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23 Cards in this Set

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ADHD/ The "666" of ADHD
Symptoms of ADHD
Symptom classes:
a) inattention
b) hyperactivity
c) impulsivity
Subtypes:
INATTENTIVE: inattention = 6+; hyperactive = <6
HYPERACTIVE-IMPULSIVE: inattention = <6; hyperactive = 6+
COMBINED: inattention = 6+; hyperactive = 6+

“666” of ADHD:
Onset of symptoms before age 7 (age 6!)
Min 6 mos of sx’s
Sx’ present in 2 settings

Brain = Prefrontal cortex (lower activity in frontal lobe) Inability to focus, concentrate, organize
A mother brings her kid in and says my kid has ADHD. What is the first thing a clinician should do?
Contact the teacher.
(Dx requires 2 settings for dx)
ADHD IN ADULTS
d
ENURESIS
Onset 5yrs
BEST TREATMENT OF ENURESIS
Bell and pad

Other tx’s:
Tricyclics
Hypnosis
Bladder control exercises
TOURETTE'S
TOURETTE'S
1. 1+ vocal/motor tics
2. Onset <18 (+18 can get dx of “NOS”)

COMORBIDITY
obsessions / compulsions (^OCD)
Hyperactivity, impulsivity, destractability
= social/school problems
Brain:
Excessive dopamine hypothesis
Treatment (fyi)
Anti-psychotics
Haloperidol, pimozide (80% of cases effective)
Clonidine, desipramine (for attn probs – stimus make worse)
ALZHEIMER'S DEMENTIA
ALZHEIMER'S
50% of all dementias
Early tx of choice = Group treatment
DX = definitive dx only via autopsy or brain biopsy
Monitoring = ongoing neuro-cognitive testing
ALZHEIMER'S PROGRESSION
Stage 1 (anomia) 0-2 yrs
Anterograde amnesia (recent memory)
Declarative memory loss
Deficits in visuospatial skills (wandering)
Indifference, irritability, sadness

Stage 2 (paranoia) 2-10 yrs
^Retrograde amnesia
Personality changes
Flat or labile mood
Restless, agitated
Delusions, hallucinations
Aphasia, apraxia, agnosia

Stage 3 (shutting down)8-10+ yrs
Apathy
Incontinence
Limb rigidity (can’t walk or sit)
DECLARATIVE v. PROCEDURAL MEMORY
DECLARATIVE:
Episodic: Events/Anecdotal
Semantic: Words, Meaning
PROCEDURAL:
Implicit memory(eg. Driving car)
DEMENTIA v. PSEUDO-DEMENTIA
insert data here
HEADACHES (4 types)
Migraine:
Severe throbbing, unilateral (one side) w/ nausea, vomiting, sensitivity to light.
Classic – Aura (less common)
Common – no Aura (more common)

** stress, relaxation after stress, foods with teramine (avos, tomatoes, soy, aged cheese, wine), high humidity.
** treated with increased Seratonin

Cluster:
“4th of July” in head. ^^ burst of pain, non-throbbing pain behind one eye occurs in “clusters”

Tension Headaches – non-throbbing pain. Band of pressure around head

Sinus:
Fullness, tension, or throbbing ache over eyes. Worse if bent over. Worse in am.
SEIZURES
Abnormal discharges of electrical energy in brain

TONIC-CLONIC: “grand mal”
Tonic= muscles contract, body stiffens
Clonic=rhythmic shaking
Post-seizure depression or confusion w/ amnesia of seizure
whole body shakes

ABSENCE “petite mal” “generalized”
brief attack w/loss of consciousness. W/out motor activity

PARTIAL SEIZURE
Begin in one side of brain and effect one side of body
(can develop into generalized seizure on both side of body).
SIMPLE partial = w/out loss of consciousness; COMPLEX = some loss of consciousness

