Week 7 Flashcards
What is the appropriate age at which pharm tx is recommended or consided for in children with ADHD
6 years and older
In children with ADHD
1. dopamine decreases (distraction/focus) in prefrontal cortex
2. NE increases (distraction/focus) in prefrontal cortex
- distraction
- focus
Stimulants (methylphenidate, amphetamine, dextroamphetamine, dexmethylphenidate)
1. MOA
2. Used for what disorder?
- Increase catecholamines (dopamine, NE) in the synaptic cleft by blocking reuptake or increasing amount released into synapse
- ADHD
Methylphenidate, dextroamphetamine, amphetamine, dexmethylphenidate
1. What kind of drug are these?
2. In what situation is this used?
3. side effects
- stimulant
- ADHD
- Nervousness, agitation, anxiety, insomnia, anorexia, tachycardia, hypertension, weight loss, tics,
bruxism.
Atomoxetine
1. What kind of drug is this
2. What disorder is this used in?
3. MOA
4. side effects
- non-stimulant medication
- for ADHD
- inhibits reuptake of NOREPINEPHRINE
- dry mouth, sleep problems, anxiety, fatigue, etc
Clonidine, Guanfacine
1. What kind of drugs are these?
2. What disorder are these used in?
3. MOA?
- non-stimulant medications
- ADHD
- alpha 2 agonists - this agonism acts like norepinephrine
What is the preferential drug category that is 1st line therapy for ADHD?
- stimulant drugs
- What are the main hormones of attachment? (2)
- Where are they synthesized?
- oxytocin and vasopressin
- Hypothalamus
How do individuals most like endure/prolong bonds?
- start with dopamine and pleasure centers
- Propagated with oxytocin (bonding hormone) and vasopressin (increases prosocial behavior, particularly in males)
What are the 3 ways that oxytocin and vasopressin are circulated?
can act as hormones and NT
- How do you dx intellectual disabilities
- What are some warnings against dx
- IQ test and assessment of adaptive functioning
- Careful to dx very young children because may be too early to do so
What is the difference between language and speech disorders?
- Language has to do with vocabulary and grammar
- Speech has to do with sound of words
what is childhood onset fluency disorder?
stuttering, reptitions, or prolongation of sounds or syllables
what is social pragmatic communication disorder?
- pragmatic use of language is not understood by a person
- Pragmatics focuses on conversational implicatures—or that which a speaker implies and which a listener infers.
Autism Spectrum Disorder
1. At what ages are children screened
2. What screening test is used?
3. What typical tx is given to autistic children/adults
- at 9 and 18 months (more common in males - and overal more severe ASD at times)
- M-CHAT (screening does not equal dx)
- Behavioral management (shaping behavior)
What dx criteria is needed for ASD dx? (4)
- deficits in social interactions in multiple settings
- restricted, repetitive patterns (unwavering adherence to routines)
- Sx must impair function
- sx present in early development
ADHD (attention deficit/hyperactivity disorder)
1. more common in which sex and what age range
2. Dx criteria (6)
- males 6-12 years old
- frequent hyperactivity/impulsivity/poor impulse control
- present in more than one setting
- for at least 6 months
- present before age of 12
- impairs social/school functioning
- excessive for developmental level of the child
ADHD
1. Common co-morbidities
2. Affect to intelligence
- depression, tourette’s, oppositional defiant disorder
- normal intelligence
Rett syndrome
1. more common in which sex
2. inheritence pattern
3. sx (5)
- only occurs in females
- X linked dominant gene mutation in MECP2
- initially pts show normal development but then at 1-2 years they show regression of congitive/motor skills
- deceleration of head growth
- loss of motor, intellectual, speech abilities
- loss of balance (ataxia)
- repetitive hand movements
Tourette Syndrome
1. what age range is this first seen in
2. hallmark sx
3. co-morbid disorders?
