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Psychiatry > Adolescent mental health > Flashcards

Adolescent mental health Flashcards

1
Q

Describe the management of anxiety disorders in adolescents

A
  • mild anxiety; CBT
  • unresponsive or moderate-severe; SSRIs, up to 12 wees to take effect, continue for 1 year
  • benodiazepines; paradoxical agitation, initial titration
  • NOT PROPRANOLOL
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2
Q

Describe the management of depression in adolescents

A

Mild depression;
- watchful waiting for 2 weeks
- then group IPT/CBT, digital CBT, non directive supportive therapy for 2-3 months
Unresponsive or moderate to severe;
- individual CBT etc, family therapy, psychodynamic psychotherapy 4-6 sessions
- then fluoxetine
- then sertraline or citalopram
- consider augmentation with low dose antipsychotic if poor response to at least 2 SSRIs

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3
Q

Describe the features of non-suicidal self-injury

A
  • periods of optimism and some sense of control
  • successful decrease in discomfort
  • frequently chronic and repetitive
  • intent to relieve from unpleasant emotions
  • uncomfortable but intermittent psychological pain
  • choices available; ‘temporary solution’
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4
Q

Describe the features of suicidal self-injruy

A
  • hopeless and helplessness central
  • no release of discomfort after self injury
  • generally not chronic or repetitive
  • intent to escape pain or end consciousness
  • unendurable, persistent psychological pain
  • tunnel vision; ‘one way out’
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5
Q

Describe the initial management of self harm

A
  • educate about signs of distress in themselves and others
  • use of positive coping skills
  • learn about the difference between self injury and suicide and normalise the experiences
  • some people will just want to be heard and empathised with
  • refer to specialist mental health professional for assessment of risk and underlying causes
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6
Q

Autism spectrum disorder is an umbrella term for what 5 disorders?

A
  • aspergers syndrome
  • retts syndrome
  • childhood autism
  • pervasive developmental disorder
  • pervasive developmental disorder NOS
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7
Q

What are the core features of ASD?

A
  • triad of impairments
  • social communication
  • social interaction
  • social imagination
  • repetitive behaviours
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8
Q

How is social communication impaired in ASD?

A
  • generally good language skills but find it hard to grasp the underlying meaning of conversation
  • difficulties understanding jokes, idioms, metaphors and sarcasm
  • voices often sound monotonous
  • language can be pedantic and idiosyncratic
  • they often have narrow interests which dominate their conversations (lack of reciprocity)
  • difficulty sharing thoughts and feelings
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9
Q

How is social interaction impaired in ASD?

A
  • difficulties picking up non-verbal cues
  • appear self focused and lacking in empathy, when in fact, they are simply trying to figure out social situations
  • continually struggle to make and sustain personal and social relationships
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10
Q

How is social imagination impaired in ASD?

A
  • difficulties thinking flexibly and in abstract ways
  • inability to understand other peoples points of view, taking things literally
  • difficulties applying knowledge and skills across settings with different people
  • difficulties projecting themselves into the future or planning goals sensibly
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11
Q

Describe potential biological-perinatal causes of ASD

A
  • umbilical cord complications
  • foetal distress
  • birth injury or trauma
  • multiple birth and maternal haemorrhage
  • low birth weight / small for gestational age
  • congenital malformation
  • meconium aspiration
  • neonatal anaemia, ABO or Rh incompatibility and hyperbilirubinaemia
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12
Q

Describe the neuroanatomical changes in ASD

A
  • frontal lobes, amygdala and cerebellum appear pathological in autism
  • amygdala in boys with autism appears 13-16% larger assoc. with more severe anxiety and worse social and communications skills
  • however, there is no clear and consistent pathology that has emerged for autism
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13
Q

Describe the sensory processing difficulties in ASD

A
  • any of the senses can be over or under sensitive or both at different times
  • taste; find some flavours too strong, has a restricted diet, certain textures cause discomfort
  • smell; can be intense and overpowering, can cause toileting problems
  • sound; inability to cut out sounds
  • touch; can be painful and uncomfortable, only certain types and textures of clothing
  • sight; poor depth perception, sensitive to light
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14
Q

Describe features that can lead to diagnosis of ASD in children

A
  • language difficulties
  • may lack awareness of an interest in other children
  • struggle to initiate friendships
  • gravitate to older or younger children
  • tend to play alone
  • difficulties understanding other peoples emotions and feelings
  • may flap their hand or twist their fingers when upset or excited
  • repetitive play
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15
Q

What is the essential criteria for ASD diagnosis?

A
  • symptoms must be present in the early developmental period
  • symptoms cause clinically significant impairment in social, occupational or other important areas of current functioning (regardless of age)
  • disturbances are not better explained by other mental health problems, intellectual disability or global developmental delay
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16
Q

Describe the non-pharmacological management of ASD

A
  • aims to lessen associated deficits and family distress, and to increase quality of life and functional independence
  • self and fammily psychoeducation is helpful
  • applied behavioural analysis, speech and language therapy, social skills training all have some success
  • family and school based supports (social care to support independence in adulthood may be required)
17
Q

What is the triad of difficulties for ADHD?

