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Flashcards in Developmental disorders Deck (146):
1

Reactive Attachment disorder

History of extreme insufficient care

2

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

3

What are the criteria for Intellectual Disability disorder?

Deficits in intellectual functions
problems with adaptive functioning
onset during developmental period

4

How do you calculate IQ?

Mental age/chronological age

5

What is the Vineland Adaptive behaviour scale?

Assesses social skills from birth to 19
question are directed to primary caregivers

6

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

7

What are the types of Intellectual disability disorders?

Mild - guidance needed
Moderate- directive support
severe- constant supervision
profound -dependent on others

8

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

9

At what age is Autism spectrum disorder diagnosed?

After age 2

10

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

11

Who is most affect by autism spectrum disorder?
What is autism spectrum disorder attributed to?
Treatments?

Male>female
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
Shaping

12

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

13

When is ADHD diagnosed?

Prior to age 12

14

What are some characteristics of ADHD?

males> females
lower dopamine levels
delays in frontal lobes and anterior cingulate gyrus

15

What are the treatments for ADHD ?

Behavioral therapy +methylpenidate or destroamphetamine
2nd: atomoxetime, modafinil

16

What is disruptive mood dysregulation?

Recurrent temper outburst - verbal & physical
btw outburst : irritable or angry

17

When is disruptive mood dysregulation diagnosed?

6 -18 yrs

18

What is oppositional defiant disorder?

Persistent angry, irritable, argumentative, defiant , vindictive

19

When are the symptoms of oppositional defiant disorder first seen?

Preschool

20

What is intermittent explosive disorder?

verbal and behavioural outburst
Aggression is out of proportion to stressor
Mood btw outburst: normal

21

Conduct disorder

repetitive disregard for other
males>females
underage of 18 yrs
earlier onset -worst prognosis

22

Projection

seeing self emotions in others

23

Denial

refusal to accept reality

24

splitting

there is only two extremes no middle ground

25

Blocking

Gap in thinking process

26

Repression

what was conscious is permanently posed from awareness

27

Displacement

Redirection of emotions to a different target

28

Regression

return to earlier functioning

29

Somatization

psychological action produces physical symptoms

30

introjection( identification)

parts of the outside world is brought in to make self

31

Isolation of affect

cognitive facts retained; emotion pushed aside

32

Intellectualization

emotion pushed aside and replaced with excessive cognition

33

Acting out

emotion pushed aside and replaced with excessive sensation producing behaviours

34

Reaction formation

expression of the opposite of what is felt

35

Undoing

action to fix or repair the unacceptable

36

Rationalization

reasons why an action or reason is OK

37

Passive aggressive

hostility expressed by inaction

38

Dissociation

self separated from experience

39

Suppression

conscious decision to push thins into unconscious

40

Humor

the unpleasant becomes laughter

41

Altruism

doing good to feel good

42

Sublimation

Acceptable means to gratify unacceptable impulse

43

Transference

Unconscious emotion from the past are brought to the present

44

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
Relationship :

45

Medicare

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

46

Medicaid

poor or near poor
pays for everything

47

Classical conditioning

old response to new stimulus

48

Operant conditioning

new response to an old stimulus

49

What is the living will?

it only applies to end of life care
it is the clear wishes of the patient

50

What is Power of Attorney ?

This person speaks as the patients voice

51

Competency in children

Children are not competent until 18 so parents or guardians must be consented

52

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

53

NREM

brain off , body on

54

REM

brain on , body off

55

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

56

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?

REM

Delta

57

What are the waves seen
awake
drowsy
stage 1
stage 2
stage 3
REM

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

58

When does stage 3 sleep vanish?

65 and older

59

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

60

Important characteristics of melatonin?

made in pineal gland and in the retinas of the eyes
effects suprachiasmatic nucleus above optic chasm
daylight inhibits release

61

How does sleep affect major depression?

Increases REM
decreases REM latency
early morning waking
sleep deprivation decreases depression symptoms

62

What are neurochemial help sleep ?

serotonin- sense of sleep
GABA- relaxation
Melatonin- need for sleep
Adenosine - puts you to sleep

63

What is the importance of REM sleep ?

