Psych Impulse, Disruptive, CD Flashcards
Patient will present as → a 9-year-old boy who is brought by his mother after the child was suspended from school for being disruptive during class. The teacher noted that the patient is always fidgeting, has difficulty concentrating, and does not complete assignments. His mother notes that he often gets up and runs around the house when she is trying to call everyone for dinner and that this has been going on since he was 6 years old
ADHD
ADHD
Attention-Deficit Hyperactive Disorder:
→ Disease Presentation:
An 8-year old who is disruptive in class, always fidgeting, has difficulty concentrating and does not complete assignments
→ DSM-5:
- HYPERACTIVE, IMPULSIVE, INATTENTIVE BEFORE THE AGE OF 12!!!
- >6 symptoms, >6 months
** MUST OCCUR in more than 1 setting **
Fails to give attention, difficulty paying attention, doesn’t listen, can’t organize tasks, avoids tasks that require mental effort, loses things, forgetful, distracted
Fidgets, taps hand/leg, leaves their seat, can’t be quiet, on the go, blurts out answer, talks excessively, interrupts
→ Treatment:
Behavior Mods + CBT (<6 YO)
** MEDS >6 years old **
1st line: STIMULANTS
S/E: Weight Loss, Stunt Growth
Methylphenidate (Ritalin, Concerta)
Dexmethylphenidate (Focalin)
Amphetamine/Dextroamphetamine (Adderall)
NON-STIMULANT:
Atomoxetine (Strattera)
Good for hx of abuse
2nd Line: Antidepressants
Guanfacine, Clonidine, imipramine, bupropion, venlafaxine
Patient will present as → a 3-year-old boy is brought to your office by his mother due to abnormal behavior. She reports that he does not appear to respond to affection, does not look her in the eyes, and constantly lines up his toys. He becomes agitated when she tries to take him away from his toys or if the mother cooks a different meal for dinner. On physical examination, he does not respond to questions and is distracted by the texture of the exam-table cloth.
Autism
Autism Spectrum DO
Autism Spectrum Disorder:
→ Disease Presentation:
A child has normal cognitive development, poor relationships and does not spontaneously seek activities with others - Asperger disorder
OR
Disruption of social interaction and language at age 3 or earlier - Autistic disorder
** DX between 1-2 YEARS OLD **
→ DSM-5:
Neurodevelopmental disorders causing:
Impaired social interaction/comm.
Restricted, Repetitive Stereotypical behavior
Deterioration of social/language skills
Atypical social communication
Restricted, Repetitive Behavior/Interests
Avoiding eye contact
Sameness/Routines
Causes:
Prenatal neurological insults, Advanced maternal age, low birth weight
FRAGILE X = gene that causes ASD
→ Treatment:
Multidisciplinary:
Autism Specialist, S/L Pathologist
Behavioral therapy/Applied Behavior Anaylsis
Meds:
SGAPS: Risperidone, Aripiprazole
SSRIs: Behavior reps
Patient will present as → a 16-year-old male who has demonstrated significant behavioral and impulsive problems since early childhood, which were manifested more prominently when he was four. During this time he was removed from his mothers care due to her continuous substance abuse. She reported using alcohol, cocaine, and crack cocaine during her pregnancy. He has a history of repeated violations of school rules and disruption in class. He often was aggressive and cut school. He also reported torturing animals and doing “sexual things” to them. He once set his grandmother’s bed on fire while she was sleeping in it. Another disclosure involved playing in the backyard of his grandmother’s home where he burned several toys. Psychological testing was carried out and his results indicated an average IQ using the Wechsler Intelligence Scale for Children. His scale scores included a verbal score of 93, performance score of 104 and a full scale score of 95. Further testing revealed his struggles with an extremely low self-esteem. He also provided somewhat odd answers on a sentence completion assessment, mentioning several times “that I wish I was never born.
Conduct DO
Conduct DO
Conduct Disorder:
→ Disease Presentation:
A child is referred to your office for unusual animal cruelty and bullying at school
** Comorbidities: ADHD & ODD
** Processes to ANTISOCIAL Personality DO
→ DSM-5:
Physical or Sexual Violence + Lack of Empathy + Lack of Remorse
< 18 YO
BADD:
Breaking the law
Aggressive conduct
Destructive conduct
Deceitful
→ Treatment:
Multimodal:
Behavior Modifications, Family Involvement, Parental Management Training
Patient will present as → a 10-year-old boy whose parents c/o constant arguments. His parents state that he has “been a handful.” He argues all the time. He is always angry and is easily agitated. He seems to enjoy making others upset. At school, he does not listen to his teachers and argues with them all the time. His parents report that they are “fed up” with him and his behavior is “putting a lot of strain on our marriage.” Past medical history is significant for ADHD with panic disorder.
Oppositional Defiant DO
Oppositional Defiant DO
Oppositional Defiant Disorder:
→ Disease Presentation:
A child is found to back talk and resist following instruction from parents or authorities
** Can lead to CD **
→ DSM-5:
Negative, angry, irritable, argumentative, vindictive mood for at least 6 MONTHS
Must be with someone NOT a sibling - usually authority
DO NOT cause physical harm to the person
→ Treatment:
Psychotherapy/Behavioral Therapy
PARENT MANAGEMENT TRAINING
Can use: Antipsychotics, Mood stabilizers, or stimulants
Haldol, Thioridazine, Methylphenidate
