impact fetal development in utero increase the risk for preterm birth and low birth weight, and lead to an insecure attachment between the mother and infant as well as suboptimal breastfeeding practices Diagnostic criteria for GAD in children and teens only one physical or cognitive symptom is required for diagnosis whereas three symptoms are required for adult diagnosis Screen for Child Anxiety Related Disorders (SCARED) tool Child Version enables providers to screen for several types of anxiety disorders, including generalized anxiety, panic disorder, separation anxiety, and social anxiety. A total score of ___ or more points on the SCARED scale indicates a potential anxiety disorder 25 To meet diagnostic criteria for OCD, the obsessions and compulsions must be time-consuming (1 hour per day) and disrupt normal routines, functioning, or relationships. PANDAS pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections lab test to detect PANDAS Cunningham panel First-line treatment for mild to moderate OCD CBT which includes exposure and response prevention If symptoms persist after two or more trials of an SSRI or clomipramine and failure to respond to CBT, treatment may be augmented with an atypical antispcyhotic Body dysmorphic disorder (BDD) type of obsessive-compulsive disorder in which an individual becomes preoccupied with one or more perceived flaws in physical appearance that are not visible or appear slight to others screening tools for use with clients who may have BDD Body Dysmorphic Disorder Questionnaire (BDDQ) The BDD Yale-Brown Obsessive Compulsive Scale for Adolescents (BDD-YBOCS-A) scoring for BDD-YBOCS-A Scores range from 0-to 48. Scores above 20 indicate the presence of BDD. The higher the score, the more severe the disorder screening tool that provides different scoring thresholds to screen for mild, moderate, or moderately severe depression GLAD-PC SSRI acute phase of treatment goals Aim is to achieve a significant reduction or disappearance of symptoms for 8-12 weeks. SSRI continuation phase of treatment goals Aim is to consolidate treatment gains and prevent relapse for 6 to 12 months SSRI maintenance phase of treatment goals Aim is to prevent relapse by continuing treatment for those with recurrent, severe, or chronic depression. _______ is a possible late-onset side effect in clients who take antidepressant medication emotional disinhibition presentation differences of children vs adults with BiPD Children typically experience more rapidly cycling moods and mixed episodes characterized by symptoms of both mania and depression together validated tool used for dx BiPD Kiddie Schedule for Affective Disorders and Schizophrenia for School-Aged Children interview tool an evidence-based treatment that can help clients manage life with a mood disorder by promoting regularity in daily routines interpersonal and social rhythm therapy Early intervention for youth at genetic risk for developing BPT IRPT with Data-Informed Referral (IPSRT+DIR) before symptoms manifest shows promise in helping youth establish more regular sleep-wake cycles which may help decrease mood fluctuations the preferred drug for adolescents with bipolar disorder with mixed features Divalproex The hallmark clinical feature of DMDD chronic, persistent irritability and anger. DSM5 criteria of DMDD outbursts of temper 3 times per week, chronically irritable or anger that is observable to others, symptoms present 12 months, symptoms present in at least 2 out of 3 settings (home, school, peers), ages 6-18, onset before age 10 when can DMDD not be diagnosed if bipolar, intermittent explosive disorder, or oppositional defiant disorder are present screening tool for DMDD KSADS-PL therapies for DMDD CBT= first line computer-based interpretation bias training (IBT) to help children and adolescents more accurately interpret others' emotions medications for DMDD stimulant medications- decrease irritability Antidepressants- irritability and other mood problems Atypical antipsychotics- control severe outbursts of temper/ aggression which medication requires up to 30% increased dosage for clients who smoke concurrently olanzapine actors associated with an increased likelihood of developing ASD having a sibling with ASD, having older parents, having certain genetic conditions such as Fragile X syndrome or Down syndrome, or having a very low birth weight DSM-5 criteria for ASD includes ersistent deficits in communication and social interaction across multiple contexts and restrictive, repetitive patterns of behavior, interests, or activities. Symptoms must appear early in development and can cause clinically significant impairment in functioning. Early signs of ASD include avoiding eye contact showing little interest in peers or caretakers limited language abilities frustration with minor changes in routine repetitive behaviors The American Academy of Pediatrics recommends that all children be screened for ASD at which well-child visits? 