Flashcards in Developmental disorders Deck (146):
Reactive Attachment disorder
History of extreme insufficient care
What are the symptoms seen with reactive attachment disorder?
1. rarely seeks comfort or rarely responds to comfort
2.minimal responsiveness to others
3. limited positive affect
4. episodes of unexplained sadness, irritability , fearfulness
What are the criteria for Intellectual Disability disorder?
Deficits in intellectual functions
problems with adaptive functioning
onset during developmental period
How do you calculate IQ?
Mental age/chronological age
What is the Vineland Adaptive behaviour scale?
Assesses social skills from birth to 19
question are directed to primary caregivers
What is the Diagnostic adaptive behaviour scale (AIDD)?
How is it assessed ?
Measures adaptive behavioural skills
looks at three areas conceptual, social , practical life skills
What are the types of Intellectual disability disorders?
Mild - guidance needed
Moderate- directive support
severe- constant supervision
profound -dependent on others
What is Autism Spectrum disorder?
Persistent problems with social interaction and communication
deficits in nonverbal behaviours
difficulty developing , understanding and maintaining relationships
Restricted / repetitive patterns (routine, repetitive movements, fixed interest)
Resemblance to cat like behaviour
At what age is Autism spectrum disorder diagnosed?
After age 2
What are the stages of Autism spectrum disorder?
Requiring support- difficult socially, inflexibility interferes with behaviours
Requiring substantial support - problematic social communication , inflexible behaviours
Requiring very substantial support- severe social deficits, rigid behaviour
Who is most affect by autism spectrum disorder?
What is autism spectrum disorder attributed to?
Failure to apoptosis ; brain at age 3 tries to take in as much information as it will not have neuroplasticity from that point onward so it tends to look much larger
What is attention deficit hyperactivity disorder?
inattention - 6 maths of 6 symptoms
hyperactivity- 6 maths of 6 symptoms
symptoms must be present across multiple settings
When is ADHD diagnosed?
Prior to age 12
What are some characteristics of ADHD?
lower dopamine levels
delays in frontal lobes and anterior cingulate gyrus
What are the treatments for ADHD ?
Behavioral therapy +methylpenidate or destroamphetamine
2nd: atomoxetime, modafinil
What is disruptive mood dysregulation?
Recurrent temper outburst - verbal & physical
btw outburst : irritable or angry
When is disruptive mood dysregulation diagnosed?
6 -18 yrs
What is oppositional defiant disorder?
Persistent angry, irritable, argumentative, defiant , vindictive
When are the symptoms of oppositional defiant disorder first seen?
What is intermittent explosive disorder?
verbal and behavioural outburst
Aggression is out of proportion to stressor
Mood btw outburst: normal
repetitive disregard for other
underage of 18 yrs
earlier onset -worst prognosis
seeing self emotions in others
refusal to accept reality
there is only two extremes no middle ground
Gap in thinking process
what was conscious is permanently posed from awareness
Redirection of emotions to a different target
return to earlier functioning
psychological action produces physical symptoms
parts of the outside world is brought in to make self
Isolation of affect
cognitive facts retained; emotion pushed aside
emotion pushed aside and replaced with excessive cognition
emotion pushed aside and replaced with excessive sensation producing behaviours
expression of the opposite of what is felt
action to fix or repair the unacceptable
reasons why an action or reason is OK
hostility expressed by inaction
self separated from experience
conscious decision to push thins into unconscious
the unpleasant becomes laughter
doing good to feel good
Acceptable means to gratify unacceptable impulse
Unconscious emotion from the past are brought to the present
What is the ADOPT-R model?
Assess: open ended questions
Differentials :close ended questions
Options: present all options
Plan: be able to negotiate
Treatment: verbal & written instructions w reminders
pays for 65 and older, disabled, or dependents of disabled
deductibles & copayments
Part A- Hospital payments
Part B- Physician payments
Part C- Hospital care payments
Part D- Drugs
poor or near poor
pays for everything
old response to new stimulus
new response to an old stimulus
What is the living will?
it only applies to end of life care
it is the clear wishes of the patient
What is Power of Attorney ?
This person speaks as the patients voice
Competency in children
Children are not competent until 18 so parents or guardians must be consented
Exception to competency in children ?
parent cannot withhold life or limb saving procedures
age 13 emancipated minor
age 14 partial emancipation for health issues such as contraceptive, STI, substance disorders, pregnancy & prenatal , mental health
abortions can follow teenagers wishes but parents must be told
brain off , body on
brain on , body off
What are the characteristics of Sleep?
Delta is first 4 hrs , REM is second half from 5hrs onward
initial sleep cycle take 90 mins before REM
Stepwise progression to delta
If you remember your dreams what sleep stage did you wake up from ?
