4.4 Child and Adolescent psychiatry Dr. Graham Flashcards Preview

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Flashcards in 4.4 Child and Adolescent psychiatry Dr. Graham Deck (20)
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1
Q

What is the diagnostic triad for ADHD?

A
  1. Inattention
  2. Hyperactivity
  3. Impulsivity.

ADHD is a cluster of impairing symptoms relating to self-regulation = executive functioning.

2
Q

What are some common comorbid difficulties in ADHD?

A
Social communication difficulties
Learning disability
Attachment difficulties
Mood and anxiety problems
Behavioural disorders- OCC, CD
Substance use
3
Q

What is the prevalence of ADHD?

What is the ratio of boys to girls?

A

About 5.29% globally

M2:F1

4
Q

The working memory in those with ADHD resembles the elderly with what disease?

A

Alzheimer’s

5
Q

What are the main psychological treatment options for ADHD?

A

1st line: Parent training- New Forest Parenting Programme, behavioural classroom management strategies
2nd linke: social skills training, sleep and diet modifications

6
Q

What are the main pharmacological treatment options for ADHD?

A

1st line: (stimulants) Methylphenidate (‘Ritalin’)
Dexamfetamine
Lisdexamfetamine

2nd line: Atomoxetine

3rd line: Antidepressants, antihypertensives, antipsychotics

7
Q

What effect does methylphenidate (‘Ritalin’) have on the brain?

A

As a stimulant, it increased dopaminergic neurotransmission in networks involved in executive functioning.
Functions in the pre-frontal cortex, and others.

Directly improves symptoms
Minor side effects: appetite and sleep reduction
dysphoria, anxiety, and tics also possible SE.

8
Q

Is pharmacological treatment in ADHD effective?

A

YES! Unusually so.
NNT for methylphenidate, amfetamine, and atomoxetine are all 4. Compare to antidepressants and antipsychotics in depression and schizophrenia- which is 10.

9
Q

What is autism?

A

Problems in the area of social communication and interaction

And

restricted/repetitive patterns of thinking.

10
Q

How common is autism?

A

1 in 68

M>F

11
Q

What are the triad of impairments in autism?

A
  1. Qualitative impairment in reciprocal social interactions.
  2. Language and impairment deficits
  3. Restricted thought and behaviour
12
Q

What does it mean to have qualitative impairment in reciprocal relationships?

A
  1. Relationships difficult to establish
  2. Not motivated by need for social approval
  3. No interest in the needs of others
  4. Little awareness of the feelings of others.
13
Q

What does it mean to have language impairment/deficits?

A
No speech 
Difficulty using pronouns 
Speech intonation may be odd 
Difficulty interpreting non-verbal communication 
Difficulty with similes and metaphors 
Peculiar or no eye contact
Unresponsive to non-verbal feedback
14
Q

What does it mean to have restricted thought and behaviours?

A

Restricted, repetitive and stereotyped patterns of behaviour, interests and activities
Resistance to change
Lack of social imagination/theory of mind
Concrete and inflexible thinking
Ritualistic behaviours/stereotypies

15
Q

What assessment tools can help the diagnosis of autism?

A

Social responsiveness scale- screening
Semi-structured interview - 3DI
Standardized assessment tools- Autism Diagnostic Observation Schedule - ADOS

16
Q

How many symptoms min, in which categories must be fulfilled for the diagnosis of autism in the DSM IV TR?

A

Min 2 symptoms in social interaction- qualitative impairment
Min 1 symptom in communication-qualitative impairment
Min 1 symptom in behaviour- restrictive and repetitive

For a total of minimum 6 symptoms
They should have an early onset and be longstanding

17
Q

What pharmacological treatment can be used for short term significant aggression, tantrums or self-injury in autism?

A

RISPERIDONE

18
Q

What pharmacological treatment can be used for ADHD symptoms in autism?

A

METHYLPHENIDATE (‘RITALIN’)

19
Q

What pharmacological treamtent can be used for difficult sleep problems in autism?

A

Melatonin

Endogenous hormone secreted by the pineal gland

20
Q

What pharmacological treatment can be used to treat the core symptoms of autism?

A

None.

Maybe broccoli works. We don’t know.