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Case Files Psychiatry > Neurodevelopmental Disorders > Flashcards

Neurodevelopmental Disorders Flashcards

1
Q

What is the role of a psychiatrist in when treating intellectual disability?

A
  1. Complete evaluation
  2. Appropiate interventions
  3. Screen for other psychatric disorders
    - 35 to 40% will have at least 1
  4. Coordinate necessary services
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2
Q

What two areas are evaluated to make the dx of intellectual disability?

A
  1. Intelligence - Cognitive function
  2. Adaptive functioning
  3. Developmental period
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3
Q

Intelligence metrics

A
  1. Reasoning
  2. Problem solving
  3. Planning
  4. Abstract thinking
  5. Jugement
  6. Academic learning
  7. Experiential learning
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4
Q

Adaptive functioning

A
  1. Communication
  2. Socail particiaption
  3. Independent living
  4. Standards of developmental and societal independence and responsiblity
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5
Q

Symptoms of down syndrome

A
  1. Hypotonia
  2. Language and motor develomental delay
  3. Facial features
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6
Q

What is the most common cause of moderate to severe intellectual disability?

A

Down syndrome

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7
Q

What is the second most common cause of intellectual disability?

A

Fragile X

- Xq27.3 locus

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8
Q

What are some preventive measures that can be taken to avoid intellectual disability?

A 
Pregnancy
- Avoid alcohol
- Immunize
- Nutrition- Folic acid and vitamins
Diet restriction
- PKU
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9
Q

What comes after prevention?

A

Intervention

  • Early education
  • Speech therapy
  • OT
  • Family therapy
  • Respite care
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10
Q

What psychiatric condtions are common in patients with intellectual disability?

A
  1. Depression
  2. Anxiety
  3. Psychosis
  4. Conduct disorder
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11
Q

How do comorbid psychiatric disorders often present in patients with intellectual disability?

A
  1. Behavioral distrubance

2. Aggression

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12
Q

What must be ruled out if a patient with intellectual disability starts to present with aggression or self-destructive behavior? Other then psychiatric disorders

A

Pain

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13
Q

What is the minimal level of intellectual disability that can hold a job?

A

Mild

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14
Q

What is the most common cause of intellectual disability?

A

Idiopathic

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15
Q

When are symptoms of ASD typically identified?

A

When they child is put in an environment with children from their age group

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16
Q

What are the typical symtoms of autism?

A
  1. Social reciprocity
  2. Poor peer interaction
  3. Poor language development
  4. Repetitive and odd play
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17
Q

What is the identifying factor of a child with RETT syndrome?

A
  1. Progressive encephalopahty
  2. Loss of speech
  3. Gait issues
  4. Stereotyped movements
  5. Microcehpaly
  6. Poor social interaction skills

History of normal development
Female disorder

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18
Q

What are some stereotyped behaviors?

A
  1. Spinning toys
  2. Toe walking
  3. Hand flapping
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19
Q

What neurotransmitter is abnormal in autism?

A

Serum serotonin

- Elevated

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20
Q

What anatomical abnormality has been seen on MRI in patients with autism?

A

Increased cortical thickness

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21
Q

fMRI has show decreased activity in what area of the brain in patients with autism?

A

Prefrontal regions

- Dysfunction of the frontostriatal networks

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22
Q

What deficits may be present in the limbic areas in patients with autism?

A

Glutamate/glutamine

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23
Q

What is the corner stone of diagnosing autism?

A
  1. Impaired social interaction skills
  2. Impaired communication
  3. Repetitive and stereotyped patterns of behavior
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24
Q

Impaired social interaction

A
  1. Nonverbal behaviors
  2. Failure to develop social appropiate peer relationships
  3. Lack social reciprocity
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25
Q

Repetitive and stereotyped patterns of behavior

A
  1. Inflexible adherence to rules
  2. Stereotyped motor mannerisms
  3. Preoccupation with parts of objects
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26
Q

What conditions need to be considered in patients suspected of having autism?

A
  1. Intellectual disability
  2. Schizophrenia
  3. OCD
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27
Q

What distinguishes autism from intellectual disability?

A

Intellectual disability will not have

  1. Restricted activities or interests
  2. Impariments in communication and social skills
28
Q

What distinguishes autism from schizophrenia?

A
  1. Social symptoms will present later in life
  2. Positive family history
  3. Less intellectual impairment
29
Q

What distinguishes autism from OCD?

