Mood 2 Nerodevelopment Flashcards
fetal stress can
permanently change fetal brain development
Fetal Alcohol Syndrome
interferes with embryonic/fetal development
FASD
fetal alcohol spectrum disorders
physical, behavioral, cognitive, neural impairments
FAS Causes
alcohol abuse during pregnancy
birth-induced morphologic injury & developmental disabilities
FAS s/s
deficiency in weight/height
abnormalities in development of nervous system
thin upper lip
smooth philtrum (smooth between nose and lip)
small palpebral fissures
HIV-positive infants
delayed neurodevlopment
Maternal Depression on child development
ADD/hyperactivity disorder
oppositional defiant disorder
lower levels of social engagement/empathy
large genetic components in which disorders
autism spectrum disorder
intellectual disability
advanced paternal age plays role in
autism
bipolar disorder
schizophrenia
advanced maternal age plays role in
down syndrome (trisomy 21) autism and other
Down syndrome
most common chromosomal condition
intellectual disability and other serious morbidity
can be subtle w/ not all features
Down syndrome pathogenesis
chromosome 21 trisomy
total intracranial volume smaller, especially cerebellum/brainstem/frontal lobes
down syndrome s/s
facial characteristics short stature dysmorphism growth delays hearing problems
down syndrome tx
no known cure
pt/ot
speech therapy
family interventions (sign language/visual cues)
autism spectrum disorder s/s
series of deficits in social interaction & communication
restricted, repetitive stereotyped behavior patterns
anxiety disorders
autism spectrum disorder dx
based on child’s behavior & development
MMR does not cause autism
autism spectrum disorder tx/interventions
discrete trial training
comprehensive behavioral treatment
joint attention intervention
self-management
Psychosis
symptom rather than disorder
abnormal thought processes interfering significantly with perceptions of reality
psychosis associated with
underlying illness or substance use, schizophrenia trauma severe peripartum depression bipolar disorder stroke
mean duration of untreated psychosis
364-721 days
longer = pooer outcome
psychosis assessment
toxicology screening
screening for suicidal ideation/self-injurious behavior
referral for further evaluation by mh provider
special considerations in pregnant/postpartum women
Schizophrenia
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
schizophrenia manifests men/women
15-24
25-34
schizophrenia etiology/pathogenesis
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
schizophrenia formal thought disorder
altered thought processes pressured/distracted speech poverty of speech loose associations word salad
schizophrenia s/s
social withdrawal abnormal movements memory & attention loss of executive function avolition (reduced ability to engage in goal-directed behavior)
schizophrenia positive symptoms
additions to normal experiences delusions hallucinations abnormal movements formal thought disorder
schizophrenia negative sympotoms
diminished affects/behaviors flat/blunted affect thought blocking avolition poverty of speech social withdrawal
schizophrenia cognitive symptoms
memory deficits
attention deficits
language difficulties
loss of executive function
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
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
schizophrenia tx goal
to reduce psychotic symptoms
drugs do not cure mental illness but must continue drug regimen to remain in remission
conventional antipsychotics
phenothiazines, chlorpromazine (first generation)
nonphenothiazines
atypical antipsychotics
second generation (70s/80s) less side effects
atypical antipsychotics
new -10 years
dopamine-serotonin system stabilizers (aripiprazole)
chloropromazine thioridazine fluphenazine perphenazine procchlorperaine trifluperazine
PHENOTHIAZINES first generation antipsychotics tx positive symptoms takes 7-8 weeks injections can tx extreme agitation preg c
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
tardive dyskinesisas
lip smacking
wormlike movements of tongue
uncontrolled chewing/grimacing
haloperidol
phenylbutyliperadine
first gen antipsychotic
blocks dopamine type 2 receptor
tx sever acute/chronic psychotic disorders, tourette’s syndrome
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
extrapyramidal symptoms
acute dystonias
akathisia
secondary/pseudo-parkinsonism
tardive dyskinesias
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
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
aripiprazole
Quinolinone
second gen
tx: autism, bipolar, tourette’s, major depressive disorder, schizophrenia
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
Dementia causes
illnesses, head trauma
alzheimer (more than 50%)
vascular dementia (following series of small strokes)
dementia s/s
slow, progressive decline of cognitive fx
alzheimer’s vs vascular dementia
eventually unable to care for self/communicate
dementia tx
monitoring reinforcing orientation x3 encouraging establishment of advance directives drugs will only delay progression break things into steps that are simple
alzheimer’s
causes 70% of all dementia
progressive loss of brain fx (memory loss, confusion, dementia, fx, behavior)
associated w/ cerebral atrophy
alzheimer’s structural damange
hippocampus (learning/memory)
decreases number/fx of neurons
alzheimer’s s/s
impaired memory/judgment confusion/disorientation can't recognize fam/friends agressive depression psychoses anxiety
alzheimer’s drug therapy
no cure
intensify acetylcholine
modest efficacy
ineffective in late stages
donepezil
galantamine
rivastigmine
memantine
cholinesterase inhibitors alzheimer's disease drugs prevent breakdown of acetylcholine slows progression of disease used all through
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
tension headaches
pericranial mofascial pain
tension headaches causes
excessive contraction, ischemia, inflammation of neck/scalp muscles
emotional stress, inadequate rest
poor posture
tension headaches s/s ,, tx
constant, bilateral, dull, nonthrobbing bandlike pain
aspirin, acetominophen, nsaids
migraine
chronic complex, neurovascular disorder
migraine causes
genetics triggers: diet hormones environment altitude stress sleep noise odors
migraine s/s
throbbing, pulsing unilateral headache
n/v
sensitivity to light/sound
aura
migraine dx
w/ or w/out aura
specific criteria
migraine tx
prophylactic therapy
acute abortive therapy
complementary therapy
opiates can cause rebound headache
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)
cluster headache
unilateral severe pain associated w/ ipsilateral cranial autonomic symptoms
cluster headache s/s
sudden onset
severe, piercing unilateral pain behind/around eye
cluster headache tx
subQ or nasal tiptans, dihydroergotamine
100% o2
occipital nerve blocks
headache danger signs
sudden new/severe progressively worsening onest after exertion, straining, coughing, sexual activity n/v onset after age 50
sumatriptan fovatiptan naratriptan rizatriptan almotriptan zolmitriptan eletriptan
serotonin receptor agonist
migraine abortive agents
vasoconstriction in brain
tx migraine (acute) or cluster ha
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
ergotamine tartrate
dihydroergotamine
isometheptene mucate
ergotamine derivatives
migraine abortive agents
tx migraines, vascular ha
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
botox
botulinum toxin type a
chronic migraine prophylaxis
blocks neuromuscular conduction
tx chronic migraine, bladder muscle dysfx, hyperhidrosis of axilla
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
other migraine agents
betablockers verapamil divalproex topiramate gabapentin fluoxetine amitriptyline
bell’s palsy
acute peripheral facial nerve palsy
risk 3x greater during pregnancy
bell’s palsy s/s
sudden unilateral facial paralysis
eyebrow sagging/inability to close eye, drooping mouth, prodromal ear pain
bell’s palsy dx/tx
rule out cva, lyme disease, gbs, tumor
glucocorticoid
antiviral therapy
eye patch/artificial tears
