Psychiatry Flashcards
ADHD
-treatment-
1. Psychosocial
- parents and children make goals to improve relationship, study skills and behaviour
2. Behavioural
- identify problem behaviours and set goals
3. Medications
- methylphenidate/dexamphetamine
- atomoxetine (NRI), TCA, clonidine
Borderline personality disorder
pervasive pattern of instability: interpersonal relationships, self-image, affects, impulsivity in variety of contexts
1. Effort to avoid real of imagined abandonment
2. Unstable/intense interpersonal relationships
3. Identity disturbance
4. Impulsivity
5. Recurrent suicidal behaviour
6. Affective instability
7. Chronic feeling of emptiness
8. Inappropriate/intense anger
9. Transient stress related paranoia/dissociative symptoms
Oppositional Defiant Disorder
prevalence: 2-16%
definition: negativitistic, hostile, defiant behaviour > 6 months
Criteria: 4 of
- often losing temper
- often argues with adults
- often actively defies adults requests/rules
- deliberately annoys people
- blames others for own mistakes
- touchy/ easily annoyed by others
- angry/ resentful
- spiteful/ vindictive
- impairs daily living
- doesn’t meet criteria for conduct disorder
Prevalence at 15yrs
1. Anxiety 10%
2. Mood 8%
3. Conduct/Oppositional 10%
4. ADHD 5%
5. Substance abuse 7%
Chronic disease with disability: 3x risk
Chronic disease: 2x risk
Neuroepileptic disorder: 6x risk
Risk factors attachment disorder
- hx prolonged separation
- neglect/FTT
- abuse
- extreme psychosocial risk
- parental psychopathology
- parental substance abuse
Risk factors psychiatric illness
- hx maternal mental illness/anxiety
- rigid parental beliefs
- unskilled worker
- low maternal education
- disadvantaged minority
- large family
- poor family support
- stressful life events
Schizophrenia
prodrome: decreased concentration/attention, decreased motivation, sleep disturbance, anxiety, social withdrawal, paranoia
DSM criteria >2 of:
- delusions
- hallucinations
- disorganised speech (derailment/incoherence)
- grossly disorganised/catatonia behaviour
- negative affect (flat/avolition)
duration:
- <6months: schizophreniform
- <1month: brief psychotic disorder
Schizophrenia inheritance
risk for individual if:
- sibling has schizo: 9%
- parent has schizo: 13%
- non identical twin: 17%
- identical twin has schizo: 50%
*general population 1%*
School refusal
common: 1-2%
cause: young children SAD, older children social phobia
associations: anxiety 40-50%, depression 50-60%, oppositional behaviour 50%, somatic complains common
treatment: family and or family therapy
Specific Learning Disorder
incidence: school age, 15-20%, M>F
clinical: learning problems but otherwise normal intelligence and development
classification
- input problems: auditory/visual perceptual disability
- integration problems: sequencing, abstraction difficulty
- memory problems: short and long term
- output problems: speech and language, skill problem (ie dyslexia 80% LD)
Stimulant medications side effects
mechanism: enhancement of dopaminergic and noradrenergic neurotransmission
common SE: headache, nausea, loss of appetite, anxiety, insomnia, dry mouth
infrequent SE: movement disorders, tics, rash, wt loss, growth retardation
rare SE: psychosis, liver dysfunction
Treatment Depression
Antipsychotics
1st generation: D2 receptor antagonist
- eg. haloperidol (movement), chlorpromazine (agranulocytosis, cholestatic jaundice, retinitis)
2nd generation (atypicals): post-synaptic D2 block, 5HT2 agonist
- eg. risperidone, quietiapine, olanzapine, clozapine
- SE: weight (olanzapine/clozapine), prolactinaemia, sedation, long QT
