Developmental Psychiatry Flashcards
What does ADHD stand for?
Attention deficit hyperactivity disorder
What is the diagnostic triad of ADHD?
Inattention
Hyperactivity
Impulsivity
How would you describe a person with ADHD’s actions?
Essentially act before they think - impulsive and often later regret
What further attributes does “combined-type ADHD” have?
Triad of ADHD which are developmentally inappropriate, impair functioning, pervasive across setting, longstanding from age 5
What impacts can ADHD have at home?
Parents can’t cope
Raised family stress
Increased anger and upset
Increased risk of harm
What impacts can ADHD have at school?
Barrier to learning Frequently in trouble Disorganised Forgetful Lose things
List some comorbid difficulties that can occur with ADHD
Social difficulty Learning disability Mood and anxiety problems Behavioural disorder Substance use + crime
Is ADHD more common in males or females?
Males
List methods of diagnosing ADHD
Parent + school report
Screening and structured questionnaires (Conners Rating, SDQ…)
Family and developmental history (genes)
Cognitive assessment
List essential criteria needed to diagnose ADHD
6 (5 for adults) or more symptoms of inattentiveness
6 (5 for adults) or more symptoms of hyperactivity and impulsiveness
Historical concerns since early age
Current symptoms consistent with ADHD
Impact on daily functioning
Children can grow out of ADHD. True/False?
True
Some will as part of brain’s natural process of cortical maturation, which compensates for cognitive deficiency
List some psychological therapies for ADHD
Parent training Behavioural management Social skills training Sleep + diet review Specific educational interventions
List 1st line drugs for ADHD
“stimulants”
Methylphenidate
Dexamfetamine
Lisdexamfetamine
List 2nd line drug for ADHD
SSRI - Atomoxetine
List 3rd line drug classes for ADHD
Alpha agonist
Clonidine
Guanfacine
What is the aim/purpose of using stimulant drugs in ADHD?
Improve dopaminergic neurotransmission in networks involved in higher executive functioning
What does ASD stand for?
Autism spectrum disorder
List the triad of impairments in autism
Social communication
Social interaction
Social imagination
Repetitive behaviours
Is autism more common in boys or girls? Why?
Boys (5:1)
Sex harmones role in organisation of brain circuits during early development
Poor specifity in diagnostic tests for females
List some social interaction difficulties in autism
Difficulty establishing relationships Lack of motivation for social approval No interest in others' needs Little awareness of feelings of others (lack of empathy) Difficulty picking up non-verbal cues
List some social communication difficulties in autism
Hard to grasp meaning of conversations e.g. sarcasm
Monotonous voice
Pedantic language
Narrow interests
Difficulting sharing thoughts and feeling
List some social imagination difficulties in autism
Lack of imagination Inflexible thoughts Understanding other people's views Using knowledge and skills across setting Thinking about the future
List some comorbid conditions that may be found with autism
Learning disability Mood and anxiety disorder OCD ADHD Dyspraxia Tourette's syndrome
List methods of diagnosing autism
Developmental and collateral history Screening scales Interviews (3di, DISCO) ADOS assessment SALT, OT, psychology
What is the DSM criteria for diagnosing autism?
6 symptoms in total
2 symptoms of social interaction
1 symptoms of communication
1 symptom of behaviour
Early onset
Longstanding and cause significant in functioning
Disturbances not better explained by a MH problem, intellectual disability or global developmental delay
List non-pharmacological management of autism
Self and family psychoeducation Family and school support Behaviour analysis SALT Social skills training
List pharmacological management of autism
None for core symptoms of autism Risperidone for ST Mx of severe aggression/ self-injury Methylphenidate (ADHD) Melatonin (chronic insomnia) Mood stabilisers (learning disability)
Outline aetiology of ADHD which contributes to the neuroanatomical brain changes seen in this condition
Genetic predisposition (dopamine/serotonin receptors) Perinatal precipitants (smoking, alcohol, prematurity, hypoxia, complication of delivery) Psychosocial adversity (parenting style, criminality, maltreatment)
Which part of the brain is affected in ADHD?
Frontal lobe
Outline the neurochemical changes in ADHD
Higher concentration of dopamine reuptake inhibitors
Reduced norephirine
Reduced serotonin
List 4th line drug classes for ADHD
Antidepressants (imipramine)
Antipsychotics (risperidone)
List some repetitive behaviour difficulties in autism
Stereotyped movements, speech, use of objects
Insist on sameness/ rituals
Fixated interests
Hyper/ hypoactivity to SENSORY STIMULUS
Outline aetiology of autism
Genetics (strong heritability)
Environmental (rubella in pregnancy)
Biological (birth complications/injury, foetal distress, low birth weight, meconium aspiration)
Which parts of the brain are affected in autism?
Frontal lobes
Amygdala
Cerebellum
Outline the neurochemical changes that occur in autism
Reduction in glutamate receptors
Reduced GABA
Reduced serotonin
