1-5

Question 1

role of psyD in treating individuals with intellectual disabilities

Answer 1

1. complete eval (karyotype)
2. make sure appropriate interventions occur
3. ensure other dx are found as 35-40% have another psych disorder
4. provide adequate tx
5. coordinate care

Question 2

psychological assessments for intellectual capacities

Answer 2

Wechsler scales (the Wechsler Preschool and Primary Scale of Intelligence, the Wechsler Intelligence Scale for Children, and the Wechsler Adult Intelligence Scale) and the Stanford-Binet Scale

Question 3

prevalence of intellectual disability is approximately ? of the population

Answer 3

1%

males being more affected than females

Question 4

Two pieces of information are needed to make a diagnosis of intellectual disability:

Answer 4

Evidence of deficits in intellectual functioning both clinically and via standardized testing AND evidence of deficits in adaptive functioning

Question 5

typical symptoms of ASD

Answer 5

difficulty with social reciprocity, poor peer interaction, poor language development, and repetitive and odd play

Question 6

Asperger’s disorder

Answer 6

old terminology for a type of ASD that describes individuals who display social impairment and restricted interests and behavior (stereotyped behavior) but have normal language and cognitive skills.

Question 7

Rett disorder

Answer 7

old term for a type of ASD that describes individuals who show a type of childhood developmental disorder of unknown etiology in which the patient develops progressive encephalopathy, loss of speech capacity, gait problems, stereotyped movements, microcephaly, and poor social interaction skills. The child must have shown normal development in early infancy, and only females are affected.

Question 8

ASD findings:
MRI
fMRI
others

Answer 8

increased cortical thickness that may relate to abnormalities in cortical connectivity

less activation of the prefrontal regions indicating a dysfunction of the frontostriatal networks

abnormalities in glutamate/glutamine physiology, particularly in the limbic areas

Question 9

ASD characteristics

Answer 9

failure to develop relationships
lack of social reciprocity
impairment in nonverbal behaviors
impairments in communication: delay/failure in learning spoken language
exhibit repetitive behaviors and strict adherence to mannerisms
preoccupation with specific objects

Question 10

what previous diagnoses have been consolidated into the term autistic spectrum disorder (ASD)?

Answer 10

autistic disorder
Rett disorder
childhood disintegrative disorder
Asperger disorder
pervasive developmental disorder NOS

Question 11

ASD vs schizophrenia

Answer 11

the onset of childhood schizophrenia usually occurs later, there is a family history of schizophrenia, and the child is less impaired in the area of intellectual functioning

Question 12

approach to managing ASD

Answer 12

family education, behavior shaping, speech therapy, occupational therapy, and educational planning

Question 13

recent studies indicate a role for ? in the etiology and treatment of ASD

Answer 13

oxytocin (the neuropeptide)

shown a likely benefit in improving nonverbal communication behaviors

Question 14

other medications used in ASD

Answer 14

low-dose Risperdal (risperidone)

aripiprazole may also be of benefit with the irritability symptoms of ASD

Question 15

look for these comorbid disorders in ASD

Answer 15

ADHD), OCD, behavior disorders, and psychotic disorders

Question 16

the best predictor of future outcome in autistic disorder

Answer 16

Language development

Question 17

symptoms seen in ADHD inattentive type

Answer 17

Making careless mistakes
Having difficulty focusing one’s attention
Often seeming not to listen
Often failing to follow directions
Having difficulty in organizing tasks
Avoiding tasks requiring sustained mental effort
Often losing things
Often becoming distracted by other stimuli
Being forgetful
girls > boys

Question 18

first line treatment of ADHD inattentive

Answer 18

stimulants: Adderall (dextroamphetamine and amphetamine), Ritalin (methylphenidate) (Concerta is XR), Focalin (dexmethylphenidate)

or Strattera (Atomoxetine) (NE reuptake inhibitor-NRI)

Question 19

what ADHD patients should use Strattera over stimulants?

