BH Quiz 2

oppositional defiant disorder, intermittent explosive disorder, conduct disorder

what are the 3 disruptive, impulse control, and conduct disorders that are discussed?

oppositional defiant disorder

frequent and persistent pattern of angry and irritable mood, argumentative, defiant behavior, and vindictiveness

oppositional defiant disorder

what conduct disorder is more frequently confined to one setting (usually home)?

true

true or false: individuals with oppositional defiant disorder do not regard themselves as angry, oppositional, or defiant

males

which gender is oppositional defiant disorder more common in?

first symptoms around preschool and rarely later than adolescence

what is the symptom course for oppositional defiant disorder?

oppositional defiant disorder

what disorder often precedes the development of conduct disorder?

temperamental factors

oppositional defiant disorder factors: high levels of emotional reactivity, poor frustration tolerance

environmental factors

oppositional defiant disorder factors: harsh, inconsistent disciplining, neglectful child rearing

genetic and physiological factors

oppositional defiant disorder factors: neurobiological markers (reduced basal cortisol reactivity, abnormality in PFC and amygdala

6 months

how long does oppositional defiant disorder need to last for?

oppositional defiant disorder

child often loses temper, angry and resentful, argues with authority figures, refuses to comply with rules, deliberately annoys others, blames others, spiteful or vindictive behaviors at least twice

angry/irritable mood

criteria for oppositional defiant disorder: often loses temper, often touchy or easily annoyed, angry or resentful

argumentative/defiant behavior

criteria for oppositional defiant disorder: argues with authority, children, or adolescents, denies or refuses to comply with requests or rules, deliberately annoys others, blames others for behavior

vindications

criteria for oppositional defiant disorder: has been spiteful at least twice within the past 6 months

1st line therapy

adjunct pharmacotherapy (aggression especially)

what is the treatment for oppositional defiant disorder?

atypical antipsychotics and mood stabilizers

what pharmacotherapy can be used as an adjunct therapy for aggressive children with oppositional defiant disorder?

SSRI

what pharmacotherapy can be used as an adjunct therapy for aggressive children with anxiety or sadness

intermittent expolosive disorder

impulsive aggressive outbursts that are anger based with NO PRODROMAL PERIOD

late childhood/adolescence

what is the most common age onset for intermittent explosive disorder?

males

what gender is more common with intermittent explosive disoroder?

intermittent explosive disorder

verbal aggression (temper tantrums, verbal arguments, fights) or physical aggression towards property, animals, of other individuals

occurring twice weekly for 3 months

what is the minimal duration for aggression for intermittent explosive disorder?

intermittent explosive disorder

verbal aggression and physical aggression that results in physical injury against animals or other individuals within a 12 month period

intermittent explosive disorder

recurrent aggressive outbursts are NOT premeditated (they are impulsive or anger based, in which they cannot control their behavior)

6 years old or older

what age must you be to be diagnosed with intermittent explosive disorder?

therapy

adjunct pharmacotherapy

what is the treatment for intermittent explosive disorder?

conduct disorder

an enduring set of behaviors in a child/adolescent that evolves over time, characterized by AGGRESSION and VIOLATION of the rights of others

physical aggression, destruction of property, acts of deceit/theft, and frequent violation of age appropriate rules

what are the 4 categories for conduct disorder?

pre mediated, not pre mediated

conduct disorder is (pre mediated, not pre meditated)

intermittent explosive disorder is (pre mediated, not pre meditated)

males

what gender is conduct disorder more common in?

