3 subtypes of mental retardation based on etiology
Mental retardation
- Organic (idiopathic)
- Prenatal (genetic)- Fragile X, Downs, TORCHES (perinatal infection), Prader-Willi
- Perinatal or postnatal: fetal alcohol, lead or mercury exposure
Criteria for mental retardation
MR/ID: Subaverage IQ below 70 + developmental disability
Developmental disability = deficits in 2+
- self care, learning, mobility
- receptive/expressive language
- self-direction, independent living
- economic self sufficiency
Which 2 diseases overlap significantly w/ Tourette’s syndrome
High comorbidity/overlap btwn Tourette’s, OCD, and ADHD
Tourettes
(a) more common in which gender?
(b) neurochemical mechansim
(c) time criteria
Tourette’s
(a) 3:1 M:F
(b) Dopamine dysregulation in the caudate
(c) 12+ months of both motor and vocal tics
What makes it difficult to treat comorbid Tourettes and ADHD
Tourette’s and ADHD are often comorbid, but stimulants can make the tics worse => have to find a good balance
- pimozide or haloperidol for Tourette’s
- low stimulant for ADHD (low enough to not exacerbate tics)
- clonidine
Psychopharm to treat Tourette’s d/o
- typical antipsychotic: usually pimozide or haloperidol
- clonidine = alpha2 agonist
Enuresis
(a) time requirement
(b) age requirement
Enuresis = involuntary voiding of bladder
(a) 3+ months, twice a week
(b) after age 5
Distinguish chronic pain vs. chronic pain syndrome
Both are pain w/o apparent biological cause
Chronic Pain: 3+ months, NOT maladaptive
Chronic Pain Syndrome: 6+ months, MALADAPTIVE**
-factors: depression, inactivity
Intermittent Explosive D/o
(a) more common in which gender
(b) neurochemical etiology
(c) symptoms
(d) differentiate from ATPD
Intermittent explosive d/o
(a) almost always in females
(b) low 5HT
(c) impulses of assault or property destruction out of proportion to the trigger
(d) intermittent explosive d/o- pts usually feel remorseful afterwards (while ASPD don’t have remorse)
Treatment for Intermittent Explosive D/o
Intermittent explosive d/o treatment
- SSRI, anticonvulsant, lithium, propanolol
- group therapy
**psychotherapy not helpful
What is kleptomania?
Kleptomania = stealing not for personal or monetary gain
-pleasure is derived from the act of stealing
Kleptomania
(a) more common in which gender
(b) common comorbidity
(c) therapy
Kleptomania
(a) F > M
(b) 1/4 of bulimics are kleptomaniacs
(c) insight-oriented psychotherapy
Pyromania
(a) more common in which gender
(b) common morbidity
Pyromania
(a) F > M
(b) common in MR
Criteria for pyromania
Criteria: 1+ intentional fire setting
- tension before fire, relieved after
- fascination w/ fire
- not for monteary gain or expression of anger
Tx for pyromania
- behavior therapy
- SSRI
What is trichotillomania?
Trichotillomania = recurrent pulling out of hair resulting in visible hair loss
-can be eyebrows, public hair
- tension before, relieved by action
- causes marked distress or impairment
Trichotillomania
(a) more common in which gender
(b) common comorbidity
(c) common trigger
(d) treatment
Trichotillomania
(a) F > M
(b) comorbid w/ OCD/OCPD
(c) often after stressful event
(d) tx: SSRI, antipsychotic, hypnosis, behavioral therapy
Define delirium
Basically a change in mental status w/ evidence of underlying cause
- impaired consciousness
- change in cognition or perception
- acute onset, fluctuates
WHIMP acronym for delirium
Etiologies of delirium
W- Wernicke's encephalopathy (B12 deficiency) H- hypoxemia I- intracranial bleeding M- meningitis P- poisons
Delirium vs. dementia
Main difference
(a) onset
(b) duration
(c) alertness and attention
(d) sleep
(e) consistently of course
Delirium vs. dementia
Change in mental status vs. memory problems
Delirium
(a) acute onset
(b) transient, hours to days
(c) alertness and attention are impaired
(d) awake at night (same as dementia)
(e) fluctuates**
Dementia
(a) insidious, gradual onset
(b) much longer lasting: months to years
(c) alertness and attention are normal
(d) awake at night
(e) symptoms stable throughout the day
Treatment for delirium
(a) Use
(b) Don’t use
Delirium treatment
(a) Quetiapine or haloperidol
(b) Avoid benzos- can have paradoxically worsening effect in elderly
Hallmarks symptoms of delirium
Waxing and waning symptoms (may have lucid intervals)
- visual hallucinations
- short attention span
- impairment in recent memory
- disorientation: usually to time and place
Most common finding in delirium
Impairment in recent memory
What can cause delirium?
Almost any medical condition can cause delirium
Most common causes
- infection
- meds
- intoxication or withdrawal
- electrolyte imbalance