18 month and 24 month general developmental screening tool. Parent-completed questionnaire; series of 19 age specific questionnaires screening communication, gross motor, fine motor, problem solving, and personal adaptive skills; results in a pass/fail score for domains. ages and stages questionnaires Standardized tool for screening of communication and symbolic abilities up to the 24 month level; the Infant Toddler Checklist is a 1-page, parent-completed screening tool communication and symbolic behavior scales This is a general developmental screening tool. Parent-interview form; screens for developmental and behavioral problems needing further evaluation; single response form used for all ages; may be useful as a surveillance tool. parents evaluation of developmental status Parent-completed questionnaire designed to identify children at risk for autism in the general population. modified checklist for autism in toddlers This is an interactive screening tool designed for children when developmental concerns are suspected. It consists of 12 activities assessing play, communication, and imitation skills and takes 20 minutes to administer. screening tool for autism in toddlers and young children Enhances new skill development through rewards-based motivational systems applied behavior analysis therapy Provides educational resources, coping strategies, and communication skills for parents of children with ASD parent training Improves social skills including conversation, being a good sport, and managing teasing from other children social skills training may be used for clients with ASD who have hyperactivity, impulsive behaviors, and sleep problems. guanfacine and clonidine may be used for clients with ASD who have aggressive behaviors, tantrums, sleep disorders, or motor tics. second gen antipsychotics may be used for clients with ASD who have repetitive behaviors and aggression. Tricyclic antidepressants (clompiramine) may be used for clients with ASD who have hyperactivity, short attention spans, and impulsive behaviors. stimulants rare neurodevelopmental disorder that is typically caused by a mutation in the methyl CpG binding protein and is characterized by normal growth and development early in life followed by impaired growth and development later in life Rett syndrome what usually happens when boys develop Rett syndrome? severe problems when they are born and die shortly after birth one of the most disabling aspects of Rett syndrome, interfering with all body movements, including eye gaze and speech Apraxia TS often occurs comorbidly with other psychiatric conditions such as ADHD, OCD, learning difficulties, depression four diagnostic criteria are required for TS including: he presence of multiple motor tics and one or more vocal tics, which may not occur concurrently tics may wax and wane in frequency but have persisted for more than 1 year since the first tic onset tic onset is before 18 years of age tics are not caused by the use of a substance or other medical conditions scaling for Tics 0= none 10= minimal 20=mild 30=moderate 40=marked 50=severe caused by contraction of the diaphragm or oropharynx muscles and include frequent throat clearing, sniffs, chirps, barks, or grunting simple vocal tics are of short duration and can include eye blinks, facial grimaces, shoulder shrugs, or extension of the extremities. simple motor tics include a combination of simple tics that last for a longer duration. complex motor tics characterized by abrupt, sharp bark or grunt vocalization of socially unacceptable words, including obscenities, or ethnic, racial, or religious slurs. This type of tic is less common. Complex vocal ttics: coprolalia a less common complex motor tic that involves making obscene gestures Complex motor tics: Copropraxia complex vocal tic characterized by repeating the last heard word or phrase Complex vocal tics: Echolalia first-line intervention for TS psychoeducation medications for TS pimozide and aripiprazole Childhood-onset schizophrenia (COS) is diagnosed in clients younger than... 13 The most common symptom in children with COS auditory hallucinations What privacy rules apply under HIPAA for children and adolescents? HIPAA protects the confidentiality of all personal health information. For minors, parents or legal guardians typically have access to their child's mental health records— but providers must respect state laws and agency policies regarding sensitive services (e.g., reproductive or substance-use treatment). Providers should explain confidentiality limits and parental access as part of informed consent. 