Psychiatry lectures - u-szeged.hu

Psychiatry lecturesPsychiatry lectures

Prof. János Kálmán

Signs of baby Autism

• ASD can be diagnosed as early as 1 year of age– No big smiles or other warm,

joyful expressions by six months or thereafter

– No back-and-forth sharing of sounds, smiles or other facial expressions by nine months

– No babbling by 12 months

– No back-and-forth gestures such as pointing, showing, reaching or waving by 12 months

– No words by 16 months

– No meaningful, two-word phrases (not including imitating or repeating) by 24 months

– Any loss of speech, babbling or social skills at any age

2Kálmán - Psychiatry

Behavioral Signs and Symptoms

• Speech: monotone, rhythmic, nasally/high

pitched (dysarthric), pedantic, repeating

phrases (echolalic), and other idiosyncratic

speech patterns.

• Eye contact: no, limited, or inappropriate eye

contact- towards the ceiling, looking at the

body, avoiding face/eyes.

• Gross and fine motor coordination: unable

to balance on foot or tandem walk, or poor

writing (dysgraphia).

• Stereotyped behaviors: hand-wringing or

twisting, spinning in chair, complex whole

body movement, hand-flapping, pacing.3Kálmán - Psychiatry

Risk for Abuse

• A child with any type of developmental disability was 4xs

more likely to be sexually abused than a child without

(Sullivan & Knutson, 2000).

• 50% of children with autism are nonverbal and unable to

participate in usual means for verbal interviews that require

reciprocal communication.


Kálmán - Psychiatry 5

Pervasive Developmental Disorders


Social Communication Disorder

• Impairment of pragmatics, social uses of

verbal and nonverbal communication and

social relationships.

• Functional limitations in effective

communication, social participation, academic

achievement, or occupational performance,

alone or in any combination.


Asperger Explosion

• ASD without Intellectual disabilities.

• Replaced A Cluster personality disorders.

• Represents social impairments.

• High Function Autism (HFA) intelligent and

odd.

• Easiest to assess, study and treat.


Broader Autistic Phenotype

• Broader Autistic Phenotype is marked by personality qualities seen in families.

• Revolves around Asperser's Syndrome.

• Aloof, rigid, anxious, social isolated, restricted nonverbal skills.

• Deficits in Executive Functions.


Rett’s Syndrome

• 1966 Andreas Rhett published reports of

girls with similar symptoms.

• 1999 Ruthie Amir discovered MECP2 X-

linked dominant disorder, Methyl-cytosine

binding protein dysregulation.


Rett’s Syndrome

• Cerebroatrophic hyperammoneia starts at 6 to 18 months of age.

• Hand wringing, washing/clapping movements, head growth stops.

• Prone to apnea/hyperventilation.

• Limited awareness, seizures and motor loss.


Childhood Disintegrative Disorder

(CDD)

• 1908 Theodor Heller described dementia

infantilis marked by psychosis.

• After 2 years normal development abrupt

onset of ASD in severe form and loss of motor

skills.

• Rare cause of ASD.



Developmental Growth

• 20-30% have seizures, up to 72% abnormal EEG

• 75% smaller head circumferences at birth, but rapid

growth by first year in the 85th percentile

• 100-200g heavier brain weight in autism

– Deficits in emotion centers: amygdala, prefrontal cortex,

temporal lobes, & thalamus

– Dysregulated neurochemicals like serotonin, dopamine,

melatonin, and oxytocin



A Few Theories on the Cause of ASD

• No single theory explains ASD

• Genetic and heredity

• Abnormal development

• Physical health issues

• Autoimmune problems

• Environmental toxins16Kálmán - Psychiatry

Heredity & Genetic Abnormalities

• Monozygotic twins as high as 60-95%

• Siblings are 45-60 times greater to develop autism

• First degree relatives might have psychiatric issues like

depression, OCD, anxiety disorders, etc

• X Chromosome as a factor?

– Fragile , Turner’s syndrome, Klinefelter, Rett, Prader-Willi,

Timothy, Phenylketonuria, and Angelman syndromes.

– Reason for higher rates in males? (XY vs. XX in females)


Autism related genes


Genetics of autism spectrum disorders



Summary of infection effects on the

placentaPlacental pathophysiology and subsequent effects on fetal development


DISC1: from psychopathology to structure

and function


Behavioral Treatments

• Behavioral treatments are always the first

step prior to any medication.

• The three pillars: communication, transitional

programs, sensory integration.

• Behavioral research has focused mainly on

Intensive Behavioral Modification and

communication programs.


Communication

• Programming addresses one of the core deficits of Autism.

• Most training focuses in on picture or symbolic language.

• Training is intensive, time consuming and repetitive.


Sensory Integration

• Uses a wide variety of stimulation– vestibular, skin, deep touch, massage—to enrich and

calm.

• May involve cerebellar pathways and.

• Requires training, equipment and usually daily stimulation.

• Little research.


Cognitive-Behavioral Therapy

• Social skills training

• Anger management

• Rethinking perspective

• Regulate emotions

• Social skills training

• Social Autopsies

• Social Stories26Kálmán - Psychiatry

Social Skills Training

• Social skills training utilizes variety of

techniques breaking down complex social

behaviors.

