CAMHS Flashcards
Symptoms of depression
Low mood Anhedonia Low energy Anxiety and worry Cling in Ess. Irritability Avoiding social situations Hopelessness about future Poor sleep Poor appetite Poor concentration Abdominal pain
History of depression
Potential triggers Home environment Relationships: friends, family, sexual 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 abuse History of abuse or neglect
Management of mild depression
Low mood associated with single negative event
Watchful waiting
Advice about healthy habits, healthy diet, exercise, avoiding alcohol and cannabis
Follow up within 2 weeks
Management of moderate to severe depression
CAMHS
Full assessment to establish a diagnosis
Psychological therapy as the first line treatment with CBT, non-directive supportive therapy, interpersonal therapy and family therapy
Fluoxetine first line antidepressant in children
Sertraline and citalopram second line
When the child responds to medical treatment, it should continue 6 months after remission is achieved
When the child doesnt respond they may require intensive psychological therapy
Mood and feelings questionnaire
When is admission considered in depression?
High risk of self harm, suicide, self-neglect
Immediate safeguarding issue
What is generalised anxiety disorder?
Mental health condition that causes excessive and disproportionate anxiety and worry that negatively impacts the person’s everyday activity
Assessment of GAD
GAD-7 anxiety questionnaire
Assess for co-morbid mental health conditions like OCD and depression
Assess for environmental triggers and contributors
Management of generalised anxiety disorder
Mild: watchful waiting, advice about self-help strategies, diet, exercise, avoiding alcohol, caffeine and drugs
Moderate to severe: counselling, CBT, medical management (SSRI-sertraline)
Obsessions in OCD
Unwanted and uncontrolled thoughts and intrusive images that the person finds very difficult to ignore
Overwhelming fear of contamination with dirt or germs or violent or explicit images that keep appearing in their mind
Compulsions in OCD
Repetitive actions the person feels they must do, generating anxiety if they are not done
What is OCD associated with?
Anxiety Depression ED ASD Phobias
Management of significant OCD
Referral to CAMHS
Patient and carer education
CBT
SSRI medications
Features of anorexia nervosa
Excessive weight loss Amenorrhea Lanugo hair Hypokalaemia Hypotension Hypothermia Changes in mood, anxiety and depression Solitude
Cardiac complications of anorexia
Arrhythmia
Cardiac atrophy
Sudden cardiac death
Features of bulimia nervosa
Alkalosis, vomiting HCl Hypokalaemia Erosion of teeth Swollen salivary glands Mouth ulcers GORD and irritation Russell’s sign: calluses on knuckles
What may binge eating 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 binge eating
Patient and carer education Self-help resources Counselling CBT Addressing other areas of life Monitor for refeeding syndrome SSRI medication
What is refeeding syndrome
Metabolism in cells slows during prolonged periods of malnutrition
Starved cells use up Mg, K and PO4 while they process glucose, protein and fats
Hypomagnesaemia
Hypokalaemia
Hypophosphataemia
Risk of cardiac arrhythmias, heart failure and fluid overload
Management of refeeding syndrome
Slowly reintroduction food with restricted calories
Magnesium, potassium, phosphate and glucose
Fluid balance monitoring
ECG monitoring
Supplementation with electrolytes and vitamins, especially B vitamins and thiamine
MDT involved in management of children with learning disabilities
Health visitors Social workers Schools Educational psychologists Paediatricians, GPs and nurses Occupational therapists Speech and language therapists
Assessing capacity
Understand the decision that needs to be made
Retain the information long enough to make the decision
Weigh up the options and the implications of choosing each options
Communicate their decision
Sleep problems in childhood
Refusal to go to bed
Frequent night waking
Common parasomnias
Medical problems: inte-current illness, chronic illness e.g. asthma, acute/chronic pain
Parasomnias
Episodic sleep behaviours Head banging Sleep walking Bruxism Nightmares Night terrors
Management of sleep problems
Keep sleep diary Sleep hygiene Positive bedtime routine Controlled crying Education Medication: melatonin
Non-epileptic behaviours
Simple faint Breath holding spells Temper tantrums Hyperventilation Infantile colic Self-stimulatory behaviours
Assessment and investigation of problem eaters
History and examination
Monitor growth against projected range
Admission for assessment as a last resort
Investigate for organic causes: severe reflux- pH probe or barium swallow
Management of problem eaters
Social reinforcement (praise) crucial Avoid coaxing and forcing Avoid using preferred foods as a reward Family mealtimes Encourage communal eating with peers Rejection of new foods can be overcome by repeated exposure to small quantities
Causes of soiling child
Loose stools: malabsorption, excess fruit juice
Stools normal: faulty toilet training, neglect, other stressors
Combination stool: constipation with overflow diarrhoea
Investigations for soiling
Hirschsprung’s disease: rectal biopsy Hypothyroidism- TFTs Hypercalcaemia: serum Ca Lead poisoning; serum lead Renal tubular disorders- plasma bicarbonate
Management of soiling child
NICE guidance
Consider neuropathic cause if urinary incontinence coexists
Psychological management
Assessment and investigation of ADHD
Standard clinical assessment
Consider epilepsy and EEG
Check for fragile X if also global developmental delay
Learning disability and ADHD screen
FBC, UE, LFT, Ca, TFT, iron, CK, blood sugar Karyotyping +/- fragile X Serum amino acids, urine organic acids Urine GAGs Consider MRI brain
