Child and Adolescent Psychiatry

Child and Adolescent Psychiatry Indian Medical PG Question 1: Preferred first-line drug for infantile spasms is –

• A. ACTH
• B. Ethosuximide
• C. Vigabatrin (Correct Answer)
• D. Carbamazepine

Child and Adolescent Psychiatry Explanation: ***Vigabatrin*** - **Vigabatrin** is considered the preferred first-line treatment for infantile spasms, particularly effective for both **cryptogenic** and **symptomatic** cases, and especially for cases associated with **tuberous sclerosis complex (TSC)**. - It works by irreversibly inhibiting **GABA transaminase**, increasing GABA levels in the brain, thereby suppressing seizures with fewer long-term side effects compared to ACTH. *ACTH* - **ACTH** is also an effective first-line treatment for infantile spasms and may be preferred in certain clinical scenarios or when vigabatrin is **contraindicated** or **unavailable**. - Its mechanism of action is not fully understood but may involve **steroid receptors**, suppression of inflammatory cytokines, and modulation of neuronal excitability. *Ethosuximide* - **Ethosuximide** is the drug of choice for **absence seizures** (petit mal seizures), not infantile spasms. - It acts by blocking **T-type calcium channels** in the thalamus, which are crucial for the generation of absence seizures. *Carbamazepine* - **Carbamazepine** is primarily used for **focal (partial) seizures** and **tonic-clonic seizures**, not infantile spasms. - It works by blocking **voltage-gated sodium channels**, stabilizing inactivated states and preventing repetitive neuronal firing.

Child and Adolescent Psychiatry Indian Medical PG Question 2: A 14-year-old boy has difficulty in expressing himself in writing and makes frequent spelling mistakes, does not follow instructions and cannot wait for his turn while playing a game. He is likely to be suffering from

• A. Examination anxiety
• B. Lack of interest in studies
• C. Intellectual disability
• D. Specific learning disability (Correct Answer)

Child and Adolescent Psychiatry Explanation: ***Specific learning disability*** - Difficulty in expressing himself in **writing** and **frequent spelling mistakes** are hallmark features of a **specific learning disability** affecting written expression (**dysgraphia**). - These academic skill deficits are the primary presenting features and indicate a **specific learning disorder** as per DSM-5 criteria. - The inability to follow instructions and difficulty waiting for turns suggest **comorbid ADHD**, which occurs in 30-50% of children with learning disabilities. - When both conditions coexist, the **learning disability** is typically identified first in school-aged children through academic difficulties, making it the most likely primary diagnosis in this clinical scenario. *Examination anxiety* - Examination anxiety manifests as psychological distress **specifically during test situations** (nervousness, worry, physical symptoms like sweating or rapid heartbeat). - It does not explain **persistent difficulties** with writing, spelling, following instructions, or impulse control across multiple settings (school and play). - The symptoms described occur in everyday activities, not just during examinations. *Lack of interest in studies* - Lack of interest or motivation leads to **poor effort** and **disengagement**, but not to specific skill deficits like spelling mistakes or writing difficulties. - Children with low motivation can typically perform adequately when interested, unlike those with learning disabilities who struggle despite effort. - This option doesn't account for the **impulsivity** (cannot wait for turn) which suggests a neurobiological basis rather than motivational issues. *Intellectual disability* - Intellectual disability involves **global cognitive impairment** affecting all areas of functioning with IQ typically below 70. - The pattern described shows **specific deficits** in writing and spelling (academic skills) alongside behavioral regulation issues, rather than pervasive intellectual limitations. - Children with intellectual disability would show broader developmental delays across multiple domains (communication, self-care, social skills), not just circumscribed learning and behavioral difficulties.

Child and Adolescent Psychiatry Indian Medical PG Question 3: Attention deficit hyperactivity disorder is characterized by-

• A. Impulsivity
• B. Poor attention
• C. Hyperactivity
• D. All of the options (Correct Answer)

