CNS DISORDERS Flashcards
what treatment should be considered before medication?
‘talking therapies’
such as CBT (cognitive behavioural therapy) AND medication
what type of disorder is AUTISM SPECTRUM DISORDER and symptoms
neurodevelopmental disorder
- repetitive behaviours - hand flapping/spinning
- communication deficits
- social interaction deficits
severe form ASD symptoms
language regression
seizures
low measured IQ
how to notice ASD in babies
slow to reach baby and toddler developmental milestones in motor skills and language
likelihood of co-morbidities with ASD and what are they
70%
anxiety
depression
epilepsy
ADHD
what is pathological demand avoidance (PDA)
describes features presented in many children diagnosed with ASD: resisting and avoiding everyday demands of life, mood swings, procrastinating, lacking social understanding
non-pharmcological treatment for ASD
support/care/management of child and family
environmental modification: efforts to increase sensory stimuli
psychological intervention: communication and interaction
only recommended medication for ASD
antipsychotic
risperidone in low doses in children with severe irritability/aggression (up to 2mg daily in children weighing up to 45kg, and up to 3.5mg daily in those weighing over 45kg)
what does ADHD stand for
ATTENTION DEFICIT HYPERACTIVITY DISORDER aka hyperkinetic disorder
3 main symptom categories of ADHD
inattention
hyperactivity
impulsivity
non-pharmacological intervention in ADHD
- group treatment: coping strategies/developing control/developing social skills
- cognitive behavioural therapy
considerations when prescribing for ADHD
- issues with side effects
- problems with medication at school
- risk of misuse of drug
Methylphenidate moa
PSYCHOSTIMULANT
(potential cognitive enhancer)
blocks the dopamine transporter and norepinephrine transporter, leading to increased concentrations of dopamine and norepinephrine within the synaptic cleft
increased receptor binding > increased neuronal activity
drug classification of methylphenidate
schedule 2 controlled drug
not licensed for use in children under 6 years old
why do CNS drugs prevent release NT from being cleared from the synapse?
synaptic concentration increased > greater stimulation of post-synaptic neutron through receptors
chief symptom of Tourette’s syndrone
tics
can be vocal (sounds) or physical (movements)
underlying problem in Tourette’s syndrome
lies in the basal ganglia, which is part of the brain that controls motor learning, executive functions/behaviours, and emotions
non-pharmacological treatment of Tourette’s syndrome
- habit reversal therapy
- exposure with responsive prevention (ERP)
habit reversal therapy
trying to identify and stop feelings/sensations that trigger a tic
exposure with responsive prevention (ERP)
involves increasing exposure to the urge to tic leads to suppression of the tic response for longer
medicating tourette’s
antipsychotics/neuroleptics (risperidone, olanzapine), clonidine, topiramate
issue with Tourette’s and ADHD medication
thought to exacerbate tics, atomoxetine does not have this effect
an obsession
an obsession is an unwanted and unpleasant thought, image or urge that repeatedly enters a person’s mind, causing feelings of anxiety, disgust or unease
obsessive-compulsive disorder (OCD)
an anxiety disorder characterised by unwanted repetitive thoughts (obsession) and/or actions (compulsions)
a compulsion
a repetitive behaviour or mental act that some feel they need to carry out to try to temporarily relieve the unpleasant feelings brought on by the obsessive thought
OCD - mild functional impairment
obsessive thinking and compulsive behaviour <1hr/day
OCD - moderate functional impairment
obsessive thinking and compulsive behaviour 1-3 hours/day
OCD - severe functional impairment
> 3 hours/day
OCD presentation
- fear of deliberately harming yourself or others
- fear of harming yourself or others by mistake or accident
- fear of contamination by disease, infection or an unpleasant substance
body dysmorphic disorder (BDD)
fears about physical appearance that go beyond self-esteem: a functional impact on life
BDD presentation
- constantly comparing looks
- spend a long time concealing what they believe is a defect
- feel anxious around people
- reluctant to seek help (feel seen as vain/self-obsessed)
- excessively dieting and exercise
OCD and BDD treatment
CBT + sertraline or fluvoxamine
except if co-morbid with depression then fluoxetine
anorexia nervosa (eating disorder)
when a person tries to keep their weight as low as possible (by starving themselves or exercising excessively)
bulimia (eating disorder)
when a person goes through periods of binge eating and is then deliberately sick or uses laxatives to try to control their weight
binge eating disorder (BED)
when a person feels compelled to overeat large amounts of food in a short space of time
non-pharmacological treatment of eating disorders
- CBT
- interpersonal psychotherapy
- dietary counselling
cautions with prescribing for anorexia
heart is weakened by emaciation, SSRIs often prescribed
bulimia medication
SSRIs (fluoxetine) prescribed generally at higher doses than for depression
