Mood 2 Nerodevelopment Flashcards
1
Q
fetal stress can
A
permanently change fetal brain development
2
Q
Fetal Alcohol Syndrome
A
interferes with embryonic/fetal development
3
Q
FASD
A
fetal alcohol spectrum disorders
physical, behavioral, cognitive, neural impairments
4
Q
FAS Causes
A
alcohol abuse during pregnancy
birth-induced morphologic injury & developmental disabilities
5
Q
FAS s/s
A
deficiency in weight/height
abnormalities in development of nervous system
thin upper lip
smooth philtrum (smooth between nose and lip)
small palpebral fissures
6
Q
HIV-positive infants
A
delayed neurodevlopment
7
Q
Maternal Depression on child development
A
ADD/hyperactivity disorder
oppositional defiant disorder
lower levels of social engagement/empathy
8
Q
large genetic components in which disorders
A
autism spectrum disorder
intellectual disability
9
Q
advanced paternal age plays role in
A
autism
bipolar disorder
schizophrenia
10
Q
advanced maternal age plays role in
A
down syndrome (trisomy 21) autism and other
11
Q
Down syndrome
A
most common chromosomal condition
intellectual disability and other serious morbidity
can be subtle w/ not all features
12
Q
Down syndrome pathogenesis
A
chromosome 21 trisomy
total intracranial volume smaller, especially cerebellum/brainstem/frontal lobes
13
Q
down syndrome s/s
A
facial characteristics short stature dysmorphism growth delays hearing problems
14
Q
down syndrome tx
A
no known cure
pt/ot
speech therapy
family interventions (sign language/visual cues)
15
Q
autism spectrum disorder s/s
A
series of deficits in social interaction & communication
restricted, repetitive stereotyped behavior patterns
anxiety disorders
16
Q
autism spectrum disorder dx
A
based on child’s behavior & development
MMR does not cause autism
17
Q
autism spectrum disorder tx/interventions
A
discrete trial training
comprehensive behavioral treatment
joint attention intervention
self-management
18
Q
Psychosis
A
symptom rather than disorder
abnormal thought processes interfering significantly with perceptions of reality
19
Q
psychosis associated with
A
underlying illness or substance use, schizophrenia trauma severe peripartum depression bipolar disorder stroke
20
Q
mean duration of untreated psychosis
A
364-721 days
longer = pooer outcome
21
Q
psychosis assessment
A
toxicology screening
screening for suicidal ideation/self-injurious behavior
referral for further evaluation by mh provider
special considerations in pregnant/postpartum women
22
Q
Schizophrenia
A
devastating long-term mental disorder
breakdown between thought, emotion, behavior
faulty perception
inappropriate actions & feelings,
withdrawal from reality/personal relationshps into fantasy/delusion
hallucinations
mental fragmentation
23
Q
schizophrenia manifests men/women
A
15-24
25-34
24
Q
schizophrenia etiology/pathogenesis
A
cause not known may be genetic 1% of world's population similar rates across ethnicities very variable childhood trauma usually increased levels of cytokines neurotransmitter abnormalities/impaired immune fx neuronal malformation
25
schizophrenia formal thought disorder
```
altered thought processes
pressured/distracted speech
poverty of speech
loose associations
word salad
```
26
schizophrenia s/s
```
social withdrawal
abnormal movements
memory & attention
loss of executive function
avolition (reduced ability to engage in goal-directed behavior)
```
27
schizophrenia positive symptoms
```
additions to normal experiences
delusions
hallucinations
abnormal movements
formal thought disorder
```
28
schizophrenia negative sympotoms
```
diminished affects/behaviors
flat/blunted affect
thought blocking
avolition
poverty of speech
social withdrawal
```
29
schizophrenia cognitive symptoms
memory deficits
attention deficits
language difficulties
loss of executive function
30
schizophrenia dx
predictors of fx in early dx parallel factors that predict fx chronically
clinical signs persist for at least 6 months
lack of clinical insight one of most important features
31
schizophrenia tx
pharm (limited effectiveness) [no single drug of choice, depends on pt]
cognitive enhancement approaches
tailored interventions
traditional clinic-based cognitive &psychosocial rehab
family psychoeducation
