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Decreased effects of the same dose of a

Tolerance (PB pg. 114)
medication over time.
The tendency of some regions of the
brain to react to repeated low-level bio-
Kindling (PB pg. 174) electrical stimulation by progressively
boosting synaptic discharges, thereby
lowering seizure thresholds.
Compulsive substance use despite
Addiction (PB pg. 299)
harmful consequence.
The amount of drug required to produce
Potency (PB pg. 113)
an effect of given intensity.
Attention-deficit hyperactivity disorder
(ADHD) is persistent pattern of inatten-
Attention-deficit hyperactivity disorder
tion or hyperactivity, impulsivity, or both
(ADHD) (PB pg. 335)
that interferes with functioning and devel-
opment.
Þ Frontal cortex
Abnormalities of fronto-subcortical path- Þ Basal ganglia (motor control, motor
ways (PB 336) learning, executive functions and behav-
iors, and emotions).
Motor control, motor learning, executive
What does the basal ganglia control?
functions and behaviors, and emotions
Ability to focus, fight-flight response, reg-
What are the abnormalities of reticular
ulating arousal and sleep-wake transi-
activating system?
tions
Þ Dopamine dysfunction
Þ Norepinephrine dysfunction
Structural abnormalities producing neu-
Þ Serotonin
rotransmitter abnormalities
Mnemonic: DNS
Assess cardiac history before placing pa-
Pharmacology Management (PB pg. tient on stimulants (amphetamines for
338) example can cause elevated heart rate
Stimulants and blood pressure, and increase risk of
heart attack, and stroke).

