Adolescent psychiatry Flashcards
What is CAMHS?
Child and adolescent mental health services
What are the 4 P’s of formulation?
- Predisposing
- Precipitating
- Perpetuating
- Protective
What is important to ask about in the history on top of the normal full psychiatric history in children?
Developmental history
What is involved in formulation?
- Consider problem in terms of biopsychosocial aspects
- Identify the 4 P’s
- Include risk assessment
- Differential diagnosis
- Develop management plan
What is resilience?
Refers to the process of, capacity for, or outcome of successful adapatation despite challenging or threatening circumstances
What is the theory of mind?
The ability to attribute beliefs, knowledge and desires to oneself, and to understand that other people also hold beliefs, knowledge and desires which may differ from one’s own. This allows the child to understand the concepts of deception, that other’s may hold different beliefs, and distinguishing fantasy from reality.
Pre-school children lack this ability, but by age 10 children start to develop this skill.
What does emotional development involve?
Skills of emotion differentiation, acceptable expression of emotion, and emotional concealment/containment.
What does social development involve?
This include types of play (solitary, parallel, co-operative), friendships, social skills, and popularity
What does cognitive development involve?
Involves a number of mental processes including understanding, believing, calculating, reasoning, inference and conceptualising
What are conduct disorders?
Disorders characterised by a repetitive and persistent pattern of antisocial, aggressive or defiant behavious that violate age-appropriate societal norms. Can be divided into conduct disorder and oppositional defiant disorder
Which sex are conduct disorders most prevalent in?
Boys
What are conduct disorders?
Disorders characterised by repetitive and persistent patterns of antisocial, aggressive, or defiant behaviours that violate age-appropriate societal norms
What are the two main classes of conduct disorders?
- Conduct disorder
- Oppositional defiant disorder
What are features of conduct disorder?
https://www.youtube.com/watch?v=XH46Nm1QOcg
- Aggression/cruelty to people +/- animals
- Destruction of property
- Deceitfulness
- Theft
- Fire-setting
- Truancy
- Running away from home
- Severe provocative or disobedient behaviour
What factors can feed into a child developing conduct disorder?
- Social disadvantage
- Parenting
- Child - low IQ, brain damage etc.
What comorbidities can co-eist in children with conduct disorders?
- ADHD
- LD
- Substance abuse
- Anxiety disorders
- ASDs
What is the prognosis for those with conduct disorder in terms of mortality?
Increased risk of early death. often by violent or sudden means
How would you manage a child with a conduct disorder?
-
Parent training program - age 12 years or younger
- Incredible years programme
- Functional family therapy
- Multi-systemic therapy
- Child interventions - social skills, problem-solving, anger management
- Consider child protection concerns
What is oppositional defiant disorder?
https://www.youtube.com/watch?v=XH46Nm1QOcg
An enduring pattern of negative, hostile and defiant behaviour, without serious violations of societal norms or the rights of others. Behaviour may occur in one situation only
What are the features of ODD?
- Irritability
- Resentful
- Angry
- Dislike for authority
- Argumentative
- Vindicitive/Spiteful
What is the difference between conduct disorder and oppositional defiant disorder?
Those with conduct disorder show aggression/cruelty to people +/- animals. They also have antisocial behaviours such as destroying property and stealing things
What is attention deficit deficit hyperactivity disorder?
https://www.youtube.com/watch?v=XH46Nm1QOcg
A disorder characterised by 3 core symptoms:
- Inattention
- Hyperactivity
- Impulsiveness
What are the subtypes of ADHD recognised in DSM-V?
- Inattentive subtype
- Hyperactive/impulsive subtype
- Combined subtype - most common
In ADHD, what are features of inattention?
- Careless with detail
- Fails to sustain attention
- Fidgets with hands or feet
- Fails to finish task
- Poor self-organisation
- Loses things
- Forgetful
- Easily distractible
In ADHD, what are features of hyperactivity?
- Fidgets with hands/feet
- Leaves seat in class
- Runs/climbs about
- Cannot play quietly
- Always on the go
In ADHD, what are features of impulsiveness?
- Talks excessively
- Blurts out answers
- Cannot await turn
- Interrupts others
- Intrudes on others
What comorbidities are present in children with ADHD?
- Specific learning disorder
- Motor co-ordination problems
- ASD
- Tic disorders
- CD/ODD
- Substance abuse
- Anxiety
- Depression
- Bipolar disorder
What percentage of children with ADHD have other co-morbid psychiatric conditions?
50-80%
According to DSM-V, how many symptoms from their criteria need to be present for a diagnosis of ADHD (or specifically one of its subtypes) to be made?
6/9 symptoms for at least 6 months
What age range is used as part of the diagnostic criteria for ADHD?
Started betwee 6-12 years - considered a neurodevelopmental disorder
What short-term problems occur in children with ADHD?
- Sleep problems
- Low self-esteem
- Family and peer relationship problems
- Reduced academic achievement
- Increased risk of accidents
What are long-term problems that occur in those with ADHD?
- Reduced academic achievement and employment success
- Increased criminal activity
- Antisocial personality disorder
How would you manage a child with ADHD?
- Psychoeducation
- Medication
- Behavioural interventions
- School interventions
- Dietary changes
- Parenting training
- Treat comorbidity
What medications are used in the treatment of ADHD?
- Methylphenidate - ritalin, ceoncerta XL
- Atomoxetine
What is methylphenidate?
CNS stimulant licensed for tratment of children with ADHD
What is the difference between methylphenidate and methamphetamines?
Release pattern - methylphenidate is much slower release than methamphetamines
What are the side effects to methyphenidate?
- Abdo pain
- Nausea and vomiting
- Dry mouth
- Anxiety
- Insomnia
- Dysphoria
- Heacaches
- Anorexia/reduced weight gain
How does methyphenidate work?
Primarily acts as a norepinephrine-dopamine reuptake inhibitor. It is most active at modulating levels of dopamine and blocks dopamine transporters
What is are autistic spectrum disorders?
https://www.youtube.com/watch?v=_HGUyk5U_j8
A group of lifelong developmental disorders characterised by their effect on social and communication skills as well as restricted, stereotyped, repetitive repertoire of interests and activities. The spectrum ranges from clear-cut autism, to subtle variants, to traits found in normal populations and includes the diagnosis of autism, asperger’s syndrome, and pervasive developmental disorder otherwise specified (PDD-NOS)
What is self-harm?
This is any act which causes harm to self that is used as a coping strategy to deal with emotional pain, or to break feelings of numbness by arousing sensation.
What might self-harm indicate?
- Psychiatric disorder
- Significant psychological problems
What factors increase the risk of completed/attempted suicide in young people?
- Persistent suicidal ideation
- Previous suicidal behaviour
- High lethality of method
- Sigh levels of intent
- Ongoing precipitating stresses
- Mental disorder
- Poor physical health
- Psychological factors
- Parental psychopathology/suicidal behaviour
- Disconnection from support systems
How would you manage a child who was at high risk of suicide?
- Assessment by specifically trained staff
- Admit to age-appropriate ward if serious attempt made
- Refer to local CAMHS
If a child/adolescent was presenting with symptoms of psychosis, what would you consider as part of your differential diangosis?
- Normal experience
- Organic cause
- Mood disorder
- PDD/Autism
- OCD
- SChizophrenia
- Language disorder
- Dissociative disorder
What can be organic causes of psychosis in children/adolescents?
- TLE
- Thyroid disease
- Brain tumour
- Wilson’s Disease
- Substance misuse
