ch 10 review Flashcards
What are the Neurodevelopmental disorders and when do they begin?
- Begin in childhood
- 4 in DSM-5
- Attention-deficit hyperactivity disorder
- Autism spectrum disorder
- Intellectual disability disorder
- Learning, communication, and motor disorders
What are the Neurocognitive disorders and when do they begin?
- Arise in older age
- 2 in DSM-5
- Major and mild neurocognitive disorders
- Delirium
Attention Deficit Hyperactivity disorder definition:
- Persistent pattern of inattention and/or hyperactivity
3 Subtypes of ADHD:
Combined presentation
- 6+ inattention symptoms and 6+ hyperactivity-impulsivity symptoms
Predominantly inattentive
- 6+ inattention symptoms and < 6 inattention symptoms
Predominantly hyperactive/impulsive
- 6+ hyperactivity-impulsivity symptoms and < 6 inattention symptoms
Attention Deficit Hyperactivity disorder: prevalence, onset, prognosis
- Prevalence rate: 3.4 -6%?
- Age limit for onset of symptoms: 12 years
- More than one setting
- Boys 2x more likely to be diagnosed
- Difficulties in school functioning
- Poorer peer relationships
- 45-60% develop conduct disorder
- Increased risk for problems in adulthood
- 4.4% of adults diagnosed with ADHD
Biological factors for ADHD:
- Abnormal activity in prefrontal cortex, striatum, and cerebellum
- Less connectivity between frontal cortex and brain areas that influence motor behavior, memory and attention
- Abnormal functioning of dopamine and norepinephrine
- Strongly tied to genetic factors
- Higher rates in twins and siblings
- Genes that influence dopamine, noradrenaline and serotonin
- Prenatal birth complications
- Low birth weight
- Premature delivery
- Oxygen deprivation
- Lead exposure
- Diet?
- “Poor Western diet”?
Psychological factors for ADHD:
- Aggressive and hostile behavior from parents
- Parental substance abuse
- Family interaction patterns influence course and severity of ADHD
Treatments for ADHD:
- Stimulant drugs increase dopamine
- Effective but side effects
- Non stimulant drugs affect norepinephrine
- Reduce tics and increase cognitive performance
- Side effects
- Antidepressants?
- Some effect on cognitive performance
- Behavioral therapies
- reinforce attentive, goal-directed, prosocial behaviors
- extinguish impulsive and hyperactive behaviors
- Combination of stimulant therapy and psychosocial therapy is best
Autism spectrum disorder: criteria, symptoms, and prognosis
- Impairment in two fundamental behavior domains
- Deficits in social interactions and communications
- Autism: non-reciprocal adoration
- Echolalia: Echoing what one hears
- Deficits in restricted, repetitive patterns of behaviors, interests, and activities
- Preoccupation with one object
- Obsessed with routine and order
- Self-stimulatory behaviors
- Deficits in social interactions and communications
- 50% show at least moderate intellectual disability
- Some only show language deficits
- Wide variation in severity and outcomes
- Best predictors of outcomes:
- Child’s IQ
- Language development before age 6
- IQ above 50 and communicative speech before age 6
Biological theories for ASD:
- Family and twin studies
- Siblings 50 times more likely to have disorder
- Concordance rates: MZ twins = 60%, DZ twins = 0-10%
- Polygenic
- Neurological factors
- 30% develop seizures by adolescence
- Greater head and brain size
- Neuroimaging studies
- Structural abnormalities in cerebellum, cerebrum, amygdala, and hippocampus
- Less activation in brain areas for perception of facial expressions and thinking about social situations
- Higher than average rate of prenatal and birth complications
- Maternal immune activation (MIA)
- Differences in levels of serotonin and dopamine
Drug therapy for ASD
- SSRIs
- Reduce repetitive behaviors and aggression
- Atypical antipsychotic medications
- Reduce obsessive and repetitive behaviors and improves self-control
- Naltrexone
- Reduces hyperactivity
- Stimulants
- improve attention
Psychosocial therapies for ASD
- Combination of behavioral techniques and structured educational services
- Operant conditioning strategies
- reduce excessive behaviors - Comprehensive behavior therapy
- parents and at school
Intellectual developmental disability: criteria
Deficits in the ability to function in 3 broad domains
- Conceptual domain
- language, reading, memory
- IQ under 70
- Social domain
- interpersonal communication skills, social judgment
- Practical domain
- self-care
Intellectual developmental disability: 4 levels of severity
Mild
- Some academic or vocational limitations, but can hold non-competitive jobs
- Self-care, with exception of complex situations
Moderate
- Significant language delays
- Low academic ability, but can acquire simple vocational skills
Severe
- Very limited vocabulary
- Require support for daily living
Profound
- Fully dependent on others
Biological factors for intellectual disability:
Genetic contributors
- Genes can lead to various conditions that cause ID
- Phenylketonuria (PKU)
- Tay-Sachs disease
- Chromosomal disorders, such as Down’s syndrome
- Fragile X syndrome
Brain damage
- Infectious diseases
- Fetal alcohol syndrome
- Head trauma
- Exposure to toxins
Sociocultural factors for intellectual disability:
Low socioeconomic backgrounds
- Parents with intellectual disability
- Poorer prenatal care
Living in lower socio-economic areas
- Exposure to lead
- Poorly funded schools
Treatment for intellectual disability:
Drug therapy
