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
Differences between Conduct disorder and ODD?
- ODD have worse social skills
- ODD do better in school
- Conduct disorder is the most serious childhood psychiatric disorder*
Conduct Disorder is characterized by?
Tx
Prognosis
Characterized:
- aggression to people and animals
- bullies, physical fights, use of weapons to harm others
- steals
- forces others into sexual acts
- destruction of property (arson)
- lying
Tx:
- referral to psychiatrist for
- -behavioral therapy
- -psychotherapy
- -parental support and training
- -medications for comorbid conditions such as ADHD, depression, or anxiety.
Prognosis:
- substance abuse
- 4x more likely to develop personality disorder when grown up
- risky sexual behaviors
Depression:
-Diagnostic criteria
Dx criteria: at least 5 of the following sx during same 2wk period: -depressed mood -anhedonia -sleep disturbance -weight change (up or down) -decreased concentration -suicidal ideation -fatigue or loss of energy -feelings of worthlessness -inappropriate guilt -sleeping all the time or insomnia -psychomotor agitation (figidity unintentional purposeless motions), retardation (neglecting appearance, showering, not taking care of yourself).
Signs and Sx of Major Depression
SIGECAPS
Sleep disturbance
Interests (anhedonia)
Guilt
Energy
Concentration probs
Appetite change
Pleasure (decreased)
Suicidal thoughts or actions
Tx for Depression
Psychotherapy
Medical therapy
Combination or both
Medical:
- SSRI:
- -prozac (fluoxetine)
- -lexaproa (escitalopram)
- These are only 2 FDA approved, use others off label.
What are the SSRI black box warnings?
-increased suicidality risk
