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Psychiatric Principles > Lecture 1: DSM/MSE & ADHD > Flashcards

Lecture 1: DSM/MSE & ADHD Flashcards

1
Q

Axis I contents

A

clinical disorders

other conditions that may be a focus of clinical attention

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2
Q

Axis II contents

A

Personality disorders

Mental retardation

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3
Q

Axis III contents

A

General Medical Conditions

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4
Q

Axis IV

A

Psychosocial & Environmental problems

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5
Q

Axis V

A

Global Assessment of functioning

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6
Q

GAF: scale, useful for what, takes into account what

A

0-100
-useful in planning treatment, predicting outcome and tracking clinical progress
-takes into account psychosocial functioning, social functioning, occupational functioning
NOT PHYSICAL LIMITATIONS!

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7
Q

Mental Status Examination (13 components)

A

[GAS, Motor, MA’AM, PIJ, Thought C & P]

  1. General description
  2. Alertness & orientation
  3. Speech
  4. Motor behavior
  5. Mood
  6. Affect
  7. Attention
  8. Memory
  9. Perception
  10. Insight
  11. Judgement
  12. Thought Content
  13. Thought Processes
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8
Q

General Description is what & 3 parts

A

Overall Appearance
posture
poise
grooming/clothing

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9
Q

Alertness and orientation consists of

A 
Awareness of environment
person
time
place
level of consciousness: alertness or state of awareness of the environment
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10
Q

Speech: define this

A

system for expressing, receiving and comprehending words

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11
Q

When assessing Speech consider which 4 main components

A

Rate
Volume
Quantity
Type

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12
Q

9 types of speech

A 
slurred
mumbled
emotional
dramatic
hesitant
word salad
clang associations
neologisms
aphasia
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13
Q

Motor Behavior (6 types)

A 
Hyperactive
Hypoactive (Psychomotor retardation)
Rigid
Restless/aasthisia
Combative
Tics
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14
Q

Mood definition

A

patient’s SUBJECTIVE DESCRIPTION OF HIS/HER EMOTIONAL STATE IN HIS/HER OWN WORDS
-sustained emotion that affects a person’s view of the world

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15
Q

Mood descriptors

A

depressed, irritable, anxious, angry, labile, euphoric, euthymic, dysphoric, apathetic, futile, frightened, guilty

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16
Q

Affect definition

A
  • an observable feeling or tone expressed through voice, facial expression & demeanor
  • emotional responsiveness
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17
Q

Affect descriptors

A

normal, BLUNTED, exaggerated, FLAT, constricted, labile

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18
Q

Attention definition

A

the ability to focus or concentrate over time on one task or activity

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19
Q

Memory definition

A

the process of registering or recording information

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20
Q

4 types of memory (& examples)

A
  1. Remote memory: childhood
  2. Recent remote memory: current events within the past few months
  3. Recent memory: what he or she had for breakfast
  4. Immediate retention & recall: 6 digit test
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21
Q

Perception definition

A
  • sensory awareness of objects in the environment & their interrelationships
  • also refers to internal stimuli
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22
Q

Hallucinations definition

A

false sensory perception NOT a/w a real external stimul

auditory, visual, olfactory, tactile, gustatory

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23
Q

Illusion definition

A

misperception or misinterpretation of a real external stimuli

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24
Q

Depersonalization definition

A

a person’s subjective sense of being unreal, strange or unfamiliar

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25
Q

Derealization definition

A

a subjective sense that the environment is strange or unreal

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26
Q

Formication definition

A

the feeling of bugs crawling on or under the skin

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27
Q

Insight definition

A

awareness that symptoms or disturbed behaviors are normal or abnormal
-patient’s awareness and understanding of his or her illness

28
Q

Judgment definition

A

process of comparing and evaluating alternatives when deciding on a course of action

29
Q

Thought Content Definition & 4 large categories

A

what the patient thinks about and the focus of their concerns

  • delusions
  • obsessions
  • compulsions
  • phobias
30
Q

Delusions definition

A
  • fixed, false, personal beliefs that are not shared by other members of the person’s culture
  • cannot be corrected by reasoning
31
Q

Types of Delusions (6)