32
schizophrenia tx goal
to reduce psychotic symptoms
| drugs do not cure mental illness but must continue drug regimen to remain in remission
33
conventional antipsychotics
phenothiazines, chlorpromazine (first generation)
| nonphenothiazines
34
atypical antipsychotics
```
second generation (70s/80s)
less side effects
```
35
atypical antipsychotics
new -10 years
| dopamine-serotonin system stabilizers (aripiprazole)
36
```
chloropromazine
thioridazine
fluphenazine
perphenazine
procchlorperaine
trifluperazine
```
```
PHENOTHIAZINES
first generation antipsychotics
tx positive symptoms
takes 7-8 weeks
injections can tx extreme agitation
preg c
```
37
Phenothiazines se, bbw, contra, intx
chloropromazine
blocked alpha-adenergic receptors
weak blocking of cholinergic receptors
dizziness, drowsiness, orthostatic hypotension
anticholinergic effects, secondary parkinsonism, sedation, sexual dysfunction, tardive dyskineasia akathisia, acute dystonia (severe spasms/tiwtching movements), risk for suicide, high fever/serum ceatine kinase
bbw: in elderly pts w/ dementia pyschosis = risk for death
contra: alcohol withdrawal, comatose state, subcortical brain damage, bbd, reye's syndrome
intx: TCAS = ^ BP, antiseizure meds: lower seizure threshold, kava/st. john's wort increase severity of dystonia
38
tardive dyskinesisas
lip smacking
wormlike movements of tongue
uncontrolled chewing/grimacing
39
haloperidol
phenylbutyliperadine
first gen antipsychotic
blocks dopamine type 2 receptor
tx sever acute/chronic psychotic disorders, tourette's syndrome
40
haloperidol se, bbw, contra, interx
first gen antipsychotic
sedation, hypotension, ^ extrapyramidal symptoms
bbw: elderly w/ dementia r/t psychosis = ^ risk for death
contra: meds for parkinson's, seizure disorders, alcoholism, severe mental depression
interx: antacids, levodopa, lithium, phenobarbital, phenytoin, rifampin, beta-blockers, kava
41
extrapyramidal symptoms
acute dystonias
akathisia
secondary/pseudo-parkinsonism
tardive dyskinesias
42
risperidone
quetiapine
olanzapine
ziprasidone
benzisoxazole
second generation atypical antipsychotic
blocks dopamine type 2 receptors, serotonin, aa receptors
tx positive and negative symptoms and prevention of schizo relapse/expression of mania
C
risperidone tx autism
43
benzisoxazole se, bbw, contra, intx, overdose
risperidone
< than first gens
obesity, hyperglycemia, some extrapyramidal symptoms, hyperactivity, fatigue, n, dizziness, visual disturbances, fever, orthostatic hypotension
bbw: elderly w/ dementia = risk for death
contra: heart failure, pneumonia, dysrhythmias, hypotension, seizures, suicidal ideations, kidney/liver disease
intx: kava, valerian, chamomile SSRIs, antifungals (liver), clozapine (kidneys)
overdose: activated charcoal
44
aripiprazole
Quinolinone
second gen
tx: autism, bipolar, tourette's, major depressive disorder, schizophrenia
45
aripiprazole se, bbw, contra, interx
quinolinone
weight gain, constipation, n/v, dizziness, extrapyramdial signs, sedation
SEVERE: pancreatitis, agranuloctosis, suicidal behavior, angioedma, neuroleptic malignant syndrome
bbw: elderly w/ dementia = death
contra: ketoconazole, ziprasidone, saquinavir, amisulpride, metoclopramide, amiodarone, prolonged QT intervals
interx: CNS depressants
no preg
46
Dementia causes
illnesses, head trauma
alzheimer (more than 50%)
vascular dementia (following series of small strokes)
47
dementia s/s
slow, progressive decline of cognitive fx
alzheimer's vs vascular dementia
eventually unable to care for self/communicate
48
dementia tx
```
monitoring
reinforcing orientation x3
encouraging establishment of advance directives
drugs will only delay progression
break things into steps that are simple
```
49
alzheimer's
causes 70% of all dementia
progressive loss of brain fx (memory loss, confusion, dementia, fx, behavior)
associated w/ cerebral atrophy
50
alzheimer's structural damange
hippocampus (learning/memory)
| decreases number/fx of neurons
51
alzheimer's s/s
```
impaired memory/judgment
confusion/disorientation
can't recognize fam/friends
agressive
depression
psychoses
anxiety
```
52
alzheimer's drug therapy
no cure
intensify acetylcholine
modest efficacy
ineffective in late stages
53
donepezil
