Unit 2: adhd, eating disorders, substance abuse Flashcards
etiology of ADD/ADHD
- genetics
- metabolic issues
- CNS trauma or infection
- premature birth
- sleep apnea & other organic causes
- majority is unknown
ADD/ADHD is the most common _______
neurodevelopment disorder
ADD/ADHD can occur alone or with other comorbidities such as
- learning disabilities
- anxiety disorders (MOST COMMON)
- depression
ADD/ADHD occurs in _____% of children and _____% of adults
- 7-8% of children
* 2.5% of adults
triad of symptoms/characteristics for ADD/ADHD
- hyperactive- impulsive = interrupting, taking risks, “bugs” people, hyperactive
- inattentive = messy, not organized, no timg mgmt, fails deadlines, can occur with OSA
- combined type
early diagnosis of ADD/ADHD and treatment is important for ______ outcomes
improved
major factors of ADD/ADHD treatment failure are (2)
- improper dx
* failure to recognize comorbidities
symptoms need to be present before age _____ and in more than 1 _____
- 12
* setting
mgmt ADD/ADHD
- treat comorbidities
- behavior modification techniques
- social skill training
- counseling
meds for ADD/ADHD are usually what class?
stimulants
CNS stimulants are a schedule _____ drug
2
stimulants have a high potential for ____ & _____ and therefore you must assess ______ risk before prescribing and monitor for symptoms during use
- abuse and dependence
* abuse risk
every pt on stimulants needs a baseline _____ eval
cardiac
pts on stimulants with additional cardiac risk factors require _____ and _____ assessment (in addition to cardiac) at baseline and when else?
- BP and HR
* after dose increase and periodically
in peds what other baseline assessment is needed prior to initiation of stimulants
- height and weight
* required periodically as well
if pt is under prolonged tx with stimulants what other dx tests should you consider?
annual CBC w diff and platelets (why?)
stimulant names mentioned in pt
*methlyphenidate = concerta, ritalin, quillichew ER, etc…
ALWAYS check for _____ when rx’ing stimulants…. or anything really….
drug interactions
you must discuss ______ with pts on stimulants
safety
ppt says “can get jail time” meaning if they sell or if we dont discuss safety….?
non stimulant meds for ADD/ADHD
- bupropion
- clonidine Er
- Guanfacine
- Atomoxetine adjunct 2nd line
- others when treating other comorbidities
non stimulants can be used _____ or with other _____ when treating ADD/ADHD
alone or in combo with other stimulants
eating disorders mentioned in ppt (5)
- anorexica nervosa (AN)
- bulimia nervosa (BN)
- binge eating disorders (BED)
- atypical AN
- avoidant-restrictive food intake disorders (ARFID)
etio of eating disorders?
strong evidence in genetics
*other theories = environmental factors
psychological factors
societal factors (promotion of thinness)
science is unsure if neurotransmitters ______ to the development of EDs or if the changes are a ________ of the physiologic changes associated with the EDs
- contribute to
* consequence of
dx of AN in adolescents….
see ppt… vague but general stuff we’re all prob already aware of
dx of AN in adults
- disturbance of body image
- intense fear of becoming fat
- weight loss leading to body weight <15% below expected
- absence of 3 consecutive menstrual cycles
2 major types of AN are?
- restricting
- binge-eating/purging
- can have combination
atypical AN is defined as what?
someone having a type of AN but weight is normal or above normal
what labs should you check on a pt w AN?
TSH, electrolytes, LFTs, cholesterol, CBC w diff, creatinine, phosphorus, calcium, magnesium, U/A, EKG, bone density
_____ is a common side effect of AN, esp in females with amenorrhea
osteoporosis
AN is associated with what thyroid disorder?
functional hypothyroid (euthyroid sick)
name 3 s/s of hypothyroid
- hair thins
- brittle nails
- dry skin
AN is associated with what arrythmia? especially in what position?
- brady
* supine
AN is associated with what BP abnormality? what is the A&P behind this?
- hypotension
- LV mass decreased»_space; stroke volume compromised»_space; peripheral resistance increases»_space;> all contribute to LV systolic dysfunction
AN can develop what 2 cardiac irregularities?
- prolonged QTc syndrome
- increased QT dispersion (irregular QT intervals)
- ***these put them at risk for cardiac arrythmias
AN is associated with what circulatory abnormalities?
- decreased peripheral circulation
* hands and feet maybe cold/blue
AN is associated with what dermatologic abnormality?
- lanugo
* primal response to starvation
as the GI tract adapts to reduced intake associated with AN… what s/s might you see?
- early satiety
- GERD
- inability take in normal amounts of food
in AN normal _______ reflex may be ______ due to lack of stimulation by food. This can cause what 2 symptoms?
- gastrocolic reflex
- bloating and constipation
- delayed gastric emptying may develop
what labs should you check in a pt with BN?
- electrolytes
* amylase (may be increased due to chronic parotid stimulation)
treatment for enlarged parotid glands ST BN?
heat
suck tart candy
what labs do you want to check in BED?
- thyroid
- cholesterol
- trigs
BED treatment?
psychotherapy, meds
meds for BED?
topamax antidepressants vyvyanse wellbutrin nutritional supps if needed
for dx s/s of BED must occur at least _____ for how long?
- 1x/week
* 3mo
ARFID definition:
*avoidance or restriction of oral food intake
ARFID definition:
- avoidance or restriction of oral food intake
- ABSENCE OF criteria for AN (disturbed body image, fear of weight gain/body fat)
- **AN w/o distress of body shape or fears of fatness
s/s of ARFID
- lack of interest in eating
- avoidance to sensory characteristics of food (?)
- concern for aversive consequences of eating (?)
- inadequate nutritional/energy needs met
there is a lack of what AN feature in the ARFID dx?
*lack of drive for thinness
treatment for ARFID?
- brief medical hospitalizations
* long psychiatric or residential hospitalizations…. wtf
labs to run on pts suspected of substance abuse?
- urine & blood tests
* hair - can be false +
treatment for SA?
- office-based
- inpt
- outpt
- individual/group
- may need detox
_____ is the gateway drug and usually begins in ______ school and occurs more in boys or girls? whites or other races?
- alcohol
- middle school
- boys > girls
- whites > other races
______ is the most common illegal drug
marijuana
nicotine addiction can occur as quickly as ______
one month
smoking cessation referral sources:
- 1-800-quitnow
- tobacco cessation clinics
- community programs
- psychotherapies
five A’s for tobacco cessation
- ask
- advise
- assess
- assist
- arrange
meds for tobacco cessation include (4) and can decrease relapse rates by _____x as those quitting without
- sustianed release antidepressants
- bupropion
- clonidine
- nortriptyline
- 5x
facility referrals for tobacco cessation
- low-intensity
- outpt
- school based
- residential
- hospital based
- day treatment
- dual-diagnosis facilities
