CAMHS Flashcards
what age is schizophrenia likely to present
20s
what age does depression usually occur
20s
what age does BAD typically occur
20s, very rare in CAMHS units
what age can personality disorders be diagnosed
> 18
if <18 can be listed as likely when symptoms are clear, persistent and impair functioning
typical onset is abour 14
what are disruptive/behavioural disorders in CAMHS referred to as
Conduct disorder in >12
<12 is oppositional defiant disorder
what is the most important management form to managing disruptive or behavioural disorders
early intervention
what gender is ASD more common in
males
overall management of ADHD
parenting and educational intervention
medication in moderate to severe cases
what features would a child with trauma/attachment disorders possibly have
PTSD like symptoms oppositional behaviour irritability and anxiety quasi psychiatric symptokms other mental illness
some primary presentations that are not always related to mental illness?
developmentally appropriate anxiety hyperactivity/short attention span grandiose ideas imaginary friends intense interest non-impairing tics
some secondary presentations that are not always related to mental illness?
mood swings sullen, withdrawn, anxious sleep change peer pressure influence OCD type behaviour intrusive thoughts and pseudohallucination
what is puerperal psychosis
acute onset psychotic or manic symptoms
psychiatric emergency
risk factors for puerperal psychosis
bipolar disorder previous thyroid disease FHx unmarries 1st pregnancy C/s perinatal death
onset of postnatal depression
1-4 weeks post delivery
risk factors for postnatal depression
FHx of Hx depression complicated delivery traumatic birth relationship issues trauma or abuse lack of support financial issues
risk factors for late onset old age depression
genes
life events
financial hardship
poor health
what is pseudodementia
older people affected by predominant cognitive symptoms flux loss memory good insight into memory loss slow movement depressed mood responds to meds and or ECT
cause of anxiety in adolescents - genetic and behavioural
inherited
classical and operant conditioning leading to fear
cognitive factors leading to anxiety in adolescents
attention bias selective attention negative spin on situations tendency to remember anxiety provoking cues perfectionistic beliefs inflated sense of responsibility
managing adolescent anxiety
mild CBT
unresponsive to CBT or mod/severe - fluoxetine/sertraline
BZD short term but look out for paradoxical agitation
DO NOT GIVE PROPRANOLOL
predisposing factors to adolescent depression
FHx psychological conflict divorce school stress bereavement
managing adolescent depression
watchful waiting
CBT or supportive therapy
unresponsive, moderate/severe - CBT, fluoxetine, consider sertraline or citalopram
consider low dose antipsychotic if failure of >2 SSRI
venlafaxine, mirtazapine
causes of DSH
cope with intense emotion
distress
attempt to end life
attempt to save life
biological reason for self harm
promotes endorphin release so leads to temp distress reduction
tends to be repeated
features of non-suicidal DSH
optimism decrease discomfort chronic intent to relieve emotion uncomfortable with intermittent psychological pain
features of suicidal DSH
hopeless helpless no release of discomfort following injury persistent psychological pain "no other way out"
managing self harm
educate on signs distress
positive coping skills
refer for risk assessment
what is the autistic triad
social communication, interaction and imagination
associated with repetition
autistic triad - features within social communication
good language but cant grasp conversation meaning cannot understand sarcasm monotone voice idiosyncratic language narrow interest dominating conversation cannot share thoughts, feelings
autistic triad - features within social interaction
struggle with non-verbal cues
self focused
lack empathy
struggle to maintain and sustain personal and social relationships
autistic triad - features within social imagination
takes things literally
hard to apply knowledge and skills with others
hard to project themselves in future
autistic triad - features within repetitive behaviour
stereotype or repetitive motor movement
adherence to routine
highly restricted and fixated interest abnormal in focus intensity
hyper/hypo reactivity to sensoty input or unusual interest in sensory aspects
why is ASD higher in women with CAH
they have a higher testosterone
