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3: Psych Y3 - Mental Health [10] > [14] Hyperkinetic Disorder > Flashcards

[14] Hyperkinetic Disorder Flashcards

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1
Q

What is hyperkinetic disorder commonly referred to as?

A

ADHD (attention deficit hyperactivity disorder)

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2
Q

What is hyperkinetic disorder characterised by?

A

An early onset, persistent pattern of inattention, hyperactivity and impulsivity that are more frequent and severe than in individuals at a comparable stage of development, and present in more than one situation

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3
Q

Who presents with hyperkinetic disorder?

A
  • Children who are having difficulties at school or home
  • Adults are now presenting, wondering if they have unidentified ADHD
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4
Q

What can the aetiology of ADHD be divided into?

A
  • Genetic
  • Neurochemical
  • Neurodevelopmental
  • Social
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5
Q

What indicates that there is a genetic link in ADHD?

A

Twin and adoption studies, with a concordance rate of 82% for monozygotic twins

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6
Q

What genes are thought to play a role in the aetiology of ADHD?

A

DRD4 and DRD5 genes

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7
Q

What is the neurochemical aetiology of ADHD?

A

There are reports of a link between hyperkinetic disorder and the genes coding for the dopamine system, suggesting an abnormality in the dopaminergic pathways

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8
Q

What is the neurodevelopmental aetiology of ADHD?

A

Neurodevelopmental abnormalities of the pre-frontal cortex are hypothesised

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9
Q

Why is the pre-frontal cortex hypothesised to be involved in ADHD development?

A

Because of the symptoms of recklessness, inattention, and learning difficulties

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10
Q

What social factors are associated with the development of ADHD?

A

There is an association with social deprivation and family conflict, as well as parental cannabis and alcohol exposure

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11
Q

What is the prevalence of ADHD in the UK?

A

Around 2.4% of children

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12
Q

What is the age of onset of ADHD?

A

Commonly between 3 and 7 years

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13
Q

What are the risk factors for ADHD? qMal

A
  • Male gender
  • Family history
  • Social deprivation
  • Family conflict
  • Parental cannabis and alcohol exposure
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14
Q

What are the three core features of hyperkinetic disorder?

A
  • Inattention
  • Hyperactivity
  • Impulsitivity
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15
Q

What are the features of inattention in hyperkinetic disorder?

A
  • Not listening when spoken too
  • Highly distractable, moving from one activity to the next
  • Reluctant to engage in activities that require persistent mental effort, e.g. school work which contains careless mistakes
  • Forgetting or regularly losing belongings
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16
Q

What are the features of hyperactivity in hyperkinetic disorder?

A
  • Restlessness and figeting or tapping with hands or feet
  • Recklessness
  • Running and jumping about in inappropriate places
  • Difficulty in engaging in quiet activities
  • Excessive talking or noisiness
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17
Q

What are the features of impulsivity in hyperkinetic disorder?

A
  • Difficulty waiting their turn
  • Interrupting others
  • Prematurely blurting out answers
  • Temper tantrums and aggression
  • Disobedient
  • Running into street without looking
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18
Q

What are the ICD-10 criteria for the diagnosis of hyperkinetic disorder?

A
  • Demonstrable abnormality of attention, activity and impulsivity at home, for the age and developmental level of the child.
  • Demonstrable abnormality of attention and activity at school or nursery (if applicable), for the age and developmental level of the child.
  • Directly observed abnormality of attention or activity. This must be excessive for the child’s age and developmental level.
  • Does not meet criteria for a pervasive developmental disorder, mania, depressive or anxiety disorder.
  • Onset before the age of 7 years.
  • Duration of at least 6 months.
  • IQ above 50.
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19
Q

What investigation is done into hyperkinetic disorder?

A
  • History
  • MSE
  • Blood tests, including TFT
  • Hearing tests
  • Rating scales
20
Q

Why is a collateral history from teachers important in hyperkinetic disorders?

A

As problem behaviours may vary in different settings

21
Q

What is often used as an information source when adults are seeking a diagnosis of ADHD?

A
  • School reports
  • Collateral history from parents
22
Q

How is hearing tested in ADHD?

A
  • Examination of middle/inner ear with otoscope
  • Consider pure tone audiogram
23
Q

What rating scales may be used in hyperkinetic disorder?

A
  • Conner’s rating scale
  • Strengths and Difficulties questionnaire
24
Q

What are the differential diagnoses of hyperkinetic disorder?

A
  • Learning disability/dyslexia
  • Oppositional defiant disorder
  • Conduct disorder
  • Autism
  • Sleep disorders
  • Mood disorder, particularly bipolar
  • Anxiety disorder
  • Hearing impairment
25
Q

What % of hyperkinetic disorder patients have co-morbidities?

A

70%

26
Q

What co-morbidities might a person with hyperkinetic disorder have?

A
  • Learning difficulties, e.g. ASD, dyslexia
  • Dyspraxia
  • Tourette’s syndrome
  • Mood/anxiety disorders
27
Q

What % of hyperkinetic children have co-existing conduct disorder?

A

50%

28
Q

What is conduct disorder?

A

A repetitive and severe pattern of antisocial behaviour including aggression, destruction of property, deceitfulness/stealing, and major violations of age-appropriate social expectations.

29
Q

What are the risk factors for hyperkinetic disorders?

A
  • Male gender
  • Childhood abuse
  • Poor socioeconomic status
  • Parental psychiatric disorders
30
Q

What is oppositional defiant disorder characterised by?

A

Defiant and disruptive behaviour against authoriative figures

31
Q

How does oppositional defiant disorder compare to conduct disorder?

A

Oppositional defiant disorder is less severe than conduct disorder in that violations of law and physical abuse of others are far less common

32
Q

Who can make a diagnosis of hyperkinetic disorder?

A

Specialists

33
Q

What does treatment for hyperkinetic disorder depend on?

A

Whether the patient is pre-school, school-age, or adult, as well as the severity of symptoms

34
Q

Give two examples of support groups available for parents and teachers affected by ADHD

A
  • add+up
  • ADDISS
35
Q

What should be done if there is a clear link between food or drink consumed and behaviour?

A

Parents should be advised to keep a food diary, and a referral to a dietician can be made if appropriate

36
Q

What is the first line treatment of ADHD in pre-school children?

A

Parent-training and education programmes (psychoeducation)

37
Q

What is meant by parent-training in ADHD?

A

A type of behavioural therapy, with parents being helped to reinforce positive behaviour and to find alternative ways of managing disruptive behaviour

38
Q

Are drug treatments recommended in ADHD in pre-school children?

A

No

39
Q

What are the options in the management of ADHD in school-age childrens?

A
  • Psychoeducation and CBT (and/or social skills training)
  • Drug treatment
40
Q

Where is drug treatment first-line in ADHD?

A

In severe ADHD in school-age children

41
Q

What drug is most commonly used in ADHD?

A

Methylphenidate (Ritalin)

42
Q

What kind of drug is Ritalin?

A

CNS stimulant

43
Q

What drugs can be used in ADHD if Ritalin is ineffective?

A

Atomoxetine, or if this fails, dexamfetamine

44
Q

What are the side effects of CNS stimulants such as Ritalin?

A
  • Headache
  • Insomnia
  • Loss of appetite
  • Weight loss
45
Q

Is there a link between extended stimulant use and growth retardation?

A

No

3: Psych Y3 - Mental Health [10] (21 decks)

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