neurology and psychiatry Flashcards
what is reactive attachment disorder
Markedly disturbed and developmentally inappropriate social relatedness in most contexts that begins before 5 years
risk factors for reactive attachment disorder
adverse childhood events
orphaned at a young age
what are the 2 main subtypes of reactive attachment disorder
inhibited and disinhibited
what is inhibited RAD
children who continually fail to initiate and respond to social interactions in a developmentally appropriate way
give an example of inhibited RAD
a child or infant that does not seek comfort from a parent or caregiver during times of threat, alarm, or distress
what is another name for disinhibited RAD
disinhibited social engagement disorder
what is disinhibited RAD
a child who has an inability to display appropriate selective attachments
co-morbid disorders of RAD
emotional disorders, ADHD, behavioural disorders
investigations for reactive attachment disorder
strange situation (1-2 yrs)
modified strange situation (2-4yrs)
story stem attachment profile (4-7yrs)
child attachment interview (7-15) or adult attachment interview
management of RAD
parental sensitivity and behaviour training
psychotherapy/CBT for those who have been maltreated
what is conduct disorder
repetitive and persistent pattern of behaviour in which major age-appropriate norms or roles are violated
what is conduct disorder referred to in younger children
oppositional defiant disorder
what are some causes of conduct disorder
brain injury
family circumstances - ACEs
parenting style - inconsistency and lack of rules
what are the 2 main types of conduct disorder
mild-moderate and severe
mild-moderate conduct disorder
behaviour is restricted to the family environment
what are the 2 types of severe conduct disorder
unsocialised and socialised
socialised conduct disorder
more covert antisocial acts or better ability to avoid getting involved with the police
unsocialised conduct disorder
predominantly violent behaviour and more likely to be dealt with by the police
name some comorbidities of conduct disorder
ADHD
RAD
learning difficulties
depression
substance misuse
deviant sexual behaviour
diagnosis of conduct disorder
3 of the following in the last 12 months with one in the last 6 months
- Aggression to people or animals
- Destruction of property
- Deceitfulness or theft
- Serious violation of rules
pharm management of conduct disorder
risperidone for extreme impulsivity and aggression
SSRIs for depression
cerebral palsy
permanent neurological problems resulting from damage to the brain around the time of birth
antenatal causes of cerebral palsy
maternal infections
trauma during pregnancy
perinatal causes of cerebral palsy
birth asphyxia
pre-term birth
post natal causes of cerebral palsy
meningitis
severe neonatal jaundice
head injury
what is duchennes muscular dystrophy
a genetic disease what causes muscle weakness and wasting
inheritance seen in duchennes muscular dystrophy
x-linked recessive
pathophysiology of duchennes
defective gene for dystrophin on the x chromosome
when do people present with duchennes
3-5 years
clinical presentation of duchennes
delay fatigue, difficulty getting up from the floor, walking or talking
name 2 typical features of duchennes
progressive lordotic posture with marked arching of the back
calf pseudohypertrophy
what is gowers sign
Children with proximal muscle weakness use a specific technique to stand up from a lying position
investigation prior to genetic testing for duchennes
creatine kinase > 10,000
management of duchennes
physio
steroids
surgery
ventilatory support
inheritance in spinal muscular atrophy
autosomal recessive
genetics of spinal muscular atrophy
deletion/mutation of both SMN1 genes on 5q
what is affected by spinal muscular atrophy
proximal legs
pathophysiology of spinal muscular atrophy
↓SMN protein in spinal cord → degeneration of motor neurones
clinical presentation of spinal muscular atrophy
hypotonia
progressive weakness
bulbar and intercostal weakness
investigation for spinal muscular atrophy
genetic testing for SMN1+2
what are the 3 main areas of development affected by autism
social interaction
communication
behaviour
