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Neurodevelopmental Disorders Flashcards

1
Q

What is the role of a psychiatrist in when treating intellectual disability?

A
  1. Complete evaluation
  2. Appropiate interventions
  3. Screen for other psychatric disorders
    - 35 to 40% will have at least 1
  4. Coordinate necessary services
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2
Q

What two areas are evaluated to make the dx of intellectual disability?

A
  1. Intelligence - Cognitive function
  2. Adaptive functioning
  3. Developmental period
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3
Q

Intelligence metrics

A
  1. Reasoning
  2. Problem solving
  3. Planning
  4. Abstract thinking
  5. Jugement
  6. Academic learning
  7. Experiential learning
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4
Q

Adaptive functioning

A
  1. Communication
  2. Socail particiaption
  3. Independent living
  4. Standards of developmental and societal independence and responsiblity
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5
Q

Symptoms of down syndrome

A
  1. Hypotonia
  2. Language and motor develomental delay
  3. Facial features
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6
Q

What is the most common cause of moderate to severe intellectual disability?

A

Down syndrome

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7
Q

What is the second most common cause of intellectual disability?

A

Fragile X

- Xq27.3 locus

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8
Q

What are some preventive measures that can be taken to avoid intellectual disability?

A 
Pregnancy
- Avoid alcohol
- Immunize
- Nutrition- Folic acid and vitamins
Diet restriction
- PKU
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9
Q

What comes after prevention?

A

Intervention

  • Early education
  • Speech therapy
  • OT
  • Family therapy
  • Respite care
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10
Q

What psychiatric condtions are common in patients with intellectual disability?

A
  1. Depression
  2. Anxiety
  3. Psychosis
  4. Conduct disorder
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11
Q

How do comorbid psychiatric disorders often present in patients with intellectual disability?

A
  1. Behavioral distrubance

2. Aggression

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12
Q

What must be ruled out if a patient with intellectual disability starts to present with aggression or self-destructive behavior? Other then psychiatric disorders

A

Pain

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13
Q

What is the minimal level of intellectual disability that can hold a job?

A

Mild

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14
Q

What is the most common cause of intellectual disability?

A

Idiopathic

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15
Q

When are symptoms of ASD typically identified?

A

When they child is put in an environment with children from their age group

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16
Q

What are the typical symtoms of autism?

A
  1. Social reciprocity
  2. Poor peer interaction
  3. Poor language development
  4. Repetitive and odd play
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17
Q

What is the identifying factor of a child with RETT syndrome?

A
  1. Progressive encephalopahty
  2. Loss of speech
  3. Gait issues
  4. Stereotyped movements
  5. Microcehpaly
  6. Poor social interaction skills

History of normal development
Female disorder

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18
Q

What are some stereotyped behaviors?

A
  1. Spinning toys
  2. Toe walking
  3. Hand flapping
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19
Q

What neurotransmitter is abnormal in autism?

A

Serum serotonin

- Elevated

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20
Q

What anatomical abnormality has been seen on MRI in patients with autism?

A

Increased cortical thickness

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21
Q

fMRI has show decreased activity in what area of the brain in patients with autism?

A

Prefrontal regions

- Dysfunction of the frontostriatal networks

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22
Q

What deficits may be present in the limbic areas in patients with autism?

A

Glutamate/glutamine

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23
Q

What is the corner stone of diagnosing autism?

A
  1. Impaired social interaction skills
  2. Impaired communication
  3. Repetitive and stereotyped patterns of behavior
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24
Q

