CPS Mental Health Committee Flashcards
What are challenges facing children with untreated ADHD? (6)
- School difficulties
- Low self-esteem
- Family stress
- Psychiatric comorbidities
- Poor social skills –> social isolation
- Poor peer/sibling relationships
What behavioural condition are children with repaired congenital heart disease at risk of?
ADHD
Among persons with known structural CHD, sudden death is associated with which two specific conditions?
- Tetralogy of fallot
- Transposition of the great arteries
What is the risk of sudden death of children on ADHD medications compared to children in the general population?
SAME risk!
What screening questions should be asked to identify potential cardiac risk factors for sudden death among children starting stimulant medication?
-if yes to any of these questions, what is your next management step?
1. Symptoms of:
Shortness of breath with exercise?
Decreased exercise tolerance?
Fainting or seizures with exercise, startle or fright
Palpitations brought on by exercise
2. Personal MHx of:
Wolf Parkinson White syndrome
Cardiomyopathy
Heart transplant
Pulmonary hypertension
Implantable defibrillator
3. Personal or family history of:
sudden or unexplained death: -SIDS -unexplained drowning -unexplained motor vehicle accidents
nonischemic heart disease
Long QT syndrome or other familial arrhythmias
-next management step if yes: consult cardiology
What is the recommendation on whether you should obtain an ECG prior to or during ADHD medication therapy?
If the history, family history and physical exam are all normal, there is no indication to perform an ECG
For patients with known congenital heart disease or arrhythmias, are they are increased risk of sudden death with ADHD medications?
Keep in mind that in certain patients with known congenital heart disease (ie. TOF or transposition), there is already an increased risk of sudden cardiac death.
-however, ADHD medications do NOT raise the risk of sudden death further (no evidence that shows this)
What is the Feingold diet in ADHD management?
An “alternative” therapy in ADHD management where a salicylate and additive-free diet is pursued -multiple controlled studies showed that this was not effective
How effective is elimination of food allergens in the managment of ADHD?
-what foods are commonly implicated?
Double-blind, placebo controlled food allergen challenge studies showed some improvement in behaviour:
- Appropriate elimination diets are more likely to improve behaviour in younger children with:
1. Atopic histories
2. Family history of migraine
3. Family history of food reactivity - common foods: milk, nuts, fish, wheat, soy, additives
How effective is the elimination of sugar and aspartame from the diet in treating ADHD?
-what about The Yeast Connexion?
No effect!
Many studies have shown no causality between dietary sucrose or aspartame on children’s behaviour
-yeast connexion: postulates that chronic candidasis and candida toxin production = antifungal agents and a diet free of any sugar source that could promote yeast growth and any foods made with or contaminated by molds and yeast (eg. bread, cheese, processed foods, dried fruits) = NOT scientifically validated
Is there scientific evidence to support the following in ADHD treatment?
-megavitamin therapy -iron -magnesium -vitamin B6 -zinc -essential fatty acids
- megavitamin therapy: NO! double-blind, placebo controlled, study showed NO improvement
- iron: NO!
- magnesium: NO! One small study showed behavioural improvement but only one study
- vitamin B6: NO! Again only one study showed an improvement
- Zinc: NO!
- essential fatty acids: NO! three blinded placebo controlled studies on essential fatty acid supplementation with evening primrose oil and fish oil showed NO behavioural improvement!
What are nootropics used in alternatives therapies for ADHD? (2)
Substances reported to enhance mental competence
- Piracetam = thought to enhance dopamine and noreadenaline transmission -no controlled studies to date
- Deanol: acetylcholine precursor -double blind placebo controlled study showed improved ADHD comparable to methylphenidate BUT the study quality was poor!!
What is the evidence behind use of valerian in improving ADHD?
-most worrisome possible side effect?
In adults, valerian has been shown to be more effective than placebo in clinical randomized trials for improving sleep disorders and insomnia -no studies in children
-most common side effects: GI upset and headache but most worrisome possible side effect is in people with Grave’s disease due to inhibiton of thyroid hormones
What is auditory stimulation in ADHD alternative therapy?
Tomatis method of sound training = based on hypothesis that focus and attention can be improved with a combination of auditory stimulation and listening training, using human voice and classical music…no controlled studies to date.
What is the role of biofeedback in treatment of ADHD?
-what about hypnotherapy?
May be offered in cases where medication is not suitable:
- Poor response
- Significant side effects
- Parental and/or child refusal -involves substantial commitment from the child and the family
hypnotherapy may be helpful in decreasing anxiety/stress related to ADHD; most helpful when integrated into multimodal treatment context. No studies have shown that it improves ADHD symptoms but does improve sleep disturbance or tics
Why has kava been banned?
Too many side effects!
-Causes muscle weakness, rash, weight loss, increased HDL, hematuria, necrotizing hepatitis when combined with other herbs
What are side effects associated with use of blue-green algae in alternative therapy for ADHD?
Gastrointestinal symptoms, weakness, numbness, tingling -
blue green algae can produce toxins AND be contaminated with animal feces, heavy metals, sewage
What are possible side effects of melatonin?
- Possible suppression of puberty
- Proconvulsant effects in children with neurological disabilities
- Headache/fatigue/irritability/sleepiness
What are the clinical features of postpartum blues?
- timing?
- how long does it last?
Emotional disturbance with crying, confusion, mood lability, anxiety and depressed mood
- appear during the first week postpartum
- lasts few hours to few days
What are the clinical features of postpartum psychosis? -timing?
Severe disorder with delusions, hallucinations, gross impairment in functioning
-begins within 4 weeks postpartum
What are the clinical features of postpartum depression?
-how does the severity of symptoms compare with episodes of depression at other times?
Clinical features
Symptoms of depression (YOU KNOW THIS) that are present for at least one month and result in impairment of woman’s functioning
how does the severity of symptoms compare with episodes of depression at other times?
- can last several months
- compared with depression at other times, usually have more mild symptoms
What are risk factors for postpartum depression? (3)
- Family history of psychiatric disorders
- Depression symptoms during the pregnancy
- History of mood disorders
What are the prenatal consequences of maternal depression? (6)
1. Effects on mother:
a. Inadequate prenatal care
b. Poor nutrition
c. Preeclampsia
2. Effects on fetus/newborn:
a. Higher preterm birth
b. Low birth weight
c. Spontaneous abortion
What are the consequences of maternal depression on infants? (5)
Depends if mom has hostile vs. withdrawn affect
- Cognition: Lower cognitive performance, passivity
2. Behavior:
a. Withdrawal
b. Self-regulatory behaviour (ie. sucking on thumb)
c. Dysregulated attention and arousal
d. Internalize an angry and protective style of coping