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What age are amphetamines approved
In children ages 3 and older.
for?
What age is methylphenidate approved
In children ages 6 and older.
for?
Alpha agonist or alpha 2 adrenergic re-
What are classes are non-stimulants?
ceptor agonist
What age are Guanfacine and Clonidine
In ages 6-17 with ADHD.
approved for?
Are Guanfacine and Clonidine FDA ap-
Yes
proved?
What age is Strattera (atomoxetine) ap-
In children aged 6 and older with ADHD.
proved for?
· Insomnia
· Tremors
· Increase blood pressure and heart rate
· Heart palpitations
Signs of stimulants abuse (PB pg. 301) · Agitation
· Anxiety
· Irritability
· Mood swings
· Elevated mood
Þ Behavioral therapy
Þ Patient and parent cognitive behavioral
Nonpharmacological Management of training program
ADHD (PB pg. 339) Þ Psychoeducation
Þ Treatment of learning disorders
Þ Family therapy and education
Monitor clinical progress over time with
ADHD Follow-up (PB pg. 340)
standardized rating scales.
Þ Conner's Parent and Teacher Rating
Scales (copyrighted)
What standardized rating scales can be
Þ Vanderbilt ADHD Diagnostic Parent
used to follow-up on ADHD?
and Teacher Rating Scales (public do-
main)
Borderline personality disorder (PB pg.
320)
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· Impulsivity, often with self-damaging
behavior
· Identity disturbances
· Chronic feelings of emptiness
· Inappropriate, intensified affective
anger responses
What does borderline personality disor-
Suicidal behavior
der have a recurrent of?
What kind of pattern does borderline per- Unstable, intense interpersonal relation-
sonality disorder have? ships
What type of frantic efforts does one do
if they have borderline personality disor- Avoid real or imagined abandonment
der?
Borderline personality disorder Non-
Dialectal Behavioral Therapy (DBT)
pharmacologic Treatment
· Reckless disregard for the welfare of
others
· Lack of remorse; indifference to the feel-
ings of others
· Failure to conform to social norms
Antisocial personality disorder (PB pg.
· Repeated acts that are grounds for ar-
320)
rest
· Deceitfulness, lying, and use of aliases
for profit or pleasure
· Impulsivity and failure of future planning
· Consistent irresponsibility
Persistent deficits in social communica-
tion and social interaction across multiple
settings associated with deficits in:
· Social reciprocity
· Nonverbal communication
Autism spectrum disorder (PB pg.
· Developing, maintaining, and under-
340-343)
standing relationships
· Restricted repetitive behavior
· Stereotyped or repetitive motor move-
ments
· Insistence on sameness
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· Highly restricted with fixed interests
· Hyper- or hypo sensory input
· Male gender
Autism spectrum disorder Risk Factors
· Intellectual disability
(PB pg. 341)
· Genetic loading
· No response when called by name
· Little or no eye contact
· ****Children with autism often like to line
up, stack, or organize objects and toys in
What are symptoms parents may report long tidy rows.
of autism spectrum disorder? (PB pg. · No imaginary play
342) · Little interest in playing with other chil-
dren
· Intense tantrum
· Extremely short attention span
· Self-injurious behavior
· Modified Checklist for Autism in Tod-
dlers (M-CHAT)
Autism spectrum disorder Screening (PB
· Autism Diagnostic Observation Sched-
pg. 343)
ule-Generic (ADOS-G)
· Ages and Stages Questionnaire (ASQ)
Antipsychotics are effective for symp-
toms such as tantrums; aggressive be-
Autism spectrum disorder Pharmacolog-
havior, self-injurious behavior; hyperac-
ical management (PB pg. 343)
tivity; and repetitive, stereotyped behav-
iors.
Rett syndrome is the development of
RETT SYNDROME (PB pg. 344) specific deficits following a period of nor-
mal functioning after birth.
In what gender does RETT syndrome
Girls
occur primarily in?
There is normal psychomotor develop-
ment in Rett syndrome through what The first 5-7 months after birth.
months?
RETT SYNDROME Physical exam find-
ings
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· Loss of purposeful hand skills
· Stereotypic hand movements
· Deceleration of head growth
· Early loss of social engagement
· Appearance of poorly coordinated gait
or trunk movements
· Severely impaired expressive - and re-
ceptive-language development with se-
vere psychomotor retardation.
· Seizure
· Irregular respirations
Childhood depressive disorder that is di-
Disruptive mood dysregulation disorder
agnosed in children older than age 6 but
(DMDD) (PB pg. 355)
younger than age 18.
· Chronic dysregulated mood ("moody")
· Frequent intense temper out-
What are the disruptive mood dysregula-
bursts/tantrums
tion disorder (DMDD) symptoms?
· Severe irritability
· Anger
What is the treatment for disruptive Stimulants, antipsychotics, antidepres-
mood dysregulation disorder (DMDD)? sants
Involves repeated, sudden episodes of
impulsive, aggressive, violent behavior,
Intermittent explosive disorder (IED) or angry verbal outburst in which the pa-
tient reacts grossly out of proportion to
the situation.
Large head, elongated face, hyperex-
Fragile X tensible joints, abnormally large testes,
short stature
Dysregulation of one or more biogenic
Major Depressive Disorder (PB pg. 164) anime neurotransmitters: dopamine, nor-
epinephrine, serotonin (DNS).
What can be confused with dementia-re-
Cognition and memory symptoms of
lated symptoms in the older adult popu-
MDD (pseudodementia)
lation?