A
  • inattention
  • hyperactivity
  • impulsivity

These are;

  • developmentally inappropriate
  • impairing functioning
  • pervasive across settings (i.e. home, school, work, etc)
  • longstanding from age 5
18
Q

What are the genetic factors involved in ADHD?

A
  • shows familial clustering within and across generations

- mainly dopamine and serotonin transporter genes involved

19
Q

What are the perinatal factors in ADHD?

A
  • links tobacco and alcohol use during pregnancy to higher risk
  • significant prematurity and perinatal hypoxia
  • other complications include unusually short or long labour, foetal distress, low forceps delivery and eclampsia
20
Q

Describe the neurobiology of ADHD

A
  • the typical brainmap pattern in children shows an underactive function within the frontal lobe
  • frontal lobe is responsible for; reasoning, planning, impulse control, judgement, initiation of actions, social / sexual behaviour and long term memory
21
Q

Describe the neurochemistry of ADHD

A
  • excessively efficient dopamine removal system (higher concentration of dopamine transporters called re-uptake inhibitors)
  • symptoms may also be caused by the reduction of norepinephrine and serotonin
22
Q

What is the diagnostic criteria for ADHD in children?

A
  • 6 or more symptoms of inattentiveness and/or
  • 6 or more symptoms of hyperactivity and impulsiveness
  • present before age 5 years (or 3 for some clinicians)
  • reported by parents, school and seen in clinic
  • symptoms get in the way of daily life
23
Q

What is the diagnostic criteria for ADHD in adults?

A
  • in general, 5 or more of the symptoms of inattentiveness and/ or
  • 5 or more of hyperactivity and impulsiveness
  • historical concerns since early age
  • for adults, it is essential for the diagnosis that symptoms should have a moderate effect on different areas of their life, such as; underachieving in work or education, driving dangerously, difficulty making or keeping friends or difficulty in relationships with partners
24
Q

Describe the psychosocial interventions for mild, moderate and severe ADHD in children

A
  • parent training (i.e. new forest parenting programme)
  • social skills training
  • sleep and diet; eliminations and supplements (controversial)
  • behavioural classroom management strategies
  • specific educational interventions
25
Q

Describe the pharmacological management of moderate severe ADHD

A 
1st line (stimulants);
- methylphenidate (increases dopamine by blocking its transporter)
- dexamfetamine (^ also increases extracellular norepinephrine)
- lizdexamfetamine 
2nd line (SNRI);
 - atomoxetine (reduces sympathetic stimulation)
3rd line (alpha agonist);
- clonidine
-guanfacine 
4th line; 
 - antidepressants (imipramine) 
- antipsychotics (risperidone)
26
Q

Define learning disability

A

A condition of arrested or incomplete development of the mind, which is especially characterised by impairment of skills, manifested during the developmental period, which contribute to the overall level of intelligence i.e. cognitive, language, motor and social abilities

27
Q

Describe the psychometric assessment for people with learning disabilities

A
  • most commonly used; wechsler adult intelligence scale (WAIS)
  • in children, depending on age, wechsler intelligence scale for children (WISC), weschler preschool and primary scale of intelligence (WPPSI)
  • others; stanford binet, ravens progressive matrices
28
Q

Describe the presentation of a mild intellectual disability

A
  • IQ range 50-60, mental age 9 to under 12 yeas
  • most common
  • delayed speech; able to use everyday speech
  • full independence
  • difficulties in reading and writing
  • capable of unskilled or semi-skilled work
  • problems if social or emotional immaturity
29
Q

Describe the presentation o a moderate learning disability

A
  • IQ range 35-49, mental age 6 to under 9 years
  • slow with comprehension and language
  • limited achievements
  • delayed self care and motor skills
  • simple practical tasks; often with supervision
  • usually fully mobile
  • discrepant profiles
  • majority organic aetiology
  • epilepsy and physical disability common
30
Q

Describe the presentation of a severe learning disability

A
  • IQ range 20-34, mental age 3 to under 6 years
  • generally more marked impairment than in moderate LD and achievements more restricted
  • epilepsy
31
Q

Describe the presentation of a profound learning disability

A
  • IQ less than 20 (difficult to measure), mental age less than 3 years
  • severe limitation in ability to understand or comply with requests or instructions
  • little or no self care
  • often severe mobility restriction
  • basic or simple tasks difficult
32
Q

Describe the different factors of aetiology in intellectual disabilties

A
  • chromosomal
  • antenatal; maternal infections, poor diet and substance abuse
  • birth; extreme prematurity, birth injury, cerebral anoxia
  • postnatal; metabolic causes, hypoglycaemia, high bilirubin
  • infections, NAI, trauma and toxins in childhood

Psychiatry (13 decks)

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