Child and Adolescent Psychiatry Explanation: ***All of the options*** - **Attention deficit hyperactivity disorder (ADHD)** is characterized by a persistent pattern of **inattention and/or hyperactivity-impulsivity** that interferes with functioning or development. - All three features—**impulsivity**, **inattention (poor attention)**, and **hyperactivity**—represent the core symptom domains of ADHD according to **DSM-5** criteria. - ADHD presentations can vary: **predominantly inattentive**, **predominantly hyperactive-impulsive**, or **combined presentation** (most common). **The Three Core Features:** **Impulsivity** - Acting without thinking or considering consequences - Difficulty waiting turns or delaying gratification - Interrupting or intruding on others - Making hasty decisions without forethought **Inattention (Poor Attention)** - Difficulty sustaining attention in tasks or play - Easily distracted by extraneous stimuli - Forgetfulness in daily activities - Poor organization and time management - Frequently loses things necessary for tasks **Hyperactivity** - Excessive motor activity and restlessness - Fidgeting, squirming, or inability to remain seated - Running or climbing inappropriately (in children) - Feeling internally restless (in adults) - Talking excessively *Why individual options alone are incomplete:* While each symptom domain can be prominent in different ADHD presentations, the disorder is comprehensively **characterized by all three core symptom clusters**, making "All of the options" the most accurate and complete answer.

Child and Adolescent Psychiatry Indian Medical PG Question 4: Best therapy suited to teach daily life skills to a child with intellectual disability:

• A. Applied Behavior Analysis (ABA) (Correct Answer)
• B. Cognitive Behavioral Therapy (CBT)
• C. Social skills training
• D. Self-instructional training

Child and Adolescent Psychiatry Explanation: **Applied Behavior Analysis (ABA)** - **ABA** is a highly structured, evidence-based therapy that focuses on teaching specific skills by breaking them down into smaller steps and using **positive reinforcement**. - It is particularly effective for children with intellectual disabilities in acquiring **adaptive daily living skills**, communication, and social behaviors. *Cognitive Behavioral Therapy (CBT)* - **CBT** primarily targets changing negative thought patterns and behaviors, requiring a level of abstract reasoning that may be challenging for children with significant intellectual disabilities. - While it can be adapted, its core methods rely on cognitive processes that might not be the most direct approach for teaching basic daily life skills to a mentally challenged child. *Social skills training* - **Social skills training** focuses specifically on improving social interactions and communication within social contexts. - While important for overall development, it is a subcomponent of broader skill development and may not directly address all aspects of **daily living skills** in a comprehensive manner. *Self-instructional training* - **Self-instructional training** involves teaching individuals to guide themselves through tasks using internal speech or self-talk, which relies on a child's ability to internalize and follow complex verbal instructions. - This approach might be too cognitively demanding for a child with significant developmental delays when the primary goal is mastering basic, functional daily life skills.

Child and Adolescent Psychiatry Indian Medical PG Question 5: A 2.5 year old boy is brought by the parents because of the concern that he is not developing appropriately. Child often is unable to engage with others using eye contact and does not play with other children. He continuously bangs his head against the wall and remains confined to himself most of the time. What is the most likely diagnosis?

• A. Conduct disorder
• B. Social phobia
• C. Autism (Correct Answer)
• D. ADHD

Child and Adolescent Psychiatry Explanation: ***Autism*** - The child's lack of **eye contact**, inability to **play with other children**, and repetitive self-stimulatory behavior (banging head) are classic signs of **autism spectrum disorder (ASD)**. - ASD is characterized by persistent deficits in **social communication** and **social interaction** across multiple contexts, along with restricted, repetitive patterns of behavior, interests, or activities. *Conduct disorder* - Characterized by a repetitive and persistent pattern of behavior in which the **basic rights of others** or major age-appropriate **societal norms or rules are violated**. - Symptoms include aggression to people and animals, destruction of property, deceitfulness or theft, and serious violations of rules, which are not described in this case. *Social phobia* - Involves an intense, persistent fear of social or performance situations where the individual fears **embarrassment** or **humiliation**. - While there is social avoidance, it is driven by fear of negative evaluation rather than a fundamental inability to engage socially or repetitive behaviors. *ADHD* - Primarily defined by persistent patterns of **inattention** and/or **hyperactivity-impulsivity** that interfere with functioning or development. - While children with ADHD may have social difficulties, the core symptoms of lack of eye contact, repetitive behaviors, and profound social engagement deficits are not typical of ADHD.

Child and Adolescent Psychiatry Indian Medical PG Question 6: Stimulant drugs are primarily given to children for the treatment of:

• A. Speech developmental disorder
• B. Conduct disorder
• C. ADHD (Correct Answer)
• D. Pervasive disorder

Child and Adolescent Psychiatry Explanation: ***ADHD*** - Stimulant medications like **methylphenidate** and **amphetamine** are first-line treatments for attention-deficit/hyperactivity disorder (ADHD) in children. - They work by increasing the levels of **dopamine** and **norepinephrine** in the brain, improving focus and reducing impulsivity. *Speech developmental disorder* - This disorder primarily involves difficulties with **language production** or comprehension. - Treatment typically focuses on **speech therapy** and educational interventions, not stimulant medications. *Conduct disorder* - This condition involves persistent patterns of **antisocial behavior**, aggression, and violations of rules. - While therapy is the primary treatment, if there are co-occurring symptoms of ADHD, stimulants might be used to address those specific symptoms, but aren't a direct treatment for conduct disorder itself. *Pervasive disorder* - This term is an older term for what is now known as **autism spectrum disorder (ASD)**. - There is no evidence that stimulant medications are effective for the core symptoms of ASD, and they might exacerbate some behavioral symptoms.