- children
- recurrent tics (motor or speech)
- ADHD or OCD
Dx criteria for Tourette syndrome (3)
- tics for at least ONE YEAR
- onset before 18
- multiple motor tics and one or more phonic tics that occur many times a day
*coprolalia - when phonic tics include obscene language
Disruptive Disorder (DMDD)
1. presentation (3)
2. must occur before what age
3. common in what sex?
- persistant irritable or angy behavior, frequent temper outburts (at least 3 a week and in at least 2 settings), behavior out of proportion to situation
- age of 10
- males
Oppositional Defiant Disorder
1. what are some presentations/sx (8)
2. How many do you need for dx and for how long
- often loses temper
- often touchy or easily annoyed
- often angry
- often argues
- actively defies authority figures
- deliberately annoys others
- Blames others for their own mistakes
- spiteful and vindictive attitude
-> 4 sx for at least 6 months (individuals cannot be siblings)
Treatment of ODD
- Parent management training
- family therapy
- therapy in general
Intermittent Explosive Disorder
1. What is it?
2. What tx is given?
- recurrent behavioral outbursts representing a failure to control aggressive impulses (can be verbal (verbal fights, tantrums) or physical aggression (toward propery, animals, other individuals)) -> for 3 months
aggression does not damage property or injure animals or others - CBT and distress tolerance skills training
What is the difference between DMDD and Intermittent Explosive Disorder
- DMDD is a severe form of mood disorder in which anger is present most of time occurring before the age of ten
- IED describes individuals in whom aggressive outbursts are frequent but episodic and in whom anger is not present most of the time between outbursts.
Conduct Disorder
1. presentation/sx
2. what can it become in adults?
- repeated patterns of violating rights of others, aggression towards ppl and animals (including torture), destruction of property, lying or stealing
- Antisocial Personality Disorder as adult (most will not develop this though)
- what is pyromania?
- how is it tx
- deliberate and purposeful fire setting on more than one occasion
- CBT
- What is kleptomania?
- Recurrent failure to resist impulses to steal objects that are not needed for personal use or monetary value - but stealing is not done to express anger or vengeance it is done in response to impulse/hallucination
What are the two routes that visual signals can go through when registering fear and anxiety?
- thalamus (LGN) to amygdala (quick and dirty)
- thalamus (LGN) -> sensory cortex -> amygdala (slow and accurate)
What are the two routes that auditory signals can go through when registering fear and anxiety?
- MGN of thalamus -> primary auditory cortex
there may be a connection from MGN to amygdala
What is amygdala typically known to be responsible for?
The fear response
What is hippocampus typically known to be responsible for?
- Allows us to use memories of previous events to interpret the current events (context)
What is anterior cingulate typically known to be responsible for?
- interpret signals/resolving conflict information
What is medial frontal cortex typically known to be responsible for?
- inhibitory regulation of amygdala
Fear Response
Once signals reach amygdala -> amygdala sends out signals to 5 areas: including ….
- Hypothalamus
- periaquaductal gray
- locus coeuruleus
- VTA
- Basal ganglia/striatum
for what function??
- signals to hypothalamus to activate HPA stress axis (for release of cortisol, epi, NE) + increases heart rate
- sends out signal to periaquaductal gray (freeze response)
- sends out signal to locus coeuruleus (source of NE)
- sends out signal to Ventral tegmental area (has dopaminergic receptors)
- sends out signal to Basal ganglia/striatum (motor response)
- What axis does stress activate?
- How does trauma affect this?
- HPA axis - increase levels of cortisol
- Those with trauama lack inhibitory pathways to turn off HPA
Anxiety - what changes to these NT can improve anxiety
1. GABA
2. NE
3. 5-HT
4. BDNF
- increase GABA activity
- decrease NE output
- some 5HT receptors are anxiolytic but some are anxiety producing - so mechanism unknown (!!!)
- BDNF helps in neurogenesis. More BDNF is better to prevent anxiety.