2. What are the key components of informed consent in pediatric mental health? Capacity & assent: Children should give age-appropriate assent; adolescents may give informed consent in some states. Children should be included in discussions about medication and tx. Understanding: Present purpose, benefits, risks, alternatives, and limits (e.g., mandatory reporting) in developmentally appropriate language. Voluntariness: No coercion. Documentation: Consent and assent should be recorded formally. 3. What prescribing considerations are unique to children/adolescents? Start with low, weight-based doses and uptitrate carefully. Consider developmental PK/PD factors (liver/kidney immaturity, different body water/fat ratios). Watch for off-label use due to limited pediatric trials. Monitor side effects rigorously (e.g., growth suppression, metabolic changes). Remember children have a faster metabolism than adults and may require larger doses of medication per unit of body weight. Around puberty pharmacokinetic properties reach adult parameters.After puberty dosing may need to be decreased What triggers mandatory reporting when treating minors? Providers must report suspected child abuse, neglect, or intent to harm self/others. Familiarity with your state's statutes and clear documentation are essential. 5. What considerations apply to psychotropic use during pregnancy? Risk–benefit analysis is essential: untreated maternal illness may pose higher risks. Medication selection: SSRIs are generally first-line; some mood stabilizers and antipsychotics may also be acceptable. Physical changes: Increased volume of distribution and altered metabolism require dosing adjustments Fetal risks: Consider teratogenicity (e.g., certain mood stabilizers), withdrawal syndromes, or neonatal adaptation syndromes. 6. What are the concerns when prescribing to breastfeeding mothers? Assess drug excretion into breast milk—prefer medications with low infant exposure and favorable safety profiles (e.g., many SSRIs). Balance maternal benefit and infant safety. Monitor baby for sedation, feeding difficulties, or irritability. What are the main substance risks during pregnancy?(highest age group is 18-29) Alcohol: Fetal Alcohol Spectrum Disorders—neurodevelopmental and physical impacts. Exposure within the first trimester has the most significant alcohol related birth outcomes Causes: miscarriage, stillbirth, congenital anomalies, low birth wt, preterm delivery. Life long effects include: fetal alcohol spectrum disorder, neurodevelopmental and CNS deficits, speech and language challenges, cognitive and behavioral deficits, impaired executive functioning, psychosocial difficulties in adulthood Tobacco: during pregnancy causes: Ectopic pregnancy Placental abruption Placenta previa Fatal mortality Stillbirth Smoking related effects on neonates SIDS Birth malformations i.e oral clefts & neural tube defects Infants Asthma Cognitive impairment Lower respiratory illness ADHD CNS tumors Cannabis: Cognitive and behavioral concerns, emerging but inconclusive. Causes: preterm labor, low birth wt, adverse effects on fetal and adolescent brain growth, executive functioning skills, behavioral problems and academic achievement Opioids: Neonatal abstinence syndrome post-birth, increased risk of toxemia, low birth wt, respiratory complications, third trimester bleeding and mortality, SIDS Eclampsia, heart attack, HF, sepsis Cocaine causes Premature rupture of membranes, placental abruption, preterm birth, low birth wt,lower short term memory, delinquent behavior, earlier age of sexual activity & substance use 8. What ethical and legal issues arise with perinatal substance use? Reporting vs. treatment: Providers may fear legal reporting, deterring care. Criminalization risk: Some states prosecute prenatal substance use under child endangerment laws. Balance: Provide nonjudgmental, accessible treatment and clarify reporting regulations. How does stigma affect perinatal substance use? It can bar access to care and perpetuate disparities in tx services and outcomes Public stigma: Leads to shame and social isolation. Public stigma encompasses the attitudes, beliefs, and behaviors of groups or individuals which form a stereotype that creates an emotional reaction or prejudice and results in discrimination. A stereotypic belief that individuals choose to use alcohol or other drugs and blame them for their substance use disorder is an example of public stigma. Healthcare providers who have a conscious or unconscious bias against clients who use substances in the perinatal period may not provide appropriate care and treatment Self-stigma: Self-stigma refers to the shame individuals internalize about negative stereotypes. For individuals affected by SUDs, self-stigma may lead to feelings of being flawed or unworthy of love or connection. It may also prevent them from seeking help. Structural barriers: Structural stigma, or institutional stigma, includes policies, regulations, or laws that intentionally or unintentionally lead to discrimination. Structural stigma can limit access to resources and other opportunities, thereby impacting the well-being of the stigmatized group. A program policy that prohibits individuals from using specific forms of prescribed medication for addiction (MAT i.e methadone) treatment is an example of structural stigma. 