SoBe Disorders & Meds – Flashcards
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Hyperactivity Impulsivity Inattention Dxable at 12 yo Present in 2+ Settings
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ADHD
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ADHD Clinical Features
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Deficits in execuative function: planning, detail oriented, interrupts, little focus Coodination: spinning, poor penmanship
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Brain Areas Involved in ADHD
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Prefrontal Cortex Basal Ganglia Cerebellum Dorsal Anterior Cingulate Cortex Dorsal Lateral Prefrontal Cortex Prefrontal Motor Cortex Orbital Frontal Cortex
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ADHD Neurotransmission
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Decreased quantity of DA & NE Lower firing rate Decrease in receptors
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ADHD Treatment
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1. Adjunctive special education, support group, behavioral, family 2. Amphetamines 3. Non-stimulant meds 4. TCAs 5. Alpha-2 agonists
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ADHD Subtypes & Gender Prevalence
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Mixed: Male > Female Inattentive: Female > Male Hyper/Impulsive
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Learning Disorder Clinical Features
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Persistent Performace is less than intelligence Variable skill development
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Intellectual Disability Clinical Features
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Decrease in adaptive functioning Evident in multiple environments Onset in developmental/childhood period No trauma or illness >70 IQ
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Types of Adaptive Functioning
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Conceptual Social Practical
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Intellecutal Disability Etiology
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Genetics Developmental Disease Prenatal Environment Home Environment
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Autism Spectrum Disorder Etiology
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Genetic Environment Disease Preterm with low birth weight
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Autism Spectrum Brain MRI
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Brain enlargement
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Social communication & interaction deficits Stereotyped/ritualized patterns: Behavior & activities Echolalia Routines Hyper/hypoactivity response to sensory input Developmental period
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Autism Spectrum
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Autism Spectrum Tx
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Behavioral Specialized: OT, PT, Speech-Lang Diet Child-Family Therapy Medication: Comorbidities, Hyperactivity, OC Behavior
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Externalizing Disorders
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Conduct Disorder Oppositional Defiant Disorder Hyperactivity Disorder Inattentive
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Internalizing Disorders
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Special phobias/Agoraphobia Seasonal Affect Disorder Obsessive Compulsive Disorder Social Anxiety
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Diathesis-Stress Model
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Predisposition/Genetics + Environment --> Disorder (Multi-factorial)
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Repetative, persistent Pervasive behavior Violate Norms & others rights: Aggression, Property destruction, deceit, violate rules <18 yo
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Conduct Disorder
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Hostile & defiant behavior Violates social norms <18 yo
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Oppositional Defiant Disorder (Mild CD)
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Male vs Female CD
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Males more common in younger age group Same rates as teens Men ~ Aggressive Women ~ Indirect delinquent behavior
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Conduct Disorder Risk Factors
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Hyperactive, irritable infant Stressed family environment Parenting styles (neg, supportive)
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Conduct Disorder Tx
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Positive Parenting: Positive attn, Ignore inappropriate behavior, clear simple instructions, token economy Problem-Solving Communication Training Multisystemic Family Therapy
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Etoh Use Disorder Screening Tools
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CRAFFT C = Car R = Relax A = Alone F = Family F = Forget T = Trouble AUDIT
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Depression Phenomenology Categories
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Mood changes Neurovegetative Cognitive/Thoughts Behavior/Affect
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Primary MDD Etiology
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Biological (5HT Reuptake Pump promoter polymorphism) Psychological (neglect) Social (povery)
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5HT Reuptake Pump Genetic Influence for Depression
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Longer promoter => protective Shorter promoter => high risk
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2 Weeks Low mood and/or anhedonia Change in appetite sleep psychomotor fatigue worthlessness difficulty concentrating thoughts of death
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MDD
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Dorsal Raphe Nucleus Function
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Make 5HT
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Locus Coeruleus Function
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Make NE
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Ventral Tegmental Area Function
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Make DA
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Nucleus accumbens Function
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Pleasure
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Hypothalamus Mood Function
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HPA Axis Stress response
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Ant Cingulate Cortex Function
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Relay in mood
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Dorsal Lateral Prefrontal Cortex Function
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Executive Function
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HPA Axis Function
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Cortisol response decreases BDNF resulting in decreased hippocampal volume & dendritic spine density
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Depression Tx
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Lifestyle: Excersise, sleep, diet Psychotherapies: CBT, Psychodynamic, Interpersonal therapy) Somatic: Surgery, ECT, TMS, DBS, Meds
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Depression Med MOA
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Overall increases BDNF transcription enhancing neurogenesis
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Causes of Secondary MDD
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Health Substances Seasons
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Metabolic Syndrome Tx
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Int fasting low carb, high fat diet Bariatric Surgery Medication
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Metformin MOA
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Decreases blood glucose --> increasing insulin sensitivity
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GLP1 Inhibitor MOA
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More efficient insulin production Helps to feel full and stop overeating behavior
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SGLT2 Inhibitor MOA
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Blocks renal sugar reabsorption lower blood glucose
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4 Outcomes for Carbs
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Use energy while exercising Store in liver Store in muscle Store in adipose
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What is insulin resistance?