A
  1. Normal course of development

2. No impairments in social skills or communication

30
Q

What is the cornerstone of treatment for autism?

A

Multimodal

  • Family education
  • Behavior shaping
  • Speech therapy
  • Occupational therapy
  • Education planning
31
Q

What is the goal of treatment for autism?

A

Development of basic skills

32
Q

What are psychiatric disorders are often coexisty with autism?

A
  1. ADHD
  2. OCD
  3. Behavior disorders
  4. Psychosis
33
Q

What medications have show some promise in treating symptoms of autism?

A

Risperidal
Aripripozole- Irritability symptoms
Oxytocin- Nonverbal communication

34
Q

What is a proposed etiology causing autism?

A

Unkown

- Complex heritable and in utero environmental influence

35
Q

What is the best predictor of future outcome in patients with autism?

A

Languange development

36
Q

What conditions must be ruled out when making a diagnosis of autism?

A

Hearing or vision difficulties that may lead to poor language development

37
Q

What are the diagnostic steps involved in dx intellectual disability?

A
  1. Individualized intelligence testing

2. Adaptive functioning

38
Q

What are the most commonly used medications to treat tourette disorder?

A
  1. Risperdal
  2. Clonidine
  3. Aripiprazole
39
Q

How many motor and vocal tics need to be present for tourette disorder?

A

Multiple motor

1+ verbal

40
Q

How long do the tics for tourette disorder need to be present?

A

1+ year

41
Q

When must the tics for tourette disorder begin?

A

Before 18

42
Q

Is there a genetic disposition to tourette disorder?

A

Yes, most likely AD

43
Q

What is a dangerous side effect of antipsychotics (haloperidol and pimozide)?

A

Long QT

44
Q

Slow, irregular, writhing movements

A

Athetoid movements

45
Q

Dancing, random, irregular, nonrepetitive movement

A

choreiform

46
Q

Vocal tic involving involuntary vocalization of obscenities

A

Coprolalia

47
Q

Slower than choreiform movements, these are twisting motion interspersed with prolonged states of muscular tension

A

Dystonic

48
Q

Intermittent, coarse, large-amplitude, unilateral movements of limbs

A

Hemiballistic

49
Q

Brief, shock-like muscle contractions

A

Myoclonic

50
Q

Sudden, rapid, recurrent, nonrhythmic, stereotype motor movement or vocalization

A

Tic

51
Q

When does the motor component of tourette disorder usually present?

A

7 years of age

52
Q

When does the vocal component of tourette disorder usually present?

A

11 years of age

53
Q

Tourette disorder has a strong relationship with what other psychiatric disorders?

A

OCD

ADHD

54
Q

What neurotransmitter abnormalities are suspected in tourette disorder? What part of the brain?

A

Decreased GABA and increased Dopamine

Caudate nucleus

55
Q

What other conditions may present with myoclonus, athetosis, dystonias, and hemiballismus?

A

Huntington chorea
Wilsons
Strokes

56
Q

What organism is responsible for Sydenham chorea?

A

Beta-hemolytic strep/Group A Strep

  • Joints
  • Heart
  • CNS
57
Q

What tic disorder gets worse during the winter-spring seasons?

A

Pediatric autoimmune neuropsychiatric disorder associated with strep infection (PANDAS)

58
Q

What is the cornerstone for treating tourette disorder?

A
  1. Somatic therapies

2. Psychotherapies

59
Q

Which psychotherapy has shown the most efficacy in treating tourette disorder?

A

Habit reversal training

  • Awareness of premonitory urge
  • Develop competing response
60
Q

When should medications be used?

A

Moderate to severe tics

61
Q

Where does clonidine act in the brain?

A

Presynaptic alpha-adrenegic receptors (agonist)

Locus ceruleus

62
Q

Where does guanfacine act in the brain?

A

Postsynaptic alpha-adrenergic receptors (agonist)

Prefrontal

63
Q

Where to atypical antipsychotic work in the brain?

A

Block dopamine and serotonin

Decrease input from the substantia nigra and ventral tegmentum to the basal ganglia

64
Q

What would be some examples of “atypical” vocal tic?

A

Throat clearing
Grunting
Squeaking

65
Q

What are some examples of motor tics?

A

Hair rubbing
Picking scabs
Any repetitive and intricate hand or arm movement

Case Files Psychiatry (10 decks)

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