- Neuroleptic medications control aggression and self-injurious behavior
- Atypical antipsychotics reduce aggression
- Antidepressants reduce depression
Behavioral Programs
- Help individuals learn new skills; social and communication skills * Involvement of parents and caregivers
Social Programs
- Early intervention, mainstreaming, institutionalization, group homes that provide comprehensive care
Learning disorders: criteria and types
- Deficits or abnormalities in specific skills or behaviors
- Specific learning disorder: Deficits in one or more academic skills
- Reading
- Written expression
- Mathematics
Communication disorders: criteria, types, and definitions
Language Disorder
- Difficulties with spoken, written language, and other language modalities
Speech Sound Disorder
- Difficulty in producing speech
Childhood-onset fluency disorder or stuttering
- Problems with speaking evenly and fluently, voicing frequent repetitions of sounds or syllables
Social communication disorder
- Deficits in using verbal and nonverbal communication for social purposes, in a manner that is appropriate for the social context
*Causes of learning and communication disorders:
Genetic factors -Abnormalities in brain structure and functioning
- Broca’sarea
Environmental factors
- Lead poisoning
- Birth defects
- Sensory deprivation
- Low socioeconomic status
*Treatment for learning and communication disorders:
- Therapies designed to build missing skills
- Individualized Education Plans (IEP) used in schools
Motor disorders: criteria/symptoms of 4 types
Tourette’s disorder
- Multiple motor tics and at least 1 vocal tic
- More debilitating than PMVTD
Persistent motor or vocal tic disorder (PMVTD)
- Have only motor or vocal tics, not both
Stereotypic movement disorder
- Engage in repetitive, driven, and purposeless motor behavior
- Behavior persists for extended period of time
- Comorbid with autism, intellectual disability, and ADHD
Developmental coordination disorder
- Deficits or delays in development of basic motor skills
- Prevalence: 5-6%
- Causes unknown
- Treated with physical or occupational therapy
Motor disorder: course, comorbidity, causes, and treatment
- All begin in childhood, increase in adolescence and decline in adulthood.
- All highly comorbid with OCD
- Dysfunctions in the dopamine system
- Treated with habit reversal therapy
- Triggers for and signs of impending tics identified
- Clients taught to engage in competing behaviors
Neurocognitive disorders: definition and disorders
- New category in DSM-5: Neurocognitive Disorders
- Involve a loss of cognitive ability that is presumed to be caused by brain damage or disease
- Disorders:
- Major neurocognitive disorder (FKA dementia)
- Mild neurocognitive disorder
- Delirium
Major neurocognitive disorder: symptoms
- Decline in cognitive functioning severe enough to interfere with daily functioning
- Memory loss
- Aphasia: Deterioration of language
- Echolalia: Repeating what is heard
- Palilalia: Repeating sounds or words over and over
- Apraxia: inability to execute common actions
- Agnosia: Failure to recognize objects or people
- Lose of executive functions
- ability to plan, initiate, monitor, and stop complex behaviors
- Changes in emotional functioning and personality
Mild neurocognitive disorder: symptoms, course
- Modest cognitive decline from a previous level of performance
- No significant impairment in functioning
Alzheimer’s disease: symptoms and description
- Mild memory loss that quickly progresses to profound memory loss and disorientation
- 2/3s show psychiatric symptoms
- Some hallucinations and delusions in severe cases
- 100-year-old kills self and wife
- Usually begins after 65
Vascular neurocognitive disorder: symptoms
- Can be major or mild NCD depending on severity of symptoms
- Significant decline in:
- processing speed
- ability to pay attention *executive functions
- Evidence of recent Cerebrovascular disease:
- Blood supply to areas of the brain is blocked, causing brain tissue damage
- Can occur after 1 large stroke or several small strokes
- 25% of stroke patients develop NCD
Treatment of neurocognitive disorder:
Cholinesterase inhibitors
- Treat cognitive symptoms by preventingthe breakdown of the neurotransmitter acetylcholine
Antidepressants and antianxiety drugs
- Help control emotional symptoms
Antipsychotic drugs
- Control hallucinations, delusions, and agitation
Behavior therapieshelp to control patients
- Train family members
Physical and mental activity helps reduce the risk of NCDs
- Nun Study (Snowdon, 1996; 1997)
Delirium: criteria, course, onset
- Disorientation, recent memory loss, and a clouding of attention
- Sudden onset, fluctuating state of reduced awareness
- Duration is short: approximately 1 month or less
- Onset: any age
- Elderly at high-risk
- Prevalence estimates vary
- 10-15% of patients who have had surgery
Causes of delirium:
- Neurocognitive disorder is strongest predictor
- Medical disorders
- Stroke, congestive heart failure, infectious diseases, high fever, HIV
- Intoxication of illicit drugs and withdrawal – - - Fluid and electrolyte imbalances, medication side effects, and toxic substances
- Abnormalities in a number of neurotransmitters
Treatments for delirium
- Discontinue drugs that contribute to delirium
- Antipsychotic medications
- Help treat a delirium person’s confusion
- Nursing care
- Secure atmosphere helps create a secure feeling and a feeling of being in control
