Medex Winter BS Final Review Page
MEDEX Objectives Home: http://faculty.washington.edu/alexbert/MEDEX/
WE’RE ALL IN THIS TOGETHER
Children’s’ Issues
Interviewing children:
Information from Parents, School, child, your own Observations – is it the child or the parents?
Whether to see child with parents or separately
Toys – in your office
Cards, board games, miniature figures and animals, legos
Drawing – depends on amount of time how many
House, tree, person
Care or truck
Family with each person doing something [together or separate]
ADD - kid have trouble drawing – pet everything in
-leave out details
-forget parts of the car
-cars out of control
-speeding
-can’t complete it because of can’t hold attention
-so cars don’t have detaitls
Fetal etob – doesn’t respond to meds like ADHD
Draw yourself - with each person doing something … otherwise you get stick figures…family can tuck themselves
Prowords – good concepts, good fine motor control, good relaying, great detail, spelling good, lots of concentration, draw anything you want to draw, preoccupied with religion, felling guilty/disabled, unusual rage, preoccupied with muscle and strength
3 questions – young adolescent – teenagers
a million molars – what would you do with it?
5 magical wishes – what would you do?
Persons on a desert island – you could take one person who? 2 people? Three (instead of how things are at home)
- maybe leave younger sibling
- one parent
- maybe leave parents. Take aunts and uncles
- usually don’t ask why. Kids get defensive
- How does info fit into why they are here in your office
- Will clam up if to pushy.
What sense of competence does child have
What is child preoccupied with?
? career after high school
ideal life at 25
Any kind of animal what whould they lide to be? Hate to be?
Feelings:
How do you like school? Specifics. Does anyone tease you? How do You feel, what do you do?
Do you [sibs] get into your things? - kids might complain about destroying tap, parent always take younger one’s side
Who makes you mad at home
Who would you like most to be with at home
If you were really unhappy, who would you talk to?
Do you trust anyone at school?
Do you ever feel real sad? [specifics]; scared [specifics]
ADHD
ADHD most common
8-10% male, 5% girl
ADHD = ADHD and bipolar
Alcololisom in 1st and 2nd generation family – higher incidence of getting ADHD.
Depression manic depression parent
Kid ADHD adult manic
Attention deficit hyperactive disorder
Tell child to write 3 sentences – you say all at once.
John ran around and around the mountain
John ran over the Mountain
John came home
ADHD kids can’t remember the end of the sentences.
Could be not attentive because learning disorder, can’t read
Can’t watch TV for any length of time
No acting
Can’t keep friends
Risk takers
Ball player watching butterflies
Compulsive
Disorganized
Can’t find stuff
Speaks without thinking
Raise hand compulsive but don’t know answer
Anything can distract them, noise etc.
Can’t follow multiply commands
Misbehaving due to boredom
Self esteem down – feel like failures – moodiness, depression, social anxiety, 2°depression
Parents are mad at kids very much but Teachers not at all - probably home problem
Average peak age 9 been in school 2-3 years and parents decide something is wrong
Need consistent raitises raitises don’t change them.
Need predictability
Consequences
Teachers reports
Hyperactive – difficult stading is like, bugging other kids, can’t stay in chair
Impulsiveness
6 of 9 in both categories – consider ADHD
symptoms are normal at some ages – not all
difference in severity
most of school day, at home, recess etc. all day symptoms not just everyday during class
medicine by itself will not help by itself
tightly structure expectations
home/school plan
find if learning disabilities or
a lot of kids don’t thank them in anything wrong at all.
They just know they get in trouble a lot
Alert, Dexedrine, Ritalin
Improve neurotransmission
Assess arousal
Stimulates attention centers
Stimulates reward centers
Focus attention normally instead of trying to focus attention on anactside sauce
Can get nauseated
Decrease weight
Insomnia
HA – initially
Worsens TICS
Strange behaviors or moods
Fingernail biting
Tics
Nervous habits
TCA’s if psychostimulates doesn’t work – well bevter, clonidine, tenisye
Affects the way the brain processes information.
Bad is academic
Good is art sports
Kids with ADHD not treated more likely to become drug addicts with adult life/teenager
No telerence issues with meds with true ADD – just need to go up until ???? dose
“Vit R” – for school use, kids like taking vitamins so they don’t get teased as much
take kids off for 1 month a year at least (not during summer camps)
Mood disorders in children and adolescents
Don’t enjoy anything
Depression – act ???ability
Separation anxiety – don’t want to go to school or leave home
Prozac zolof + not good with anxiety
Ancay ativan hard to get kids off these meds
Panic disorder – unually respond to Paxil : Cayebor
Hx Strep infection – obsessive compulsive disorder – draw a titer see if it’s elevated.
OCD – anxiety disorder with chautuyed thoughts of bad thoughts
Withdrawal
Obsessed
No risky situations – including leaving home
Genetics
Do repetive vegavior to deal with thoughts
Excessive worry
Stress related disorders – ulcers – but can’t find them
“he doesn’t need to hurt this bad, there are theys that can help him”
4th most common ????
Symptoms
-increased anxiety 1 hour a day
rituals are distression
not a learned behavior
Treatment
Rx – serotin Uptake inhibitors
Coagneive behavior therapy – exposure and response therapy
SSRI- high doses
20 mg Prozac – depression dose
80 mg prozac – OCD dose
Disability and the Disabled Patient
Chronic Pain
Negotiation Training
Hard on the problem, not on the people – look at problems solving
Focus on what does the person want
Not how stupid they are
Don’t take it personally
Allow face saving – don’t embarrass them
Speak to be understood “talk Turkey” don’t’ use unknown language – need real words
Explain in language they will understand
Focus on interests, not position – what do you both want to accomplish not who’s right and who’s wrong
Steps in inventing options
What you’d do without agreement – go on but keep suffering – is that of with you?
What ideas are impeding agreement – what works
What would you do in the other person’s shoes and vice versa – what would you do in their shoes.
Avoid falling for “don’t you trust me”: trust is irrelevant to a solution – “just trust me” – don’t say this – this will backfire
Reaffirm principles of fairness – be fair - respect other person
Lets negotiate on how we can cut down (i.e. ETOH use). Just say “son” doesn’t work for everyone.
Don’t do – “don’t you understand that every cigarette you smoke puts a nail in your coffin”
Humiliating
“if you can’t do it now, then when do you think you might”
if they feel judged they may not tell you the truth about what they’re on etc.
moderate drinking
1-2 drinks a day
< 10 drinks a week
decrease blood level
negotiation tactics
respect
provider explaining how well
if you don’t do anything…
Charts – to make for pts – keep track at home
Sleep
Appetite
Mood
Energy
Instruction in writing for patients.
Pat dairy for pt to look for signs/symptoms
Chart it?
Counseling of reoccurrence? How is it working?
Will you take this? Do you have any concerns taking it?
Updated 7 Dec 2003