Removal of waste products
for learning and making memories

64

Hypersomnolence disorder

excessive sleeping despite seven or more hours
recurrent lapses into sleep
sleep is unrefreshing

65

Narcolepsy

sleep attacks with cataplexy, hypocretin ,rapid REM

66

What are some characteristics with Narcolepsy ?

sleep paralysis
hypnagogic hallucinations
HLA-DQB1 *06:02

67

What is sleep related hypoventilation?

decreased respiration with elevated CO

68

What is the key symptoms of sleep related hypoventilation

headaches in the morning

69

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

70

What is the most common cause of death in sleep apnea patients?

Nocturnal cardiac arrhythmia

71

Night Terror

panic attack while sleeping
tachycardia, profuse sweating
dreams not recalled
run in the family
Male> female
4 to 12 yrs

72

Nightmare

Anxiety dream
recalled after waking
3 to 8 yrs
Assoc with major depression, anxiety disorder, PRSD, substance abuse

73

Bruxism

Teeth grinding
stage 2 of sleep

74

Restless leg syndrome

unpleasant urge to move limbs
can be due to iron deficiency

75

What pathway is affected in substance abuse?

NAC ; medial forebrain bundle(MFB)--> Nucleus accumbens--> ventral segmental area

76

What is the assessment of alcohol abuse?

CAGE
Cut down on intake
Annoyed about criticism
Guilty about drinking
Eye-opener

77

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

78

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)

79

What are the drugs given for alcohol withdrawal ?

Benzos: chlordiazepoxide (long, self-tapers), lorazepam ( short acting, tapered over 4 to 5 days)

80

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

81

What are the characteristics of nicotine users?

depression
erectile dysfunction
days lost from work

82

What are the withdrawal reactions of nicotine ?

depressed mood
reduced heart rate
irritability
trouble sleeping
anxiety
increased appetite

83

What are the treatments for nicotine abuse?

behavioural change
provide other options that will motivate -family, appearance
Buproprion: antidepressant,reduces cravings
Varenicline:receptor partial agonist
Bromocriptine: dopamine agonist

84

What is the mechanism of cannabis?

inhibit G protein
increase GABA
increase serotonin

85

What is the mechanism of cocaine/amphetamines?

cocaine: block reuptake of dopamine
amphetamines: stimulate the release and blocks the reuptake of dopamine

86

What are the symptoms of cocaine/ amphetamine use?

enhanced sexual experience
excessive talking
tachycardia
dilated pupils
hallucinations & delusions
itchy/ bleeding nose

87

What are the withdrawal reactions of cocaine/amphetamines?

Crash
very hungry
no shaking or vomiting

88

What are the treatment options for cocaine/amphetamine abuse?

Cocaine anonymous
bromocriptine
amatadine

89

What are the intoxication symptoms of opiates?

pupillary constriction
constipation
sweating
respiratory & cardiac depression
slurred speech

90

What are the withdrawal reaction of opiates?

Flu like symptoms for 7 to 10 days

91

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

92

LSD/ Mushrooms mechanism

Partial agonist of serotonin

93

What are the symptoms of intoxication with LSD/shrooms?

hallucinations
illusions
tremors
lack of coordination
altered sense of reality -flashbacks

94

Phencyclidine (PCP) & Ketamine (special K) intoxication symptoms ?

Violence
agitation
adrenaline strength
paranoia
Vertical nystagmus

95

What is the treatment for PCP & special K

antipsychotic , bentos, vitamin C

96

What is the mechanism of NMDA (ecstasy)?

releases dopamine, norepinephrine & serotonin

97

What are the intoxication symptoms

sense of personal closeness with other
dilated pupils
sensory distortion
hyperthermia and dehydration are seen late

98

What are the withdrawal reactions for ecstasy - NMDA?

fatigue, change in appetite, difficulty concentrating, anxiety

99

Schizophrenia factors

delusions
hallucinations
disorganized speech
grossly disorganized behaviour
negative symptoms

100

What are the physiologic abnormalities ?

frontal lobe, hippocampus, amygdala atrophies
decreased metabolism of glucose

101

Schizophreniform disorder

Less than 6 months
delusions
hallucinations
disorganized speech
grossly disorganized behaviour
negative symptoms

102

Brief psychotic disorder

Less than 1 month then return to normal
delusions
hallucinations
disorganized speech
grossly disorganized behaviour
negative symptoms

103

Delusional disorder

one or more delusions for at least 1 month

104

What is the treatment for schizophrenia?