A
  • Paranoid
  • Grandeur
  • Nihilistic
  • Ideas of Reference (ie. newscaster is speaking directly to me)
  • Ideas of influence (ie. thought broadcast & ideas placed into you)
  • Persecution
32
Q

Obsession definition

A

recurrent, uncontrollable THOUGHTS, images or impulses

33
Q

Compulsions definition

A

repetitive BEHAVIORS or mental acts that a person feels drive to perform

34
Q

Phobias def

A
  • persistent, irrational, exaggerated fear of a specific stimulus or situation
  • accompanied by a compelling desire to avoid the stimulus
35
Q

Social phobia

A

fear of public humiliation

36
Q

Acrophobia

A

fear of heights

37
Q

Agoraphobia

A

fear of open places

38
Q

claustrophobia

A

fear of closed places

39
Q

zoophobia

A

fear of animals

40
Q

Thought Processes definition

A

the logic, coherence and relevance of the patient’s thought as it leads to selected goals (aka…how a patient thinks)

41
Q

Thought processes (9 types)

A 
Rapid Thinking
Slow or hesitant thinking
Goal-directed thinking
Relevant responses
Loose associations, flight of ideas
Tangential
Circumstantial
Perseveration
Blocking
42
Q

ADHD definition

A

persistent pattern of INATTENTION and/or HYPERACTIVITY/IMPUSLIVITY that is more frequently displayed and more severe than is typically observed in individuals at a comparable level of development
-sxs affect cognitive, academic, behavioral, emotional and social functioning

43
Q

Pathophysiology of ADHD

A
  • not exactly known
  • DECREASED DOPAMINE and/or NOREPINEPHERINE IN BRAIN appears to play primary role
  • ?environmental factors
44
Q

ADHD Inattention features (9)

A
  • careless mistakes due to inattention
  • difficulty sustaining attention
  • does not listen
  • does not follow through or finish work
  • difficulty organizing tasks
  • avoids tasks that require sustained mental effort
  • loses things necessary for tasks
  • easily distracted
  • forgetful
45
Q

ADHD Hyperactivity-Impulsivity features (9)

A
  • fidgets
  • leaves seat when sitting in seat is expected
  • runs/climbs excessively in inappropriate situations
  • difficulty playing/engaging in leisurely activities quietly
  • “on the go”
  • talks excessively
  • blurts out answers prematurely
  • difficulty awaiting turn
  • interrupts or intrudes others
46
Q

Types of ADHD

A

ADHD, combined type: meets inattentive & hyperactive-impulsive sxs (most common)
ADHD, Predominantly Inattentive type
ADHD, Predominantly Hyperactive-Impulsive Type

47
Q

DSM-IV-TR Diagnostic Criteria

A
  • at least 6 symptoms of inattention OR hyperactivity-impulsivity that have persisted for at least 6 mons to a degree that is maladaptive & inconsistent w/developmental level
  • sxs present before age 7
  • sxs with associated impairment present in at least 2 settings
  • clinically significant impairment in social, academic or occupational functioning
  • symptoms not better accounted for by another mental disorder
48
Q

ADHD: age & dx

A

-dif to dx s childhood recall of ADHD)

49
Q

ADHD ddx (11 listed here)

A
  • age-appropriate behaviors in active kids
  • intellectual disability
  • learning disorder
  • depression
  • bipolar disorder
  • anxiety
  • post-traumatic stress disorder
  • oppositional behavior
  • substance abuse
  • other medical conditions
  • environmental factors
50
Q

ADHD evaluation

A

comprehensive medical, developmental, educational & psychosocial eval to:

  • confirm sxs, demonstrate fxnal complications, exclude other explanations for sxs, identify comorbid conditions
  • review of medical, social & family histories
  • interview patients & parents
  • collect info from other caregivers & teachers
51
Q

ADHD eval: what to ask parents

A

How is the kid doing in school?
Have you or teacher noticed any probs w/learning?
Is your child happy in school?
Does your child have any behavioral probs at school or home when playing with friends?
Does your kid have probs completing school assignments at school or home?