Child and Adolescent Psychiatry Indian Medical PG Question 7: Best therapy suited to teach daily life skill to a mentally challenged child:

• A. Contingency management (Correct Answer)
• B. Cognitive reconstruction
• C. Self instruction
• D. CBT (Cognitive behavior therapy)

Child and Adolescent Psychiatry Explanation: ***Contingency management*** - This therapy involves consistently **rewarding desired behaviors** and withholding rewards for undesirable ones, which is highly effective for teaching new skills to individuals with intellectual disabilities. - It uses principles of **operant conditioning** to shape behavior through positive reinforcement, making it suitable for acquiring daily living skills. *Cognitive reconstruction* - This technique focuses on identifying and changing **maladaptive thought patterns**, which typically requires a higher level of cognitive function. - It is generally not the primary or most effective approach for teaching concrete daily life skills to individuals with significant **cognitive limitations**. *Self instruction* - This involves teaching individuals to guide their own behavior using **internal verbal cues** or self-talk. - While beneficial for some, it often requires a certain degree of **abstract thinking** and memory, making it less suitable as a standalone method for those with profound cognitive challenges in acquiring basic skills. *CBT (Cognitive behavior therapy)* - CBT integrates cognitive and behavioral strategies to address emotional and behavioral problems by modifying **thoughts, feelings, and behaviors**. - While beneficial for a range of psychological issues, its emphasis on **cognitive restructuring** makes it less directly applicable or the most effective first-line therapy for teaching concrete, functional daily living skills to mentally challenged children.

Child and Adolescent Psychiatry Indian Medical PG Question 8: A 24-year-old male presents for evaluation. He appears very calm and charming in front of the psychiatrist but often gets into fights with friends, skips classes, breaks traffic rules, and is involved in multiple police cases. What is the most likely diagnosis?

• A. Narcissistic personality disorder
• B. Paranoid personality disorder
• C. Schizotypal personality disorder
• D. Antisocial personality disorder (Correct Answer)

Child and Adolescent Psychiatry Explanation: ***Antisocial personality disorder*** - The patient's **charming demeanor** while frequently engaging in **fights, rule-breaking**, and **legal issues** is characteristic of antisocial personality disorder. - Individuals with this disorder often display **disregard for social norms**, lack **empathy**, and have a history of **irresponsibility** and **deceitfulness**. *Narcissistic personality disorder* - This disorder is marked by a pervasive pattern of **grandiosity**, a need for **admiration**, and a lack of **empathy**, but it does not typically involve a pattern of recurrent **antisocial behavior** or **criminality** like that described. - While they might be perceived as charming, their primary motivation is self-enhancement and they are less likely to repeatedly engage in behaviors that actively violate the rights of others or societal rules for personal gain or impulsivity. *Paranoid personality disorder* - Characterized by pervasive **distrust and suspiciousness** of others' motives, interpreting them as malevolent, which is not depicted in this patient's presentation. - Individuals with this disorder tend to be **guarded, hold grudges**, and may be **secretive**, rather than openly engaging in antisocial acts and charming manipulation. *Schizotypal personality disorder* - Involves patterns of **eccentric behavior**, peculiar thinking, and extreme discomfort in close relationships, often due to **perceptual distortions** or **magical beliefs**. - This patient's presentation of social charm and calculated antisocial acts is not consistent with the **social isolation** and **oddities** typical of schizotypal personality disorder.

Child and Adolescent Psychiatry Indian Medical PG Question 9: A 15-year-old adolescent is brought in for evaluation due to repeated failure to conform to social norms, deceitfulness, impulsivity, and lack of remorse. What is the most likely diagnosis?

