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Psychiatry > ASD and ADHD > Flashcards

ASD and ADHD Flashcards

1
Q

state some neurodevelopmentla disorders 6

A

ADHD

ASD

tourettes

learning difficulties

dyslexia

dyspraxia

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2
Q

define ADHD

A

syx of inattention and/or hyperactivity/impulsviity significantly interfere with daily function

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3
Q

prevalanece of ADHD

A

5.2% in US

3.45% europe

2.8% worldwide

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4
Q

gender bias of ADHD

A

M:F 4:1

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5
Q

developmental impact of ADHD at the following age:
pre-school 1

A

behaviour disturbance

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6
Q

developmental impact of ADHD at the following age:
school age 4

A

behavioural distrubance

academic impairment

poor social interaction

peer acceptance

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7
Q

developmental impact of ADHD at the following age:
adolescent 5

A

academic impairment

social skills learning

self-esteem

smoking/alcohol/drugs

antisocial behaviour

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8
Q

developmental impact of ADHD at the following age:
college age 5

A

academic failure

occupational difficulties

self esteem

alcohol and substance abuse

injury/accidnet

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9
Q

developmental impact of ADHD at the following age:
adult 6

A

not coping with daily tasks

unemployment

relaitonship problems

motor accidents

alcohol and substance abuse

mood instabi.ity

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10
Q

presentation of ADHD in adults

A

chaotic

disorganised

always late

restless

fidgeting

and more

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11
Q

diagnosis of ADHD 4

A

2-3 sessions,. no rush

detailed psychatirc and developmental assessment

collateral history
-school reports
-parental reports
-sbiling report

Neuropsychatirc assessment

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12
Q

inattentive syx of ADHD 9
-*mneomic

A

*-mneomonic -DADMOMLFC
(mom taught me ABC dad taught me LFC)

Difficulty sustaining attention
Avoids sustaining attention
Distracted easily
Misplaces things
Organisation problems
Mistakes made
Listening difficult
Forgetful in daily activities
Completing tasks or jobs

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13
Q

hyperactive/impulsive syx of ADHD 9
*-mneominc

A

*-LFROST/WIB

Loud in quiet situations
Fidgetiness
Restless or overactive
On the go all the time
Seating difficult
Talks excessively

Waiting difficult
Interrupts or intrudes
Blurts out prematurely

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14
Q

other syx of ADHD 5

A

affective instability

ceasless mental acitivty

mind wandering

initial insomnia

hyperfocus

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15
Q

differenital diagnosis for ADHD

A

normal behaviour

malingering or seeking stimulant medications

hyperthyroidism, susbtance abuse, mania

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16
Q

important point abotu differntials for ADHD

A

could also be a co-morbidiity
-check other syx
-check response to treatment

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17
Q

what happens after someone is diagnosed with ADHD 2

A

delineate ADHD syx from comorbid syx and normal behaviour

inform:- employer, university/college, DVLA, car insurers

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18
Q

medication for ADHD

A

suppress syx
-treatmetns increase neurotransmission of dopamine and/or noradrenaline

