Adolescent Psychology Flashcards
Autism Spectrum Disorder
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
Etiology of ASD (Unproven Theories)
Electromagnetic power stations
Bad parenting
Mercury toxin hypothesis
Current Hypotheses
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
ASD Pharmacotherapy
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
Early Start Denver Model
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
Results of ESDM
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
Depression
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
Depression Etiology
Depressed parents have a 15-45% risk over their lifetime of developing depression
Early onset and recurrent episodes increase risk
Depression Treatment
Shorten acute episode Limit dysfunction caused by episode Prevent recurrence Treta comorbid conditions Prevent future problems into adulthood
SSRI
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
Fluoxetine (Prozac)
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
ADHD
Attention deficit hyperactive disorder Neurological disorder hyperactivity forgetfulness poor impulse control distractibility
Chronic, no medical cure
Some believe it is psychological in origin
ADHD Cause
hereditary
Neurobiological
environmental
Three Subtypes ADHD
Predominately Inattentive (ADD Predominately hyperactive impulsive combined
ADHD Innatention Diagnosis
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
Hyperactive Impulse
- Fidgeting with hands or feet, or squirming
- Leaving seat often, even when inappropriate
- Running or climbing at inappropriate times
- Difficulty with quiet play
- Frequently feeling restless
- Excessive speech
- Answering question before speaker has time to finish
- Failing to wait ones turn
- Interrupting activities of others at inappropriate times
- Impulse spending, leading to financial difficulties
Objective Testing
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
Objective Testing ADHD
Subject asked to play video games while movement is monitored by infared camera
Neuroimaging ADHD
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
ADHD Neuroimaging
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
ADHD Neuroimaging + Methylphenidate
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
Methylphenidate and Neuronal Functioning
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
Methylphenidate patch (daytrana)
Slowly releases methylphenidate
Once daily
Methylphenidate (Focalin XR)
Dextratory isomer of methylphenidate
Schedule II
Capsules most not be crushed or chewed, but can be sprinkled on applesause
Once a day
Amphetamine (Adderall)
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
Adderall XR
eXtended release
Utilizes Microtrol delivery system
Two beads- one dissolves immediately, the other dissolves 4 hours later
Maximum plasma levels achieved in 7 housr
Side Effects of Adderall
Restlessness Dizziness Insomnia Headache Dry Mouth Weight Loss
Atomexetine(Strattera)
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
Atomexetine(Strattera) Side effects
Drowsiness, sleep problems Light Headedness, jitteriness, irritability heart burn upset stomach nausea vomiting
Stimulants- Concern
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
Why Medicate
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
Understand Psychiatric Disorder
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
Medication Holiday
Structured Treatment Interruption
Short time- school holiday
Only under physician guidance
Biofeedback
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