ODD

what is a common precursor to conduct disorder?

males: 10-12 years

females: 14-16 years

what is the average age of onset for conduct disorder in males? females?

conduct disorder

expressing overt aggressive behavior, frequently misperceive the intentions of others as more hostile and threatening

overt behavior

openly demonstrating your aggression (walking up and punching someone in the face)

covert behavior

doing something sneakily behind someones back

conduct disorder

substance misuse, suicidal ideation, suicide attempts, and completed suicide occur at a higher than expected rate in this disorder

conduct disorder

negative emotionality, poor self control, poor frustration tolerance, irritability, temper outbursts, suspiciousness, insensitivity to punishment, thrill seeking, recklessness

aggression to people or animals

conduct disorder criteria: bullies, threatens other, physical fights, used weapons, physically cruel to people or animals, stolen while confronting a victim, has forced someone into sexual activity

3 or more in the past 12 months, 1 or more in the past 6 months

how many symptoms and how long do symptoms have to occur in conduct disorder?

destruction of property

conduct disorder criteria: fire setting with intention of causing serious damage

deceitfulness or theft

conduct disorder criteria: breaking into someone else's house, cars, lies to obtain goods, stolen items of nontrivial value

serious violations of rules

conduct disorder criteria: stays out at night despite parental prohibitions, run away from home twice, of once without returning home for a lengthy period, often truant from school

below 18 years old

if above 18, be concerned about antisocial personality disorder

what is the age LIMIT for conduct disorder?

what disorder is it if they are above this age?

multimodality recommended: pharmacotherapy and behavioral intervention

what is the treatment for conduct disorder?

atypical antipsychotics (decrease agitation and aggression)

mood stabilizers, SSRIs can also be used

what is the chosen pharmacotherapy for conduct disorder?

ADHD

a pattern of diminished sustained attention and higher levels of impulsivity

dopamine

what neurotransmitter is involved the most in ADHD?

premature, maternal infections during pregnancy, perinatal birth injury, infection

what are some developmental factors that might cause ADHD?

chronic abuse, maltreatment, and neglect

what are some psychosocial factors for ADHD?

1st relatives, siblings with ADHD, low birth weight, tobacco use during pregnancy

what are some risk factors for ADHD?

males

what gender is ADHD more prevalent in?

false, needs to be in at least 2 different settings

true or false: impulsivity or inattention only at home is enough to diagnose someone with ADHD

ADHD

short attention span, high levels of distractibility

hyperactivity symptoms

excessive motor activity, excessive fidgeting, tapping, talkativeness

inattention symptoms

short attention span, wandering off task, lacking persistance, difficulty sustaining focus/poor concentration

impulsivity symptoms

hasty actions that occur in the moments without forethought and have high potential for harm to the individual, lack of organization

ADHD

low frustration tolerance, irritability, mood swings, academic/work performance impaired, cognitive problems, difficulty with memory

easily upset by noise, light, temperature; active in crib, sleeps little, cries alot

what are some symptoms of ADHD in infants?

attacks test rapidly but only answers the 1st few questions, unable to sit still, blurts out responses to questions, explosive, irritable

what are some symptoms of ADHD in chikldren?

true

true or false: there are brain wave changes (EEG irregularity) in those with ADHD

true

may see decreased hyperactivity, but remain impulsive and accident prone

true or false: children with ADHD can have symptoms wane into adulthood

6 or more inattention AND/OR hyperactivity/impulsivity symptoms that have lasted for 6 months or more

what is the symptom criteria for ADHD?

inattentive ADHD criteria

fails to give close attention to details, makes careless mistakes in school/work, difficulty staining attention, does not seem to listen when spoken to directly, does not follow through on instruction, difficulty organizating

inattentive ADHD criteria

avoids, dislikes or is reluctant to engage in tasks that require sustained mental effort, loses things necessary for tasks, often easily distracted, often forgetful in daily activities

impulsive/hyperactive ADHD criteria

fidgets with or taps hands, squirms in seat, leaves seat in classroom, runs about, climbs excessively, difficulty playing or engaging in leisure activities, often "on the go" or driven by a motor

impulsive/hyperactive ADHD criteria

talks excessively, blurts out answers before questions have been completed, often has difficulty waiting for their turn, often interrupts or intrudes on others

true

true or false: you can have predominantly inattentive ADHD and not impulsive ADHD

pharmacotherapy, CNS stimulants are the 1st line

behavior modification programs are other interventions

what is the 1st line treatment for ADHD?

