Adolescent Psychology

Question 1

Autism Spectrum Disorder

Answer 1

Disorder with core features
deficits in social interactions
deficits in communication and speech
engage in repetitive behavior
restricted interest
Other features may include
seizure and EEG abnormality
affective instability
impulsivity
aggression

Question 2

Etiology of ASD (Unproven Theories)

Answer 2

Electromagnetic power stations
Bad parenting
Mercury toxin hypothesis

Question 3

Current Hypotheses

Answer 3

Improved diagnostic techniques and increased awareness
Genetics- exact nature unknown but identical twins have 60-90% relation
Food allergies- gluten and cassein
oxytocin- cuddling chemical, bonding hormone
Thought to be in low levels, some may benefit from oxytocin therapy

Question 4

ASD Pharmacotherapy

Answer 4

SSRI appear to work with adults, unknown with children
Psychostimulants make them worse
Antipsychotics have limited usefullness
Promising mediction
Risperidone (Risperdal)
Apriprazole (Abilify)
Olanzapine (Zyprexa)
Atypical antipsychotic ziprasideone
Mood stabilizers (lithium) may be useful
All well tolerated in the population

Question 5

Early Start Denver Model

Answer 5

Behavioral early start intervention approach for children with ASD 12-48 months
Defines skills to be taught at any given time, with teaching procedures to deliver these skills
Integrates relationship focused developmental model with the well-validated teaching practices of Applied Behavioral Analysis
Core features include
Naturalistic behavior analytic strategies
Deep parental involvement
Sensitive to normal behavioral development
Focus on interpersonal exchange and affect
Shared engagement with joint activities
Language and communication

Question 6

Results of ESDM

Answer 6

Children who received EDSM for 20 hours a week for two years showed greater cognitive ability and adaptive behavior
Had fewer autism symptoms than children who received generic intervention

Question 7

Depression

Answer 7

Adolescent girls attempt 2-3 times more than boys
Boys twice as likely to complete suicide than girls
15-24, suicide 3rd leading cause of death
5-15, suicide 5th leading cause of death

Question 8

Depression Etiology

Answer 8

Depressed parents have a 15-45% risk over their lifetime of developing depression
Early onset and recurrent episodes increase risk

Question 9

Depression Treatment

Answer 9

Shorten acute episode
Limit dysfunction caused by episode
Prevent recurrence
Treta comorbid conditions
Prevent future problems into adulthood

Question 10

SSRI

Answer 10

Selective Serotonin Reuptake Inhibitor
Most effective for treating depression
Good efficacy and low rates of side effects
Drug of choice is fluoxetine (prozac)
Typically have 50-60% efficacy in well controlled trials
Binds to the receptor and prevents reuptake of serotonin
Selective so fewer anticholinergic and antihistaminergic side effects
less incidence of sedation, impaired leaning, memory or cognition

Question 11

Fluoxetine (Prozac)

Answer 11

Half Life is 2-3 days, but has an active (more potent) metabolite norfluoxetine that has a half life of 6-10 days
Much longer than other SSRIs, that have half lives of 1 day
Can be taken as infrequently as 1 week
Onset of response s 4-6 weeks

Question 12

ADHD

Answer 12

Attention deficit hyperactive disorder
Neurological disorder
hyperactivity
forgetfulness
poor impulse control
distractibility

Chronic, no medical cure
Some believe it is psychological in origin

Question 13

ADHD Cause

Answer 13

hereditary
Neurobiological
environmental

Question 14

Three Subtypes ADHD

Answer 14

Predominately Inattentive (ADD
Predominately hyperactive impulsive
combined

Question 15

ADHD Innatention Diagnosis

Answer 15

Failing to pay close attention or making careless mistakes when doing activities
Trouble keeping attention focused during tasks
Appearing not to listen when spoken to
Failing to follow instructions or finish tasks
Avoiding tasks that require a lot of attention
Frequently losing items required to facilitate tasks
Excessive distractibility
Forgetfullness
Procrastination

Question 16

Hyperactive Impulse

Answer 16

1. Fidgeting with hands or feet, or squirming
2. Leaving seat often, even when inappropriate
3. Running or climbing at inappropriate times
4. Difficulty with quiet play
5. Frequently feeling restless
6. Excessive speech
7. Answering question before speaker has time to finish
8. Failing to wait ones turn
9. Interrupting activities of others at inappropriate times
10. Impulse spending, leading to financial difficulties

