Lecture 2: CNS disorders associated with childhood & adolescence

Question 1

What are the features of austism?

Answer 1

• Repetitive behaviours: hand flapping/ spinning
• Communicatiom deficits
• Social interaction deficits
• Slow to reach baby and todler developmental milestones in motor skills and language
• Severe forms can be accompnanied by language regression, seizures and low measured IQ
• 70% have additional co-morbid conditions such as anxiety, depression, epilepsy or ADHD

Question 2

What are the stages in the autism spectrum, from. mild to severe?

Answer 2

• Asperegrs disorder
• PDD - NOS
• Autistic disorder
• Retts disorder
• Childhood disintegrative disorder

Question 3

What is the treatment for autsim?

Answer 3

Doesnt direct;y involbe medication, involves support/ care/ managemtn of child and damily, environmental modification - effeorts to increae sensory stimuli, psychosocial intervention - communication and interaction strategies.

The only recommednded medication os antipuchotis - reperidone, which is given in low doeses in children with severe irritability/ aggression. . Up to 2 mg is given daily in children weighing up to 45kg, and up to 3.5mg daily in those weighing over 45kg. Also pharmalogical treatment for co-morbidities such as ADHD/ anxiety/ depression/ epilepsy

Question 4

What are the symptoms of ADHD?

Answer 4

• Inattention: doesnt listen, easiyly ditracted, often forgets thigs, disorganized
• Hyperactivity: Cant stay seated, talks too much, cant play quietly
• Impulsivity: cant wait for things, interupts others

Question 4

What is the treatment for ADHD?

Answer 4

1. Group treatment - coping strategies, developing contro;/ developing social skills, congnitie behavioural therapy
2. May be prescribed methylphenidate, dexamfetamine, atomoxetine

Question 5

What is methylphanidate?

Answer 5

A pychostimulant - The stimulation is there to focus attention and to allow the individual to focus on one aspect at a time.

It works by blocking the dopamine and norepinephrine transporter, leading to increased concentrations of dopamine and norepinephrine within the synaptic cleft. The neurotransmitters hang around in the synaptic cleft for longer, so increased receptor binding and increased neuronal activity.

Methylphenidate is a schedule 2 CD. It is not licensed for use in children less than 6 years old. 90% of all ADHD prescriptions are methylphenidate

Question 5

What is tourettes syndrome? Underlying problem? Symptoms? Non pharmacological treatment? Medication?

Answer 5

The main symptoms are tics, which can be vocal sounds such as grunting, coughing or shouting words, and physical movements such as jerking of the head or jumping up and down. The underlying problem may lie in the basal ganglia which is part of the brain that controls motor learning, executive functions/ behaviours and emotions

Non pharmacological treatment includes; habit reversal therapy - trying to identify and stop feelings/ sensations that trigger a tic. Exposure with response prevention - this involves increasing exposure to the urge to tic to suppress the tic response for longer.

Medication includes antipsychotics and neuroleptics; aripiprazole, sulpiride, risperidone, pimozide, olanzapine, quetiapine, haloperidol. Clonidine works by stimulating the alpha 2 adrenrgic system which inhibits the release of noradrenaline, but causes drowsienss/ depression and dizziness. Topirimate which is used for epilepsy may also be used

Question 6

What is OCD and what are the severity levels?

Answer 6

An obsession is an unwanted and unpleasant thought, image or urge that repeatedly enters a persons mind, causing feelings of anxiety, disgust or unease. A compulsion is 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 though. It is often diagnosed in terms of severity.
1. Mild functional impairment – obsessive thinking and compulsive behaviour <1 hour a day
2. Moderate functional impairment: 1-3 hours a day
3. Severe functional impairment: >3 hours a day

Question 7

What is the presentation of OCD?

Answer 7

Fear of deliberately harming yourself or others. Fear of harming yourself or others accidentaly. Fear of contamination by disease, infection or an unpleasant substance which leads to contant hand washing. Need for symmetry or orderliness

Question 8

What is body dismorphic disorder?

Answer 8

A fear about physical appearance that goes beyond low self esteem. . It includes constantly comparing their looks to others, spends a long time Infront of the mirror, but at other times avoids mirrors altogether. Spends a long time concealing what they believe is a defect. Feel anxious when around other people, be reluctant to seek help, because they believe others wills see them as vain or self obsessed. Seek cosmetic surgery, which is unlikely to relive their distress, excessively diet and exercise

Question 9

What is the treatment for OCD and Body dysmorphia?

Answer 9

• Cognitive behavioural therapy – eg exposure with response prevention, which encourages you to face your fear and let the obsessive thoughts occur without neutralising them with compulsions
• Sertraline or fluvoxamine should be used when an SSRI is prescribed to children and young people with OCD, except in patients with significant comorbid depression when fluoxetine should be used, because of current regulatory requirements. Fluoxetine should be used when an SSRI is prescribes to children and young people with BDD. Fluoxetine blocks the reuptake of serotonin so increases the activation of serotonin receptors

Question 10

What are the types of eating disorders?

Answer 10

Anorexia nervosa – when a person tries to keep their weight as low as possible; for example, by starving themselves or exercising excessively
Bulimia – when a person goes through periods of binge eating and is then deliberately sick or uses laxatives to control their weight
Binge eating disorder – when a person feels compelled to overeat large amounts of food in a short space of time – generally adults

Question 11

What is the treatment for eating disorders?

Answer 11

Cognitive behavioural therapy, interpersonal psychotherapy, dietary counselling.
Anorexia – SSRI, caution because heart is weakened by emaciation
Bulimia – SSRI (fluoxetine) prescribed at generally higher doses than for depression

Question 12

What are the genetics related to these disorders?

Answer 12

• 40% of ASD cases have an identifiable genetic/ cytogenetic issue.
• Eating disorders have been shown to be ‘metabo-psychiatric’ disorders, not just psychiatric.
• OCD – new risk gene, SLITRK5, may be a future drug target.
• Tourette’s: SLIRRK1 and HDC gene mutations found.
• ADHD risk gene FOXP2 shown to regulate dopamine levels in mouse knockout models

Question 13

What are the 3 common features of CNS disorders?

Answer 13

1. Autism develops from birth to 2 months, ADHD develops from 9 months to 10 years, pschychological disorders develop from 11 to 70 years
2. Co morbidities of CNS disorders include depression, ADHD, anxiety, bipolar, OCD, tourettes, autism
3. Conditions of the CNS often require treating the mind as well as treating the brain