Day 2 - Psych2 Delirium/Dementia, Peds

Question 1

Comorbidities common w/ ADHD in children

Answer 1

Oppositional deviant disorder, Conduct disorder, Learning disabilities, Depression, Bipolar disorder, Anxiety disorder

Question 2

Criteria met before pharmacotherapy for ADHD

Answer 2

(1) Dx assessment (2) Age 6+ (3) Parents accept meds as appropriate (4) School cooperate w/ administration & monitoring (5) No prior high bp (6) Seizure free (7) Absence of developmental delay (8) No substance abusers in household (9) No prior hypersensitivity to med

Question 3

Other meds for ADHD if failed stimulants/atomoxetine

Answer 3

TCAs, bupropion, alpha2 agonists (e.g., clonidine)

Question 4

Common complications of stimulant drugs (e.g., methylphenidate, dextroamphetamine in ADHD) & how mgt

Answer 4

(1) Insomnia (sleep hygiene, meds earlier in day, shorter duration formulation, Clonidine - also bp med) (2) Appetite suppression/weight loss (meds after meals not before, med holidays on weekends/summer) (3) Tics (usually transient, low to moderate dose of methylphenidate - never give these meds to pts with Tourette’s) (4) Psychosis/Mania - d/c (5) Decreased growth velocity (Adult height not affected, drug holidays may help w/ catch up growth)

Question 5

Atomoxetine (tx ADHD) s/e

Answer 5

Increased risk of suicidality (closely observe, d/c), liver injury (d/c)

Question 6

Tx options for

Answer 6

Counseling, psychotherapy; If interefering with daily functioning, antidopamine agents like phenazine, pimozide, or tetrabenazine (all tolerated better than haloperidol); If only focal vocal/motor tics, botulinum toxin injection; If impulse control issues, Clonidine or SSRIs; If refractory to medical mgt, deep brain stimulation to globus pallidus, thalamus, or other subcortical targets

Question 7

Characteristic feat. of autism

Answer 7

Evident prior to age 3, lack of responsiveness to others, poor eye contact, lack of social smile, repetitive phrases, language delay, ritualistic habits, preoccupation, below normal IQ

Question 8

Asperger’s syndrome

Answer 8

Social impairment, repetitive activities, behavioral/interest abnormalities; No language problems or cognitive delays; (Think: weird but functional)

Question 9

Childhood disintegrative disorder (CDD)

Answer 9

Regression of dev. in multiple areas after normal dev. for at least 2 years; Areas of regression - expressive or receptive language, adaptive behaviors, bowel/bladder control, play, motor skills; Assoc. w/ organic disease like seizures or metabolic disorders