If you dont remember tour dreams what sleep stage did you wake up from?
What are the waves seen
awake= beta waves
drowsy = alpha waves
stage 1= theta waves
stage 2= steep spindles & K complexes
stage 3= delta waves
REM= sawtooth. similar to awake
When does stage 3 sleep vanish?
65 and older
What Neurochemicals play a role in Sleep?
serotonin- helps initiate sleep
acetylcholine-higher during REM sleep
norepinephrine - lower during REM sleep
Dopamine- produces arousal and wakefulness
Important characteristics of melatonin?
made in pineal gland and in the retinas of the eyes
effects suprachiasmatic nucleus above optic chasm
daylight inhibits release
How does sleep affect major depression?
decreases REM latency
early morning waking
sleep deprivation decreases depression symptoms
What are neurochemial help sleep ?
serotonin- sense of sleep
Melatonin- need for sleep
Adenosine - puts you to sleep
What is the importance of REM sleep ?
Removal of waste products
for learning and making memories
excessive sleeping despite seven or more hours
recurrent lapses into sleep
sleep is unrefreshing
sleep attacks with cataplexy, hypocretin ,rapid REM
What are some characteristics with Narcolepsy ?
What is sleep related hypoventilation?
decreased respiration with elevated CO
What is the key symptoms of sleep related hypoventilation
headaches in the morning
What the types of Sleep Apnea?
Obstructive: middle age, overweight, Loud snoring, something is blocking the air passage
Central:elderly, failure of apart of the respiratory system , cheyene-stokes respiration
What is the most common cause of death in sleep apnea patients?
Nocturnal cardiac arrhythmia
panic attack while sleeping
tachycardia, profuse sweating
dreams not recalled
run in the family
4 to 12 yrs
recalled after waking
3 to 8 yrs
Assoc with major depression, anxiety disorder, PRSD, substance abuse
stage 2 of sleep
Restless leg syndrome
unpleasant urge to move limbs
can be due to iron deficiency
What pathway is affected in substance abuse?
NAC ; medial forebrain bundle(MFB)--> Nucleus accumbens--> ventral segmental area
What is the assessment of alcohol abuse?
Cut down on intake
Annoyed about criticism
Guilty about drinking
What are the two complications with alcohol abuse?
Wernicke encephalopathy: acute, thiamine deficient , reversible, altered mental status, ataxia and ophthalmoplegia
Korsakoff psychosis: irreversible , chronic, retrograde amnesia, confabulation, disorientation, polyneuritis + Wernickes triad
What are the withdrawal reaction of alcohol abuse?
1: tremors (6 to 8 hrs)
2: hallucinations (1 to 2 days)
3:seizures (1 to 2 days)
4 delirium tremans (3 to 5 days since last drink)
What are the drugs given for alcohol withdrawal ?
Benzos: chlordiazepoxide (long, self-tapers), lorazepam ( short acting, tapered over 4 to 5 days)
What is longterm treatment for alcoholics?
Alcoholics Anonymous - friend of bill , al non for family
disulfram ( prevent relapse): gives an unpleasant reaction to alcohol
acamprosate ( increase rate of abstinence): acts on GABA & NMDA
topiramate (prevent relapse): stimulates GABA --> decrease dopamine release
Naltrexone (decrease cravings): blocks endogenous opioids
Flumazenil(reduces relapse): benzo receptor antagomist
What are the characteristics of nicotine users?
days lost from work
What are the withdrawal reactions of nicotine ?
reduced heart rate
What are the treatments for nicotine abuse?
provide other options that will motivate -family, appearance
Buproprion: antidepressant,reduces cravings
Varenicline:receptor partial agonist
Bromocriptine: dopamine agonist
What is the mechanism of cannabis?
inhibit G protein
What is the mechanism of cocaine/amphetamines?
cocaine: block reuptake of dopamine
amphetamines: stimulate the release and blocks the reuptake of dopamine
What are the symptoms of cocaine/ amphetamine use?
enhanced sexual experience
hallucinations & delusions
itchy/ bleeding nose
What are the withdrawal reactions of cocaine/amphetamines?
no shaking or vomiting
What are the treatment options for cocaine/amphetamine abuse?
What are the intoxication symptoms of opiates?
respiratory & cardiac depression
What are the withdrawal reaction of opiates?
Flu like symptoms for 7 to 10 days
What are the treatments for opiates?
