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Psychiatry clerkship > Neurodevelopmental/child disorders > Flashcards

Neurodevelopmental/child disorders Flashcards

1
Q

What are the main characteristics of intellectual disability (formerly mental retardation)?

A

Severely impaired cognitive and/or adaptive/social functioning

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2
Q

Diagnostic criteria for intellectual disability

A

Deficits in intellectual functioning (reasoning, problem solving, planning, abstract thinking, judgment, learning)
Deficits in adaptive functioning (communication, social participation, and independent living)
Deficits affect multiple domains: conceptual, practical, social
Onset during developmental period
Intellectual deficits confirmed by clinical assessment and standardized tests (scores <2SD below mean)
Requires ongoing support for ADLs

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3
Q

Genetic causes of mental retardation

A 
Down syndrome (1/700 live births)
Fragile X syndrome (second most common cause of ID)
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4
Q

Prenatal causes of mental retardation

A 
Infection and toxins
TORCH infections
Toxoplasmosis
Other (syphilis, AIDS)
Rubella
CMV
Herpes simplex
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5
Q

Perinatal causes of mental retardation

A 
Anoxia
Prematurity
Birth trauma
Meningitis
Hyperbilirubinemia
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6
Q

Postnatal causes of mental retardation

A 
Hypothyroidism
Malnutrition
Toxin exposure
Trauma
Psychosocial causes
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7
Q

What is global developmental delay?

A

Failure to meet expected developmental milestones in several areas of intellectual functioning
Diagnosis reserved for pts <5yo

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8
Q

What is specific learning disorder?

A

Delayed cognitive development in a particular academic domain (reading, writing, ‘rithmetic)

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9
Q

Diagnostic criteria for specific learning disorder

A
  • Academic skills significantly impaired/below expected for chronologic age, causing interference in school, occupation, or ADLs
  • Begins during school age
  • Affected areas: Reading (dyslexia), writing, or arithmetic (dyscalculia)
  • Not better accounted for by intellectual disabilities, sensory disabilities, language barriers, or poor education
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10
Q

What is speech sound disorder?

A

Difficulty producing articulate, intelligible speech

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11
Q

What is language disorder?

A

Difficulty acquiring and using language due to expressive or receptive impairment

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12
Q

What is childhood-onset fluency disorder?

A

Stuttering

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13
Q

What is social communication disorder?

A

Challenges with the social use of verbal and nonverbal communication.

*If restricted/repetitive behaviors, activities, or interests also present –> autism spectrum disorder

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14
Q

What are the main characteristics of ADHD?

A

Persistent inattention, hyperactivity, and impulsivity

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15
Q

Diagnostic criteria for ADHD

A

At least 6 inattentive symptoms and/or at least 6 hyperactivity symptoms
>6 months
Symptoms interfere with or reduce quality of social/academic/occupational functioning

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16
Q

Inattentive symptoms of ADHD

A

Fails to give attention to details/makes careless mistakes
Has difficulty paying attention
Does not appear to listen
Struggles to follow through on instructions
Difficulty with organization
Avoids or dislikes tasks requiring a lot of thinking
Loses things
Easily distracted
Forgetful in daily activities

17
Q

Hyperactivity symptoms of ADHD

A

Fidgets with hands/feet or squirms in chair
Has difficulty remaining seated
Runs about or climbs excessively in childhood; extreme restlessness in adults
Difficulty engaging in activities quietly
Acts as if driven by a motor
Talks excessively
Blurts out answers
Difficulty waiting or taking turns
Interrupts/intrudes

18
Q

Pharmacologic treatments for ADHD

A

First line: stimulants (methylphenidate, dextroamphetamine, mixed amphetamine salts)
Second-line: atomoxitene (norepi reuptake inhibitor)
Alpha-2 agonists (clonidine, guanfacine) can be used instead or as an adjunctive treatment

19
Q

Nonpharmacologic treatments of ADHD

A

Behavior modification techniques and social skills training
Educational interventions
Parent education

20
Q

What are the characteristic features of autism spectrum disorder (ASD)?