Question 17

Objective Testing

Answer 17

Methylphenidate not the answer for all with ADHD
ADHD has a biological basis, not just kids who are willfully disobedient
Girls have a more subtle form of hyperactivity than boys, therefore underdiagnosed

Question 18

Objective Testing ADHD

Answer 18

Subject asked to play video games while movement is monitored by infared camera

Question 19

Neuroimaging ADHD

Answer 19

Enlarged hippocampus found in those who have more mild symptoms of ADHD
Compensatory response to help children cope with impatience and stimulus seeking aspect of the disorder
Poor connection between prefrontal cortex and amygdala could explain poor impulse control

Question 20

ADHD Neuroimaging

Answer 20

Striatum, frontal lobes and posterior periventricular region are important for controlling and directing attention
Richly interconnected with sensory cortex
Act as a gate, allowing important information through and filtering out unimportant stimuli
Gate are underfunctioning, unable to filter out stimuli- blood flow increases to occipital and temporal lobes to compensate for these messages

Question 21

ADHD Neuroimaging + Methylphenidate

Answer 21

Redirects blood flow to this gate to rebuild the filter
Increases function of frontal lobes, striatum and posterior periventricular region
Helps suppress reflex responses and maintain concentration

Question 22

Methylphenidate and Neuronal Functioning

Answer 22

Improves neuronal functioning
Increases dopamine levels in striatum
Binding at D2 receptors was reduced, indicating that DA levels increased
Blocks the DA transporter
Enhances task specific signaling, improves attention, reduces distractibility
Increases motivation and reward

Question 23

Methylphenidate patch (daytrana)

Answer 23

Slowly releases methylphenidate

Once daily

Question 24

Methylphenidate (Focalin XR)

Answer 24

Dextratory isomer of methylphenidate
Schedule II
Capsules most not be crushed or chewed, but can be sprinkled on applesause
Once a day

Question 25

Amphetamine (Adderall)

Answer 25

Combination product of 4 related amphetamine
.25 dextroamphetamine saccharate
.25 dextroamphetamine sulfate
.25 dextro/levo-amphetamine aspartate
.25 dextro/levo emphetamine sulfate
Each claim to have different rate of metabolism, provide a more gradual and smooth onset/offset– has not been substantiated
Duration of action is 6 hours, reduces the need for dosing while at school
d-isomer- thought to work on the dopaminergic system
l- isomer thought to work on norepinephrinergic system
Works on both both the transporter to limit reuptake and is transported into the cell to increase transmitter efflux

Question 26

Adderall XR

Answer 26

eXtended release
Utilizes Microtrol delivery system
Two beads- one dissolves immediately, the other dissolves 4 hours later
Maximum plasma levels achieved in 7 housr

Question 27

Side Effects of Adderall

Answer 27

Restlessness
Dizziness
Insomnia
Headache
Dry Mouth
Weight Loss

Question 28

Atomexetine(Strattera)

Answer 28

First non stimulant drug approved for treatment of ADHD
Norepinephrine reuptake inhibitor
Less abuse potential, non scheduled, 24 hour coverage
Can be “felt” immediately, but takes 3-4 weeks to be effective
Active metabolite

Question 29

Atomexetine(Strattera) Side effects

Answer 29

Drowsiness, sleep problems
Light Headedness, jitteriness, irritability
heart burn
upset stomach
nausea
vomiting

Question 30

Stimulants- Concern

Answer 30

Increased risk for substance abuse
Reduction in SUD for those with stimulant therapy
Greater risk of SUD if no stimulant therapy was given before puberty

Question 31

Why Medicate

Answer 31

Still unclear how to best treat ADHD
Still trying to understand disorder
Some concern that children are being overmedicated, just trying to control the problem children
1 in 8 children who take ritalin, adderall or other ADHD medicaion

Question 32

Understand Psychiatric Disorder

Answer 32

Brain chemistry affects all processes including behavior and process
Brains are plastic and adapt to a changing climate of internal biochemistry as environmental conditions change
Behavioral methods may not be strong enough to change or repair brain, medications necessary to jumpstart changes
For some this is a progressive disorder, will get worse without intervention
Ultimate goal is to wean patients off- for some not a possibility

Question 33

Medication Holiday

Answer 33

Structured Treatment Interruption
Short time- school holiday
Only under physician guidance

Question 34

Biofeedback

Answer 34

Developmental aspect of ASD leave right brain in overactive state
During training- patient is rewarded for calming brain
Program designed to increase beta and decrease theta EEG activity- improves concentration