adderall, focalin, ritalin, concerta, methylin, dexerdrine, procentra, vyvanase

what are the 1st line stimulant medications for ADHD treatment?

tachycardia, heart palpitations, increased BP, decreased appetite, GI upset, headache, ansomnia, seizures

what are some adverse effects of stimulants?

false

true or false: stimulants do not have a potential for addiction and future substance abuse

monitor height and weight, they are ADRs

what should we monitor in ADHD patients who are on stimulants?

non stimulants (kapvay, intuiv, straterra)

what is the 2nd line treatment for ADHD?

wellbutrin (bupropion), an atypical antidepressant

what is the 3rd line for ADHD treatment?

NE-DA reuptake inhibitor (leaving them in the synapse)

what is the MOA for wellbutrin?

wellbutrin

what med used for ADHD lowers the seizure threshold so it has the potential to cause seizures

as young as 7

we can use wellbutrin in ADHD patients as young as what age?

wellbutrin

we can use what med in patients with ADHD and concurrent depression symptoms?

before 12 years old

remission of ADHD is unlikely before what age?

conduct disorder

those with ADHD are at an increased risk for what other mental disorder if symptoms persist into adolescence?

higher rates of comorbid psychiatric disorders and more problems with behavior

socially dysfunctional children + ADHD = what?

between 12-20

what age does remission commonly occur in ADHD?

combined ADHD, stimulants

a 6 year old male patient presents with his parents for a yearly check up. his parents have some concerns about behavior at school and at home. mother states that "he seems to struggle with concentrating on his schoolwork" she describes the patient as unorganized, forgetful, and says he gets a lot of questions wrong on his homework because he rushes through it. it is hard for him to sit still. this happens as well wit household chores. patient's mother states that he has too much energy! he is tapping his foot on the table and ripping at the exam table paper at the visit. what is the most likely diagnosis? what is the 1st line treatment?

conduct disorder, multimodality treatment, therapy, pharmacotherapy (ANTIPSYCHOTICS).

mood stabilizers and SSRIs can also be used.

a 13 year old boy presents with his foster mother who is concerned for behavioral issues. patient's foster mother states that his attitude and actions are getting worse. patient was expelled from his school for fighting and bullying this past well. it has been happening for a year. she had to give away the family dog because she was scared for the dog's safety. she says that he bets up his brother and is consistently disrespectful to the foster mother. he also breaks into the neighbors house for stealing. what is the diagnosis and treatment?

autism spectrum disorder (ASD)

disorder that is characterized by impairment in social interaction and social communication, restricted repetitive patterns of behavior, interests, and activities

level of severity and presence/absence of associated conditions

what are the specifiers of ASD?

genetic basis

what is the etiology of ASD in most cases?

no

is there any evidence to support assoication with vaccines?

siblings of a child with autism

what are the risk factors for an increased rate of autism?

genes, imbalances in NTs, prenatal toxin exposures, prenatal maternal infections, advanced parental age

what are some etiology risk factors for ASD?

45-60%

what percentage of ASD is due to intellectual disability?

11-39%

what percentage of ASD is associated with seizures?

PKU, fetal alcohol syndrome, fragile x syndrome

what are some miscellaneous conditions for ASD?

boys

ASD is more frequent in what gender?

ASD

early communicative behaviors, trouble tolerating change, possible seizures, self injury

tuberous sclerosis

rare, multi-system genetic disorder that causes the growth of benign tumors in various organs, including the brain, kidneys, heart, liver, eyes, lungs, and skin. Symptoms may include seizures, intellectual disability, and developmental delay.

12-24 months

when is ASD most commonly recognized?

impaired social communication

what is the hallmark for ASD?

ASD

delayed language development, regression of skills, deficits in emotion/social reprocity, decreased/lack of joint attention, impaired ability to interpret nonverbal behaviors (eye contact, gestures), fail to develop peer relationships