0-12 months in child development
1. What motor milestones occur? (4)
- Primitive reflexes disappear (moro-3, rooting-4, palmar-6, and babinski-12)
- Posture - lifts head up prone, rolls and sits, crawls, stands, walks
- Picks - passes toys hand to hand
- Points at objects
0-12 months in child development
1. What social milestones occur? (3)
- social smile
- stranger anxiety
- separation anxiety
0-12 months in child development
1. What verbal/cognitive milestones occur? (3)
- orients themselves -> first to voice, then to their name and gestures
- Object permanence by 9 months
- Oratory - says mama and dada
12-36 months in child development
1. What motor milestones occur? (5)
- Cruises- takes first steps by 12 months
- climbs stairs
- cubes stacked
- cutlery - feeds self with fork and spoon
- kicks ball
12-36 months in child development
1. What social milestones occur? (3)
- recreation - parallel play
- rapprochement - moves away from parent and returns
- realization - core gender identity formed
12-36 months in child development
1. What verbal/cognitive milestones occur? (1)
- words - uses 50-200 words by 2yrs and 300+ by 3 yrs
3-5 yrs in child development
1. What motor milestones occur? (3)
- drive - tricycle
- drawings - copies line or circle
- dexterity - hops on one foot by 4 yrs, uses buttons or zippers
3-5 yrs in child development
1. What social milestones occur? (2)
- Freedom - comfortably spends part of day away from parent
- Friends - cooperative play, has imaginary friends
3-5 yrs in child development
1. What verbal/cognitive milestones occur? (2)
- language - understands 1000 words by 3yrs, uses complete sentences and prepositions by 4yrs
- Legends - can tell detailed stories by 4 yrs
What are the parts of the personality according to freud?
- Id
- Ego
- Superego
What is the difference between the Id, Ego, Superego?
- Id - is instinctual drives, desires
- Superego - societal rules
- Ego - reduces conflict between Id and superego
Explain the various stages to formation of ego
1. Oral (0-2)
2. Anal (2-4)
3. Phallic (4-6)
4. Latent (6-puberty)
5. Genital (puberty-forward)
- infant achieves gratification through oral activities like sucking thumb, babbling
- Child learns to respond to some of the demands of society like bowel and bladder control
- Child learns to realize the diff between males and females + becomes aware of sexuality
- Child continues his/her development but sexual urges are relatively quiet. Children have same sex friends.
- Direct sexual feelings toward others for sexual gratification
What is
1. moro reflex
2. rooting reflex
3. palmar reflex
- startle reflex where baby is startled by loud sound or movement
- involuntary response to stimulation of their mouth
- fingers of baby closing around an object when elicited by pressure to infants palm
Erikson 8 stages
1. Explain and give age range of **basic trust vs basic mistrust **
2. Explain and give age range of autonomy vs shame and doubt
- learn to trust a caregiver - if not then infants come to see human relationships as too disappointing or dangerous to rely on (birth - 1 year)
- To become independent via rudimentary aspects of living - failure will lead to self doubt (1-3 years)
Erikson 8 stages
1. Explain and give age range of Initiative vs Guilt
2. Explain and give age range of Industry vs Inferiority
- Children begin to assert their power and control over the world through directing play and other social interaction. Kids who don’t develop initiative at this stage may become fearful of trying new things or feel that they are doing something wrong.** (3-6 years)**
- Challenges to meet school and social demands - failure leads to feelings of inequality, inferiority, and worthlessness (6-12 years)
Erikson 8 stages
1. Explain and give age range of Identity vs Role
2. Explain and give age range of Intimacy vs Isolation
- To establish a sense of self as a physical, sexual, and vocational being. - Failure leads to indecision, vacillation, and sense of purposelessness (12-20 years)
- During this stage, the major conflict centers on forming intimate, loving relationships with other people. (20-40 years)
Erikson 8 stages
1. Explain and give age range of Generativity vs Stagnation
2. Explain and give age range of Ego integrity vs despair
- individuals become teachers of next generation and repay society - failure leads to stagnation and boredom (40-65 years)
- acceptance of one’s life - failure leads to cynicism and hopelessness (65 to death) - It represents the stage for positive resolution of the successes and failures of life leading to wisdom (if succesful in this stage)
Habituation vs Sensitization
- Habituation - learning process in which an innate response to a stimulus decreases after repeated exposure to the stimulus
- Sensitization -when repeated exposure to a stimulus results in an increased response to the stimulus
Piaget Stages of Cognitive Development
1. Sensorimotor - explain and give age range
Birth - 2 years
- Begins intentional action, object perminance is achieved, symbolic representation is achieved
Piaget Stages of Cognitive Development
1. Preoperational - explain and give age range
2-7 years
- Uses language to represent objects, images, and thoughts
-Thinking is still egocentric, hard to establish viewpoints
-Classifies objects by single features
Piaget Stages of Cognitive Development
1. Concrete operational - explain and give age range
7-11 years
- Can think logically about objects and events
-Achieves conservation of numbers
Piaget Stages of Cognitive Development
1. Formal operational - explain and give age range
11 years and onward
-Can think logically about abstract processes
- Becomes concerned with the hypothetical, future, and abstract concepts
Classical vs Operant conditioning
- Classical: Learning in which a natural response usually elicits involuntary responses. (salivation) is elicited by a conditioned, or learned, stimulus (bell) that previously was presented in conjunction with an unconditioned stimulus (food).