Impaired social interaction

A
  1. Nonverbal behaviors
  2. Failure to develop social appropiate peer relationships
  3. Lack social reciprocity
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25
Repetitive and stereotyped patterns of behavior
1. Inflexible adherence to rules 2. Stereotyped motor mannerisms 3. Preoccupation with parts of objects
26
What conditions need to be considered in patients suspected of having autism?
1. Intellectual disability 2. Schizophrenia 3. OCD
27
What distinguishes autism from intellectual disability?
Intellectual disability will not have 1. Restricted activities or interests 2. Impariments in communication and social skills
28
What distinguishes autism from schizophrenia?
1. Social symptoms will present later in life 2. Positive family history 3. Less intellectual impairment
29
What distinguishes autism from OCD?
1. Normal course of development | 2. No impairments in social skills or communication
30
What is the cornerstone of treatment for autism?
Multimodal - Family education - Behavior shaping - Speech therapy - Occupational therapy - Education planning
31
What is the goal of treatment for autism?
Development of basic skills
32
What are psychiatric disorders are often coexisty with autism?
1. ADHD 2. OCD 3. Behavior disorders 4. Psychosis
33
What medications have show some promise in treating symptoms of autism?
Risperidal Aripripozole- Irritability symptoms Oxytocin- Nonverbal communication
34
What is a proposed etiology causing autism?
Unkown | - Complex heritable and in utero environmental influence
35
What is the best predictor of future outcome in patients with autism?
Languange development
36
What conditions must be ruled out when making a diagnosis of autism?
Hearing or vision difficulties that may lead to poor language development
37
What are the diagnostic steps involved in dx intellectual disability?
1. Individualized intelligence testing | 2. Adaptive functioning
38
What are the most commonly used medications to treat tourette disorder?
1. Risperdal 2. Clonidine 3. Aripiprazole
39
How many motor and vocal tics need to be present for tourette disorder?
Multiple motor | 1+ verbal
40
How long do the tics for tourette disorder need to be present?
1+ year
41
When must the tics for tourette disorder begin?
Before 18
42
Is there a genetic disposition to tourette disorder?
Yes, most likely AD
43
What is a dangerous side effect of antipsychotics (haloperidol and pimozide)?
Long QT
44
Slow, irregular, writhing movements
Athetoid movements
45
Dancing, random, irregular, nonrepetitive movement
choreiform
46
Vocal tic involving involuntary vocalization of obscenities
Coprolalia
47
Slower than choreiform movements, these are twisting motion interspersed with prolonged states of muscular tension
Dystonic
48
Intermittent, coarse, large-amplitude, unilateral movements of limbs
Hemiballistic
49
Brief, shock-like muscle contractions
Myoclonic
50
Sudden, rapid, recurrent, nonrhythmic, stereotype motor movement or vocalization
Tic
51
When does the motor component of tourette disorder usually present?
7 years of age
52
When does the vocal component of tourette disorder usually present?
11 years of age
53
Tourette disorder has a strong relationship with what other psychiatric disorders?
OCD | ADHD
54
What neurotransmitter abnormalities are suspected in tourette disorder? What part of the brain?
Decreased GABA and increased Dopamine | Caudate nucleus
55
What other conditions may present with myoclonus, athetosis, dystonias, and hemiballismus?
Huntington chorea Wilsons Strokes
56
What organism is responsible for Sydenham chorea?
Beta-hemolytic strep/Group A Strep - Joints - Heart - CNS
57
What tic disorder gets worse during the winter-spring seasons?
Pediatric autoimmune neuropsychiatric disorder associated with strep infection (PANDAS)
58
What is the cornerstone for treating tourette disorder?
1. Somatic therapies | 2. Psychotherapies
59
Which psychotherapy has shown the most efficacy in treating tourette disorder?
Habit reversal training - Awareness of premonitory urge - Develop competing response
60
When should medications be used?
Moderate to severe tics
61
Where does clonidine act in the brain?
Presynaptic alpha-adrenegic receptors (agonist) | Locus ceruleus
62
Where does guanfacine act in the brain?
Postsynaptic alpha-adrenergic receptors (agonist) | Prefrontal
63
Where to atypical antipsychotic work in the brain?
Block dopamine and serotonin | Decrease input from the substantia nigra and ventral tegmentum to the basal ganglia
64
What would be some examples of "atypical" vocal tic?
Throat clearing Grunting Squeaking
65
What are some examples of motor tics?
Hair rubbing Picking scabs Any repetitive and intricate hand or arm movement

Case Files Psychiatry (10 decks)

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