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CASC > CAMHS > Flashcards

CAMHS Flashcards

1
Q

What are the core features of ADHD?

A

Inattention
Impulsivity
Hyperactivity

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2
Q

Examples of hyperactivity symptoms in ADHD

A 
Fidgeting
Climbing on furniture
Always on the go
Talking excessively
Interrupting
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3
Q

Examples of inattention in ADHD

A 
Easily distracted
Unable to complete tasks
Unable to organise
Forgetful
Losing things
Appearing not to listen
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4
Q

Age of onset for hyperkinetic disorder (ICD-10)

A

Before 5

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5
Q

Age of onset for ADHD in DSM-IV and V

A

IV: Before 7
V: Before 12

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6
Q

Gender ratio of ADHD in children

A

3:1 boys:girls

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7
Q

Risk of ADHD in siblings

A

2-3x increase

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8
Q

Prevalence of ADHD in the UK

A

ICD-10 criteria: 1-2%

DSM IV criteria: 3-4%

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9
Q

Neuro-imaging aetiology of ADHD

A

Reduced cerebral blood flow in frontal lobe.

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10
Q

Neutrotransmitter aetiology of ADHD

A

Dopamine and noradrenaline dysregulation in pre-frontal cortex

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11
Q

Which neurotransmitters do psychostimulants impact for ADHD symptoms?

A

Release Noradrenaline, Dopamine and Seretonin (which modulates dopamine transmission)

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12
Q

Environmental aetiological factors

A 
Obstetric complications
Low birth weight and prematurity
Prenatal exposure to alcohol, nicotine and benzos
Poor attachment and early deprivation
Growing up in institutions
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13
Q

Co-morbid disorders in ADHD

A 
Oppositional
defiant disorder (40%)
Anxiety disorder (34%)
Conduct disorder (14%)
Tics (11%) 
Mood disorder
(6%)
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14
Q

How many children with ADHD have a comorbid disorder?

A

50-80%

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15
Q

How many children with ADHD go on to develop problems with substance misuse?

A

15-20%

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16
Q

How many children will continue to suffer residual symptoms into adulthood?

A

50%

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17
Q

What happens to ADHD symptoms as one gets older?

A

Fewer impulsive-hyperactivity symptoms

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18
Q

Factors that result in poor prognosis for ADHD

A 
Poverty and overcrowding
High EE
Parental psychopathology
Severe symptoms
Symptoms predominantly hyperactive-impulsive 
Conduct disorder
Language disorders
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19
Q

Non-pharmacological treatment options for ADHD

A

Educational/remedial interventions
o Parent training programme for child management skills– based on social learning theory and
behavioural interventions
o Individual/family/group therapies
o CBT methods, especially behavioural, are often effective
o Social skills training

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20
Q

Which medication for ADHD has the most rapid onset?

A

Methylphenidate - 1-3 hours

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21
Q

What type of medication is Atomoxetine?

A

NARI

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22
Q

How does Atomoxetine work?

A

Increases NA in synaptic cleft

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23
Q

Monitoring for methylphenidate

A

Height & weight, HR and BP at initially 3 then 6 montys

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24
Q

Monitoring for atomoxetine

A

Height and weight at 3 then 6 months

Signs of depression or suicidality

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25
Q

Adverse effects of Methylphenidate

A 
Appetite and weight loss
Insomnia if taken late in day
Abdominal cramps in first few weeks
Headache
BP and HR increase
Evening crash
Depression
Tics
Hallucinations - skin crawling, visual
Mild growth slowing first two years
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26
Q

Atomoxetine SEs

A

Appetite and weight loss
GI symptoms; nausea, vomiting, diarrhoea, constipation
Fatigue and dizziness

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27
Q

Diagnostic criteria for conduct disorder for ICD-10

A

At least one of the following behaviours to be present for at leat 6 months:
- Physical aggression or threats of harm to people, cruelty to people and animals
o Destruction of their own property or that of others
o Theft or acts of deceit
o Frequent and serious violation of age-appropriate rules (Like truanting or running away)

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28
Q

Prevalence of CD in UK

A

5-7%

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29
Q

M:F ratio of CD

A

4:1

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30
Q

Environmental aetiological factors for CD

A 
Parental MI
Low income
Criminality and substance use of father
Maternal neurosis
Overcrowding & institutional care
DV and child abuse
Large family size
Maternal smoking during pregnancy
Early loss and deprivation
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31
Q

