Lecture 2 - childhood and Adolescent CNS disorders Flashcards
what are core symptoms interactions of autism?
social interaction difficulties, communication challenges, repetitive behaviours - hand flapping/ spinning.
slow to reach baby and toddler developmental milestones in motor skills and language. severe forms can be accompanied by language regression, seizures and low measured IQ. 70% with ASD diagnosis have additional co-morbid conditions such as anxiety, depression, epilepsy or ADHD
what is pathological demand avoidance?
newer terminology used to describe features presented in many children diagnosed with ASD: resisting and avoiding everyday demands of life, mood swings, procrastinating, lacking social understanding
what does autism treatment involve?
does not require medication treatment. support/care/ management of child and family.
environmental modification: efforts to increase sensory stimuli
psychological intervention: communication and interaction strategies.
what is medication treatment for autism ?
there is no recommended medication for CORE autism except anti-psychotic risperidone in low doses in children with severe irritability and aggression - up to 2mg daily in children weighing up to 45kg and up to 3.5mg daily weighing over 45kg
and pharmacological treatment for co-morbidities may be required eg anxiety/depression/epilepsy.
what are the symptoms of ADHD?
inattention - loses items, easily distracted form oak or play
hyperactivity - cannot stay seated, constant motion, talks too much, cannot play quietly
impulsivity - frequently acts and seeks without thinking, cannot wait for things, frequently interrupts others.
what do NICE say about treating ADHD?
NICE suggests medication is not to be used however, a decision may be made by specialist to additionally prescribe 1.methylphenidate, 2.dexamfetamine, 3.atomoxetine
what is the difference between autism and ADHD?
ADHD is primarily characterized by symptoms of inattention, hyperactivity, and impulsivity
Autism is a complex neurodevelopmental disorder characterized by difficulties in social interaction, communication, and repetitive or restrictive behaviors and interests.
describe the mechanism action of methylphenidate
methylphenidate is schedule 2 psychostimulant drug. it blocks the dopamine transporter and norepinephrine transported, leading to increased concentrations of dopamine and norepinephrine within the synaptic cleft. increased receptor binding - > increased neuronal activity. used to focus attention and concentrate on one aspect of life. schedule 2 controlled drugs is not currently licensed for use in children less than 6 years old.
what is Tourettes syndrome?
chief symptoms are tics which can be: vocal - such as grunting, coughing or shouting words, physical - such as jerking of the head or jumping up and down.
often associated with ADHD and OCD - and runs in families. overall, less than 0.5% of children present with TS
what is the underlying cause of TS?
underlying problem may lie in the basal ganglia which is a part of the brain that controls motor learning, executive functions/ behaviours and emotions.
what are non pharmacological treatments of ts?
habit reversal therapy - trying to identify and stop feelings/ sensations that trigger a tic
exposure with response prevention (ERP) - involves increasing exposure to the urge to tic to suppress the tic response for longer
what re medications used fr Tourette and associated conditions?
antipsychotics/ neuroleptics: aripiprazole, sulpiride, risperidone, pimozide, olanzapine, quetiapine and haloperidol. but all have side effects - pimozide has fewer but risk of heart problems.
clonidine works by stimulating the alpha-2 adrenergic system which inhibits the release of noradrenaline/ norepinephrine. but drowsiness/depression/dizziness
topiramate (epilepsy) also used
if co-morbid with ADHD then ADHD medications were thought to exacerbate tics. but atomoxetine does not have this effect.
what is obsessive compulsive disorder?
an obsession is an unwanted and unpleasant thought, image or urge that repeatedly enters a person mind, causing feelings of anxiety, disgust or unease.
a compulsion is a repetitive behaviour or mental act that someone feels they need to carry out to try to temporarily relieve the unpleasant feelings brought on by the obsessive thought.
what is the impact of OCD on a person?
- mild functional impairment - obsessive thinking and compulsive behaviour <1hr/day
- moderate functional impairment - 1-3 hrs/day
- severe functional impairment -> 3 hrs/day
how may OCD manifest itself in situations a person may experience?
fear of deliberately harming yourself or other - for example, you ma attack someone else, even though this type of behaviour disgusts you.
fear of harming yourself or others by mistake or accident - for example, fear you may set the house on fire by accidentally leaving the cooker on
fear of contamination by disease, infection or an unpleasant substance (hand washing)
need for symmetry or orderliness - for example feel th needs to ensure all the labels on the tins in your cupboard face the same way
