child and adolescent - mentor & more 3 Flashcards
worldwide population prevalence of Autism
1%
Comorbidity in ASD
very common about 70%
male to female ratio of ASD
4:1
ASD heritibility
80-90
Monozygotic twin concordance : ASD
60-90%
Dizygotic twin concordance : ASD
30%
the most consistent risk factors for ASD
- Family history
- Children born to older parents
- Children who are born prematurely or with low birth weight
- Valproate exposure during pregnancy
unrelated to risk of ASD
-Vaccination
-Maternal smoking -Thimerosal (ethylmercury) exposure
-Assisted reproductive technologies
treatment for children and adolescents with ASD and associated irritability,disruptive behaviours, aggression and hyperactivity
Risperidone and aripiprazole
(approved by the FDA)
The peak age of onset of bipolar
15-19
The peak age of onset of bipolar I
18
The peak age of onset of bipolar II
20
lifetime prevalence of bipolar I
2.1%
The 12-month prevalence of bipolar I
1.5%
The 12-month prevalence of bipolar II
.8%
Male to female ratio of bipolar I
1:1
Male to female ratio of bipolar II
not clear
might be more common in females
rapid cycling and mixed states, depressive symptoms
Male or female ?
more in female
lifetime risk of suicide in bipolar
15 times more
prevalence of suicide attempt biplar I & II
32-34%
The number of lifetime episodes
I or II?
I (both mania and depression) more than II’s depression episode
interval between mood episodes in the course of bipolar II with age, decrease or increase?
decrease
Hypomania is generally thought of as a
less severe form of mania
Hypomania is an elevated mood for a minimum of
4 days
Mania requires a minimum of
7 days
Features which would suggest mania rather than hypomania
- Flight of ideas
- Psychotic symptoms
- Loss of social inhibitions
Bipolar depression differs from unipolar depression
- rapid in onset
- more frequent
- more severe
- shorter
- more likely to involve reverse neurovegetative symptoms such as hyperphagia and hypersomnia
Neurovegetative symptoms
directly related to the body (e.g., insomnia/hypersomnia, dysregulated eating, fatigue, and decreased energy).
Emotional-cognitive symptoms
related to how a person processes information (e.g. suicidal ideation, decreased concentration, feeling worthless, anhedonia, and depressed mood)
Rapid cycling
is not a subtype of bipolar disorder but instead is a qualifier (as in Bipolar I with rapid cycling).
Definition of rapid cycling
at least four mood episodes in the previous 12 months that meet the criteria for a manic, hypomanic, or major depressive episode.
how rapid cycling episodes are demarcated?
either by partial or full remissions of at least 2 months or by a switch to an episode of the opposite polarity (e.g., major depressive episode to manic episode).
The rapid cycling specifier can be applied to
bipolar I or bipolar II disorder
should rapid cycling be treated differently?
no (NICE: no evidence)
estimated prevalence of rapid cycling
10-20%
Onset and course of the Rapid cycling
late in the course
lasts less than 2 years in 50%
does Rapid cycling increases the risk fo suicide?
yes (controversial though)
Compared with non-rapid-cycling bipolar disorder, rapid cycling is
- More common in women
- Associated with an earlier age at onset
- Associated with a greater illness burden
- Associated with higher treatment resistance
Rapid cycling precipitated by
life events, alcohol abuse, use of antidepressants, and medical disorders
Medical disorders associated with rapid cycling
- Hypothyroidism
- Grave’s
-SAH
-Stroke
-Head Injury
-MS
-Drugs
Drugs that cause rapid cycling
propranolol
LEvadopa
Cyproheptadine
subtypes of bipolar disorder
- Bipolar I - full blown manic episode (depression not required)
- Bipolar II - a less severe manic episodes (hypomania) with periods of depression.
- Cyclothymic disorder - numerous periods of subthreshold hypomanic and depressive symptoms over a two-year period
Bipolar I
One manic episode in a lifetime, marked by a distinct period of persistently elevated or irritable mood and increased goal-directed activity, lasting at least one week or any duration if hospitalization is needed.
This requires at least three additional symptoms (four if the mood is irritable).
additional bipolar I symptoms
- grandiosity
- flight of ideas
- decreased need for sleep
- more talkative than usual
- Distractibility
- increase in goal-directed activity or psychomotor agitation
- excessive involvement in high-risk activities
not required for the diagnosis of bipolar I disorder
Major depressive episodes
Bipolar II:
-Requires at least one, current or past, hypomanic episode and one episode, current or past, of a major depressive episode.
-Lasting at least 4 consecutive days and present most of the day, nearly every day
-Accompanied by 3 or more (four if the mood is only irritable) additional symptoms
The episode severity in bipolar II?
must not be severe enough to cause marked impairment
what if hypomania is accompanied by psychosis?
then, it is mania, not hypomania!! Kapish?
treating moderate to severe manic episodes in adolescents
- Aripiprazole (licenced in adolescents aged 13 and above)
- Do not offer what in mania?
valproate to children, girls or young women of childbearing age (unless no other option present)
Bipolar depression 1st _____ rx
- structured psychological intervention (for 4-6 weeks)
Bipolar depression 2nd _____ rx
alternative psychological or family therapy
Moderate to sever bipolar depression 1st ____ pharma Rx?
Quetiapine and olanzapine
SSRI might be considered alongside either but not alone
Long-term (once in remission) Rx of bipolar depression?
Lithium (alternative or addition ot SGA)
