Psych Disorders Flashcards
Attention Deficit Hyperactivity Disorder (ADHD)
- sx
- MC in boys/girls?
- comorbid psych disorders
- pathogenesis
sx: manifests in childhood w/ sx of hyperactivity, impulsivity, and/or inattention
MC in boys (hyperactive type)
Comorbid disorders:
- oppositional defiant disorder
- conduct disorder
- depression
- anxiety disorder
- learning disabilties
Patho: genetic imbalance of catecholamine metabolism in cerebral cortex causing sx.
ADHD:
-common influences/associations
Common influences/associations:
- food additives
- refined sugar intake
- food sensitivity
- iron/zinc deficiency
- prenatal tobacco/alcohol exposure
- prematurity/low birth weight
Criteria for ADHD sx must…?
- be present in more than one setting
- persists for at least 6 months
- be present before the age of 12years
- impair function in academic, social, or occupational activities
- be excessive for the developmental elvel of the child
- not be caused by other mental disorders.
Sx of Hyperactivity in ADHD
- age at onset?
- age at peak?
- excessive fidgetiness (tapping hands and feet)
- difficulty remaining seated when sitting is required
- feeling restlessness/inappropriate running/climbing
- difficulty playing quietly
- always seem to be on the go
Age at onset: 4 yo
Age at peak: 7-8yo
Sx of Impulsivity in ADHD?
How long do sx persist?
- excessive talking
- difficulty waiting turns
- blurting out answers too quickly
- interruption
Sx persist throughout life.
Sx of inattention?
- age at onset of sx?
- how long do sx persist?
DAYDREAMER!
- failure to provide close attention to detail, careless mistakes
- difficulty maintaining attention in play, school, or home activities
- seems not to listen, even when directly addressed
- fails to follow through (eg homework, chores)
- diff organizing tasks, activities
- loses objects required for tasks/activities (eg school books, sports equp)
- easily distracted
- forgetfullness in routine activities
Age onset of sx: 8-9yo
Sx persist through life.
Evaluation of ADHD
-medical, developmental, educational, psychosocial
WHat is the DSM V requirements of ADHD Dx?
-greater than or equal to 6 sx of hyperactivity and impulsivity
OR greater than or equal to 6 sx of inattention
- sx of hyperactivity/impulsivity or inattention must occur:
- often
- be present for more than one setting
- persist for at least 6 mo
- be present before age of 12 yrs
- impair function in academic, social, or occupational activites
- be excessive for the development level of the child.
What are the three subtypes of ADHD?
predominatntly inattentive
predominately hyperactive-impulsive
combined; greater than 6sx of inattention and greater than 6 sx of hyperactivity/impulsivity
Tx ADHD
Goals of ADHD tx
Indications for referral?
Tx:
- behavioral interventions
- medication
- school-based interventions
- psychological interventions alone or in combo
Goals:
- relationships
- academic performance
- rule follwoing
Referral:
- coexisting psychiatric, neurologic, or medical conditions
- lack of response to stimulant therapy or atomoxetine
Medical Therapy for ADHD
- when can you initiate medications?
- what are the meds used?
- when starting on medication what do you tell the pt as to the reason for RX?
begin when child is 6yrs or older, healthy, and dx w/ ADHD.
Meds:
- stimulants;
- -dextroamphetamine (Adderall)
- -methylphenidate (Ritalin)
- if stimulants dont work…refer!
explain the medication is being prescribed to help with self-control and ability to focus.
How do you prescribe ADHD meds?
BBX of stimulants?
Common SE of stimulants?
- try short acting meds first
- start low and titrate up
BBX: increased risk of sudden death, cardiovascular problems including heart attacks. Potential for drug dependency.
Common SE:
- appetite suppression
- abdominal pain
- HA
- insomnia
- irritablity
- tics
- growth delay
Autism Spectrum Disorders
- what are the three and list them in order of worsening severity.
- etiologies
- what are the 3 main areas of functioning affected?
Mild = aspergers Med = Pervasive developmental disorder not otherwise specified Severe = autistic disorder
Etiologies:
- unknown
- could be environmental, biologic, or genetic
- prenatal exposure to valproic acid or thalidomide
- older maternal age
3 affected areas:
- social interaction
- communication
- behaviors and interests
Aspergers:
- MC affects which gender?
- what is this?
- IQ?
MC affects boys
What: become obsessively interested in a single object or topic. learn all about their subject and discuss it nonstop.
-impaired social interaction.
IQ: normal to above average intelligence
Pervasive Developmental disorder not otherwise specified (PPD-NOS)
-what is this?
What: between autism and aspergers in terms of severity of sx, impaired social interaction
Better language skills than kids with autistic disorder but not as good as those with aspergers.
Autism:
- severe impairments in what?
- sx
Severe impairments in social functioning, language, repetitive behaviors.
Sx: slow to develop words and talk, many are nonverbal.
-shaking hands constantly, tapping, lip smacking, oral fixation (putting things in their mouth)
Risk factors for surveillance of ASD?
At what ages is routine screening done?
- siblings with ASD
- parent concern, inconsistent hearing, unusual responsiveness
- pediatrician concern
-screen specifically for ASD at 18 and 24mo, MCHAT (16-48mo) & STAT screening tools.
Red flags for ASD in 2nd year of life.
- Regression
- in his own world
- lack of showing, sharing interest or enjoyment
- using caregivers hands to obtain needs
- repetative movements with objects
- lack of approriate gaze
- lack of response to name
- talk in rhymes or sing-song way nonstop
- repetitive movements or posturing of body
Tx of ASD
-25hrs per week, 12 mo per year in systematically planned, developmentally appropriate educational activities.
- speech and language therapy
- social skill instruction
- OT
Common behavioral issues associated with ASD?
Associated medical conditions?
- disruption/aggression
- eating
- sleeping (not normal circadian rhythm)
- toileting
- self injurious
Medical conditions:
- GI: chronic constipation/diarrhea
- seizures
- sleep problems
Oppositional Defiant Disorder
- characterized by which two sets of problems?
- definition
- etiology
Characterized by aggressiveness, tendency to purposefully bother and irritate others.
Def:
negative, manipulative, hostile, and defiant behavior
Etiology:
- family hx
- if parent is alcoholic and has been in trouble with the law their children are 3x more likely to have ODD.
ODD
-DSM V criteria
Criteria: must have 4 of the following 8 sx:
- often loses temper
- touchy or easily annoyed
- angry/resentful
- argues with authority figures
- actively defies or refuses to comply with requests from authority figures
- deliberately annoys others
- blames others for mistakes
- has been spiteful or vindictive at least twice in last 6 mo.
ODD:
- prognosis
- tx
some will outgrow this, others will continue to have ODD and develop other disorders such as ADHDD, depressive disorder, etc. only 5% continue to have ODD without anything else.
Tx:
- referral to pediatric psychiatrist
- meds for comorbid disorders
- behavioral therapy
- parental therapy for setting clear boundaries.
Conduct Disorder
- what?
- factors that contribute to this mental illness?
What: group of behavioral and emotional problems in children that have difficulty following rules and behaving in a socially acceptable way. “bad kids or delinquents”
Factors:
- brain damage
- child abuse
- neglect
- genetic vulnerability
- school failure
- traumatic life experience