Naloxone (receptor antagonist) 90 min half life given for respiratory depression
Naltrexone(decrease craving):24 hr half life
Clonidine (alpha 2 agonist): palliative
Methadone/ LAMM : long acting substitute
buprenorphine (partial agonist): taken sublingually, prevents IV abuse
LSD/ Mushrooms mechanism
Partial agonist of serotonin
What are the symptoms of intoxication with LSD/shrooms?
lack of coordination
altered sense of reality -flashbacks
Phencyclidine (PCP) & Ketamine (special K) intoxication symptoms ?
What is the treatment for PCP & special K
antipsychotic , bentos, vitamin C
What is the mechanism of NMDA (ecstasy)?
releases dopamine, norepinephrine & serotonin
What are the intoxication symptoms
sense of personal closeness with other
hyperthermia and dehydration are seen late
What are the withdrawal reactions for ecstasy - NMDA?
fatigue, change in appetite, difficulty concentrating, anxiety
grossly disorganized behaviour
What are the physiologic abnormalities ?
frontal lobe, hippocampus, amygdala atrophies
decreased metabolism of glucose
Less than 6 months
grossly disorganized behaviour
Brief psychotic disorder
Less than 1 month then return to normal
grossly disorganized behaviour
one or more delusions for at least 1 month
What is the treatment for schizophrenia?
Typical antipsychotics ( D2 receptor blockers)
Atypical antipsychotics (D4, D2, 5HT2 receptors)
What are the extrapyramidal effects of schizophrenia ?
week 1: dystonic reactions
week 2 : akinesia
week 3: rigidity
week 6: tremors
week 10: akathisia
week 18: pisa
What are other schizophrenia drug side effects?
Neuroleptic Malignant syndrome
A rare life threading condition to due high does typical antipsychotics
What are the symptoms of neuroleptic malignant syndrome?
elevated creatine phosphokinase (CPK)
white blood cell count
Treatment for neuroleptic malignant syndrome
cardio and respiratory support
alkalization of urine & fluids
Acute dystonic reaction
sudden, sustained, involuntary muscle spasm
> high potency antipsychotics
Major Depressive Disorder
over two week period = one episode
loss or weight gain
insomnia/ hyper insomnia every day
20 to 30 yrs old
heritability index :42%
What are patients with major depressive disorder susceptible to ?
coronary heart disease
impaired immune function
leading cause of disability
What are some biologic findings of major depressive disorder?
high glucose- high REM sleep
small hippocampus--> worst as time passes
Persistent depressive disorder
mild or severe
depressed mood for more days than not for at least 2 yrs
When do you used electroconvulsive therapy?
What is the contraindication for electroconvulsive therapy?
increased intracranial pressure
at least one manic episode
at least one hypomania episode and at least one major depressive episode
NO Manic episode
numerous periods of elevated mood but never manic
What is the definition of manic episodes?
at least 1 week
abnormal and persistent elevated and irritable mood
increased goal directed activity
decreased need for sleep
involvement in high potential activities
What is the definition of hypomanic episodes ?
at least four days
abnormal and persistent elevated and irritable mood
What drugs are mood stabilizers>
Valproic Acid- enhances GABA
carbamazepine - stabilizes inactive state of voltage gate
Lamotrigine - inhibits folate sensitive sodium channels
Obsessive compulsive disorder
ideas you cannot stop that come > 1 hr/day
increased frontal lobe activity
increased caudate nucleus activity
Body dysmorphic disorder
belief that some part of the body is malformed or ugly
Hair pulling disorder
Somatic symptom disorder
physiologic stressor causes pyschologic stressor
Illness anxiety disorder
high anxiety about health but no symptoms
Conversion disorder (FNSD)
motor/ sensory dysfunction causing physical symptom
Falsification od physical or psychological symptoms
binge and purge
Avoidant/ restrictive food intake
belief that something is wrong with the food --> weight loss
life threatening weight loss
What are the characteristics to personality disorders?
seen in all areas of life
symptoms are ego-syntonic- believe they are normal
one way of responding
What are the personality disorders in cluster A?
What are the personality disorders in cluster B?
What are the personality disorders in cluster C?
Paranoid personality disorder
suspicious and disbelieving of everyone and expecting betrayal in most situations
Schizoid personality disorder
Loner and likes to be alone
Schizotypal personality disorder
odd life pursuits; collections
Narcissistic personality disorder
arrogant and entitles behaviour
low self esteem
Histrionic personality disorder
emotionally dramatic and theatrical
Borderline personality disorder
constant state of chaos
love hate relationships
may present with superficial cutting
Antisocial personality disorder
lifeling pattern of criminal behaviour
no remorse, guilt or shame for actions
Avoidant personality disorder
avoid relationships despite their desire mohave them
timid; socially withdrawn
stay in same job, relationship
Dependent Personality disorder
Gets others to run their lives
may end up abused spouse