week 11 Flashcards
what is attention deficit-hyperactivity disorder (ADHD)
- inappropriate degree of inattention, impulsiveness, hyperactivity that interferes w functioning
- most frequently identified when child enters elementary school
- some children can have attention deficit disorder without hyperactivity
- often meets diagnostic criteria for more than one psychiatric disorder
what can attention problems and hyperactivity contribute too
low frustration tolerance, temper outbursts, labile moods, poor school performance, difficulty with peers and low self esteem
what are the presenting symptoms of ADHD (3 main categories)
- inattention
- difficulty paying attention during tasks or play
- difficulty listening
- easily distracted
- does not pay attention to social cues - hyperactivity
- fidgets, climbs in unable to sit still
- constant movement
- talks excessively
- talks excessively - impulsivity
- difficulty waiting turns, interrupts, and intrudes on conversations
- for a diagnosis of ADHD, symptoms must be present in at least 2 settings
i.e. home and school
describe the etiology of ADHD
- includes both genetic and environmental components
- one of the most heritable conditions in terms of psychiatric disorders
- viral infections, smoking during pregnancy, nutritional deficiency, and alcohol exposure in the fetus have also been explored as possible causes
- decreased dopaminergic receptors in the frontal lobes
- anterior cingulate gyrus and dorsolateral prefrontal cortex are found to be small in individual with ADHD
- activity in the frontostriatial region is also reduced in individuals with ADHD
what are 2 therapeutic treatment for ADHD
- CBT
- stimulants (amphetamine or methylphenidate)
ADHD 3 categories of medications just state + what meds r in each
- immediate release psycho-stim
- methylphenidate (ritalin)
- dextroamphetamine (dexedrine) - long-acting psycho-stimulants
- dextroamphetamine (adderall XR)
- lis-dexamphetamine (vyvanse)
- methylphenidate HCL (foquest, biphentin, concerta) - non-stimulants
- guanfacine (alpha-2A agonist) [intuniv]
- atomoxetine (SNRI) [strattera]
what is methyphenidate
CNS stimulant approved for treatment of narcolepsy and ADHD
MoA for methylphenidate
inhibits the reuptake of dopamine and norepinephrine**
increased dopaminergic and noradrenergic activity in the prefrontal cortex may explain its efficacy in ADHD
higher doses of psychostimulants on receptor stimulation do…
shown to increase NE and DA efflux throughout the brain which can result in impaired cognition and locomotor activating effects
low doses of psychostimulants on receptor stimulation do…
found to selectively activate NE and DA in the prefrontal cortex, thereby improving clinical efficacy and preventing side effects
when is methylphenidate/psychostimulants contraindicated
in pts using MAOI’s
risks/side effects of methylphenidate/psychostimulants
- serious CVS events have occured in associated w CNS-stim in peds pts w structural cardiac abnormalities
- stroke and MI have been reported in adults w stimulants
- increased BP and HR
- may cause psychotic or manic symptoms
most common SE: headache, insomnia, upper abdo pain, decreased appetite, and anorexia
- controlled substance that has high risk for abuse
what is guanfacine
non-psychostimulant
selective alpha-2A adrenergic receptor agonist, reduces the effect of sympathetic nervous system on the heart and circulatory system
-> decrease adrenergic (epinephrine and NE) response, leading to lower BP, decrease in hyperactivity, drive, impulsivity, insomnia, and emotional over-reaction
is guanfacine a controlled substance
not controlled, and is not a drug for high risk of abuse
side effect of guanfacine
sedation
low bp
dizziness
dry mouth
irritability that does not go away with time
vomiting
decreased HR
nausea
stomach pain
what is suicidal ideation
a (very) broad construct
- spectrum of thoughts ranging from indifference about life and death to imminent intent to die by suicide
-“active” suicidal ideation includes plans for harm whereas suicidation ideation does not
s/s of suicide ideation -> strong ideation/desire
depression
hopelessness
thwarted belongingness
perceived burdensomeness
psychological pain
symptoms of most mental disorders
s/s of suicidal intent/planning -> suicide attempt
capability*
access to means
preparation/mental rehearsal
pain tolerance
fearlessness about death - risk taking, painful and or terrifying events, life-threatening experiences
5 steps in addressing fears of hospitalization
- normalization
- shame attenuation
- gentle assumption
- symptom amplification
- denial of the specific
NGASR
nurses global assessment of suicide risk
characteristics of suicidal thoughts and images
- frequency
- intensity
- duration
ACE
adverse childhood experience
4 R’s for approaching trauma informed care
Realizing trauma’s impact
Recognizing s/s
Responding w procedures, policies, practices
Resistign retraumatization
6 key principles in trauma-informed care
- safety and trust
- cultural humility
- collaboration/choice
- empowerment
- sensitivity to triggers
- reducing stigma
