psych Flashcards
what is ADHD?
A condition incorporating features relating to inattention and/or hyperactivity/impulsivity that are persistent + an element of developmental delay.
what are the diagnostic features of ADHD?
For children up to the age of 16 years, six of these features have to be present; in those aged 17 or over, the threshold is five features.
how is ADHD managed?
- Following presentation, a ten-week ‘watch and wait’ period should follow to observe whether symptoms change or resolve.
- If they persist then referral to secondary care is required. This is normally to a paediatrician with a special interest in behavioural disorders, or to the local Child and Adolescent Mental Health Service (CAMHS
- Drug therapy should be seen as a last resort and is only available to those aged 5 years or more.
- Patients with mild/moderate symptoms can usually benefit from their parents attending education and training programmes.
for ADHD, what can be given to those to fail to respond/have severe symptoms?
pharmacotherapy can be considered:
- Methylphenidate is first line in children and should initially be given on a six-week trial basis. It is a CNS stimulant which primarily acts as a dopamine/norepinephrine reuptake inhibitor. Side-effects include abdominal pain, nausea and dyspepsia. In children, weight and height should be monitored every 6 months
- If there is inadequate response, switch to lisdexamfetamine;
- Dexamfetamine should be started in those who have benefited from lisdexamfetamine, but who can’t tolerate its side effects.
what is important to note before starting pharmacotherapy for ADHD?
All of these drugs are potentially cardiotoxic.
Perform a baseline ECG before starting treatment, and refer to a cardiologist if there is any significant past medical history or family history, or any doubt or ambiguity.
what is autism spectrum disorder?
a neurodevelopmental condition characterised by qualitative impairment in social interaction and communication as well as repetitive stereotyped behaviour, interests and activities.
when do sx of autism usually present?
during early childhood, but may be manifested later
what may autism occur in association with?
any level of general intellectual / learning ability
what may improve outcomes in autism?
early dx and intensive educational and behavioural mx
what is usually present during early childhood (typically before 2-3 years of age) in autism?
social communication impairments and repetitive behaviours
what are features of impared social communication and interaction seen in autism spectrum disorder?
- frequently play alone
- relatively uninterested in being with other children
- may fail to regulate social interaction with nonverbal cues e.g. eye gaze, facial expression and gestures
- fail to form and maintain appropriate relationships
- become socially isolated
what are features of repetitive behaviours, interests and activities seen in autism spectrum disorder?
- stereotyped and repetitive motor mannerisms
- inflexible adherence to nonfunctional routines or rituals are often seen
- noted to have particular ways of going about everyday activities
what are commonly seen in children with autism spectrum disorder?
- ADHD
- epilepsy
what is autism spectrum disorder also associated with?
a higher head circumference to brain volume ratio
what does treatment for autism spectrum disorder involve?
- early initiation
- education and behavioural mx
- improved social skills
- improved communivation