genetic heritability of ASD
high
environmental cause of ASD
teratogens in pregnancy
biological perinatal causes of ASD
umbilical cord issues foetal distress brain injury multiple birth meconium aspiration congenital malformation low birth weight maternal haemorrhage neonatal anaemia, ABO or Rh incompatibility rubella encephalitis
ASD diagnosis in adults - communication features
difficulty in perspective struggle with non verbal cues difficulty making eye contact confusion in social signals repeating same phrase/expression issues starting and sustaining conversation cannot understand humour/sarcasm
ASD diagnosis in adults - social features
shy or avoiding contact difficulty fitting in rude or unaware of bluntness takes things literally trouble processing thoughts
diagnostic tools to autism
developmental and collateral hx
screening questionnaires and semi structured interviews
ADOS
ASD diagnosis in children - speech/language
don’t use vocal sounds
can repeat workds or phrases without forming their own language
difficulty with non verbal behaviour
ASD diagnosis in children - taste
overpowering
can lead to ARFID
texture causing discomfort
ASD diagnosis in children - sound
magnified or distorted
inability to cut out sounds
ASD diagnosis in children - touch
painful or discomfort
difficulties washing/brushing hair/haircuts
ASD diagnosis in children - smell
can be overpowering
ASD diagnosis in children - sight
poor depth perception
focus on one detail
ASD diagnosis in children - rigidity/repetitive
cannot understand others emotions
repeat same pretend play or no imaginary play
same routine and little change can lead to tantrums
flap hand/flick fingers
lining toy sup or watching same movie over and over
emotional comorbidity in ASD
eating disorders
anxiety/depression
neurodevelopmental comorbidity in ASD
tourettes ODC ADHD SPD Dyslexia language impairment
non pharm management of ASD
self and family psychoeducation
behavioural therapy, SLT, social skills training
family and school based support
diet encouragement
pharm management ASD
risperidone - severe agression and self injury - SHORT TERM USE
Further management of any comorbid disorders
features leading to ADHD diagnosis?
inattention
hyperactivity
impulsivity
these must be developmentally inappropriate, pervasive across settings, impair functioning and longstanding from age 5
true/false - adult ADHD is more associated with impulsivity and hyperactivity
false - it is more associated with inattention
ADHD impact on children?
parenting issues increased home level stress poor relationships reckless behaviour poor problem solving poor decision making barrier to learning
ADHD impact on adults?
increase other psychiatric comorbidity, antisocial behaviour, criminality and substance abuse
genetic cause ADHD
tends to aggregate in families
perinatal cause ADHD
tobacco or alcohol use prematurity and perinatal hypoxia short or long labour foetal distress syndrome pre-eclampsia or low forceps delivery
psychosocial cause ADHD
parenting style low SE class large familties maternal mental health disorder paternal criminality or imprisonment maltreatment emotional trauma
childhood assessment ADHD?
driven by parents or school questionnaires school observation background info and developmental hx attachment style
Adult assessment ADHD
historical concern
longstanding
current clinical picture
cognitive issues and ability need assessed
diagnostic criteria of ADHD in children
6 or more symptoms inattentivenness OR 6 or more symptoms of hyperactive/impulsive
present <5
reported by parents, school, clinic
symptoms interfere with living
diagnostic criteria of ADHD in adults
5 or more symptoms of inattentiveness OR 5 or more symptoms hyperactivity/impulsiveness
historical concern since early age
moderate effect on life
non-pharm management of ADHD in children
parent training
social skills training
classroom management
educational management
clinical management ADHD - first line
methylphenidate
dexamphetamine
lisdexamfetamine
clinical management ADHD - second line
atomoxetine
clinical management ADHD - third line
alpha agonist - guanfacine, clonidine
clinical management ADHD - fourth line
imipramine
risperidone
mechanism of action of methylphenidate
increase dopamine by blockage of transporter
mechanism of action of dexamphetamine
increase in dopamine by transport block, and increase in 5-HT and NA
mechanism of action of atomoxetine
increase NA by blocking transporter - it is an SNRI
