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):
1

What is the diagnostic triad for ADHD?

1. Inattention
2. Hyperactivity
3. Impulsivity.

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

2

What are some common comorbid difficulties in ADHD?

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

3

What is the prevalence of ADHD?
What is the ratio of boys to girls?

About 5.29% globally
M2:F1

4

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

Alzheimer's

5

What are the main psychological treatment options for ADHD?

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

6

What are the main pharmacological treatment options for ADHD?

1st line: (stimulants) Methylphenidate ('Ritalin')
Dexamfetamine
Lisdexamfetamine

2nd line: Atomoxetine

3rd line: Antidepressants, antihypertensives, antipsychotics

7

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

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

Is pharmacological treatment in ADHD effective?

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

What is autism?

Problems in the area of social communication and interaction

And

restricted/repetitive patterns of thinking.

10

How common is autism?

1 in 68
M>F

11

What are the triad of impairments in autism?

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

12

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

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

13

What does it mean to have language impairment/deficits?

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

What does it mean to have restricted thought and behaviours?

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

What assessment tools can help the diagnosis of autism?

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

16

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

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

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

RISPERIDONE

18

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

METHYLPHENIDATE ('RITALIN')

19

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

Melatonin
Endogenous hormone secreted by the pineal gland

20

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

None.
Maybe broccoli works. We don't know.