1st line- stimulants
2nd line- non-stimulants

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19
Q

pros and cons of stimulant ADHD medications 2v1

A

pro- immediate action
-controlled drugs

cons
-more potential for diversion

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20
Q

pros and cons of non-stimulant ADHD medication 1v2

A

pros
-preferable if concern about diversion

cons
delayed onset of action
-similar to antidepressants

-non-controlled drugs

21
Q

First line treatement for ADHD in adults

A

methylphenidate

22
Q

moa of methylphenidate

A

DA and NA reuptake inhibitor

23
Q

types of preparations of methylphenidate and why is this beneficial

A

immeidate release preparations
-cheaper
-can allow more fine tuning of dosing

slow release preparation
-allow once daily AM dosing

*-can be combined to fine tune syx control at certain times of day

24
Q

dose titration of methylphenidate 3

A

increment- smallest available

interval- at least 2 weekly

until-adequate resonpnse or intolerable side effects or increase in BP and HR

25
Q

examples of methyphenidates 5

A

ritaline/medikinet - immediate release

slow release:
-concerta
medikinet XL
equasym

26
Q

side effects of methylphenidates 7

A

reduced appetite

insomia

headache

irritability

tachycardia

tics

seziures

27
Q

alternative stimulant medication to methylphenidate for ADHD

A

dexamfetamine

28
Q

MOA and use of dexametamine for ADHD

A

DA and NA releaser and reuptake inhibitor

USE
-worth trial if poor response to methylphenidate

*watch as considered more abuse/diversion potential than methylphenidate

29
Q

first line non-stimulant medication for ADHD

A

atomoxetine

30
Q

MOA and use of atomoxetine for ADHD

A

MOA- NARI

USE
-when stimulant not tolerated or risk of diversion

*remember has delayed onset several weeks

31
Q

severe side effects of atomoxetine 2

common side effects -5

A

acute liver failure

suicidality

*-both rare
-can be avoided by gradual dose titrations

common:
-reduced appetite
-nausea
-insomia
-dizziness
-constipation
-sweating
-sexual dysfunction
-seizures

32
Q

contraindications to atomoexteine 1

A

phaechromocytoma

33
Q

other options for ADHD medication 4

A

guanfacine/clonidine

buproprion

modafinil

nortriptule or desipramine

34
Q

assessing repsonse in ADHD 4

A

core syx

assoc syx

functionig

patient report/ collateral

35
Q

points on prescirbing in ADHD when co-morbidity is present

A

treat most severe condition first

optimise exisitng treatment

Examples:
Psychosis - non-stimulant preferable, antipsychotic cover
Depression – careful with side effects if already on antidepressant
with NA effect
Mania - mood stabiliser/antipsychotic cover
Anxiety - stimulants may exacerbate, atomoxetine preferable
Addiction – depends on substance, 6/12 abstinence
Tourette’s syndrome – stimulants make tics worse

36
Q

duration of treatment for ADHD

A

6 monthly BP/HR

drug holiday
-period without meds
-considered annual
-assess whether grown out of ADHD

37
Q

how does aspergers differ to ASD

A

similar to autism bu no general delay in language or cognigitev development

-tend to have normal intelligence

38
Q

triad of core syx of ASD

A

abnormal reciprocal social interactions

communciation/langage impairemnt

resitricted and repetitive interests/activties

39
Q

incidence of ASD and gender bias

-*IQ spread

A

M:F 4:1

prevalence- 0.5-1%

*-80% have low IQ ( learning disability)

-20% normal IQ (high functioning autism)
-aspergers syndrome (normal language)

40
Q

aetiology of ASD 4

A

tendency to run in families

genetic mutations
-many assoc w development of brain

non-genetic factors
-parental age
-birth complications
-

41
Q

charactersitics of abnormal social interactions for ASD 6

A

indiffernce

minimal shared nejoyment

reciprocal interction

only early life friends

limited empathy, insensitive

lack of intuition

42
Q

charactersitics of communcation/ langugae impairemnt for ASD 6

A

delayed or lack of speech

prolonged or avoidant eye contact

awkward posture or body language

unusual speech volume

misinterpreationof literal or implied meaning

advanced voacb- poor convo skills

43
Q

charactersitics of resistricted and repeitive intererst/behaviours for ASD 6

A

obsessive fixed intrests

motor mannerisms- hand flapping, body rocking

compulsive/repeitive behaviours

preference for smaeness

increased sensory responsiveness

change unsettling

44
Q

other featuers of ASD 3

A

clumsiness

difficulites expressing emotion

increased pain threshold

45
Q

assessment of ASD 2

A

whos involved:
-doctors
-speech and langue therapy
-occupational therapy
-psychology

standardised tools
-autism behaviour checklist
childhood autism rating scales
autism diagnostic observation schedule

46
Q

principles of ASD management 3

A

structue

routine

predicatbility

47
Q

general points about ASD managment 5

A

adapt enviornemt
-reduce complex social interactions
-use routine/timetabling

communication aids
-use of pictures or objects

social skills training

CBT, OT

family support -parenting programmes

48
Q

use of medciation for ASD 3

A

symptomaitc
-antipsychotic for stereotyped or aggressive hevioaurs

SSRIs for compulsive behaviours

melatoinin for insomnia

Psychiatry (21 decks)

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