CAHMS Flashcards
Features of depression in children and adolescents
See MH cards
Psychosocial contributors to depression in children and adolescents
Potential triggers (e.g. loss of a family member) Home environment Family relationships Relationship with friends Sexual relationships School situations and pressures Bullying Drugs and alcohol History of self harm Thoughts of self harm or suicide Family history Parental depression Parental drug and alcohol use History of abuse or neglect
Management of depression in children and adolescents
Mild depression (associated with a single negative event)- lifestyle changes, watchful waiting, review in 1 week
Moderate/severe- refer to CAHMS, psychological therapy (CBT, family therapy), fluoxetine is 1st line, sertraline/citalopram are 2nd line
NB- admission where there is risk of self-harm/suicide or safeguarding issue (ie. parental physical abuse/neglect)
Generalised Anxiety Disorder in Children and Adolescents
Assessment
- GAD-7 anxiety questionnaire: establishes severity
- Assess for co-morbid mental health problems, such as depression/OCD
- Assess for environmental triggers and contributors eg. family relationships, friendships, bullies, school pressures, alcohol and drug use
Management;
Mild- watchful waiting and advice about self-help strategies (e.g. meditation), lifestyle eg. diet, exercise and avoiding alcohol, caffeine and drugs.
Moderate/severe- referred to CAMHS services to initiate:
Counselling
Cognitive behavioural therapy
Medical management eg. SSRI (sertraline)
OCD in children and adolescents
Features
- obsessions: unwanted intrusive thoughts
- compulsions: rituals that have to be performed to relieve anxiety
- anxiety
Associations;
Anxiety Depression Eating disorders Autistic spectrum disorder Phobias
Mild- education, self-help resources, lifestyle
Moderate/severe- referral to CAHMS, education, CBT, SSRI
Autism spectrum disorder (ASD)
refers to the full range of people affected by a deficit in social interaction, communication and flexible behaviour.
Features can be categorised as deficits in social interaction, communication and behaviour. Features are usually observable before the age of 3 years.
Social Interaction
Lack of eye contact Delay in smiling Avoids physical contact Unable to read non-verbal cues Difficulty establishing friendships Not displaying a desire to share attention (i.e. not playing with others)
Communication
Delay, absence or regression in language development
Lack of appropriate non-verbal communication such as smiling, eye contact, responding to others and sharing interest
Difficulty with imaginative or imitative behaviour
Repetitive use of words or phrases
Behaviour
Greater interest in objects, numbers or patterns than people
Stereotypical repetitive movements. There may be self-stimulating movements that are used to comfort themselves, such as hand-flapping or rocking.
Intensive and deep interests that are persistent and rigid
Repetitive behaviour and fixed routines
Anxiety and distress with experiences outside their normal routine
Extremely restricted food preferences
Management of ASD
Autism cannot be cured. Management depends on the severity of the child’s condition. Management involves a multidisciplinary team to provide the best environment and support for the child and parent:
Child psychology and child and adolescent psychiatry (CAMHS)
Speech and language specialists
Dietician
Paediatrician
Social workers
Specially trained educators and special school environments
Charities such as the national autistic society
Attention Deficit Hyperactivity Disorder (ADHD)
Features;
Features should be consistent across various settings. When a child displays these features only at school but is calm and well behaved at home, this is suggestive of an environmental problem rather than an underlying diagnosis.
Very short attention span
Quickly moving from one activity to another
Quickly losing interest in a task and not being able to persist with challenging tasks
Constantly moving or fidgeting
Impulsive behaviour
Disruptive or rule breaking
Management;
Establishing a healthy diet and exercise Establishing a routine Using reward charts Setting boundaries SENCO support at school Parental education Medications- methylphenidate 1st line (ritalin- CNS stimulant): ECG (cardiotoxic), monitor growth, lisdexamfetamine 2nd line
Anorexia Nervosa
The person feel they are overweight despite evidence of normal or low body weight. It involves obsessively restricting calorie intake with the intention of losing weight.
Often the person exercises excessively and may use diet pills or laxatives to restrict absorption of food.
Features of anorexia nervosa:
Excessive weight loss Amenorrhoea Lanugo hair is fine, soft hair across most of the body Hypokalaemia Hypotension Hypothermia Changes in mood, anxiety and depression Solitude Cardiac complications include arrhythmia, cardiac atrophy and sudden cardiac death.
Anorexia Nervosa
The person feel they are overweight despite evidence of normal or low body weight. It involves obsessively restricting calorie intake with the intention of losing weight.
Often the person exercises excessively and may use diet pills or laxatives to restrict absorption of food.
Features of anorexia nervosa:
Excessive weight loss Amenorrhoea Lanugo hair is fine, soft hair across most of the body Hypokalaemia Hypotension Hypothermia Changes in mood, anxiety and depression Solitude Cardiac complications include arrhythmia, cardiac atrophy and sudden cardiac death.
Bulimia nervosa
Unlike with anorexia, people with bulimia often have a normal body weight. Their body weight tends to fluctuate. The condition involves binge eating, followed by “purging” by inducing vomiting or taking laxatives to prevent the calories being absorbed.
Features of bulimia nervosa:
Alkalosis, due to vomiting hydrochloric acid from the stomach
Hypokalaemia
Erosion of teeth
Swollen salivary glands
Mouth ulcers
Gastro-oesophageal reflux and irritation
Calluses on the knuckles where they have been scraped across the teeth. This is called Russell’s sign.
Binge eating disorder
Binge eating disorder is characterised by episodes where the person excessively overeats, often as an expression of underlying psychological distress. This is not a restrictive condition like anorexia or bulimia, and patients are likely to be overweight.
Binges may involve:
A planned binge involving “binge foods” Eating very quickly Unrelated to whether they are hungry or not Becoming uncomfortably full Eating in a “dazed state”
Management of an eating disorder
Supportive- Self help resources, Counselling, Cognitive behavioural therapy (CBT), Addressing other areas of life, such as relationships and past experiences
Medical- SSRI (initiated by CAHMS specialist)
Specialist- may require admission (either voluntary or sectioned) for observed refeeding and monitoring for refeeding syndrome.
Refeeding syndrome
Features
Hypomagnesaemia
Hypokalaemia
Hypophosphataemia
These patients are also at risk of cardiac arrhythmias, heart failure and fluid overload.
Management will be according to the local protocol under specialist supervision:
Slowly reintroducing food with restricted calories
Magnesium, potassium, phosphate and glucose monitoring along with other routine bloods
Fluid balance monitoring
ECG monitoring may be required in severe cases
Supplementation with electrolytes and vitamins, particularly B vitamins and thiamine
Personality Disorders (PD’s)
See MH notes (can’t be diagnosed until 18 anyway)
