Psychiatry Flashcards
1
Q
ADHD criteria
A
At least 6 months of inattention or hyperactivity/impulsivity, with symptoms present before age of 12, and affects daily functioning
Inattention (at least 5) DAFFODILL
- Distractible
- Avoids or dislikes lengthy tasks
- difficulty remaining Focused
- Forgetful in daily activities
- difficulty Organising tasks
- gets Distracted in tasks
- Inaccurate/makes mistakes
- doesn’t Listen when spoken to
- Loses things necessary for tasks
Hyperactivity/impulsivity (6 symptoms) FLORISTS
- Fidgets
- unable to engage in Leisure quietly
- On the go
- feels Restless
- Interrupts others
- Stands up inappropriately
- Talkative
- can’t Stand in queue
2
Q
ASD evaluation and management
A
Hx
- Early
- > quiet/placid or irritable/can’t put down
- > fussy eaters/difficult to wean onto solids
- > reduced pointing and appropriate eye gaze
- > no reciprocity/social game/initiating socialising
- > play alone/not interested in other kids
- > poor eye contact/reduced expressions/poor integration
- > particular habits/distressed when order disturbed
- > repetitive sensory habits (smelling/tasting/touching)
- > repetitive motor mannerisms (flapping/spinning/bounce)
- Older
- > difficulty making/keeping friends
- > disengaged/distracted in class
- Development
- > almost always signs by 2yrs
- > social and language development most affected
- > stereotyped speech/repetitive speech
- > patterns of play
- Family
- > affected siblings/parents
- > family with similar traits
Exam
- Dysmorphic features
- Wood’s lamp
- > hypo-pigmented macules (tuberous sclerosis)
Management
- Diagnosis
- > two specialists
- Investigations
- > formal audiometry
- > karyotyping (fragile x)
- Intensive Behavioural Interventions
- > reinforce desirable/decrease undesirable
- > uses reward based system
- > one-on-one and time intensive (40hrs a week)
- Early Start Denver Model
- > delivered by trained therapists and parents
- Social Skills Training
- > buddy system at school with modelled behaviour
- > group setting with role play
- Family support and education
- > organisations
- > workshops
- > counselling
- Risperidone
- > hyper-activity/aggression/distractibility/stereotypies
3
Q
ADHD evaluation and management
A
Hx
- Inattention
- > distractible
- > avoids lengthy tasks
- > forgetful
- > disorganised
- > inaccurate in tasks
- > loses things
- > doesn’t listen
- Hyperactivity
- > fidgets + restless
- > avoids leisure activities/on the go
- > interrupts others + talkative
- > can’t stand in queues
- Development
- > onset before 12
- Past
- > antenatal/perinatal illness
- > low birth weight
- Family
- > siblings or parents
- Social
- > disruption in at least two settings
- > learning difficulty + discipline at school
- > childhood adversity
- Comorbidities
- > ASD
- > anxiety
- > depression/bipolar
- Treatment medications
- > heart disease
- > substance use
- > tic disorder
- > psychosis
- > depression
Exam
- height/weight/bmi
- > stimulants
- movement disorder
- > tourettes
- cardiovascular
- > arrhythmia
- > HTN
- > CHD
Management
- Diagnosis
- > specialist
- > neuropsych testing
- > corroborative from school
- Non pharm
- > psychoeducation
- > involvement of school for monitoring
- > address comorbidities
- Dexamfetamine/Methylphenidate
- > monitor growth and weight
- > tourettes/depression/psychosis/cardiac/abuse
- > start low and titrate up to response
- > short acting onset = 30mins/ offset = 6 hrs
- > trial once/twice daily dosing short acting
- > long acting means no dosing at school/less rebound
- Atamoxetine
- > when stimulants contraindicated
- > delayed effects of several weeks
- > increased suicidal thoughts
- > QT prolongation
4
Q
CP evaluation and management
A
Hx
- PC
- > onset and evolution
- > stable spasticity by 5 years old
- Antenatal
- > scans
- > maternal exposures
- > maternal infections/serology/immunisation
- Perinatal
- > prematurity
- > birth asphyxia/trauma
- > abruption/uterine rupture
- Post natal
- > jaundice
- > sepsis
- > respiratory
- > seizures
- > meningitis
- > blood spot screening
- Development
- > attainment/regression of milestones
- Family
- > genetic disorder
- Social
- > shaken baby
Exam
- Growth
- Development
- Inspect
- > dysmorphism
- > dystonia/chorea/athetosis (dyskinetic)
- Tone (spastic)
- > hip adduction/knee/ankle flexion
- > wrist/elbow/thumb flexion with pronation
- Reflexes (spastic)
- > increased
- > clonus
- > primitive reflexes
- Power
- > mono/hemi/di/quadri-plegia
- Coordination
- > gait (toe walking/scissoring)
- > balance/past pointing/scanning speech/nystagmus (ataxic)
Investigations
- MRI
- > periventricular leukomalacia
- > enlarged ventricles
- Coags
- > if hemiplegia
- > haemorrhagic infarction
- Genetic testing
- > dysmorphic features
- Metabolic screen
- Serial xrays
- > hip subluxation
- > spinal scoliosis/hyphosis/lordosis
Management
- Specialist assessment
- > disability and growth motor classification
- MDT
- > OT/physio/speech therapy
- > paediatrician
- > surgeons
- Spasticity
- > orthoses/splinting/bracing for contractures
- > walking aids/crutches/scooters
- > botulinum toxin muscle injection
- > surgery (tendon transfers/contracture releases)
- Dyskinetic
- > dystonia = levodopa +- diazepam +- deep brain stimulation
- > athetosis = haloperidol
- Ataxic
- > tremor = propanolol
- > incoordination = amantadine
5
Q
ID evaluation and management
A
Hx
- Antenatal
- > substances and medications
- > complications
- Perinatal
- > prematurity
- > HIE
- > resuss or NICU
- Post natal
- > hospital admissions
- > meningitis/encephalitis
- > TBI
- > growth
- Development
- > attainment/regression of milestones
- > global delay or specific impairment
- > hearing and vision
- > ASD
- > AHDH
- Family hx
- > genetic disorders
- > epilepsy
- > consanguinity
- Social
- > home stress
- > trouble at school/specific classes
- > interaction with other children
- Red flag
- > sudden change in previously well
- > headache with nausea/vomiting
- > focal neuro signs
- > lapses in attention or speech
Exam
- Growth
- > HC
- Development
- Syndromic features
- Auroscope
- Skin
- > facial fibroangiomata
- Neuro
- > synkinesias
- > gait
- > hyper-reflexia
- > spacticity
Management
- Supportive
- > family education
- > NDIS
- > social worker
- > school involvement
- Development assessment
- > ages and stages questionnaire
- > cognitive assessment - psychologist
- > speech and language - speech therapist
- > motor ability - physio
- Specialist referral
- > confirm diagnosis
- > step wise targeted investigations
- Comorbid psychiatric disorder
- > treat accordingly
- > symptoms expressed atypically/non-verabally
- > low dose risperidone has evidence for agitation