galantamine
rivastigmine
memantine
```
cholinesterase inhibitors
alzheimer's disease drugs
prevent breakdown of acetylcholine
slows progression of disease
used all through
```
54
cholinesterase inhibitor se, overdose, contra, intx
donepezil/-mines (alzheimer's drugs)
v/n, dizziness, headache, abnormal dreams, irritability, darkened urine, htn, syncope, increased creatine kinase level, musculoskeletal cramps, AV block, torsades
overdose: atopine (anticholinergic)
contra: gi bleed, jaundice, -floxacins, oxybutynin (seizures)
reduce effectiveness of anticholinergics
55
tension headaches
pericranial mofascial pain
56
tension headaches causes
excessive contraction, ischemia, inflammation of neck/scalp muscles
emotional stress, inadequate rest
poor posture
57
tension headaches s/s ,, tx
constant, bilateral, dull, nonthrobbing bandlike pain
| aspirin, acetominophen, nsaids
58
migraine
chronic complex, neurovascular disorder
59
migraine causes
```
genetics
triggers:
diet
hormones
environment
altitude
stress
sleep
noise
odors
```
60
migraine s/s
throbbing, pulsing unilateral headache
n/v
sensitivity to light/sound
aura
61
migraine dx
w/ or w/out aura
| specific criteria
62
migraine tx
prophylactic therapy
acute abortive therapy
complementary therapy
opiates can cause rebound headache
63
migraine phases
prodrome 50% (increased/decreased perception, irritability/withdrawal, food cravings, yawning, speech difficulties, 24 h prior to overt migraine)
aura 20% (visual disturbances, numbness/tingling in hands, dysphagia, olfactory, auditory changes, 30-60 min before ha, lasts 5-60 min)
headache (4-72 h)
prodrome (fatigue, aching muscles, euphoria, lasts up to 24 h)
64
cluster headache
unilateral severe pain associated w/ ipsilateral cranial autonomic symptoms
65
cluster headache s/s
sudden onset
| severe, piercing unilateral pain behind/around eye
66
cluster headache tx
subQ or nasal tiptans, dihydroergotamine
100% o2
occipital nerve blocks
67
headache danger signs
```
sudden new/severe
progressively worsening
onest after exertion, straining, coughing, sexual activity
n/v
onset after age 50
```
68
```
sumatriptan
fovatiptan
naratriptan
rizatriptan
almotriptan
zolmitriptan
eletriptan
```
serotonin receptor agonist
migraine abortive agents
vasoconstriction in brain
tx migraine (acute) or cluster ha
69
serotonin receptor agonist se, vvw, contra, interx
-triptans
painful injection site, abnormal sensation ,dizziness, numbness vertigo, cardiac arrest, dysrhythmia, htn crisis, splenic infarction, cerebral hemorrhage, serotonin syndrome
contra: moa inhibitors, ischemic bowel or cardiac disease, peripheral vascular disease, uncontrolled htn, severe hepatic impairment, wolff-parknson-white syndrome
interx: citalopram, escitalopram, fluoxetine, paroxetine, (ssris), hydromorphone, hydrocodone, amphetamines, sertaline
70
ergotamine tartrate
dihydroergotamine
isometheptene mucate
ergotamine derivatives
migraine abortive agents
tx migraines, vascular ha
71
ergotamine derivatives se, bbw, contra, interx
aortic value fibrosis, cyanosis, ekg abnormalities, precordial pain, retoperitoneal fibrosis, pulmonary fibrosis
bbw: sl tablets = severe peripheral ischemia given w/ CYP3A4 inhibitors/macrolide abx
contra: -virs, clarithromycin, -conazole, protease inhibitors)
interx: beta blockers, metronidazole
x
72
botox
botulinum toxin type a
chronic migraine prophylaxis
blocks neuromuscular conduction
tx chronic migraine, bladder muscle dysfx, hyperhidrosis of axilla
73
botox se, bbw, contra
injection site pain, ha, dry eyes, urinary retention, overactive bladder, cough, rhintis, dysrhythmias, dysphagia, autonomic dysreflexia, seizure
bbbw: may spread toxins w/ powder upon reconstitution
contra: UTI, urinary retention, increased pvr, pregnancy, lactations
74
other migraine agents
```
betablockers
verapamil
divalproex
topiramate
gabapentin
fluoxetine
amitriptyline
```
75
bell's palsy
acute peripheral facial nerve palsy
| risk 3x greater during pregnancy
76
bell's palsy s/s
sudden unilateral facial paralysis
| eyebrow sagging/inability to close eye, drooping mouth, prodromal ear pain
77
bell's palsy dx/tx
rule out cva, lyme disease, gbs, tumor
glucocorticoid
antiviral therapy
eye patch/artificial tears
