Disruptive, Impulse-Control And Conduct Disorders; Neurodevelopmental Disorders

Question 1

ADD/ADHD

Answer 1

• neurodevelopmental disorder

- problems paying attention, difficulty controlling behaviors, hyperactivity that is not age appropriate

Question 2

ADD/ADHD- diagnosis

Answer 2

-symptoms of hyperactivity/impulsivity or inattentiveness leading to impairment

• onset= before age 12
• at least 6 months
• symptoms must occur in at least 2 settings (school, home, recreational activities)
• at least 6 symptoms…..

Question 3

ADD/ADHD- symptoms (inattentiveness)

Answer 3

• easily distracted: misses details, frequently switches from one activity to another, forgets things, easily distracted when multiple things happening
• difficulty maintaining focus on one task or learning something new
• misses details and may make careless mistakes
• forgets things or loses things needed to complete activities and tasks (pencils)
• difficulty in completing assignments
• becomes bored with task after a few minutes, unless doing something enjoyable

Question 4

ADD/ADHD- symptoms (hyperactivity/impulsivity)

Answer 4

• fidgets and squirms in seat
• constantly in motion (may often leave seat)
• talks nonstop or excessively
• impatience
• dashes around, touching or playing with everything in sight
• trouble sitting for long periods (doing homework, dinner, or school)
• difficulty doing quiet tasks
• restlessness
• blurts out appropriate or inappropriate comments, shows unrestrained emotions
• interrupts conversation or activities of others

Question 5

ADD/ADHD- management

Answer 5

Multimodal approach

• behavior modification
• medication of choice: sympathomimetics (stimulants)
  
  • methylphenidate (riatlin), amphetmaine/dextroampetamine (adderall), dexmethylphenidate (focalin)
  • MOA: blocks norepinephrine and dopamine reuptake, increases release of norepinephrine and dopamine in extraneuronal space
  • indication: ADD, ADHD, narcolepsy, excessive daytime sleepiness
  • SE: anxiety, HTN, tachycardia, weight loss, growth delays, addiction
• nonstimulants:
  
  • atomextine (strattera)
    
    • MOA: SNRI
    • similar efficacy and SE profile as stimulants (SE occur less often and less addictive ability)
• adjunctive mediations: bupropion, venlafaxine, guanfacine, clonidine

Question 6

Autism spectrum disorder

Answer 6

• spectrum of developmental disorders
• probably linked to combination of prenatal viral exposure, immune system abnormalities, and/or genetic factors

-male:female 4:1

Question 7

Autism spectrum disorder- primary signs

Answer 7

• social interaction difficulties
  
  • significant emotional discomfort or detachment (avoiding eye contact, no response to cuddling or affection)
• impaired communication
  
  • either inability to communicate or has ability to, but chooses not to in social settings
  • difficulties understanding what is not explicitly stated (metaphors, humor in jokes)
• restricted, repetitive, stereotyped behaviors and patterns of activities

Question 8

Autism spectrum disorder- other signs

Answer 8

• persistent failure to develop relationships
• failure to show preference to parents over other adults
• unusual sensitivity to visual, auditory, or olfactory stimuli
• unusual attachments to ordinary objects
• savantism- unusual talents

Question 9

Autism spectrum disorder- management

Answer 9

• referral for neuropsychologic testing
• behavioral modification strategies
• medication

Question 10

Conduct disorder

Answer 10

• persistent pattern of behaviors that deviate sharply from age-appropriate norms and violate rights of others
• social and academic difficulty
• poor prognosis
  
  • 40% develop antisocial personality disorder
• MC in boys

Question 11

Conduct disorder- main areas

Answer 11

1. Serious violations of laws
   
   • defying authority and sexual disinhibition
2. Aggressive/cruel to animals
   
   • causes fights, throws tantrums, tortures animals
3. Deceitfulness
   
   • stealing, lying, lacking guilt/remorse
4. Destruction of property (sets fires)

Question 12

Oppositional defiant disorder (ODD)

Answer 12

• persistent pattern of negative, hostile, and defiant behavior towards adults
• at least 6 months
• no association with psychosis
• may progress to conduct disorder

Question 13

ODD- components

Answer 13

1. Angry/irritable mood
   
   • blames others for misbehaviors, negative attitudes, anger/resentment
2. Argumentative/defiant behavior
3. Vindictiveness

Question 14

ODD- management

Answer 14

-psychotherapy: behavioral therapy