Neuroimaging findings in ADHD

A

Reduced volume of prefrontal area

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32
Q

Neurochemical findings in CD

A

Deficient seretonergic activity

Autonomic under-arousal

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33
Q

Future risks of child CD

A 
Criminality and ASPD
Difficulties in work and education
Homelessness and abuse
Drug and alcohol dependence
Poor physical health
Other SMI
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34
Q

Poor prognostic factors for CD

A 
Onset <10
Increased aggression at early age
Aggression carried out in isolation
Low IQ
Low socio-economic status
Poor school achievement
Attention problems and hyperactivity as a child
Poor parenting and family criminality
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35
Q

NICE guidelines for CD <12

A

Group based parent training/education programmes

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36
Q

Psychological treatment for CD

A

CBT - social skills and anger management
Family therapy - for 11-18 year olds
Multisystemic therapy

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37
Q

What is multisystemic therapy for CD?

A

Needs assessed in school and at home, then therapy used to promote strengths of young person within the system.
Therapist responsible to make sure appointments are kept
Feedback on progress from goals from multiple sources including weekly questionnaires from parents and teens

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38
Q

Difference between ODD and CD

A

Lack of serious violation of societal norms or rights of others

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39
Q

Risk factors for depression in children

A 
FHx of depression
Early loss of parent
Parental separation
Stressful life events
History of abuse
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40
Q

Management of mild depression in CAMHS

A

2 weeks watchful waiting
After 4 weeks: supportive therapy, self help or group CBT
Self help: advice on sleep hygiene, exercise and anxiety management

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41
Q

Management of mod-severe depression in CAMHS

A

CAMHS review

3/12 of individual CBT, IPT or shorter family therapy

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42
Q

NICE guidance on antidepressants for depression in CAMHS

A

Fluoxetine (first line)

Sertraline or Citalopram (second line)

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43
Q

What to monitor in use of fluoxetine in CAMHS

A

Agitation, irritability, suicidality

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44
Q

In what age groups is ECT not recommended?

A

5-11

45
Q

How many adolescent deaths are due to suicide?

A

12% - third most common cause

46
Q

Prevalence of suicidal ideation in adolescence

A

Boys 14%

Girls 25%

47
Q

How many adolescents who attempt suicide repeat within a year?

A

10%

48
Q

Risk of suicide in adolescent who has first degree relative who has committed suicide

A

2-4 times higher

49
Q

Features of early onset bipolar

A

Poor outcome - 50% have long term decline in function
Chronic and less responsive to treatment
Atypical and rapid-cycling

50
Q

Prevalence of early onset Bipolar in adolescence?

A

1%

51
Q

How many adolescents with episode of depression go on to experience a manic episode in adulthood?

A

20%

52
Q

What depressive sx in adolescents predict mania?

A

Depression with psychosis
Rapid onset with psychomotor features
FHx of mania
Hx of hypo/mania following antidepressants

53
Q

Suicide risk in early onset bipolar

A

10%

54
Q

NICE guidelines for early onset bipolar

A

Same as adults but lower doses

First line are olanzapine and risperidone in acute mania followed by valproate or lithium.

55
Q

What needs to be kept in mind when giving children lithium?

A

Higher renal filtration and higher proportion of body water so higher doses needed to reach therapeutic range.
In younger children, neurological SEs more common

56
Q

Age of onset for childhood onset schizophrenia

A

Onset of psychotic symptoms by age 12

57
Q

What does early onset SCZ refer to?

A

Onset before 18

58
Q

What does very early onset SCZ refer to?

A

Onset before 13

59
Q

Prevalence of SCZ in adolescence

A

1-2 per 1000

60
Q

M:F ratio in very early onset SCZ (<13)

A

2:1

61
Q

What symptoms are more common in child onset SCZ?

A 
Negative sx
Frightening visual hallucinations
Disorganised behaviour
Disorganised thought
>50% have delusions, increase with age
Blunted affect - almost universal
More chronic
Insidious onset
62
Q

Common premorbidities in early onset SCZ

A

Delay in language, reading, bladder control and social functioning
Reduced attention, working memory and IQ
Greater genetic component

63
Q

Physical health problems to r/o in child onset SCZ

A

TLE
Thyroid disease
Brain tumour
Wilsons disease

64
Q

How much more prevalent is SCZ in those with first degree relatives with the disease?