Typical antipsychotics ( D2 receptor blockers)
Atypical antipsychotics (D4, D2, 5HT2 receptors)

105

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
Tardive dyskinesia

106

What are other schizophrenia drug side effects?

metallic taste
teeth deteriorate
sexual effects

107

Neuroleptic Malignant syndrome

A rare life threading condition to due high does typical antipsychotics

108

What are the symptoms of neuroleptic malignant syndrome?

autonomic instability
elevated creatine phosphokinase (CPK)
white blood cell count
hyperthermia

109

Treatment for neuroleptic malignant syndrome

cardio and respiratory support
cool blankets
alkalization of urine & fluids

110

Acute dystonic reaction

sudden, sustained, involuntary muscle spasm
males> females
> high potency antipsychotics

111

Major Depressive Disorder

over two week period = one episode
loss or weight gain
insomnia/ hyper insomnia every day
females>males
20 to 30 yrs old
heritability index :42%

112

What are patients with major depressive disorder susceptible to ?

coronary heart disease
impaired immune function
suicide risk
leading cause of disability

113

What are some biologic findings of major depressive disorder?

high glucose- high REM sleep
small hippocampus--> worst as time passes

114

Persistent depressive disorder

mild or severe
depressed mood for more days than not for at least 2 yrs

115

When do you used electroconvulsive therapy?

depression
schizophrenia
bipolar disorder

116

What is the contraindication for electroconvulsive therapy?

increased intracranial pressure

117

Bipolar I

at least one manic episode

118

Bipolar II

at least one hypomania episode and at least one major depressive episode

NO Manic episode

119

Cyclothymic disorder

numerous periods of elevated mood but never manic

120

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
easily distracted
involvement in high potential activities

121

What is the definition of hypomanic episodes ?

at least four days
abnormal and persistent elevated and irritable mood

122

What drugs are mood stabilizers>

Lithium
Valproic Acid- enhances GABA
carbamazepine - stabilizes inactive state of voltage gate
Lamotrigine - inhibits folate sensitive sodium channels

123

Obsessive compulsive disorder

ideas you cannot stop that come > 1 hr/day
increased frontal lobe activity
increased caudate nucleus activity

124

Body dysmorphic disorder

belief that some part of the body is malformed or ugly

125

Trichtillomania =

Hair pulling disorder

126

Somatic symptom disorder

physiologic stressor causes pyschologic stressor

127

Illness anxiety disorder

high anxiety about health but no symptoms

128

Conversion disorder (FNSD)

motor/ sensory dysfunction causing physical symptom

129

factitious disorder

Falsification od physical or psychological symptoms

130

Bulimia nervosa

binge and purge

131

Avoidant/ restrictive food intake

belief that something is wrong with the food --> weight loss

132

Anorexia nervosa

life threatening weight loss

133

What are the characteristics to personality disorders?

lifelong
seen in all areas of life
symptoms are ego-syntonic- believe they are normal
inflexible
one way of responding

134

What are the personality disorders in cluster A?

Paranoid
schizoid
schizotypal

135

What are the personality disorders in cluster B?

Narcisstic
histrionic
borderline
antisocial

136

What are the personality disorders in cluster C?

avoidant
dependent
obsessive compulsive

137

Paranoid personality disorder

suspicious and disbelieving of everyone and expecting betrayal in most situations

138

Schizoid personality disorder

Loner and likes to be alone

139

Schizotypal personality disorder

very weird
magical thinking
odd life pursuits; collections

140

Narcissistic personality disorder

arrogant and entitles behaviour
low self esteem

141

Histrionic personality disorder

emotionally dramatic and theatrical
very shallow

142

Borderline personality disorder

constant state of chaos
love hate relationships
may present with superficial cutting

143

Antisocial personality disorder

AKA psychopath
lifeling pattern of criminal behaviour
no remorse, guilt or shame for actions

144

Avoidant personality disorder

avoid relationships despite their desire mohave them
timid; socially withdrawn
stay in same job, relationship

145

Dependent Personality disorder

Gets others to run their lives
may end up abused spouse

146

Obsessive compulsive personality disorder

perfectionist
rules and discipline
lack humour
can't stand change