First Pass Miss Exam 2 Flashcards
What are the two subtypes of ADHD, and how many symptoms do you have to have in that category in order to qualify for that subtype (or combined = affected by both)
Inattentive subtype
Hyperactive / impulsive subtype
Need at least 6 for children and 5 for adults
Must be present at least 6 months, symptoms first appearing before 12 years of age
What areas of the brain seem to have lower activity in ADHD? What neurotransmitters are affected?
Prefrontal cortex (impulse control) Caudate & Globus pallidus (basal ganglia, motor control)
Neurotransmitters include dopamine and NE
What things are commonly cormorbid with ADHD?
ODD/CD
Learning disability
Anxiety / Mood disorders
What are first line, second line, and third line pharmacotherapies for ADHD?
First line: Stimulants - Methylphenidate and dextroamphetamine
Second line: Alpha-2 agonists - Guanfacine, Clonidine
NRI - Atomoxetine
Third line: TCAs, Bupropion
What are the important side effects of stimulants?
Appetite suppression / weight loss -> may lead to growth delay
Mood disturbance in withdrawal -> will realize they are hungry
Elevated HR / BP
Can cause insomnia if taken at night, also GI / headache
What are some other indications for stimulants?
Exogenous obesity and binge-eating disorder (appetite suppressant)
Adjunct for Obstructive Sleep Apnea
Narcolepsy (treats insomnia via keeping you awake)
What are some conditions which may be mis-diagnosed at ADHD (on the differential)?
Anxiety -> will be fidgety
Depression -> lack of motivation
BPAD -> looks like hypomanic symptoms
Conduct disorder -> playing with scissors might look like conduct disorder but actually be ADHD
What are atomoxetine’s drug interactions of concern?
Metabolized by CYP2D6 - increased levels with paroxetine, fluoxetine, and TCAs
What is the mechanism of action of alpha agonists in ADHD?
Enhance NE input from locus coeruleus and stimulate post-synaptic alpha 2A receptors -> improves functional connectivity of prefrontal cortex networks
side effects include the pre-synaptic effects:
Drowsiness / sedation
Decreased BP / pulse -> discontinuation = rebound hypertension, tachycardia, anxiety / panic attacks
Take 4-6 weeks to work (same as Atomoxetine)
Give a couple key biological, individual, family, and social/school risk factors for development of DBDs?
Biology - male sex, perinatal complications, genetic
Individual - Below average IQ, reading problems, aggression / ADHD
Family - Parental antisocial behavior, single parent w/ lack of supervision, excessive control, early motherhood
Social - Peer rejection / being bullied / victimized, low SES, exposure to media violence
What are the three categories for ODD diagnosis? How long must it be present?
For >6 months - pattern of negativistic / hostile / defiant behavior
- Angry / Irritable Mood
- Argumentative / Defiant Behavior
- Spiteful / Vindictive
Basically: Mood, Behavior, and Vindictive behavior
Usually starts before age 8, average age 6
What is the treatment for ODD? What is most important?
There is NO pharmacotherapy
- > Early treatment via psychosocial therapies MUST involve parents
- > Individual or family therapy NOT effective
- -> Parent Management Training or Problem Solving Collaboration / Communication therapy is indicated*
When is conduct disorder diagnosed and what is it generally?
Repetitive & persistent pattern of behavior in which basic rights of others or major age-appropriate societal norms / rules are violated
Diagnosed until 18, or after age 18 if criteria for antisocial personality disorder are not met
What are the four categories of misconduct in conduct disorder?
TARD: Theft, aggression, rules violation, destruction of property
- Aggression towards people & animals
- Destruction of property
- Deceitfulness or theft
- Serious violations of rules (parental or school)
What are three specifiers of conduct disorder?
- Childhood onset -> at least one criteria before age 10
- Adolescent onset -> absence of criteria before age 10
- With limited prosocial emotions -> lack of remorse, guilt, empathy, shallow affect, and unconcern about performance
What are the three evidence-based psychosocial treatments for CD and which one shows a long-term reduction in arrest / incarceration?
- Parent Management Training
- Probleming-Solving Skills Training
(First two are same as ODD) - Multisystemic Therapy (MST) -> leads to a reduction in re-arrest. Includes involvement of school, home, justice system, etc.
What conditions are most frequently comorbid with ODD / CD?
ADHD (10x) Major Depression (7x) Substance Abuse (4x) -> although behavior must not be CAUSED by substance use
What are the three levels of ASD severity?
Level 1 - least severe, requires some support. Will have decreased interest in social interactions and difficulties switching between activities, with poorer independence
Level 2 - requires substantial support, marked deficits, reduced or abnormal social responses, and repeated behaviors are obvious to casual observer
Level 3 - Most needy, very limited social interactions / social responses, restricted behavior interferes with functioning in all spheres
What are the diagnostic features of ASD?
- Poor social interactions, social communication deficits
2. Repetitive / ritualized behaviors, and restricted interests.
What neurobiological abnormalities are known to be associated with ASD? One important environmental exposure?
Neurobiological - EEG abnormalities & seizure disorders
Environmental - Fetal exposure to valproate
Poor prognosis involves ASD associated with grand mal seizures.
What are the typical avenues to accomplish the treatment goals of ASD?
Language remediation for speech delay -> speech therapy
Educational interventions -> classroom changes
**Applied Behavior Analysis (ABA) ** -> teach them learning
OT/PT, and sensory integration therapy
How can ASD social developmental deficits be seen in childhood and adults?
Childhood - Difficult playing with peers due to awkward / inappropriate social behavior, cannot detect feelings of others
Adults - lack of relationships
What is an example of hypo / hyper-reactivity to the environment?
Apparent indifference to pain / temp (wont even care if they bang their head)
Will have adverse response to specific sounds, or be fascinated by lights / movement
What is Asperger’s basically?
A subset of ASD, with no language or intellectual impairment, but clearly marked decrease in social interactions which can lead to teasing / bullying