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Cognitive changes have relatively acute
What is the onset of major depressive
onset and are significant when com-
disorder (MDD)?
pared to premorbid functioning.
What do clients with dementia usually A premorbid history of slowly declining
have? cognition.
Pharmacological management of MDD Inform client that therapeutic effect may
(PB pg. 151) take at least 4 to 6 weeks.
How long do you take antidepressants Continue antidepressants for a minimum
for once they have started? of 6 to 12 months.
What is considered when a client has
Consider continuing antidepressants in-
more than two prior episodes of major
definitely.
depressive disorder (MDD)?
Is common when stopping antidepres-
When is antidepressant rebound? sants abruptly, particularly when drugs
with short half-lives are involved.
All antidepressants indicated for chil-
dren, adolescents, and young adults (up
What is the black box warning of antide-
to age 24 years) carry a black box
pressants? (PB pg. 163)
warning about an increase in suicidal
thoughts.
Suicidal thoughts, behavior, agitation,
What is monitored when taking antide-
and aggression in children taking antide-
pressants?
pressants.
Pharmacological management of MDD
Selective Serotonin Reuptake Inhibitors
(PB pg. 151)
(SSRIs)
First line
Selective serotonin reuptake inhibitors
rare.
(SSRIs) serious side effects are...
Selective serotonin reuptake inhibitors overdose than tricyclic antidepressants
(SSRIs) are much safer in... (TCAs).
· Tricyclic Antidepressants (TCAs) (PB
pg. 156)
Þ Electrocardiogram changes and car-
diac dysrhythmias are possible; avoid in
clients known to have susceptibility (per-
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sonal or family history). Monitor EKG
before treatment and annually in older
Pharmacological management of MDD adults.
(PB pg. 151) Þ Avoid abrupt withdrawal because of
Second line significant discontinuation syndrome.
Þ Avoid prescribing to people who are at
high risk for suicide.
Electrocardiogram changes and car-
What is possible when taking tricyclic diac dysrhythmias are possible; avoid in
antidepressants (TCAs)? clients known to have susceptibility (per-
sonal or family history).
What is monitored in older adults who Monitor EKG before treatment and annu-
take tricyclic antidepressants (TCAs)? ally in older adults.
Non-pharmacological Management of · Electroconvulsive Therapy (ECT)
MDD (PB pg. 159) · Cognitive Behavioral Therapy
Electroconvulsive Therapy (PB pg. · MDD with psychotic features
159-161) · Treatment resistant depression
· Cardiac disease
What are contraindications for electro- · Compromised pulmonary status
convulsive therapy? · History of brain injury or brain tumor
· Anesthesia medical complications
· Possible cardiovascular effects
· Systemic effect (e.g. headaches, mus-
Electroconvulsive Therapy
cle aches, drowsiness)
Adverse effects
· Cognitive effects (e.g., memory distur-
bance and confusion)
· Always assume client is serious when
he or she vocalizes suicidal thoughts.
Clinical Management of Suicidality (PB
· Consider hospitalization.
pg. 162)
· Consider mobilizing available social re-
sources.
What is there not enough evidence of The use of "no harm/safety" contracts
with suicidality? can reduce the risk of suicide.
Carotid bruits, fundoscopic abnormali-
Hall marks of vascular dementia
ties, enlarged cardiac chambers