- Operant: use of pos/neg reinforcement and pos/neg punishment to elicit voluntary responses
Kohlberg Studies on Morality
1. Preconventional Morality
1a. Obedience and punishment
1b. Individualism and exchange
what does each stage mean
1a. acting to avoid punishment
1b. Acting to further one’s own interest
Kohlberg Studies on Morality
2. Conventional Morality
2a. Good Interpersonal Relationship
2b. Maintaining Social Order
what does each stage mean
- Decisions based on the approval of others
- Judgements based on the relative rules and laws of society
Kohlberg Studies on Morality
3. Post-Conventional Morality
3a. Social Contract and Individual Rights
3b. Universal Principles
what does each stage mean
- Social contract rules and laws of social good (what makes for a good society)
- Guided by moral principle or justice (achieving justice among all)
Ego defense mechanisms
1. Displacement
2. Projection
3. Reaction Formation
- Redirecting emotions to a substitute target (ex: taking out anger on a person that poses less of a risk)
- Attributing uncomfortable feelings to others (ex: ascribing your own unacceptable feelings to others)
- Overacting in the opposite way to the fear (young boy bullying a girl because he actually likes her)
Ego defense mechanisms
1. Sublimation
2. Dissociation
3. Idealization
- Redirecting “wrong” urges into more socially acceptable actions (a woman who recently went through a breakup may channel her emotions into a home improvement project.)
- Detaching from reality, often after sudden triggering event and pt may appear detached with flat affect
- emphasizing positive thoughts/memories and de-emphasizing negative thoughts/memories.
Ego defense mechanisms
1. Identification
2. Isolation
3. Splitting
- an individual, in varying degree, makes himself or herself like someone else; he identifies with another person
- Avoiding the experience of an emotion associated with a person, idea, or situation but can describe in detail. This defense mechanism may be present in someone who describes the day their house burnt down in a factual way without displaying any emotion.
- categorizing others at extremes. some are wonderful and some are horrible. Common in borderline personality disorder.
Ego Defense Mechanisms
1. Suppression vs Repression
- conscious defense mechanisms which is ignoring stressful thoughts/feelings to cope.
- unconscious pushing of uncomfortable thoughts into the subconscious
N1 stage of sleep
1. describe this stage
2. What waves are found
3. percentage of total sleep time (not an actual % but a description)
- lightest sleep and easy to wake up
- theta waves
- smallest % of total sleep time
N2 stage of sleep
1. describe this stage
2. What waves are found
3. percentage of total sleep time (not an actual % but a description)
- when teeth grinding occurs
- theta waves, K complexes, and sleep spindles (spindles occur in response to sensory stimulus)
- largest perecentage of sleep time
N3 stage of sleep
1. describe this stage
2. What waves are found
- deepest sleep and hardest to wake sleeper from. This is when sleep walking, talking, and bed wetting occurs
- delta waves
REM cycle
1. describe this stage
2. What waves are found
3. How long is one cycle
- dreaming, nightmares - when males get erect;; muscle paralysis
- low voltage and saw toothed type of waves + dissynchronous waves
- 90 minutes
- How does length of REM change throughout the night?