• Communication training benefits day to day

functioning.

• Includes social cues, transition rituals,

transition objects, and picture cards.


Occupational Therapy

• OT provides critical interventions that might

offset need for medication or other therapy

• Assists in skills like in improving hand writing

• Sensory diets regulate the environment and

structure daily activities to prevent overload

– Schedules are very important in ordering the

day’s sensory input!28Kálmán - Psychiatry

ASD Psychopharmacology I


ASD PsychopharmacologY II


REFERENCES

• A Multisite Study of the Clinical Diagnosis of Different Autism Spectrum Disorders, Catherine Lord, Eva Petkova, Vanessa Hus, Weijin Gan, Feihan Lu, Donna M. Martin, Opal Ousley, Lisa Guy, Raphael Bernier, Jennifer Gerdts, Molly Algermissen, Agnes Whitaker, James S. Sutcliffe, Zachary Warren, Ami Klin, Celine Saulnier, Ellen Hanson, Rachel Hundley, Judith Piggot, Eric Fombonne, Mandy Steiman, Judith Miles, Stephen M. Kanne, Robin P. Goin-Kochel, Sarika U. Peters, Edwin H. Cook, Stephen Guter, Jennifer Tjernagel, Lee Anne Green-Snyder, Somer Bishop, Amy Esler, Katherine Gotham, Rhiannon Luyster, Fiona Miller, Jennifer Olson, Jennifer Richler, Susan Risi, Archives of General Psychiatry, 69:3 (2012) http://archpsyc.jamanetwork.com/article.aspx?articleid=1107413&maxtoshow=&hits=10&RESULTFORMAT=&fulltext=Catherine%20Lord&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT•Application of DSM-5 Criteria for Autism Spectrum D isorder to Three Samples of Children With DSM-IV Diagnoses of Pervasive Developmental Disorders, Marisela Huerta, Somer L. Bishop, Amie Duncan, Vanessa Hus, Catherine Lord, Am J Psychiatry,169(2012) 1056-1064. doi:10.1176/appi.ajp.2012.12020276, http://journals.psychiatryonline.org/article.aspx?articleid=1367813•ASD: Clinical Applications, Brian Bonfardin, https://www.etsu.edu/com/cme/documents/grand_rounds/psychiatry/Bonfardin%203-29-13.pptx•Autism and Related Disorders: An Introduction to Autism, Fred Volkmar, Ami Klin, James McPartland,http://autism.yale.edu/sites/default/files/Class1_Volkmar_CLEAR.ppt•Autism and the DSM-5, Stephen M. Kanne,http://wiggio.com/yui/folder/stream_file.php?doc_key=v0RR4ltby3/7NYb5H1uWX2AFp1NFo2GNfcRVFXsq+fo=•Autism Spectrum Disorders, Katie Cook, https://courses.mnu.edu/mod/resource/view.php?id=66263•Autism Spectrum Disorders: A Very Brief Introductio n, Nancy N. McLean, http://www.ncsswa.org/members/docs/Autism_Presentation.ppt•Autism spectrum disorders in the DSM-V: Better or worse than the DSM-IV? Lorna Wing, Judith Gould, Christopher Gillberg. Research in Developmental Disabilities 32 (2011) 768–773.•Autism Spectrum Disorder Fact Sheet, DSM V., APA.http://www.dsm5.org/Documents/Autism%20Spectrum%20Disorder%20Fact%20Sheet.pdf•Autism Spectrum Disorder Overview, Michael J. Lucido, http://is0.gaslightmedia.com/childabusecouncil/_ORIGINAL_/fs44-1367190032-08227.pptx•Changes in DSM-5: Autism Spectrum Disorder and Social (Pragmatic) Communication Disorder, Donald Oswald, http://www.autismva.org/sites/default/files/DSM-5%20Presentation.pptx•Diagnosis and Treatment: The Treatment of Emotional Disorders in High Functioning Autism, APS, http://www.psychology.org.au/Assets/Files/APS_Autism%20webinar_190314_Final.pptx•DSM-5: The New Diagnostic Criteria For Autism Spectrum Disorders, Walter E. Kaufmann, http://www.autismconsortium.org/symposium-files/WalterKaufmannAC2012Symposium.pdf•Emerging Trends in Autism Spectrum Disorders, http://www.wcu.edu/WebFiles/CEAP-hs-COUN-BBTL-EmergingTrends.pptx•Overview of DSM-5: Autism Spectrum Disorder, Courtney Burnette, https://www.cdd.unm.edu/autism/pdfs/WEBINAR%20DSM%205%20CDD%20PPT%20Template%203%20.pdf•WHAT IS Autism Spectrum Disorder?, Nancy J. Aguinaga, http://cstl-coe.semo.edu/naguinaga/Intro%20ASD.ppt•What’s New in DSM-5 and the New ASAM Criteria?: Implications in an Era of Healthcare Reform, David Mee-Lee, http://www.attcnetwork.org/learn/education/WhatsNewDSM5.pdf