• A. Conduct disorder (Correct Answer)
• B. Oppositional defiant disorder
• C. Intermittent explosive disorder
• D. Antisocial personality disorder

Child and Adolescent Psychiatry Explanation: ***Conduct disorder*** - This diagnosis is characterized by repeated patterns of behavior that **violate the rights of others** or major societal norms, consistent with the patient's presentation of **deceitfulness, impulsivity, and lack of remorse**. - For individuals under 18, it is the appropriate diagnosis, as **Antisocial Personality Disorder** cannot be diagnosed before turning 18. *Oppositional defiant disorder* - This condition involves a pattern of **angry/irritable mood, argumentative/defiant behavior**, or vindictiveness. It does not typically include the severe violations of societal norms or the rights of others seen in this case. - While there is defiance, it generally lacks the **aggression** towards people/animals, **destruction of property**, or **deceitfulness/theft** that characterize conduct disorder. *Intermittent explosive disorder* - This disorder is marked by **recurrent behavioral outbursts** representing a failure to control aggressive impulses. - The outbursts are typically **disproportionate** to the provocation but do not necessarily involve the persistent pattern of violating others' rights or societal rules as described. *Antisocial personality disorder* - This diagnosis requires an individual to be at least **18 years old** and have a history of conduct disorder symptoms before age 15. - Although the symptoms align with the criteria for **antisocial behavior**, the patient's age (15 years old) precludes this diagnosis.

Child and Adolescent Psychiatry Indian Medical PG Question 10: Which one of the following factors is the most significant as a risk factor for post-partum psychosis?

• A. History of post-partum psychosis (Correct Answer)
• B. Primiparity
• C. Undesired pregnancy
• D. Unmarried status

Child and Adolescent Psychiatry Explanation: ***History of post-partum psychosis*** - A **prior episode of postpartum psychosis** is the strongest risk factor for recurrence, with recurrence rates estimated to be as high as 50-70%. - This indicates a heightened **biological vulnerability** to the hormonal and psychosocial stresses of the postpartum period. *Primiparity* - While primiparity can be associated with increased stress, it is a **less significant risk factor** for postpartum psychosis compared to a history of the condition. - The stress of a first pregnancy and childbirth can contribute to other perinatal mood disorders, but does not carry the same high recurrence risk as previous psychosis. *Undesired pregnancy* - An undesired pregnancy is often associated with **increased maternal stress, anxiety, and depression**, but it is generally a **weaker predictor** of postpartum psychosis than a personal history of the disorder. - While it can complicate the perinatal period, it doesn't confer the same high risk for a severe psychotic episode. *Unmarried status* - Unmarried status may increase the risk of **postpartum depression** due to lack of social support or increased stress, but it is **not a primary risk factor** for postpartum psychosis itself. - The familial and social support systems are important for overall well-being, but a previous psychotic episode is a much stronger predictor.

Child and Adolescent Psychiatry Flashcard 1 of 10

Question: _____ disorder is a childhood disorder characterized by severe and recurrent temper outbursts out of proportion to a situation lasting for more than 1 year, without symptoms for not more than 3 months

Answer: Disruptive mood dysregulation

Child and Adolescent Psychiatry Flashcard 2 of 10

Question: _____ is a type of pervasive developmental disorder characterized by difficulties in social interaction and nonverbal communication, along with restricted and repetitive patterns of behavior and interests

Answer: Asperger's syndrome

Child and Adolescent Psychiatry Flashcard 3 of 10

Question: _____ syndrome is also known as childhood disintegrative disorder

Answer: Heller

Child and Adolescent Psychiatry Flashcard 4 of 10

Question: _____ syndrome is characterised by the failure to develop an attachment with a parental figure and a preoccupation with inanimate objects.

Answer: Kanner

Child and Adolescent Psychiatry Flashcard 5 of 10

Question: The developmental age of child suffering from reactive attachment disorder is atleast _____ months

Answer: 9

Child and Adolescent Psychiatry Flashcard 6 of 10

Question: In _____-onset conduct disorder, individuals show at least one symptom characteristic of conduct disorder before the age of 10 years

Answer: childhood

Child and Adolescent Psychiatry Flashcard 7 of 10

Question: bostral is for _____

Answer: child who are difficult to handle at school

Extra Information: 

Child and Adolescent Psychiatry Flashcard 8 of 10

Question: IQ< _____ classified as intellectual disability

Answer: 70

Extra Information: 

Child and Adolescent Psychiatry Flashcard 9 of 10

Question: ADHD can have three types of presentations:predominantly _____, predominantly hyperactive/impulsive and combined presentation

Answer: inattentive

Child and Adolescent Psychiatry Flashcard 10 of 10

Question: Patients with _____ mental disability have a mental age of 6-8 years

Answer: moderate