Psychiatry

An 8-year-old boy presents because his mother is concerned that he has ADHD. At home he is always restless, never seems to pay attention, and is always losing things. In the clinic, the child is cooperative and has a normal examination. The next step in management is to:
A. Give the child a 2-week trial of stimulant medication.
B. Obtain further information from the parents and teachers.
C. Send the child for psychological assessment.
D. Send the child for psychiatric evaluation.
E. Reassure the child’s mother that this is age appropriate behavior.

B. A thorough physical examination (with emphasis on the neurologic component) is completed to identify any soft signs of neurologic conditions. If none are found, this child should re¬ceive a complete evaluation for ADHD. A diagnosis is consid¬ered if the child has ADHD-specific behaviors in two or more settings. Information is obtained from caregivers and teachers regarding ADHD-specific behaviors.

A 7-year-old boy is brought to the office because he frequently appears distracted. His mother notes that he daydreams “all of the time” and when he is daydreaming, he does not respond to her. She describes these as short episodes lasting several sec¬onds that occur many times a day. When he is not daydreaming, he is attentive and can complete tasks. His behavior in class is not disruptive. The next step in management is to:
A. Obtain further information from his parents and teachers by using the Conners rating scales.
B. Send the child for an electroencephalogram.
C. Send the child for psychological assessment.
D. Reassure the child’s mother that this is age-appropriate behavior.
E. Begin a program of behavioral modification.

B. This child does not fit the classic pattern of ADHD. These episodes of “daydreaming,” which last several seconds, are con¬sistent with petit mal or absence seizures and initial evaluation for these-conditions includes obtaining an electroencephalogram.

An 8-year-old boy has completed the initial evaluation for ADHD. Information from his parents and his teachers demonstrated that he meets 7 of the 9 criteria for inattention and has many im¬pulsive behaviors. The next step in management is to:
A. Give the child a 2-week trial of stimulant medication.
B. Arrange for special education placement.
C. Send the child for a complete psychoeducational assessment.
D. Send the child for an electroencephalogram.
E. Reassure the child’s mother that this is age appropriate behavior.

C. Prior to developing a management plan, the child is assessed for coexisting psychiatric and learning disorders (psychoeducational testing). After this is complete, management can include stimulant medication, behavioral modification, and therapy ap¬propriate for coexisting conditions, if applicable.

A teenager with severe cystic acne started isotretinoin 1 month ago. Initially her acne got worse but now it is starting to im¬prove. However, she is complaining of “not feeling like herself.” She does not want to go to school, cries frequently during the day, and feels rather hopeless about her life. She also feels “achy” all over. What is the best course of action?
A. Refer to a psychiatrist for evaluation.
B. Prescribe an antidepressant.
C. Discontinue isotretinoin immediately and refer to a psy-chiatrist for evaluation.
D. Decrease the dose of isotretinoin by 20 mg/d to determine if the side effects resolve.
E. Counsel her that these symptoms will resolve over time.

C. Depression is a rare side effect of isotretinoin, but it can be severe; suicides have been reported. Myalgias and arthralgias have also been reported as side effects. It would be best to stop the drug and have the patient evaluated for depression and po¬tential suicidal tendencies

A 14-year-old child was recently diagnosed with ADHD. His evaluation for coexisting psychiatric disorders is most likely to identify which of the following disorders?
A. Schizophrenia
B. Pervasive developmental disorder
C. Posttraumatic stress disorder
D. Oppositional-defiant disorder
E. Bipolar disorder

D. Common coexisting-psychiatric conditions include opposi¬tional-defiant disorder (35.2%), conduct disorder (25.7%), anx¬iety disorder (25.8%), and depressive disorder (18.2%).