L1 - L7 Flashcards
ASD Treatment
- risperadone only licensed in 5 - 17 yrs
- support of individual and family
- no meds for Core Autism
unless : children with aggression give Risperidone (anti-psychotic)
- 2mg/day up to 45kg –> 3.5mg/day >45kg
- only for children
ADHD Overview (neurodevelopmental)
- Pre Frontal cortex has defective inhibitory response.
Symptoms : inattention, hyperactivity, impulsivity
2/3 ADHD patients have co-morbidity
- tics , OCD , depression , substance misuse
Treatment
- methylphenidate
- used in children over 6yrs old
ADHD Diagnosing
- diagnosed by clinical interview and standardised reports
Symptoms :
- inattention / hyperactivity / impulsivity
- all 3 symptoms must be present in different settings (school, home)
- must present before 12 years old
Tourette’s Syndrome
- Tics - vocal and physical
- often associated with ADHD or OCD
underlying problem in basal ganglia which controls motor skills and behaviours
Treatment
- 1st line CBT therapy
- HRT fixes bad habits
- ERP exposes you to triggers in safe environment
- can use risperidone
OCD
- mild : <1hr / day
- moderate : 1-3hrs / day
- severe : >3hrs a day
Obsession: unwanted thoughts/urge that enters the mind repeatedly (anxiety)
Compulsion: repetitive behaviour to temporarily relieve unpleasant feelings brought by obsessive thought
Body Dysmorphic Disorder (BDD)
- Fears and anxiety about physical appearance
Treatment Same as OCD
- treat with SSRI’s (inc. serotonin levels)
1st line : sertraline in children with OCD
1st line : fluoxetine for children with BDD
OR children with OCD + depression
Eating Disorders
- anorexia nervosa , bulimia , binge eating
- also use CBT, interpersonal & dietary counselling
Anorexia Nervosa
- pathological need to keep weight low as possible
- caution with drugs because heart is weakened by emaciation
- SSRI’s commonly prescribed or (SGA’s)
Bulimia
- periods of binge eating and being deliberately sick or using laxatives
- Fluoxetine given at higher dose than depression
Anti Psychotics
- 1st gen typical FGA’s
- causes ED, EPS (tremors, parkinons effects)
- arises from blocking D2 channels in nigro-strital pathway
- blocks Dopamine receptors in different pathways.
- to reduce nt for positive symptoms
- haloperidol , chlorpromazine
SGA Antipsychotics
- clozapine , risperidone ,
- less extra-pyramidal side effects because it doesnt fully block dopamine receptor
- most effective is clozapine (treatment-resistant schizo)
- more cardiotoxic + causes weight gain (metabolic Syndrome)
- effective for positive AND negative symptoms
Antipsychotic Monitoring Req’s
Weight - initial + every 3 months
U+E’s - baseline and annually
Blood Glucose - initial + every 3 months
Prolactin - if hyperprolactinaemia symptoms
ECG - if patient has cardia risk
ADHD Treatment
- 1st line CBT
- can use methylphenidate, dexamphetamine , atomoxetine , gaun
Drug Treatment
1st line - psychostimulants
- methylphenidate , then dexamphetamine
2nd line - Atomoxetine or Guanfacine
3rd line Clonodine
OCD Medication
mainly psychological treatment
- CBT
- antidepressants if severe
SSRI’s 1st
- sertraline 150mg daily
2nd line - clomipramine (ssri) 300mg daily
- used to treat delusions
Depression
- only treat children in severe cases
- discontinuation reduce by 25% weekly
mostly SSRI
1st line : sertraline 50mg/day
2nd line - fluoxetine or citalopram
Mertazepam for depression with insomnia (is a TCA tho)
Seizures Diagnosis
- Transient Seizure :
- due to abnormal or excessive activity
- affects 1/100
- Diagnosis :
- at least 2 unprovoked seizures >24hr apart
- one unprovoked seizure with 60% recurrence chance within 10yrs of original seizure
- diagnosis of epilepsy syndrome
Generalised Seizures Classes
- arising in both hemispheres engaging bilaterally
Atypical absence
– can’t respond , longer than 10 seconds
Typical Absent - altered awareness
Clonic – both arms jerking
Tonic – both arms go stiff
Atonic – going limp
Seizures Treatment Guidelines
Generalised Seizures
- 1st line sodium valproate
- 2nd lamotrigine/topiramate
Focal Seizures
- 1st lamotrigine
- 2nd carbamazapine
Absence Seizures
- 1st ethosuximide
- 2nd sodium valproate/lamotrigine
Status Epilipticus
-1st midazolam (buccal) cuz BDZ’s have fast action
- 2nd lorazepam/diazepam
Primary Headache Types
- Tension , Migraine , Cluster
- migraine is neurological
Tension
- slow onset , bilateral , dull pain
- pain in posterior
Migraine (no aura)
- unilateral , lasts 4-72hr , pulsating , moderate/severe , nausea vomiting
Migraine (with aura)
- headache with 1 of following :
- visual, sensory, speech, motor, retinal
- REFER
Cluster
- severe pain, one sided, behind the eye
- lasts weeks or months
- swelling & runny nose