LOCATION OF COMPLEX-PARTIAL SEIZURES
Temporal or frontal lobes
HEADACHES (4 types)
Migraine:
Severe throbbing, unilateral (one side) w/ nausea, vomiting, sensitivity to light.
Classic – Aura (less common)
Common – no Aura (more common)

** stress, relaxation after stress, foods with teramine (avos, tomatoes, soy, aged cheese, wine), high humidity.
** treated with increased Seratonin

Cluster:
“4th of July” in head. ^^ burst of pain, non-throbbing pain behind one eye occurs in “clusters”

Tension Headaches – non-throbbing pain. Band of pressure around head

Sinus:
Fullness, tension, or throbbing ache over eyes. Worse if bent over. Worse in am.
SEIZURES
Abnormal discharges of electrical energy in brain

TONIC-CLONIC: “grand mal”
Tonic= muscles contract, body stiffens
Clonic=rhythmic shaking
Post-seizure depression or confusion w/ amnesia of seizure
whole body shakes

ABSENCE “petite mal” “generalized”
brief attack w/loss of consciousness. W/out motor activity

PARTIAL SEIZURE
Begin in one side of brain and effect one side of body
(can develop into generalized seizure on both side of body).
SIMPLE partial = w/out loss of consciousness; COMPLEX = some loss of consciousness

LOCATION OF COMPLEX-PARTIAL SEIZURES
Temporal or frontal lobes
OBSESSIVE COMPULSIVE DISORDER (OCD)
Anxiety d/o spectrum dx. Recurrent obsessions and/or compulsions.
1 hour per day wasted. It is ego-dystonic

Brain = Basal ganglia (Caudate neucleus). Associated w/ low seratonin. Tx includes SSRI and in-vivo EXPOSURE tx.
Mental Retardation
DEGREES OF MENTAL RETARDATION
(Borderline Intellectual Functioning = 71-84 range)
Mild = IQ 50-70
85% of retarded population
Top out at 6th grade ability
Can live independently and do semi-skilled jobs
Moderate = IQ 35-50
10% of retarded population
Top out at 2nd grade ability
Need supervision in semi-skilled jobs
Severe 20-35
3-4% of retarded population
Poor motor skills, limited speech
Closely supervised living
Profound <20
1-2% of retarded population
Severely limited motor and sensory functioning
Closely supervised living

GEN CRITERIA FOR MENTAL RETARDATION
IQ < 70
Impairments in adaptive functioning in at least 2 areas
Onset < 18
TOURETTE'S
1. @ least 1 vocal tic + multiple motor tics
2. Onset <18 (+18 can get dx of “NOS”)
Q. LD and Tourette's
Children with a learning disorder have common co-diagnoses of ADHD (25-30%), Tourette’s disorder and/or a mood disorder.
Q. Explanation for school/learning difficulties in children w/Tourrettte’s
Commoribitity w/ ADHD sxs:
hyperactivity, impulsivity, distractablity
Q. Tourette's-ADHD relationship
COMORBIDITY
obsessions / compulsions (^OCD)
Hyperactivity, impulsivity, destractability
= social/school problems
Brain:
Excessive dopamine hypothesis
Treatment (fyi)
Anti-psychotics
Haloperidol, pimozide (80% of cases effective)
Clonidine, desipramine (for attn probs – stimus make worse)
Difficulty of diagnosing panic disorder or panic attacks in children
Ages 4-6.
Children have cognitive limitations that do not let them make catastrophic interpretations of bodily symptoms, however children can be diagnosed with panic disorder.
Pervasive developmental disorders
Autistic, Rhetts d/o, childhood degenerative, Aspergers
Problems w/ communication, stereotyped bx’s, social deficits
Enuresis
Effectiveness of tx for enuresis - Bell and Pad vs. tricyclics / antidepressants
A. Bell and pad better in the long-run (less relapse)
Disorders with a genetic basis
(Autosomal)
PKU – autosomal recessive
Down syndrome
Huntington’s – autosomal dominant