- How does sleep deprivation change REM
- What is REM movement behavior disorder
- Length of REM increases, NREM length decreases throughout the night
- decreases REM length
- When there is failure of muscle paralysis and ppl can enact their dreams. Associated with parkinsons, lewy body dementia, multiple system atrophy
What coordinates the rapid eye movement in REM phase?
- PPRF
- What waves occur when someone is awake w/eyes open
- What waves occur when someone is awake but eyes closed (getting ready for bed)
- beta waves - low amplitude and high frequency
- alpha waves - increased amplitude, more synchronous
- What part of the brain controls the circadian rhythms?
- How does it coordinate signals to create a circadian rhythm (2)
- suprachiasmatic nucleus of the anterior hypothalamus
- Suprachiasmatic nucleus takes in light info through retino-hypothalamic tract. This allows the SCN to know when there is ambient light in the environment.
- Light suppresses the release of melatonin from pineal gland which regulates circadian rhythm
- What is VLPO in sleep?
- What is the ARAS in sleep?
- Acts as a sleep promoter. It inhibits (via GABA) monoaminergic projections of the ARAS
- ARAS (a system) regulates wakefulness and sleep wake transitions. (works by releasing various NT through multiple locations in this system)
What stabilizes the sleep switch toward wakefullness and supports ARAS?
- orexin
- Those with narcolepsy have less orexin
Narcolepsy
1. What is it?
2. sx (4)
- a cause of excessive daytime sleepiness due to instability of the sleep switch (orexin)
- sleep attacks, cataplexy (losing muscle tone), sleep paralysis, hypnogogic hallucinations (occur when someone is falling asleep)
What is the nativist theory (chomsky)?
- supposes that the ability to learn language is inborn, but humans must experience using language to activate the language acquisition device
- There is a critical period to do this
Speech milestones specifically
1. Stage 1 (12-18 months)
- 12 months - 10 words and their own name
- 18 months - core vocabularly of about 50 words regularly used
Speech milestones specifically
1. Stage 2 (18-26 months)
- regularly use 100-200 words
- Can use multiple word sentences
- questions are being used
Speech milestones specifically
1. Stage 3 (2-3 years)
- can increase syntax skills, sentence organization, length, grammar
- 900-1000 words by age 3
Speech milestones specifically
1. Stage 4 (3-5 years)
2. 6-7 years and beyond
- as much as 90% of childs language is developed at this age
- speech is intelligible and socially useful, be able to tell a connected story
- What is the James-Lange theory of language development
- Cannon-bard theory
- Bodily changes lead to emotional feelings
- Argues physical arousal/change does not have to occur before emotion - they can occur at the simultaneously yet independently
Reactive Attachment Disorder
1. What is it?
2. sx (similar to what disease)
- in children who received negligent care or were vitims of abuse before the age of 5 and are subsequently unable to form healthy bonds with caregivers
- similar to ASD - detached, unresponsive to comforting, inhibited, and withdrawn
Disinhibited Social Engagement Disorder
1. What is it?
2. sx
- associated with early deprivation before age of 5 as well - but children show little to no reluctance to interact with adults
- hug strangers, sit on strangers laps
What are the 4 main types of child abuse?
- Physical abuse
- Sexual abuse
- Emotional abuse
- Child neglect
- What does emotional abuse cause in children?
- child feels worthless, unloved due to verbal abuse, criticism, intimidated, humiliated, etc
- confinement for prolonged periods of time as punishment
Vulnerable Child Syndrome
1. What is it?
problem of parental reactions to child where parent believe that child is highly susceptible to disease → child illness may be real or perceived
What is the TEN-4 rule?
Bruises concerning for maltreatment
1. T-torso
2. E-ear
3. N-neck
4. 4-> assess/report further if above bruises are seen in children <4 years old AND any bruise in children <4 months old