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Neurotransmitter involved in mood disor- GABA, Glutamate, Dopamine, Sero-
der tonin, and norepinephrine
What is ruled out when making a diagno-
Bipolar disorder
sis of major depressive disorder?
Neuroprotective treatment of choice for
Lithium bipolar disorder (can protect nerve cells
from damage).
What disease is Lamotrigine (Lamictal)
Bipolar depression
used for?
Olanzapine in combination with fluoxe- is FDA approved for the treatment of
tine (Prozac) (Symbyax)... bipolar depression.
What disease is Lurasidone (Latuda)
Bipolar depression
used for?
Is effective in management of acute man-
How is Divalproex sodium (Depakote) ef- ic and depressive episodes and is also
fective? useful in prevention of relapse of both
manic and depressive episodes.
Can be used to treat manic episodes
How can Carbamazepine be used as?
associated with bipolar disorder.
· Cognitive behavioral therapy (CBT)
Nonpharmacological (PB pg. 184) · Behavioral therapies
Bipolar · Interpersonal therapies
· Supportive groups
FT4 test is done to determine thyroid
Free thyroxine T4 (FT4; normal values
status, to rule out hypo- and hyperthy-
0.8 to 2.8 ng/dl) (PB pg. 87-88)
roidism, and to evaluate thyroid therapy.
What is the normal range of free thyrox-
0.8 to 2.8 ng/dl
ine (FT4)?
TSH testing is commonly performed to
Thyroid-stimulating hormone (0.5-5.0
establish the diagnosis of primary hy-
Mu/L)
pothyroidism.
What is the normal range of thyroid-stim-
0.5-5.0 Mu/L
ulating hormone?
TSH secretion decreases.
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When T3 and T4 are high (hyperthy-
roidism),
When T3 and T4 are low (hypothy-
TSH secretion increases.
roidism),
o Mimics symptoms of unipolar mood
disorders (depression)
· Sensitive to cold (cold-intolerance)
· Confusion
· Decreased libido
Symptoms of Hypothyroidism (de- · Impotence
creased T4, increased TSH) (PB pg. · Decreased appetite
87-88) · Memory loss
· Lethargy
· Constipation
· Headaches
· Slow or clumsy movements
· Weight gain
o May mimic symptoms of bipolar affec-
tive disorders (mania)
· Sensitive to heat (heat-intolerance)
· Irritability/agitation
· Motor restlessness
· Emotional liability (exaggerated
Symptoms of hyperthyroidism (in-
changes in mood e.g., uncontrollable
creased T4, decreased TSH) (PB pg.
laughing and crying)
87-88)
· Short attention span
· Compulsive movement
· Fatigue
· Tremor
· Insomnia Impotence
· Weight loss
It is an enduring pattern of angry or irri-
table mood and argumentative, defiant,
or vindictive behavior lasting at least 6
months with at least four of the associ-
ated symptoms:
· Loses temper
· Touchy or easily annoyed
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· Angry or resentful
· Argues with authority
· Actively defies or refuses to comply with
Oppositional defiant disorder (ODD) (PB
request or rules from authority figures
pg. 329)
· Blames others
· Deliberately annoys others
· Spiteful or vindictive
· Loses temper
· Touchy or easily annoyed
· Angry or resentful
· Argues with authority
What are symptoms of oppositional defi-
· Actively defies or refuses to comply with
ant disorder (ODD)?
request or rules from authority figures
· Blames others
· Deliberately annoys others
· Spiteful or vindictive
Therapy is mainstay
Þ Individual therapy
Oppositional defiant disorder (ODD)
Þ Family therapy, with emphasis on child
Non-Pharmacological (PB pg. 332)
management skills
Þ Adolescent Transitions Program

A repetitive and persistent pattern of be-

havior in which the rights of others or
societal norms or rules are violated. The
presence of at least three of the following
criteria must be present in the past 12
months, with one in the past 6 months.
· Aggression toward people or ani-
mals-bullies, threatens, intimidates, initi-
Conduct disorder (PB pg. 332)
ates physical fights, uses a weapon to
cause physical harm to others, physically
cruel to people or animals, stealing while
confronting a victim, forced sexual activ-
ity on someone.
· Destruction of property - engaged in
fire-setting, destroyed others' property.
· Deceit or theft - broke into house, build-
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ing, or car; lies, steals items.
· Lack of remorse.
· Aggression toward people or ani-
mals-bullies, threatens, intimidates, initi-
ates physical fights, uses a weapon to
cause physical harm to others, physically
cruel to people or animals, stealing while
What are symptoms fo conduct disor- confronting a victim, forced sexual activ-
der? ity on someone.
· Destruction of property - engaged in
fire-setting, destroyed others' property.
· Deceit or theft - broke into house, build-
ing, or car; lies, steals items.
· Lack of remorse.
Treatment: Target mood and aggression
· Aggression and agitation treated with
Conduct disorder antipsychotics, mood stabilizers, selec-
Pharmacological Treatment (PB pg. 334) tive serotonin reuptake inhibitors (SS-
RIs), and alpha agonists (Clonidine and
Guanfacine)
· Behavioral Therapy
Conduct disorder
o Family therapy
Nonpharmacological (PB pg. 335)
o Individual therapy
Conversion disorder is a mental condi-
tion in which a person has blindness,
mutism, paralysis, or paresthesia (glove
Conversion disorder
stocking syndrome), other nervous sys-
tem (neurologic) symptoms that cannot
be explained by medical evaluation.
When do symptoms begin with conver- Symptoms usually begin suddenly after
sion disorder? a stressful experience.
· An adjustment disorder is an emotional
or behavioral reaction to a stressful event
or change in a person's life. The reaction
is considered an unhealthy or excessive
response to the event or change within
three months of it happening.
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· Stressful events or changes in the life of
your child or adolescent may be a family
move, the parents' divorce or separation,
Adjustment disorders (PB pg. 170) the loss of a pet, or the birth of a sibling.
· A sudden illness or restriction to your
child's life due to chronic illness may also
result in an adjustment response.
What is the presentation of adjustment Presents with feelings of depression,
disorder with depressed mood? tearfulness, and hopeless.
What is the presentation of adjustment Presents with symptoms of feeling rest-
disorder with anxiety? less, nervousness, lack of concentration.
What is the presentation of adjustment A patient has a mix of symptoms from
disorder with mixed anxiety and depres- both of the above subtypes (depressed
sion? mood and anxiety).
A child may violate other people's rights
or violate social norms and rules. Exam-
What is the presentation of adjustment
ples include not going to school, destroy-
disorder with disturbance of conduct?
ing property, driving recklessly, or fight-
ing.
What is the presentation of adjustment
A child has a mix of symptoms from all of
disorder with mixed disturbance of emo-
the above.
tions and conduct?
PTSD is the reexperiencing of an ex-
tremely traumatic event accompanied by
Post-traumatic stress disorder (PTSD)
symptoms of increased arousal (hyper-
(PB pg. 222)
arousal) and avoidance of stimuli asso-
ciated with the trauma.
Post-traumatic stress disorder (PTSD)
· SSRIs, TCAs
Pharmacological Management (PB pg.
· Prazosin for nightmares
224)

