neurodevelopmental Flashcards
prevalence of ASD
1/1000
medical condiitons are identifed in less than 5% of cases. Rett Fragile X Tuberous sclerosis Chrom 15 abnormailities
functional neurological sx disorder
aka conversion
sx are invol
prevalence of childhood onset fluencey DO
5%
percentage of school aged kids with ADHD
9-12%
2: 1 male to female
1. 6-1 ratio in adults
percentage of individuals with specific learning do who are male
60-80%
features of fetal alcohol syndrome
flat upper lip, flattened philtrum, flat midface
features of serotonin syndrome
brisk reflexes, htn, hyperthermia
MDMA/ecstasy can cause this
can mimic ADHD
beta agonist side effect ie albuterol
lead poisoning
anxiety and depresion
BPD
can cause steven johnson in kids
modafinil, not fda approved
selective mutism
an anxiety DO
needs 1 mo of sx, not due to other condition
Williams syndrome
microdeletion on chromosome 7
IDD, unique personality traits, distinctive facial features, cardiovascular problems.
elfin facies, starburst irises, short stature
very outgoing with cocktail party personality.
can have supravalvular aortic stenosis, MC cardiac anomaly
outgoing cocktail personality
Prader Willi
paternal absense of expression on chrom 15
obesity, developmental delay, feeding difficulties in infancy, short stature,, small hands and feet, hypogonadism
Tourette’s pathology
deficits in frontal cortex caudate nucleus, putamen, and thalamus
deficits in density in both neuronal and non neuronal cells ie glial cells
reduced levels of choline and N-acetylaspartate in putamen
lower concentration of N acetylaspartate BL
Lower creatining on r side and reduced myoinositol on left
10% yell obsence language (coprolalia)
IDD
2 standard deviations or more below population
IQ of 70 or below
mild-able to do self care, maintain home activities and only need support
moderate- academic level, require support to live independently or maintain employment
severe- litle understanding of written language, dependent on others full time
profound- limited ability to communicte, require high intensity supervision in all areas of life
clonidine
alpha 2 adrenergic receptor agonist
FDA approved for ADHD and HTN
off label= anxiety, insomnia ,tic disorder, ODD, ptsd, substance use withdrawal
secondary prevention
detects disease early when pts are asymtomnatic ie. HIV testing, screening for nutrition and exercise, depression screening, UDS
DiGeorge syndrome
deletion on chromosome 22q11
CATCH 22 Cardiac abnormalities Abnormal facies Thymic aplasia Cleft palate Hypocalcemia
developmental, speech delay
first pass elimination
extensive drug extraction and metabolism in liver immediately after gut absorption
ASD diagnosis
deficits in social communication/interaction + restricted repetitive behaviors
discontinuation syndrome with SSRIs
dizziness, confusion, nausea, abdominal cramps, sweating, dyesthesias, irritability
Fragile X syndrome
MC inherited cause of IDD
mutation in FMR1 gene on x chromosome
elongated face, large ears, enlarged testicles
typically mutation is CGG trinucleotide segment repeat
common comorbid ADHD, ASD, Anxiety DO
up to 73% have axis 1 psych disorder
common in Down syndrome pts
thyroid disorders. Should have FT4, TSH drawn at birth, 6 mo, 12 mo and annually
sleep apnea, hearing loss otitis media vision and eye disease hypodontia neurologic dysfunction gastrointestinal atresias hirschsprung dz hip dislocation autism celiac conditions hematologic conditions atlantoaxial instability
rumination syndrome
repeated vomiting, chewing, reingesting vomitus
does not occur during sleep
should not respond to standard medical therapy for reflux
guanfacine
more selctive alpha adrenergic than clonidine
less sedation and longer duration
shows reduced tics and ADHD at doses 0.5mg BID to 1mg TID
neurobiological feature of ASD
decreased formation of purkinje cells in cerebellum
increased overall head size, accelerated head growth during infancy
FDA max doses for methyphenidate stimulants
dexmethylphenidate (focalin IR): 20mg
methylin, ritalin (SA, SR), and metadate (ER/CD)- 60mg
methylphenidate-oros (Concerta)- 72mg
methyphenidate patch (Daytrana)- 30mg
lithium monitoring
q 6 mo
BUN, creatinine, TSH, calcium, lithium, ECG
can increase OR decrease thyroid. either goiter or hypothyroidism
metabolic capacity of kid v adult
kids is higher
drugs must be given at shorter intervals.
kids have more efficient renal elimination of drugs and will excrete drugs faster
have greater extracellular water
percentage of ODD that will go to CD
30%
consequence of infantile anorexia
food refusal by infant leads to failure to develop somatopsychological differentiation, the abilty to differentiate sensations in the body
between 6mo and 3 years of age
feeding is directed by his or her emotinal needs instead of psysiological sensatios of hunger and satiety
atomoxetine
selectively inhibits presynaptic norepi reuptake
p450 2d6
CI: pheocromocytoma, MAOIs, glaucoma
TCAs
inhibit 5HT and norepi uptake
kids v adults metabolism
higher metabolic capacity in kids
drugs in kids have to be given at shorter intervals
peds have more efficinet renal elimination, will excrete drugs faster.
greater vol of extracellular water in peds patints , drugs like litium will have lower plasma concentration compared to adults
avoid this med in IDD
potent anticholinergic due to cognitive blunting
SSRIS impact when taken with food
peak plasma concentration of prozac is delayed but not decreased
paxil plama conc is inc by 6%
zoloft is inc by 25%fmoda
functional behavior
a behavior that serves a purpose for the individual that is ongoing
amphetamine isomer most rapidly eliminated from the body
dextro-isomer in acidified urine
depakote
inhibits lamimctal through glucuronidation
highly protein bound
can be combined with lithium
levels increased by salicylates
max dose is 60mg/kg/day
wellbutrin
unicyclic aminoketone
and antidepressant
modulates norepinephrine and dopamine
smoking cessation
methylphenidate metabolized through this enzyme
CES1A1
early onset bipolar is less responsive to..
lithium
why L-carnitine is effective in treatment of methamphetamine toxicity
it prevents formation of free radicals and peroxynitrate in neurons
neurodegen disorder that has lower level of coenzyme q
Parkinsons
coQ studies have shown improved heart falilaure, migraines, dec BP