52
Q

ADHD: what to ask teachers

A 
how is the kids behavior in school?
what interventions does the kid require?
what are the kid's learning patterns?
is there functional impairment?
how does the kid get along with others?
how is the kid's work?
how are the kid's grades?
53
Q

ADHD rating scales: who should complete these and when

A

should be completed by parents & teachers
-should be completed at time of dx, during med titration & at regular medication follow-up visits

[The slide points to NARROW-BAND ASSESSMENT: Vanderbilt Assessment Scales, so it must want us to use that, eh? whatevs.]

54
Q

Treatment of ADHD (5 major components)

A 
Therapy (psychotherapy & family)
Behavior modification
Educational intervention
Environmental manipulation
Pharmacologic agents
55
Q

ADHD: Behavior Modification recommendations (9)

A
  1. maintain a daily schedule
  2. keep distractions to a minimum
  3. provide specific & logical places to keep schoolwork, toys & clothes
  4. set small, reachable goals
  5. reward positive behavior
  6. use charts and checklist to stay “on task”
  7. limit choices
  8. find activities in which the child can be successful
  9. use calm discipline
56
Q

ADHD: Educational Intervention recommendations (9)

A
  1. tutoring
  2. individualized education programs (IEPs)
  3. write assignments on board
  4. smaller class size
  5. sit near the teacher
  6. frequent breaks
  7. extra time to complete tasks/tests
  8. signal from the teacher when he or she is “off-task”
  9. daily report to parents
57
Q

Criteria for initiation of pharmacotherapy in kids w/ADHD

A
  • dx assessment is complete and confirms dx of ADHD
  • kid is 6 years or older
  • parents accept meds as a contribution to management
  • school will cooperate in admin & monitoring
  • no previous sensitivity to chosen med
  • kid has normal hrt rate & BP
  • kid is seizure free
  • kid DOES NOT have: tourettes, PDD or significant anxiety
  • substance abuse among household members is not a concern (for kids who will be tx w/immediate release stimulants)
58
Q

Stimulants: first line tx for what and how do they work?

A

considered FIRST-LINE TX for ADHD

  • Affect the dopaminergic and noradrenergic systems, causing release of catecholamines
  • ↑ dopamine and norepinepherine concentrations in brain are thought to be responsible for ↑ attention span and concentration
59
Q

Which 2 stimulants are most commonly used

A

methylphenidate (trade names-Ritalin, Methylin, Concerta, Focalin, Metadate)
&
Dextroamphetamine (Dexedrine, Vyvanse)

60
Q

What is another stimulant used in ADHD

A

Adderall, a mixed amphetamine salt

61
Q

5 Short-acting formulations of stimulants used in ADHD & dosing intervals

A
  • Ritalin, Methylin, Focalin, Dexedrine, Adderrall

- must be taken BID-TID

62
Q

Long-acting formulations of stimulants used in ADHD

A 
Methylphenidate-SR
Ritalin-SR & LA,
Metadate CD & ER
Concerta
Focalin XR
Daytrana
Adderall XR
VYvanse
-dosed Qday but side effects can extend longer
-more expensive
63
Q

Forms of ADHD stimulants

A

solution, pill, chewable tablet, patch

64
Q

Efficacy of stimulants in ADHD

A

◦≈70% of patients with have ↓in hyperactivity and ↑ in attention
◦If patients do not have positive results or have significant side effects, try another agent.

65
Q

Diversion and misuse of ADHD stimulants

A

◦Short-acting preparations tend to be preferred ◦Keep track of rx dates
◦Open discussion with patients and parents

66
Q

ADHD stimulant SEs

A

Anorexia/appetite disturbance, Sleep disturbance,Weight loss, ↑ HR and BP, ? Sudden cardiac death, HA, Social withdrawal, Nervousness, Irritability, Stomach pain, Tics, Contact dermatitis (patch)

67
Q

Atomoxetine (Straterra): use, MOA, pros, cons, SEs

A

selective norepinephrine reuptake inhibitor (NRI) used for ADHD
PRO:not a controlled substance, less potential for abuse
CON: more expensive than methylphenidate & dextroamphetamine
SEs: ◦Weight loss ◦Abdominal pain ◦↓ appetite ◦N/V ◦Dyspepsia ◦Sleep disturbances ◦Tics ◦Severe liver injury ◦↑ suicidal thinking ◦Cardiac risk

Psychiatric Principles (3 decks)

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