1b// Psychiatry Across a Lifecourse Flashcards
What is important to consider with it comes child and teen mental health?
bio-psycho-social model
systemic approach (focus on relationships and social context e.g., school,m fmaily)
4 Ps formulation:
o Predisposing factors
o Precipitating factors
o Perpetuating factors
o Protective factors
When does half of all mental health conditions start by?
Half of all mental health conditions start by 14 years of age but most cases are undetected and untreated
What are the stages of development measured by?
erikson’s stages of psychosocial development
What is the adlescent brain like?
- The prefrontal cortex matures later than the cortical areas associated with sensory and motor tasks
- Adolescence is a period of neural imbalance caused by early maturation of subcortical brain areas and delayed maturation of prefrontal control areas
What are the stages of development according to erikson’s stages?
dont need to know its a visual
What is the peak age of onset for attention deficit hyperactivity disorder, autism spectrum disorder, eating disorders?
ADHD= 12
ASD= 9
eating= 17
What are the core features of diagnosis for ADHD according to DSM-5 criteria?
- Persistent pattern of inattention and/or hyperactivity-impulsivity
- Present for at least 6 months
- Inappropriate for their developmental level
- Interferes with functioning or development
- Several symptoms present before age 12
- Several symptoms present in two or more settings
- The symptoms are not better explained by another mental disorder
What are the risk factors of ADHD?
Genetic Risk Factors:
* No isolated gene for ADHD, there are likely multiple genes conferring vulnerability for developing it
* Twin studies have shown a significant heritability for ADHD - as high as 76%
* First degree relatives of children with ADHD have an ADHD diagnostic probability 4-5x higher than the
general population
* Boys are more vulnerable than girls
Environmental Risk Factors:
* Premature birth
* Low birth weight
* Prenatal smoking exposure
What are the subtypes for ADHD?
inattentive
hyperactive
combined
What is the prognosis of ADHD?
70% of children who have this disorder will have the disorder as teenagers, and about 40%- 60% will still have it as adults
- its not that it goes away, it is just easier to manage
What is dementia?
Degenerative disease of the brain:
o Irreversible and progressive changes
o Global cognitive and behavioural impairment
o Sufficiently severe to interfere significantly with
social and occupational function
o An umbrella term that has many underlying
causes
o Can be conceptualised as “chronic brain failure”
What are the reversible causes of dementia?
Reversible causes (not exhaustive)…
* Normal pressure hydrocephalus
* Intracranial tumours
* Subdural haematoma
* Depression
* B1, B6, B12 deficiency
* Folate deficiency
* Hypothyroidism
* Neurosyphilis
* Delirium
- Always think to exclude – Surgical, metabolic, infective and psychiatric reversible causes for cognitive impairment
What are causes dementia?
frontotemporal dementia
parkinson’s dementia
dementia with lewy bodies
mixed
vascular dementia
alzheimer’s disease
What is this and what caused it? What does it clinically present with?
Example of normal pressure hydrocephalus. Note the dilated ventricles.
Clinically presents with the Hakim-Adams triad;
- Cognitive impairment/confusion
- Urinary frequency/incontinence
- Gait disturbance (magnetic/stuck to the floor gait)
How does dementia cause death?
e.g., stops eating, loss of basic drive, can stop swallowing (aspiration leads to sepsis)
What are the clinical features of mild dementia?
- Living independently but some supervision/support often needed
- Can participate in community activities and can appear unimpaired to those who do not know them
- Judgement and problem solving typically impaired
- Social judgement may be preserved
- Difficulty making complex plans/decisions and handling finances
What are the clinical features of moderate dementia?
- Require supports to function outside the home and only simple household tasks are maintained
- Difficulties with basic activities of daily living (ADL’s), such as dressing and personal hygiene
- Significant memory loss
- Judgment and problem solving are typically significantly impaired, and social judgment is often compromised
- May have difficulty communicating with individuals outside the home without caregiver assistance
- Socializing is increasingly difficult as the individual may behave inappropriately (e.g., in disinhibited or aggressive ways), with associated behaviour changes (e.g., calling out, clinging, wandering, disturbed sleep, or hallucinations)
- Difficulties are often obvious to most individuals who have contact with the individual
What are the clinical features of severe dementia?
- Severe memory impairment
- Often disoriented to time and place
- Often unable to make judgments or solve problems
- May have difficulty understanding what is happening around them (situational awareness)
- Dependent on others for basic personal care) bathing, toileting and feeding)
- Urinary and faecal incontinence may emerge at this stage
What is anterograde amnesia?
Anterograde amnesia is a type of memory loss that occurs when you can’t form new memories.
Symptoms of anterograde amnesia include the inability to recall new memories, such as forgetting the most recent meal, names of people newly met, or recent life changes.
What are behavioural and psychological symptoms in dementia (BPSD)?
- Common in Dementia
- Includes apathy, mood disturbances, hallucinations, delusions, irritability, agitation, aggression and sleep changes
- Typically, these symptoms are more frequent and impairing in moderate and severe forms of Dementia
What is a screening test for dementia?
mini mental state examination (MMSE)
Do you remember these key points?
Key points to be taken from this tutorial:
- The brain as well as psychological development continues throughout childhood and beyond
- Mental health conditions in children and adolescents are common; many mental health conditions start in early life
- Attention deficit hyperactivity disorder (ADHD) is characterised a by a triad of inattention, impulsivity and hyperactivity
- Prognosis for a child with ADHD is variable: they may recover, show an improvement or remain symptomatic through life
- Ability to take and present a psychiatric history in patients presenting with cognitive impairment
- Ability to take and present a collateral psychiatric history for patients presenting with cognitive impairment
- Ability to record and present key mental state examination findings in patients presenting with cognitive impairment
- Ability to use tools to in order to assess a patient’s cognition in various cognitive domains
- Ability to consider key differentials and comorbidities for cognitive impairment
What is the somatisation disorder?
form of mental illness that causes one or more bodily symptoms, including pain
no physical cause found
What isa ADHD?
Attention deficit hyperactivity disorder (ADHD) is acondition that affects people’s behaviour. People with ADHD can seem restless, may have trouble concentrating and may act on impulse
What is ASD?
Autism spectrum disorder is acondition related to brain developmentthat impacts how a person perceives and socializes with others, causing problems in social interaction and communication. The disorder also includes limited and repetitive patterns of behavior.
What is Tourette’s syndrome?
- involves repetitive movements or unwanted sounds (tics) that can’t be easily controlled.
- Tics are sudden twitches, movements, or sounds
Describe the personality change during dementia.
often reflects an exaggeration of premorbid traits with coarsening of affect and egocentric
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