CAMHS Flashcards
How common is childhood mental health problems?
High on government and media agenda
Increased incidence and severity of referrals
Evolving speciality - lots of neuroscience underpinning child mental health
Children cannot get dementia
Cannot decrease likelihood of recurrent illness
Increased incidence of self-harm
What are the differences between CAMHS and AMH?
Both deal with severe mental illnesses
Both deal with developmental disorders
CAMHS works on a systemic framework
AMH medication is main treatment whereas CAMHS breadth of treatment options
CAMHS works mainly on preventative measures - primary and secondary, whereas AMH works with secondary and tertiary prevents
What is the developmental approach in CAMHS?
Some conditions treated are developmental disorders - ADHD, ASD
Need to take into account the developmental stage when assessing young people - use play, assessment of suicidal ideas needs to take into account concept of death at different ages
What is the systemic approach of CAMHS?
Central to CAMHS
Holistic approach
Emphasises effect of systems around child on presentation and potential treatment
Interview patient and parents before treatment
Family/systemic therapy treatment used
System around young person - family, friends, school, neighbourhood
What is the prevention used in CAMHS?
Provides opportunity for early prevention in mental illness eg treatment of attachment disorder to prevent development of personality disorder
Chronic illness CBT decreases chance of recurrence of depression
What kind of treatment do CAMHS use?
Family
Friends
School
Neighbourhood
How does ASD present in children?
Rituals
Unusual/delayed language
Social difficulty - lack of theory of mind, can’t read others
How does PTSD present in children?
Intrusive sensations/memories - flashbacks
Avoidance
Anxiety
How long might children have ASD?
Lifelong
May present with different severity at different times in life
What is the diagnostic criteria of anorexia in the ICD-10?
Deliberately keeping weight below 85% of expected
- Restricted dietary choice
- Excessive exercise
- Induced vomiting, use of appetite suppressants and diuretics
Dread of fatness - intrusive overvalued ideas
What are the endocrine effects of anorexia?
Menstruation stops or puberty is delayed if menarche not yet achieved
In men - loss of sexual interest/potency
How common is anorexia?
1 in 250 females 1 in 2000 males 1 15 year old girl in every 150 1 15 year old boy in every 1000 Mean age of onset 16-17
What can cause/increase the risk of anorexia?
Social pressure Perfectionist characteristics Reversing or halting effects of puberty Family - Attitudes to food in family to food and body shape - Refusing food as a way of being heard Some genetic links Depression Low self-esteem Occupation and interest eg ballet dancers Anxiety disorders Past or present events - Life difficulties - Sexual abuse - Physical illness - Upsetting events - death/break-up of a relationship - Important events - marriage or leaving home
How is anorexia diagnosed?
Screening for eating problems SCOFF
History
What is the SCOFF questionnaire?
Do you make yourself Sick because you’re uncomfortably full?
Do you worry that you’ve lost Control over how much you eat?
Have you recently lost more than 6kg (about One stone) in 3 months?
Do you believe you’re Fat when others say you’re thin?
Would you say that Food dominates you r life?
What questions should you ask in an anorexia history?
Ask about over-valued ideation of body shape and weight - intense fear of becoming fat
Active maintenance of low body weight < 85% expected weight
Amenorrhoea in post-pubertal females
What clinical signs might suggest anorexia?
Dry skin Lanugo hair Orange skin and palms Cold hands and feet Bradycardia Drop in BP on standing Oedema Weak proximal muscles - squat test
Who assesses an anorexia patient in CAMHS?
Psychiatrist Psychologist Family therapist Paediatrician Dietician
What decisions need to be made by the MDT?
Whether to treat in community or as an inpatient
How common is ADHD?
Common condition in people of all ages
Associated with impaired QoL
- Reduced educational attainment, higher unemployment
- Increased risk of poor peer relationships and relationship breakdown
- Association with substance misuse and mental health problems
- Increased offending behaviours
- Increased mortality
Early diagnosis and treatment reduces morbidity
3-4% of all school-aged children
5.3% under-18s worldwide and 3.4% adults
Male to female 4:1 in childhood
Equally common in adulthood
Girls tend to present in masked way
Occurs in all cultures, higher prevalence in Western cultures
Often have co-existing conditions eg ASD, attachment disorders
What are the main symptoms of ADHD?
Inattention
Hyperactivity
Impulsivity
What are the symptoms of inattention?
Decreased concentration, lack of persistent focus/attention, easily distractible, forgetful, disorganised, not following instruction, careless mistakes
What are the symptoms of hyperactivity?
Not able to sit still, constantly on the go, fidgety, not able to queue, loud/noisy play
What are the symptoms of impulsivity?
Poor sense of danger, blurts out answers, interrupts or intrudes into others - when someone is talking, during activities, games
How is ADHD diagnosed?
MDT clinical assessment Good clinical history - interview with child, parents, teachers - Presenting issues/difficulties - Birth and developmental history - Social history - Our observations in different settings - School observations - Feedback from school - Degree of impairment - Behaviour rating scales by parents and teacher Physical examination Scales - Connors Tests - Ob test, TEACH, cognitive assessment
What is the DSM-V criteria for ADHD?
Under age 17
6 or more hyperactivity or impulsivity symptoms OR 6 or more inattention symptoms
Symptoms for more than 6 months before the age of 12
Interferes with functioning or development - interferes/reduces quality of social/academic/occupational function
Must not be due to another mental illness
Developmentally inappropriate
Several symptoms in 2/more settings
What could be differential diagnoses for ADHD?
ASD Anxiety disorder Attachment difficulties Learning difficulties or learning disability Sensory issues Epilepsy Drug S/E
What causes ADHD?
Not known
Suggestions - reduced/abnormal frontal lobe function, reduced dopamine levels in brain
Genetic component - twin studies suggest 76% heritability
Environment acting through gene-environment interactions
Dietary factors idiosyncratic
What can increase the risk of ADHD?
Maternal smoking Foetal O2 deprivation Low birth weight Prematurity Heroin use during pregnancy
How is ADHD managed?
Parent training first line for most cases unless severe
Support offered to school
CBT - supports emotional regulation, problem-solving, social skills
Medication not advocated for pre-school children
Stimulants
Non-stimulant
Combined
What advice is offered to parents with a child with ADHD?
Regular routine Set clear boundaries Positive reinforcement Brief and specific instructions Incentive schemes Regular exercise and healthy diet Bedtime routine Short and sweet social interactions
Give an example of a stimulant medication used to treat ADHD
Methylphenidate
Amphetamines
- Long-acting - lisdexamphetamine
- Short-acting - dexamphetamine
