Child and Adolescent Psychiatry Flashcards
(38 cards)
What is Tourette’s syndrome?
Neuropsychiatric syndrome characterised by motor and vocal tics which run a fluctuating course, and an increased association with behavioural abnormalities and other psychological conditions.
What is the typical age of onset of Tourettes?
5-6 years
Are men or women more likely to have Tourette’s?
Men, by 3-4 times.
Does Tourette’s have a genetic element?
Yes - there are strong familial links with Tourette’s and OCD and other tic syndromes. Likely to be sue to combination of a number of genes interacting.
What is a tic?
Sudden, purposeless, repetative, non-rhythmic stereotyped movement or vocalisation.
Other than motor or vocal tics, what are some symptoms that may be seen with Tourette’s?
Echolalia (repeat others’ words); paplilalia (repeat own words); Coprolalia (compulsive saying of swear/dirty words); copropraxia (obscene gestures); echopraxia (copy others’ movements); difficulty concentrating/easily distracted
What % of people with Tourette’s have concurrent ADD?
50%
What % of people with Tourette’s have concurrent OCD?
30-50%
What % of people with Tourette’s have concurrent behavioural problems?
80%
A parent brings their 6 year old to you because of concerns regarding unusual movements. What questions should you ask about family history if you are concerned about Tourette’s?
FHx of other movement disorders including Huntington’s, Wilson’s disease, epilepsy, and tics, as well as FHx of thyroid disease.
What history is important to ilicit when a patient presents with tics?
Age of onset, progression or pattern, do they wax and wane?
What are some genetic causes of tics that would rule out Tourette’s?
Huntington’s chorea; Kleinfelter’s syndrome
What are some acquired causes of tics that would ruel out Tourette’s?
Encephalitis, CVA, hyperthyroidism, CO poisoning, streptococcus-induced autoimmune tourette’s syndrome.
What drugs can cause tics to occur?
Cocaine; amfetamines; lithium; antipsychotics; antidepressants; antihistamines; opiates
What can exacerbate tics in Tourette’s syndrome?
Anxiety, stress, fatigue, and stimulants.
How should Tourette’s be managed?
Depends on the particular set of symptoms the patient gets and their needs.
Educational support.
Education of parents, patient, and schools.
Treat any underlying pathology.
Counselling
Some long term therapies can be used to reduce tics
What pharmacological therapy can be used for severe Tourette’s?
Antipsychotic risperidone.
Neuroleptics e.g. haloperidol, initiated by specialists.
What is the prognsis like for Tourette’s?
Peaks usually in early teenage years.
1/3 are symptoms free as adults, 1/3 have mild tics, and 1/3 require clinical attention.
What is ADHD?
A persistent and pervasive pattern of inattention, hyperactivity, and impulsivity, which interferes with functioning and/or development.
What does pervasive mean, in the context of ADHD?
Occuring across different aspects of the childs life i.e. with family, at school, in social settings etc.
How long do symptoms of inattention have to be apparent for for a diagnosis of ADHD?
6 months or more
What are some symptoms of inattention?
- Failure to concentrate on work at school
- Trouble sticking to one task or activity
- Doesn’t seem to listen when spoken to drectly
- Failure to follow-through with simple tasks
- Difficulty organising tasks
- Appearance of being forgetful
What are some symptoms of hyperactivity and impulsivity?
- Fidgeting/squirms in seat
- Leaving a situation when expected to stay
- Running/climbing when it is not appropriate
- Unable to play etc quietly
- “Driven by a motor”
- Talks excessively
- Trouble waiting their turn
- Interupts or intrudes on others
When do symptoms need to be apparent for a child to be diagnosed with ADHD?
Before age 12 - however sometimes the diagnosis is made much later due to lack of recognition.