· Eye movement desensitization and re-

processing (EMDR)
Post-traumatic stress disorder (PTSD)
· CBT
Nonpharmacological (PB pg. 224)
· Exposure therapy with response pre-
vention (ERP)
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· Supportive group therapy
· Relaxation therapies
OCD is the presence of anxiety-provok-
Obsessive-compulsive disorder (OCD) ing obsessions and/or compulsions that
(PB pg. 218) function to reduce the person's subjec-
tive anxiety-level.
Defined as recurrent and persistent
thoughts, impulses, or images that are
Obsession
experienced and cause anxiety and dis-
tress.
How is obsession experienced? As intrusive and inappropriate.
Defined as repetitive behaviors or mental
Compulsion actions that a person feels driven to per-
form in response to an obsession.
· First-degree relatives.
Obsessive-compulsive disorder (OCD) · PANDAS (pediatric autoimmune neu-
Risk Factors (PB pg. 219) ropsychiatric disorders associated with
streptococcal infections)
Pediatric autoimmune neuropsychiatric
PANDAS disorders associated with streptococcal
infections
PANDAS (pediatric autoimmune neu-
What is considered in all children with
ropsychiatric disorders associated with
sudden onset OCD symptoms?
streptococcal infections)
· SSRIs (Sertraline and Fluoxetine):
Obsessive-compulsive disorder (OCD)
Clients often need higher dosage range
Pharmacological Management (PB pg.
for adequate symptom control)
221)
· TCA (clomipramine)
What kind of dosing do clients need for
Higher dosage
adequate symptom control of OCD?
Obsessive-compulsive disorder (OCD)
· CBT
Nonpharmacological Management (PB
· Exposure therapy
pg. 221)
Tourette syndrome is one type of Tic dis-
Tourette
order
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Involuntary, repetitive movements and