Answer 19

individuals/families with substance abuse problems, individuals with tics (does not cause or worsen tics as stimulants do), or patients with comorbid anxiety disorders

Question 20

second-line choices for ADHD

Answer 20

clonidine (Kapvay) 0.1 mg at bedtime max 0.4
and guanfacine (Intuniv) 1 mg per day max 4
a2 antagonists
(low-dose often used to help with sleep disturbances/agitated behavior after on a stable dose of stimulant)

Question 21

diagnostic criteria of ADHD

Answer 21

6+ symptoms of inattention or hyperactivity/impulsivity before 12 in more than one setting and there is clinically significant impairment

Question 22

ADHD hyperactive symptoms

Answer 22

Fidgeting or squirming
Often leaving one's seat
Running or climbing excessively and inappropriately
Difficulty playing quietly
Often being "on the go"
Talking excessively

Question 23

ADHD impulsive symptoms

Answer 23

Often blurting out on answer before a question is completed
Difficulty waiting for one’s turn
Often interrupting others

Question 24

third-line choices for ADHD

Answer 24

Bupropion (Wellbutrin)
-may worsen tics (Dopamine)
Imipramine (Tofranil)
-blood levels and EKG should be followed because of QT prolongation

Question 25

ADHD etiology may involve

Answer 25

decreased DA and NE tracts in several areas of the prefrontal cortex

• dorsal anterior cingulate gyrus is involved in selecting what an individual focuses
• dorsolateral prefrontal cortex is involved with sustaining attention and various executive functions

Question 26

Impairment in the ? appears to account for the hyperactivity

Decreased activity in the ? is involved with impulsive actions

Answer 26

prefrontal motor cortex

orbitofrontal cortex

Question 27

common comorbid disorders with ADHD

Answer 27

oppositional defiant disorder (ODD) or conduct disorder

failing to recognize leads some physicians to attempt to medicate away purposeful disruptive behavior

Question 28

medications for ADHD can only

Answer 28

(1) help the child sit still-if the child wants to sit still
(2) help the child to focus his or her attention-if the child wants to pay attention
(3) help the child to think before he or she acts-but will not affect whether the child makes a good decision or not

Question 29

ddx ADHD

Answer 29

ODD/conduct: but intentional
learning disabilities
bipolar: may be restless/distractible but +affective
Lead intoxication can lead to hyperactivity
petit mal seizures (Absence)

Question 30

How many kids with ADHD will respond to stimulant medications?
adverse effects

Answer 30

70% to 80%, rapid, wear off by end of day
decreased appetite (sometimes with subsequent slowed growth rate), initial insomnia, irritability, dysphoria, and headache, development or worsening of tics

Question 31

Strattera (Atomoxetine)

Answer 31

potent selective inhibitor of the presynaptic norepinephrine transporter
not a stimulant or a controlled substance
gradual onset of action: 2-3 weeks with 24-hour length of action
may cause decreased appetite, sedation, does not worsen tics

Question 32

the only medications with FDA approval to treat Tourette’s

but why not utilized?

Answer 32

haloperidol (EPS) and pimozide (prolonged QT)

instead a2 antagonists and atypical antipsychotics are used

Question 33

symptoms consistent with Tourette disorder

Answer 33

combination of multiple motor and vocal tics occurring for at least 1 year

Question 34

strong relationship between Tourette disorder and ?

Answer 34

OCD and ADHD, and these disorders run in families

Question 35

imbalances in Tourettes

Answer 35

decreased GABA and increased dopamine in the caudate nucleus

Question 36

tic disorder ddx

Answer 36

Huntington chorea, Wilson disease, and stroke, tardive dyskinesia, stimulant use, PANDAS (strep, worse in winter/spring), OCD compulsions, schizophrenia

Question 37

Transient tic disorders timeframe

Patients with a chronic motor or vocal tic disorder can have it for more than ? but there is an absence of ?

