10% Disruptive, Impulse-Control and Conduct Disorders; Neurodevelopmental Disorders Flashcards
(PPP 586)
diagnostic criteria for ADHD related to age
symptom onset before 12 yrs of age
must be present for at least 6 months
(PPP 586)
ADHD s/s must occur in at least _____
….2 SETTINGS
i.e. school, home, recreational activities
(PPP 586)
multimodal approach to ADHD management:
behavior modification (social skills training, classroom modifications, parent psychoeducation) stimulants (first line tx of choice)
(PPP 586)
first line pharm treatment of ADHD (list three)
methylphenidate
amphetamine/dextroamphetamine
dexmethylphenidate
(PPP 586)
nonstimulant tx of ADHD and it’s MOA and SE
ATOMOXETINE
norepinephrine reuptake inhibitor
SE: dry mouth, decreased appetite, insomnia
(PPP 586)
adjunctive meds for ADHD
alpha agonists = guanfacine, clonidine
bupropion
venlafaxine
(PPP 587)
four diagnostic criteria for autism spectrum disorder
social interaction difficulties
impaired communication
restricted repetitive stereotyped behavior
other signs (failure to develop social relationships, failure to prefer parents over other adults, savantism)
(PPP 587)
management for autism spectrum disorder (3 items)
referral for neuropsych testing
behavioral modification strategies
meds
(PPP 587)
when are symptoms for autism spectrum disorder usually recognized?
b/w ages 12-24 months
(PPP 579)
conduct disorder =
persistent pattern of behaviors that
DEVIATE SHARPLY FROM AGE-APPROPRIATE NORMS and
VIOLATES THE RIGHTS OF OTHERS AND ANIMALS
(PPP 579)
conduct disorders are more common in -
males
high incidence of ADHD and oppositional defiance disorder
(PPP 579)
conduct disorders may progress to
antisocial personality disorder
(PPP 579)
six diagnostic criteria for conduct disorders
1 - violation of the rights of others or age-appropriate societal norms
- at least 3 behaviors over last yr, at least 1 incident w/in last 6 months
2 - aggression to humans or animals
3 - destruction of property
4 - serious violations of rules (runs away from home, engages in truancy before 13 yrs)
5 - deceitfulness or theft
6 - <18 yrs
(PPP 579)
management of conduct disorders
behavioral modification
community/family involvement
parent management training (enforcing rules and setting limits)
(PPP 580)
oppositional defiant disorder =
disorder in which children are generally defiant towards authority but is NOT associated with physical aggression, violating others’ basic rights or breaking laws (unlike conduct disorder)
(PPP 580)
timeline for diagnostic criteria for oppositional defiant disorder
at least 4 symptoms present
at least 6 months (with at least one individual that is not a sibling)
(PPP 580)
three diagnostic criteria for oppositional defiant disorder
angry or irritable mood (loses temper, anger or resentment, blames others for misbehaviors)
argumentative or defiant behavior (breaks rules, often blames others for behavior, argues with authority, deliberately annoys others)
vindictiveness (spiteful at least 2 times/past 6 mo)
(RoshReview)
which of the following side effects is most likely with the primary alternative nonstimulant medication if a pt or family prefers this course of pharm intervention?
a) growth suppression
b) insomnia
c) motor tic development
d) nausea
D) NAUSEA
ATOMOXETINE SE's: n/v wt loss priapism psychosis with aggressive behavior sleep problems hepatotoxicity xerostomia insomnia drowsiness
(RoshReview)
what ADHD therapeutic works by blocking the reuptake of norepinephrine and dopamine into presynaptic neurons?
methylphenidate
(RoshReview)
MOA of methylphenidate
reuptake of norepinephrine and dopamine into presynaptic neurons
(RoshReview)
“what ADHD meds have been associated with priapism?”
methylphenidate and
atomoxetine
(RoshReview)
T/F: “methylphenidate is more likely to cause priapism than amphetamine stimulants”
TRUE
(RoshReview)
what are side effects of ADHD stimulant treatments?
DECREASED APPETITE INSOMNIA ELEVATIONS IN HR, BP DECREASE IN HEIGHT VELOCITY HA irritability mood lability
(RoshReview)
what is the timeline for monitoring ADHD pts who are placed on stimulant medication? and why?
regularly
1 month after starting meds
every 3 months once stable on dosage
evaluate HEIGHT, WEIGHT, v/s, mood, adherence to tx
(RoshReview)
when do we recommend ADHD stimulant medication drug holidays for children?
if child is found to have poor growth, crossing two major percentiles while on stimulant
(RoshReview)
what are alternative treatments to stimulants for ADHD?
atomoxetine and
alpha-2 adrenergic agonists (guanfacine and clonidine)