What are tics?
vocalizations.
At least 2 motor tics and at least 1 vocal
Tourette Syndrome (TS), also known as
(phonic) tic have been present, not nec-
Tourette's Disorder
essarily at the same time.
Wax and wane in frequency but have
What can tics do?
occurred for more than 1 year.
When do tics start to appear? Before the age of 18.
The use of substance or other medical
What are tics not caused by?
condition.
Tourette Syndrome (TS), also known as
Dopamine, norepinephrine (noradrena-
Tourette's Disorder
line), Serotonin
Primary neurotransmitter involved
· Atypical antipsychotic
· FDA: Haloperidol, Pimozide, Aripipra-
zole
· Medications such as clonidine (Cat-
Tourette Syndrome (TS), also known as apres, Kapvay) and guanfacine (Intuniv)
Tourette's Disorder can help control behavioral symptoms
Pharmacologic management such as impulse control problems and
rage attacks.
· Antidepressants such as Fluoxetine
(Prozac) might help control symptoms of
sadness, anxiety, and OCD.
What FDA medications are approved for
Haloperidol, Pimozide, Aripiprazole
Tourette syndrome (TS)?
What medications can help control be-
havioral symptoms such as impulse Clonidine (Catapres, Kapvay) and guan-
control problems and rage attacks in facine (Intuniv)
Tourette syndrome (TS)?
What medications can help control
Antidepressants such as Fluoxetine
symptoms of sadness, anxiety, and OCD
(Prozac)
in Tourette syndrome (TS)?
· Behavior therapy
· CBT
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Tourette Syndrome (TS), also known as
Tourette's Disorder
Non-Pharmacological management
Is a condition that involves quick, uncon-
trollable movements or vocal outbursts
Chronic motor or vocal tic disorder
(but not both). For example, excessive
blinking.
Schizophrenia (PB pg. 235) Þ 18-25 in males
Age of onset (PB pg. 236) Þ 25-35 in females
· Genetic defects such as:
Þ Inadequate synapse formation
Þ Excessive pruning of synapses
Þ Excitotoxic death of neurons
· Intrauterine insults may contribute to
Schizophrenia (PB pg. 235)
etiological picture:
Etiology (PB pg. 235)
Þ Prenatal exposure to toxins, including
viral agents
Þ Oxygen deprivation
Þ Maternal malnutrition, substance use,
or other illness
· Hallucinations
· Delusions
· Referential thinking
· Disorganized behavior
Schizophrenia (PB pg. 235)
· Hostility
Positive symptoms (PB pg. 239)
· Grandiosity
· Mania
· Suspiciousness
INCREASED DA = MESOLIMBIC

· Affective flattening
· Alogia or poverty of speech
· Avolition (lack of motivation or ability to
Schizophrenia (PB pg. 235)
do tasks)
Negative symptoms (PB pg. 239)
· Apathy (lack of interest)
· Abstract-thinking problems
· Anhedonia (inability to feel pleasure)
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· Attention deficits
DECREASED DA = MESOCORTICAL
Several abnormal brain structures have
been identified in people with schizo-
phrenia:
· Enlarged ventricles
· Smaller frontal and temporal lobes
Neurobiological defect associated with
· Reduced symmetry in temporal, frontal
schizophrenia (PB pg. 236)
and occipital lobes
· Cortical atrophy
· Decreased cerebral blood flow
· Hippocampal and amygdala reduction
MRI/PET SCAN
· Excess dopamine in mesolimbic path-
way
Schizophrenia (PB pg. 235)
· Excess glutamate
Suspected altercations in chemical neu-
· Decreased gamma-aminobutyric acid
ronal signal transmission (PB pg. 236)
(GABA)
· Decreased serotonin
· Monitor routine labs to screen for com-
plications of treatment
· Serum glucose and lipid panels
· Weight, BMI, and waist-to-hip ratio
Schizophrenia (PB pg. 235)
· Liver and kidney function (based on
Preventative care (PB pg. 257)
medication)
· Complete blood count
· Perform annual eye exam if on typical
antipsychotic agent or Seroquel
Schizophrenia (PB pg. 235) · Individual therapy
Non-pharmacological Management (PB · Group therapy
pg. 254) · Assertive community treatment (ACT)
Is the only known antipsychotic medica-
tion that has been shown to reduce the
What is Clozaril only known for?
risk of suicide in patients diagnosed with
schizophrenia.
Most of the 2nd generation antipsy- weight gain, including clozapine, olanza-
chotics cause... pine, quetiapine, and risperidone.
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Ziprasidone, aripiprazole (least sedat- weight neutral.

ing), lurasidone are... (ZAL)

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