Answer 37

4 weeks but for no longer than 1 year

1 year
multiple motor tics and/or motor and vocal tics occurring simultaneously (as the combo would be Tourette’s)

Question 38

first line pharmacotherapy for Tourettes

Answer 38

a2 agonists: Clonidine, Guanfacine

also good for ADHD symptoms in kids who have tics

Question 39

MOA for Clonidine in Tourettes

Answer 39

Clonidine: alpha-adrenergic agonist that is believed to activate presynaptic autoreceptors in the locus ceruleus to reduce norepinephrine release that may reduce tics

Question 40

MOA for Guanfacine in Tourettes

Answer 40

Guanfacine binds to postsynaptic prefrontal alpha-adrenergic cortical receptors to enhance functioning in the prefrontal cortex

Question 41

In practice most clinicians utilize ? for Tourettes/tics
MOA?
most common one used?

Answer 41

atypical antipsychotics
block dopamine and serotonin receptors, decreasing input from the substantia nigra and ventral tegmentum to the basal ganglia
Risperdal: 1 to 3.5 mg/d with weight gain, lipid abnormalities, and sedation as the most common side effects
(next: haloperidol or pimozide)

Question 42

psychotherapy with the strongest empirical evidence for effectiveness in Tourettes/tic

Answer 42

Habit reversal training:
teaching awareness of the aversive sensation or buildup of tension called a premonitory urge that is relieved by the tics, then helped build a competing response to that urge without engaging in tic behavior (+social support)

Question 43

depression that responds to antidepressant but evidence of paranoia after mood symptoms resolved think?

Answer 43

schizoaffective disorder

Question 44

treatment for schizoaffective

Answer 44

atypical antipsychotic: risperidone first,
if bipolar type, treat with mood stabilizer i.e. lithium, carbamazepine, and valproic acid
if depressive type, add antidepressant (SSRI) ONLY if antipsychotic alone not affective

Question 45

Schizoaffective d/o

Answer 45

> 2 weeks of hallucinations or delusions without major mood episode (major depression or mania), plus periods of concurrent major mood episode with schizophrenic symptoms
**psychotic episodes occur during the mood episodes, but the mood symptoms do not always occur during the psychotic episodes

Question 46

always ask about ? if considering schizoaffective

Answer 46

manic symptoms, as schizoaffective may be depressive type or bipolar type

Question 47

brain matter abnormalities in schizophrenia/schizoaffective d/o

Answer 47

white matter pathology hypotheses of frontotemporal dysfunction and abnormalities in left-hemisphere lateralization in the pathophysiology of these illnesses

Question 48

schizoaffective ddx

Answer 48

substance-induced mood disorder: cocaine or amphetamine intoxication (manic symptoms), cocaine withdrawal (depressive symptoms), and prescribed meds including steroids and antiparkinsonian medications

Question 49

schizoaffective vs schizophrenia

Answer 49

symptoms can appear similar, but the mood symptoms in schizophrenia if present are generally brief in relation to the total length of the illness while in schizoaffective mood symptoms occur during significant portions of their illness

Question 50

schizoaffective vs mood disorders

Answer 50

(*mood first then +/- psychosis)
bipolar disorder, mania, generally have had mood symptoms (euphoria, irritability) before development of the psychoses, as have patients with major depression with psychotic features (a depressed mood predating the onset of psychosis)

Question 51

other treatment for schizoaffective (correlates with schizophrenia as well)

Answer 51

hospitalization (if suicidal or unable to care for self/psychotic)
social support
TMS: transcranial magnetic stimulation

Question 52

What age group with schizoaffective disorder may exhibit more severe symptomatology

Answer 52

Younger patients

Question 53

DSM V for schizoaffective

Answer 53

Patients must exhibit psychotic symptoms consistent with the acute phase of schizophrenia.
Psychotic symptoms are accompanied by prominent mood symptoms (mania or depression) during part of the illness.
At other points in the illness, the psychotic symptoms are unopposed; that is, no mood symptoms are present. Periods of illness in which there are only psychotic symptoms, and no mood symptoms, must last for at least 2 wk.
The disorder cannot be caused by a substance or by another medical condition.