A

8x more

65
Q

Risk of SCZ with those with first degree relative with the disease in %

A

5-10%

66
Q

Antipsychotic SEs more common in children

A

EPSEs

67
Q

M:F ratio of anxiety in childhood

A

1:1

68
Q

M:F ratio of anxiety in adolescence

A

2:1

69
Q

% of children and adolescence who have anxiety in the general population

A

5-15%

70
Q

% of GAD in adolescence

A

4%

71
Q

% of social phobia in children

A

%

72
Q

% of social phobia in adolescence

A

5-15%

73
Q

Common comorbid disorders with GAD in young people

A

Other anxiety disorders
CD
Substance use

74
Q

How much more common is depression in children with an anxiety disorder?

A

8.2x more

75
Q

Duration for diagnosis of separation anxiety disorder

A

4 weeks

76
Q

Criteria for sibling rivalry disorder

A

Within 6 months of birth of sibling

Duration of 4 weeks

77
Q

Sx of sibling rivalry disorder

A 
Regression
Tantrums
Dysphoria
Insomnia
ODD/attention seeking from parents
78
Q

What characterises disinhibited attachment disorder or childhood?

A

Pattern of abnormal

social functioning that arises during the first 5 years of life.

79
Q

How does disinhibited attachment disorder manifest?

A

Early - clinging, non-selective attachment
By age of 4 - clinging, indiscriminately friendly
Late - emotional and behavioural disturbance

80
Q

What characterises reactive attachment disorder?

A

Persistent abnormalities in
the child’s pattern of social relationships, which are associated with emotional disturbance and
reactive to changes in environmental circumstances.

81
Q

Age of onset of attachment disorders

A

<5

82
Q

In which environments is reactive attachment disorder most common

A

Poverty
Socially disrupted
Neglect and abuse
Young, isolated, inexperienced or depressed caretaker

83
Q

Features or reactive attachment disorder

A 
Fearfulness and hypervigilance that do not respond to comforting are characteristic.
Poor
social interaction with peers 
Aggression towards self & others 
Growth
failure occurs in some cases.
84
Q

Typical age of onset of selective mutism

A

3-5, after normal speech has been acquired

85
Q

Which psychiatric disorder is common in selective mutism?

A

Social phobia

86
Q

Prevalence of selective mutism in UK

A

3-8 per 10,000

87
Q

Prevalence of persistent mutism

A

1 per 1000 children

88
Q

Which gender is selective more common in?

A

Girls

89
Q

Treatment for selective mutism

A

A behavioural approach with positive reinforcement techniques aimed at increasing the
frequency of talking and decreasing the frequency of non-communication will be helpful.

It is
important to ascertain what communication is like at home.

90
Q

Which mental illnesses is separation anxiety disorder a risk factor for in adulthood?

A

Panic disorder

Agoraphobia

91
Q

Treatment of anxiety disorders in children

A

CBT - modified for developmental model
Psychoeducation
Parent training

92
Q

What does CBT for CAMHS anxiety involve?

A

Relaxation training

Cognitive restructuring

93
Q

Which CAMHS anxiety disorders respond to SSRIs?

A

GAD
SAD
Social phobia
Specific phobias

94
Q

M:F ratio for PTSD in children

A

1:2

95
Q

Treatment for PTSD in CAMHS

A

Treatment-focused CBT - 8-12 sessions

Family involvement where appropriate

96
Q

Prevalence of OCD in children and adolescence

A

0.5%

97
Q

Mean age of onset of OCD in CAMHS

A

10

98
Q

M:F ratio of childhood onset OCD?

A

2:1

99
Q

In which gender is post-pubertal OCD onset more common?

A

Girls

100
Q

How many children and adolescence with OCD have another disorder?

A

70%

101
Q

Common comorbid disorders with childhood OCD

A 
Tics  17-40%
Depression 26%
Developmental disabilities 24%
Other anxiety disorders
ASD
102
Q

Treatment for childhood OCD

A

Combination of medication and CBT + ERP

103
Q

Medications licensed for OCD in children and adolescent

A

Fluoxetine

Sertraline

104
Q

Treatment for mild OCD in CAMHS

A

CBT

105
Q

What does PANDAS stand for?

A

Paediatric

autoimmune neuropsychiatric disorders associated with streptococcus?

106
Q

What is PANDAS?

A

Children who develop obsessive-compulsive symptoms associated with beta haemolytic streptococcal
infection and this presentation represents a minority of OCD cases in this population.

107
Q

In which viral illness is OCD common

A

Sydenhams chorea (in rheumatic fever) - 75% of children and young people have OCD

108
Q

Neuroimaging in PANDAS

A

Increased basal ganglia volume

CASC (16 decks)

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