10. How should providers screen for substance use during pregnancy? Use validated tools (e.g., 4Ps, CRAFFT, ASSIST). Apply routine screening for all patients. Screen continuously throughout prenatal care, recognizing dynamic usage. 11. What are effective treatment options for perinatal SUD? Behavioral: Motivational Interviewing, CBT, contingency management. Medication-assisted treatment (MAT): Methadone or buprenorphine for opioid use disorder. Integrated care: Combine prenatal, SUD, and mental health support alongside case management and peer support. A. Barriers to mental health care: Children/adolescents: Limited provider availability, insurance issues, transportation, stigma therefore many drop out, and misunderstanding of mental illness, scheduling conflicts, high staff turn over. Perinatal populations: Fear of legal consequences, limited maternity-SUD integration, childcare logistics, stigma. B. Social determinants affecting access: Income, insurance, transportation, neighborhood safety, and linguistic/cultural barriers impact service uptake, especially in youth. C. Developmentally appropriate teaching: Use simple language, visual aids, active learning (e.g., games), and involve parents/families. Ensure materials match the child's cognitive and emotional development. D. Racial and ethnic barriers: Distrust in healthcare systems, cultural stigma, lack of culturally tailored care, language limitations. The result: delayed help-seeking and poorer outcomes. E. Types of stigma: Structural: Institutional policies that reduce in states criminalizing opioid use during pregnancy are less likely to receive an accurate diagnosis and effective treatment; furthermore, criminalization strips these individuals of their ability to engage autonomously with their provider and impedes their ability to achieve recovery. Fear of legal repercussions and the involvement of children's services may lead women to avoid reporting substance use Public: Community stereotypes and prejudice. Self: Internalized shame that deters help-seeking. Intervention: Stigma focused on treatments or providers, affecting treatment engagement. F. Parental access to records: Typically, parents have the right to access their child's health records—but adolescence may shift this depending on privacy laws for sensitive services (e.g., reproductive or sexual health). G. Ethical/legal informed consent principles: Include autonomy, be I. Developmental Pharmacokinetics/pharmacodynamics in kids: Higher metabolic rates immature organs altered volumes of distribution—all affect how drugs act and are processed. Pediatric dosing principles: Use weight-based or body-surface-area dosing. Confirm dosing with reliable references. Monitor therapeutic effect and side effects. Double-check calculations (e.g., with a second clinician or pharmacy). What distinguishes "baby blues" from postpartum depression? Baby blues arise ~2–3 days after birth, peak around day 5, and resolve by day 14. Symptoms include mood swings, tearfulness, irritability, and fatigue. Additional sx include decreased appetite, difficulty sleeping, worrying. It does not impair maternal function Causes: drastic hormonal changes, fatigue after giving birth and breastfeeding, lack of support, transitioning to being a mother Postpartum depressionbegins within 4 weeks and lasts at least 2 weeks, with more severe symptoms: persistent sadness, guilt, hopelessness, impaired concentration, and possibly suicidal thoughts. 2. What are risk factors for maternal mental health disorders? History of mental illness (especially depression/anxiety), poor social support, history of trauma/survivor of abuse, unplanned pregnancy, pregnancy complications, economic stress, and sleep deprivation. . What are SSRI withdrawal symptoms in newborns? Newborns exposed to SSRIs in utero may experience irritability, feeding or sleep issues, tremors, hypoglycemia, respiratory distress, and jitteriness. These symptoms generally last a few days to a few weeks. What are diagnostic criteria for anxiety and depression in pregnancy/postpartum? Major depressive episode: ≥5 symptoms for ≥2 weeks (e.g., depressed mood, anhedonia, sleep/appetite changes, fatigue, guilt, concentration issues, suicidal thoughts). Anxiety disorders: Excessive worry, restlessness, fatigue, irritability, muscle tension for ≥6 months (Generalized Anxiety Disorder). Other disorders (e.g. OCD, PTSD) follow DSM‑5. What are key clinical signs and risk factors for postpartum PTSD? Clinical signs may include flashbacks, avoidance, hypervigilance, and guilt. Risk factors include traumatic delivery, prior trauma or PTSD, lack of support, and serious obstetric or neonatal complications. What treatments are recommended for severe postpartum depression? SSRIs (e.g., sertraline or paroxetine), psychotherapy (CBT, Interpersonal Therapy), and if severe: residential treatment, ECT, or neurostimulation (e.g., TMS) based on specialist guidance. 