Neurodevelopmental Disorders Flashcards
What is the role of a psychiatrist in when treating intellectual disability?
- Complete evaluation
- Appropiate interventions
- Screen for other psychatric disorders
- 35 to 40% will have at least 1 - Coordinate necessary services
What two areas are evaluated to make the dx of intellectual disability?
- Intelligence - Cognitive function
- Adaptive functioning
- Developmental period
Intelligence metrics
- Reasoning
- Problem solving
- Planning
- Abstract thinking
- Jugement
- Academic learning
- Experiential learning
Adaptive functioning
- Communication
- Socail particiaption
- Independent living
- Standards of developmental and societal independence and responsiblity
Symptoms of down syndrome
- Hypotonia
- Language and motor develomental delay
- Facial features
What is the most common cause of moderate to severe intellectual disability?
Down syndrome
What is the second most common cause of intellectual disability?
Fragile X
- Xq27.3 locus
What are some preventive measures that can be taken to avoid intellectual disability?
Pregnancy - Avoid alcohol - Immunize - Nutrition- Folic acid and vitamins Diet restriction - PKU
What comes after prevention?
Intervention
- Early education
- Speech therapy
- OT
- Family therapy
- Respite care
What psychiatric condtions are common in patients with intellectual disability?
- Depression
- Anxiety
- Psychosis
- Conduct disorder
How do comorbid psychiatric disorders often present in patients with intellectual disability?
- Behavioral distrubance
2. Aggression
What must be ruled out if a patient with intellectual disability starts to present with aggression or self-destructive behavior? Other then psychiatric disorders
Pain
What is the minimal level of intellectual disability that can hold a job?
Mild
What is the most common cause of intellectual disability?
Idiopathic
When are symptoms of ASD typically identified?
When they child is put in an environment with children from their age group
What are the typical symtoms of autism?
- Social reciprocity
- Poor peer interaction
- Poor language development
- Repetitive and odd play
What is the identifying factor of a child with RETT syndrome?
- Progressive encephalopahty
- Loss of speech
- Gait issues
- Stereotyped movements
- Microcehpaly
- Poor social interaction skills
History of normal development
Female disorder
What are some stereotyped behaviors?
- Spinning toys
- Toe walking
- Hand flapping
What neurotransmitter is abnormal in autism?
Serum serotonin
- Elevated
What anatomical abnormality has been seen on MRI in patients with autism?
Increased cortical thickness
fMRI has show decreased activity in what area of the brain in patients with autism?
Prefrontal regions
- Dysfunction of the frontostriatal networks
What deficits may be present in the limbic areas in patients with autism?
Glutamate/glutamine
What is the corner stone of diagnosing autism?
- Impaired social interaction skills
- Impaired communication
- Repetitive and stereotyped patterns of behavior
Impaired social interaction
- Nonverbal behaviors
- Failure to develop social appropiate peer relationships
- Lack social reciprocity
Repetitive and stereotyped patterns of behavior
- Inflexible adherence to rules
- Stereotyped motor mannerisms
- Preoccupation with parts of objects
What conditions need to be considered in patients suspected of having autism?
- Intellectual disability
- Schizophrenia
- OCD
What distinguishes autism from intellectual disability?
Intellectual disability will not have
- Restricted activities or interests
- Impariments in communication and social skills
What distinguishes autism from schizophrenia?
- Social symptoms will present later in life
- Positive family history
- Less intellectual impairment
What distinguishes autism from OCD?
- Normal course of development
2. No impairments in social skills or communication
What is the cornerstone of treatment for autism?
Multimodal
- Family education
- Behavior shaping
- Speech therapy
- Occupational therapy
- Education planning
What is the goal of treatment for autism?
Development of basic skills
What are psychiatric disorders are often coexisty with autism?
- ADHD
- OCD
- Behavior disorders
- Psychosis
What medications have show some promise in treating symptoms of autism?
Risperidal
Aripripozole- Irritability symptoms
Oxytocin- Nonverbal communication
What is a proposed etiology causing autism?
Unkown
- Complex heritable and in utero environmental influence
What is the best predictor of future outcome in patients with autism?
Languange development
What conditions must be ruled out when making a diagnosis of autism?
Hearing or vision difficulties that may lead to poor language development
What are the diagnostic steps involved in dx intellectual disability?
- Individualized intelligence testing
2. Adaptive functioning
What are the most commonly used medications to treat tourette disorder?
- Risperdal
- Clonidine
- Aripiprazole
How many motor and vocal tics need to be present for tourette disorder?
Multiple motor
1+ verbal
How long do the tics for tourette disorder need to be present?
1+ year
When must the tics for tourette disorder begin?
Before 18
Is there a genetic disposition to tourette disorder?
Yes, most likely AD
What is a dangerous side effect of antipsychotics (haloperidol and pimozide)?
Long QT
Slow, irregular, writhing movements
Athetoid movements
Dancing, random, irregular, nonrepetitive movement
choreiform
Vocal tic involving involuntary vocalization of obscenities
Coprolalia
Slower than choreiform movements, these are twisting motion interspersed with prolonged states of muscular tension
Dystonic
Intermittent, coarse, large-amplitude, unilateral movements of limbs
Hemiballistic
Brief, shock-like muscle contractions
Myoclonic
Sudden, rapid, recurrent, nonrhythmic, stereotype motor movement or vocalization
Tic
When does the motor component of tourette disorder usually present?
7 years of age
When does the vocal component of tourette disorder usually present?
11 years of age
Tourette disorder has a strong relationship with what other psychiatric disorders?
OCD
ADHD
What neurotransmitter abnormalities are suspected in tourette disorder? What part of the brain?
Decreased GABA and increased Dopamine
Caudate nucleus
What other conditions may present with myoclonus, athetosis, dystonias, and hemiballismus?
Huntington chorea
Wilsons
Strokes
What organism is responsible for Sydenham chorea?
Beta-hemolytic strep/Group A Strep
- Joints
- Heart
- CNS
What tic disorder gets worse during the winter-spring seasons?
Pediatric autoimmune neuropsychiatric disorder associated with strep infection (PANDAS)
What is the cornerstone for treating tourette disorder?
- Somatic therapies
2. Psychotherapies
Which psychotherapy has shown the most efficacy in treating tourette disorder?
Habit reversal training
- Awareness of premonitory urge
- Develop competing response
When should medications be used?
Moderate to severe tics
Where does clonidine act in the brain?
Presynaptic alpha-adrenegic receptors (agonist)
Locus ceruleus
Where does guanfacine act in the brain?
Postsynaptic alpha-adrenergic receptors (agonist)
Prefrontal
Where to atypical antipsychotic work in the brain?
Block dopamine and serotonin
Decrease input from the substantia nigra and ventral tegmentum to the basal ganglia
What would be some examples of “atypical” vocal tic?
Throat clearing
Grunting
Squeaking
What are some examples of motor tics?
Hair rubbing
Picking scabs
Any repetitive and intricate hand or arm movement