A

Impairments in social communication/interaction

Restrictive, repetitive behaviors/interests

21
Q

Diagnostic criteria for ASD

A

Problems with social interaction and communication
–Impaired social/emotional reciprocity
–Deficits in nonverbal communication
–Interpersonal challenges
Restricted, repetitive behaviors/interests/activities
–Intense, peculiar interests
–Inflexible adherence to rituals
–Stereotyped, repetitive motor mannerisms
–Hyper/hyporeactivity to sensory input
Begin in early development period
Not better accounted for by ID or GDD
Significant social or occupational impairment

22
Q

Etiology of ASD

A

Prenatal neurologic insults, advanced paternal age, LBW
Genetic
Fragile X –> single gene cause of ASD

23
Q

Management of ASD

A 
Early intervention
Remedial education
Behavioral therapy
Psychoeducation
Low dose atypical antipsychotic meds for disruptive behavior, agitation, aggression, irritability
24
Q

Characteristic features of operational defiant disorder

A

Irritability/anger, defiance, vindictiveness

25
Q

Diagnostic criteria for ODD

A

At least 4 symptoms present for at least 6mos (with at least 1 person not a sibling)
–Anger/irritable mood: loses temper, touchy/easily annoyed, often angry/resentful
–Argumentative/defiant behavior: breaks rules, argues with authority figures, deliberately annoys others
–Vindictiveness: spiteful at least 2x in past 6mos
Distress or impairment in functioning

26
Q

Treatment for ODD

A

Behavior modification, conflict management training, problem-solving skills
Parent management training (setting limits, enforcing consistent rules)
Meds for comorbid conditions (e.g. ADHD)

27
Q

Diagnostic criteria for conduct disorder

A

Pattern of recurrently violating the basic rights of others or societal norms, with at least 3 behaviors over 6 months:

  • -Aggression to people and animals
  • -Destruction of property
  • -Deceitfulness or theft
  • -Serious violations of rules (stays out late before age 13, runs away at least 2x, skips school before 13)
28
Q

Diagnostic criteria for Tourette’s disorder

A

Multiple motor and at least 1 vocal tic present for >1 year
Onset prior to age 18
Not cause by a substance or medical disease (e.g. Huntington’s)

29
Q

Epidemiology of tic disorders and Tourette’s

A

Transient tic behaviors common in kids
Tourette’s in 3/1000 school-aged children
Boys>girls

30
Q

Etiology of Tourette’s

A

Genetic

Prenatal/perinatal factors: older paternal age, obstetric complications, maternal smoking, LBW

31
Q

Course/prognosis of Tourette’s

A

Onset between 4-6yo, with peak severity 10-12yo
Tics wax and wane, change in type
Symptoms tend to diminish in adulthood
High comorbidity with OCD and ADHD

32
Q

Management of Tourette’s

A 
Psychoeducation
Behavioral interventions - habit reversal
Meds only if tics are impairing
Alpha-2 agonists: guanfacine, clonidine
Anti-psychotics if severe
33
Q

What are elimination disorders?

A

Developmentally inappropriate elimination of urine or feces

34
Q

Diagnostic criteria for enuresis

A

Recurrent urination into clothes or bed-wetting
2x/wk for at least 3 consecutive months, or clinical distress or marked impairment
At least 5 years old (developmentally)
Not due to a substance or medical condition

35
Q

Diagnostic criteria for encopresis

A

Recurrent defecation into inappropriate places
Occurs at least 1x/month for at least 3 months
At least 4 years old (developmentally)
Not due to a substance or another medical condition (except via constipation-related mechanism)

36
Q

Treatment for enuresis

A

Limit fluid and caffeine intake at night
Behavioral monitoring and reward system, bladder training exercises, or urine alarm
Drugs: DDAVP first-line, imipramine second-line

37
Q

Treatment for encopresis without constipation

A

Comprehensive behavioral program (bowel retraining) for appropriate elimination

38
Q

Treatment for encopresis with constipation

A

Initial bowel cleaning followed by stool softeners, high-fiber diet, and toileting routine

Psychiatry clerkship (11 decks)

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