7. How are tobacco use and cannabis addressed in pregnancy? Tobacco: Use the “5 A’s” — Ask, Advise, Assess, Assist (via motivational interviewing), Arrange follow-up. Nicotine replacement may be considered if non-pharmacologic tools fail. Cannabis: Educate on risks (low birth weight, neurodevelopmental effects), and offer cessation support; safe pharmacotherapies are lacking. 8. Which mood stabilizers and antipsychotics are safer in pregnancy? Mood stabilizers: Lamotrigine preferred; lithium may be used with close monitoring (renal, thyroid, fetal heart). Antipsychotics:Haloperidol, risperidone, quetiapine are acceptable. Clozapine is lower priority due to limited data. 9. What labs should be done for pregnant patients on antipsychotics? Baseline metabolic labs (glucose, lipids, liver and renal function), with regular follow-up every trimester or every 3–6 months depending on risk. What is the Edinburgh Postnatal Depression Scale (EPDS) A 10-item self-report tool scored 0–30; a score ≥10–13 suggests possible depression; ≥13 strongly indicates it. It assesses mood, anhedonia, anxiety, guilt, and suicidality. What's peripartum onset? A specifier for mood disorders (e.g., major depression) occurring during pregnancy or within 4 weeks postpartum. What are barriers to points of care (POC) in perinatal mental health? Barriers include lack of provider integration, fear of child-welfare involvement, stigma, insurance or financial limits, childcare issues, and transportation difficulties. 1. What's the process for discontinuing antidepressants in children? Taper slowly over weeks to months, depending on the dosage and duration of use, with monitoring for return of symptoms or withdrawal effects (e.g., irritability, sleep changes) What characterizes separation anxiety in children? Excessive fear or distress regarding separation from attachment figures, lasting ≥4 weeks in children -18 (DSM‑5), causing significant social, academic, or emotional impairment. Peaks between 10-18 months & ends by about 3 years old. What are DSM‑5 criteria for selective mutism? Consistent failure to speak in specific social settings (e.g., school), but speaking normally in others (e.g., at home), lasting at least 1 month and interfering with educational achievements or social communication. Starts to appear between ages 2-4 and is more common in females. It is often comorbid with social anxiety disorder How is pediatric OCD treated? First-line is a combination of SSRIs and CBT with exposure and response prevention (ERP). Clomipramine. Moderate to severe cases may benefit from antipsychotic augmentation or intensive therapy programs. (in some children OCD is a diagnosis associated with strep infections. PANDAS- pediatric autoimmune neuropsychiatric disorders is associated with OCD What are the criteria for bipolar disorder in children? Manic or hypomanic episodes with distinct mood changes (elevated or irritable), increased energy, and associated symptoms (e.g., distractibility, impulsivity) lasting ≥4 days for hypomania or ≥7 days for mania with marked impairment. What defines body dysmorphic disorder (BDD)? Preoccupation with perceived defects in appearance, causing repetitive behaviors. 1 or more perceived flaws. (e.g., mirror checking) and marked distress, despite normal appearance. What screening tools are used for child depression or anxiety? Anxiety: Screen for Child Anxiety Related Disorders (SCARED) Depression: PHQ‑9 modified for adolescents, Kiddie-SADS, Guidelines for Adolescent Depression in Primary Care (GLAD-PC), Yale‑Brown Obsessive Compulsive Scale for Adolescents (Y‑BOCS) Fluoxetine is the First line choice in adolescents What are PANS and PANDAS, and how are they assessed? PANS: Acute-onset OCD or eating restrictions PANDAS:OCD/tic disorders following strep infection Diagnosis involves observing rapid onset, tics or OCD, and anti-streptococcal testing (e.g., ASO titer). What's the difference between anxiety criteria in children vs adults? 