Lecture 3: Management of CNS disorders in children & adolescents Flashcards
What are neurodevelopmental disorders
multifaceted conditions characterized by impairments in cognition, communication, behaviour and or/ motor skills resulting from abnormal brain development eg intellectual disability, communication disorders, autism spectrum disorder, attention deficit/ hyperactivity disorder
What are emotional and behaviour disorders
characterized as either internalizing or externalizing problems – as a consequence of stressful environment at home or school, neglect/ abuse e.g. depression, anxiety, eating disorders, conduct disorders, challenging behaviours
What are the common pschotropic drugs used in CAMHS?
- Antidepressants
- Antipsuchotics
- AEDs
- Phycostimulants
- Miscellaneous (hypnotics, anxiolytics, adrenergic agents)
What is an off label drug?
A licesnsed drug that is being used for an unlicensed indication (inckudes doses, population, form)
What is an unlicensed drug?
A drug that does not have marketing authority in the UK
what are prescribing issues in CAMHS?
- Children unable to swallow large capsules or tablets
- Cant tolerate bitter/ unpleasant taste
- In austism, there may be sensory/ musular factors or have unusual eating habits
- Pharmacokinetics and drug disposition differrs been different afes of kids
What are antipshychotics used for?
Psychosis, bipolar disorder, ASD assosicaited stereotypes, compulsions, aggression and self injerous behaviour
What symptoms do antipsychotics address?
Delusions, paranoea, disordered thinking, aggression, irritability
What is the impact of antipsychotics on patients?
- Weight gain
- Metabolic/ endocrine disorders
- Lowered seizure threshold
- Potential for neuroleptic malignant syndrome
What is the difference between 1st and 2nd generation antipyschotics?
Both as effective as each other, only difference is in the side effects. Second generation are less likely to cause Extrapyramidal side effects (i.e inability to sit still, involuntary muscle contraction, tremors, stiff muscles, and involuntary facial movements) and other symptoms (hyper prolactinaemia, sexual dysfunction) as a consequence of blocked dopamine receptors . 2nd gen show efficacy against positive and negative symptoms. They are more cardiac toxic, cause weight gain/ hypoglycaemia
What monitoring is required for antipyschotics?
Identify, manage, treat the metabolic effects of the second generation antipshcyotis
- Weight/ BMI: initially and every 3 months
- Us & Es: baseline and yearly blood glucose and lipids: initially and evry 3 months
- Prolactin: If symptoms of hyperprolactinaemia present
- ECG: initially if patient cardiac risk
- LFTs: baseline and yearly
What causes ADHD?
Exact cause is unknown
- Genetics: issues with dopamine receptor or transporter gene
- Parental factors: smoking, illicit drugs, POMs - can affect brain development
- Premature birth: eg trauma from contracted labour/ hypoxia
- Encironemnetal toxins: mercury/ lead ingested during pregnancy, contaminated water
What is hyperkinetic disorder?
Another class of ADHD, ICD 10 classification. It is a narrower restrictive term requiring more pervasive and impairing symptoms
what is the diagnosis of ADHD?
Clinical interview using reports and standerdised scales
What is the prefrontal cortex?
Regulates attention - inhibits distracting stimuli/ thoughts
What is the parietal cortex?
Allocating attention to left and right
What is the temporal cortex?
Selective attention to features
What comorbidity is related to ADHD
High comorbidity of tics, anxiety, ODD, mood
How do you manage pre school overactivity ADHD?
General behaviour management training for parents eg triple P, incredible years
How do you manage mild ADHD?
General behavious management training for parents, Triple P. If required, ADHD specific behaviour management training
How do you treat moderate/ severe ADHD?
When symptoms start to impact on learning, relationships, self esteem ,risk taking then start medication
What is the developmental impact of ADHD?
- Preschool: behavioural disturbance
- School age: behavioural problems, acedemic problems, poor social interaction, co morbidity
- Adolescent: acedemic imoairment, poor social interaction, lower self esteem, smoking, alcholl, drugs, antisocial behaviour, forensic problems
- college age: Acedemic failure, not coping with daily tasts, occupational difficulties, low self esteem, alcohol and substance abuse, co morbidity, forensic problems
- Adult: not coping with daily tasks, unemployment, low self esteem, relationship problems, martail discord, alchol and substance abuse, mood instability
What are the ADHD medication limitations?
Medication doesnt change the underlying condition or cure ADHD, 60-70% of indivuduals still have symptoms in adult lufe. Medication is used to manage the symptoms/ behaviours to help ahcieve goals/ outcomes, to enjoy usuao interests and activities, to be more focused and less distracted. It is not to change personality - if this happens then the dose/ medication is wrong
What is the manangement and treatment for ADHD?
A multimodal approach consisiting of psychosoial interventions, education supports and pharmacotherapy but pressures on services often mean that medication is tries 1st line
1st - stimulants (methylphenidatae first, if not tolerated then dexamphetamine)
2nd -atomoxetine or guanfacie
3rd - clonidine