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Carbohydrate intolerance Metabolic syndrome
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Metabolic Syndrome Criteria
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Large waist circumference anl glucose metabolism/glucose intolerance Htn Elevated triglycerides Low HDL
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Sick Fat Disease vs Fat Mass Disease
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SFD = endocrine dysfunction FMD = structural induced issues of obesity
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Leptin Function
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Feel full
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Adiponectin Function
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Protective Concentration inverse relationship to amt of adipose
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Ghrelin Function
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Feel hunger
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Thyroid Function in Metabolism
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T3 drives metabolsim Hypo => overweight Hyper=> underweight
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Milder form of MDD Lasts 1+ years in children Lasts 2+ years in adults
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Persistent Depressive Disorder Criteria
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Mania +/- MDD Hypomania +/- MDD Interepisodic clearing
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Bipolar 1 & 2
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<10 yo Temper outbursts Irritability Anger NOT childhood-onset bipolar
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Disruptive Mood Dysregulation Disorder
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Adolescent Depression Tx
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SSRI for moderate to severe CBT Combo => better outcomes Longer tx => better outcomes
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Predisposing Risk Factors for Adolescent Suicide
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Previous attempt Psychiatric disorder Abuse Violent behavior exposure Fm Hx suicide/mood disorder Male Gay/Lesbian
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Precipitating Risk Factors for Adolescent Suicide
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Sub abuse Prior attempt Firearm access Social stress & emotional factor
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Specific excessive fear
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phobia
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obsessions compulsions recognize problems
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OCD
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obsessions compulsions doesn't recognize problems
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OCPD Cluster C
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trauma induced anxiety >1 mo
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PTSD
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trauma induced anxiety 3 days - 1 mo
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Acute Stress Disorder
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Personality Disorder Qualities
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Inflexible, chronic, rigid No awareness of problem
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Cluster A PDs
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Weird Schizoid Paranoid Schizotypal
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Cluster B PDs
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Wild Histronic Narcissistic Borderline Antisocial
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Cluster C PDs
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Worried Dependent OC Avoidant
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Distrusting Always suspicious
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Paranoid PD Cluster A
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Social withdrawal social isolation and okay with it limited emotional expression
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Schizoid PD Cluster A
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Eccentric Odd or magical beliefs Awkward interpersonal relationships
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Schizotypal PD Cluster A
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Violates others rights impulsive >18 yo
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Antisocial PD Cluster B
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Unstable Mood No Mania or depression
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Borderline PD Cluster B
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Excessive emotionality & excitability Attn seeking Sexually provocative
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Histrionic PD Cluster B
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Grandiose Feels entitled Lacks empathy Demands "the best" Is enraged by criticism
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Narcissistic PD Cluster B
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Hypersensitive to rejection Socially inhibited Wants relationships
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Avoidant PD Cluster C
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Submissive Clingy May be in abusive relationship
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Dependent PD Cluster C
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Limits available calories Extreme dieting, exercising, and/or binging + purging Sense of accomplishment or pleasure
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Anorexia Nervosa Over-controlling
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Binge eating purging Sense of shame
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Bulemia Nervosa Under-controlling
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Complications of Anorexia Nervosa
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Cardiac arrest Suicide
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Binge eating no purging Sense of shame
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Binge Eating Disorder
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Int hypersomnolence Behavioral & Cog disturbances Hyperphagia Hypersexuality
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Kleine-Levin Syndrome
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Brain Areas Involved in Schizophrenia
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Frontal Lobe - executive function, planning Basal ganglia - memory, motion, integration of information Limbic System - agitation Hippocampus -- memory, reality Occipital Lobe - hallucinations Auditory Lobe - hallucinations
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Drug Targets for Schizophrenia
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D2 receptors -- theraputic D1 receptors -- adverse rxns
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Poor planning Flat affect lack of purpose social avoidance delusions hallucinations
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Schizophrenia
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Substance Use Disorder Indications
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Impaired control Social impairment Risky use Pharmacologic dependence
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(Substance) Abuse Def
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Excessive substance use Can't control amt used
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Substance Dependence
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Physical need for a substance
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Compulsive Sub Use
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neglect other areas of life loss of control
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Methylamphetamine Dosing
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0.5-2.0 mg/kg/day
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Mixed Amphetamine Dosing
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0.3-0.6 mg/kg/day
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Depression Response & Remission with SSRI
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60% 30%
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SSRI Adverse Rxns
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Sexual dysfunction GI upset Agitation/Sedation
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NSRI Effects
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More energy & focus
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5HT2 Blockers
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Trazadone Mirtazapine Atypical antipsychotics
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Buproprion Uses
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Mild depression nicotine cessation w/ anxiety no other anxiety Adult ADHD as non-stimulant
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Buspirone Uses
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Mild to Mod depression Anxiety
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TCA AR
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Dry mouth Arrhythmias
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Alexithymia
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Hard time expressing emotions
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Gender Prevalence of Somatic Sx Disorders
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Women > Men
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Age at which assume medical prob > somatic sx disorder
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40 yo +
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Unconsious sx Excessive thoughts, feelings, behaviors, anxiety related to sx >6 mo
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Somatic Sx Disorder
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Preoccupation about having or getting an illness No sx or mild sx < 6 mo Unconscious
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Illness Anxiety Disorder/Hypochondriasis
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Altered voluntary motor or sensory function Unconscious
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Conversion Disorder
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Conversion Disorder Sx Prognosis
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Paralysis, weakness, & aphonia are good Seizures or tremor are bad
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Conversion Disorder Age-Related Prognosis
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Young = fast recovery Adult = long recovery if any
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Psychological factors exacerbating other medical conditions
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Conscious effort to assume sick role and receive medical attn
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Factitious Disorder
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Conscious effort to assume sick role to receive secondary gain
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Malingering