1 physical or cognitive sx is required for a diagnosis in children whereas for an adult, 3 is required. For children, fears often occur in peer or social contexts; irritability often replaces reported worry; manifested in physical symptoms (e.g., stomachaches, headaches). DO NOT USE PAROXETINE IN CHILDREN. IT CAN INCREASE SUICIDAL THINKING . How do SSRIs affect bipolar disorder? SSRIs alone may trigger manic episodes in children with undiagnosed bipolar disorder. Always evaluate mood history before prescribing antidepressants Disruptive Mood Dysregulation Disorder Criteria: 3 outburst per week Dx cannot be made before 6 & after 10 DMDD cannot coexist with dx of BPD, Intermittent explosive disorder or oppositional defiant disorder. Stimulants can be used as treatment What are the core diagnostic features of Autism Spectrum Disorder (ASD)? Complex neurodevelopmental** Persistent deficits in social communication and interaction; restrictive, repetitive behaviors and interests. Onset usually in early childhood, impairing daily functioning. What are the ASD support-level qualifiers? In DSM-5: Level 3: Very substantial support Level 2: Substantial support Level 1: Requiring support May include intellectual impairment or catatonia specifiers. What are evidence-based ASD interventions? Applied behavior analysis therapy (ABA), Speech and occupational therapy, OT, parent training, dietary therapy, Pharmacologic treatment addresses comorbid symptoms (e.g., irritability with risperidone or aripiprazole). Serotonin agents, antipsychotics, beta blockers, alpha 2 agonist, mood stabilizer & stimulants. Use MUCH LOWER doses of stimulants Joaquin, a 12-year-old with ASD, has difficulty sleeping and displays impulsive behaviors at school. what medication would be appropriate & why Guanfacine because medications, such clonidine, may be used for clients with ASD who have hyperactivity, impulsive behaviors, and sleep problems Ariana, a 9-year-old with ASD, has a history of aggressive behaviors, tantrums, and motor tics. what medication would be appopriate aripiprazole; Second-generation antipsychotic medications may be used for clients with ASD who have aggressive behaviors, tantrums, sleep disorders, or motor tics Seth, a 15-year-old with ASD, has a history of stereotypies including toe-walking and arm flapping. what medication would be appropriate clomipramine;clomipramine Tricyclic antidepressant medications may be used for clients with ASD who have repetitive behaviors and aggression. Tyrek, an 11-year-old with ASD, has a history of hyperactivity and impulsive behaviors at school. what medication would be appropriate methylphenidate;Stimulant medications may be used for clients with ASD who have hyperactivity, short attention spans, and impulsive behaviors How are aggressive behaviors in ASD treated pharmacologically? Risperidone and aripiprazole are FDA‑approved for irritability. Off-label options include SSRIs, mood stabilizers, and stimulants as clinically indicated. What characterizes Tourette's Disorder/tic? Multiple motor AND ≥1 vocal tics present for at least 1 year; tic onset must be before age 18. Characterized by abrupt, quick, recurrent and nonrhythmic motor movements or phonic vocalization. Onset is 5-7 yrs. What is first-line treatment for Tourette's Behavioral: Comprehensive Behavioral Intervention for Tics (CBIT). If pharmacotherapy is needed: low-dose atypical antipsychotics (e.g., risperidone) or antidopaminergic agents (e.g., tetrabenazine). 7. What are prodromal symptoms of early-onset schizophrenia? Includes declining academic performance, social withdrawal, unusual perceptual experiences, odd beliefs, or flattened affect in adolescents. Auditory hallucinations are the most common sx in children though many do not report their hallucinations d/t fear the voices will harm them. What's the recommended length of antipsychotic treatment for a psychotic episode? At least *2 years* after full symptom remission. It helps the brain to rewire. For children/adolescents, ensure close monitoring during the maintenance period What is Rett syndrome? A genetic disorder caused by a(MECP2 mutations) seen only in girls, characterized by early developmental regression (loss of hand skills, speech), repetitive hand-wringing and deceleration of head growth. Characterized by normal growth & development early in life followed by growth and developments later in life. Apraxia is the most disabling aspect of Rett syndrome which interferes with all body movements including eye gaze & speech. Symptoms appear 6-18 months after a period of development but then regression occurs. Genetic testing is important. This is how it's diagnosed. Often coexist with anxiety. What are early signs and treatments for schizophrenia in youth? Signs: social isolation, odd speech, perceptual disturbances. Treatment: Early intervention with antipsychotics and therapy; sustained use of medication to reduce relapse risk.