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Neurodevelopmental
impulse control d/o, ADHD, autism...
| Question | Answer |
|---|---|
| Be prepared for the interview with adolescents | review records/texts to intimate yourself with patient /family, and problem(s) First impression matters – appearance, facial expressions, attitude, greeting |
| Office milieu | wall posters, lighting, furniture, layout, clock site, fragrances, entilation/cooling/heating, facial tissues etc |
| Adolescent assessment | Discuss confidentiality, limitations including Tarasoff |
| Adolescent assessment | write prescriptions if indicated., OBTAIN WRITTEN CONSENT, REMEMBER – DO NOT LET ANYONE COERCE YOU TO GIVE A Dx OR MEDICATION. DO NOT DENY ANYONE A Dx FOR PERSONAL REASONS, DOCUMENT THOROUGHLY - THE PROGRESS NOTE IS A LEGAL DOCUMENT!!! |
| Sensitivity vs. Specificity of Screening Tests- ANCC | Sensitivity: true positives; the degree to which those who have a disease screen/test positive, Specificity: true negative; the degree to which those who do not have a disease screen/test negative |
| Sensitivity | If a person has a disease, how often will the test be positive (true positive rate)? if the test is highly sensitive and the test result is negative you can be nearly certain that they don’t have disease. |
| Specificity | In other terms, if the test result for a highly specific test is positive you can be nearly certain that they actually have the disease. |
| Primary, secondary and tertiary prevention | - Primary-measures to promote health such as healthy diet, exercise, avoiding nicotine, immunizations, Secondary- focuses on early identification and treatment of existing- pap smear, prostate or cholesterol screening, Tertiary: rehabilitation |
| Intellectual development disorder | deficits in 3 areas in reasoning, problem solving, planning, judgment, abstract thinking, and academic ability as compared to same aged peers.-Social communication, Interpreting and acting on social cues, regulation emotions. |
| Intellectual disability and IQ | Levels of severity of intellectual disability are determined on the basis of adaptive functioning –not on IQ scores. |
| Autism | 2 domains of core diagnostic impairments: Deficits in social communication. Restricted and repetitive behaviors, Impairment in social interactions- severe cases= lack of developmentally appropriate interest in social interactions |
| About 1/3 of children who meet the criteria for current DSM-5 diagnosis Autism also experience | intellectual disability. Occurs 4 times more often in boys than girls |
| ______________is a major focus of clinical investigation as possible contributing mechanism to ADHD | dopamine |
| ADHD and Dysfunction in peripheral _____________ | epinephrine, which causes the hormone to accumulate peripherally, may potentially feed back to the central system and “reset” the locus ceruleus to a lower level |
| ADHD and neurotransmitters | both dopamine and norepinephrine, that may include dysfunction in both the adrenergic and dopaminergic systems. Stimulants increase catecholamine concentrations by promoting their release and blocking their reuptake. |
| ADHD dx | Inattention, Impulsivity, Hyperactivity- Symptoms must be present in more than 1 setting. |
| Insomnia dx | Duration to meet diagnostic criteria: at least three nights per week, at least three months, sleep difficulty occurs despite adequate opportunity for sleep |
| Primary insomnia | Should last for at least 1 month and not associated with other disorders e.g.. OSA(obstructive sleep apnea), drug e.t.c |
| Comorbid insomnia | Medical, psychiatric, circadian rhythm disorders, Substance abuse |
| When to refer to sleep medicine consultant | Excessive daytime sleepiness, Loud habitual snoring & witnessed apneas, Intractable hypertension, Hx stroke, CHF, CAD w/unrefreshing sleep, Frequent nocturnal awakening, Insomnia unresponsive to medications |
Created by:
arsho453
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