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MB3 Psychiatry > CAMHS > Flashcards

CAMHS Flashcards

1
Q

what age is schizophrenia likely to present

A

20s

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2
Q

what age does depression usually occur

A

20s

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3
Q

what age does BAD typically occur

A

20s, very rare in CAMHS units

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4
Q

what age can personality disorders be diagnosed

A

> 18
if <18 can be listed as likely when symptoms are clear, persistent and impair functioning
typical onset is abour 14

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5
Q

what are disruptive/behavioural disorders in CAMHS referred to as

A

Conduct disorder in >12

<12 is oppositional defiant disorder

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6
Q

what is the most important management form to managing disruptive or behavioural disorders

A

early intervention

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7
Q

what gender is ASD more common in

A

males

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8
Q

overall management of ADHD

A

parenting and educational intervention

medication in moderate to severe cases

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9
Q

what features would a child with trauma/attachment disorders possibly have

A 
PTSD like symptoms 
oppositional behaviour 
irritability and anxiety 
quasi psychiatric symptokms 
other mental illness
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10
Q

some primary presentations that are not always related to mental illness?

A 
developmentally appropriate anxiety 
hyperactivity/short attention span
grandiose ideas
imaginary friends 
intense interest 
non-impairing tics
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11
Q

some secondary presentations that are not always related to mental illness?

A 
mood swings 
sullen, withdrawn, anxious 
sleep change 
peer pressure influence 
OCD type behaviour 
intrusive thoughts and pseudohallucination
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12
Q

what is puerperal psychosis

A

acute onset psychotic or manic symptoms

psychiatric emergency

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13
Q

risk factors for puerperal psychosis

A 
bipolar disorder 
previous thyroid disease
FHx 
unmarries 
1st pregnancy 
C/s 
perinatal death
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14
Q

onset of postnatal depression

A

1-4 weeks post delivery

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15
Q

risk factors for postnatal depression

A 
FHx of Hx depression 
complicated delivery 
traumatic birth 
relationship issues 
trauma or abuse 
lack of support 
financial issues
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16
Q

risk factors for late onset old age depression

A

genes
life events
financial hardship
poor health

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17
Q

what is pseudodementia

A 
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
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18
Q

cause of anxiety in adolescents - genetic and behavioural

A

inherited

classical and operant conditioning leading to fear

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19
Q

cognitive factors leading to anxiety in adolescents

A 
attention bias 
selective attention 
negative spin on situations 
tendency to remember anxiety provoking cues 
perfectionistic beliefs 
inflated sense of responsibility
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20
Q

managing adolescent anxiety

A

mild CBT
unresponsive to CBT or mod/severe - fluoxetine/sertraline
BZD short term but look out for paradoxical agitation
DO NOT GIVE PROPRANOLOL

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21
Q

predisposing factors to adolescent depression

A 
FHx 
psychological 
conflict 
divorce 
school stress
bereavement
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22
Q

managing adolescent depression

A

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

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23
Q

causes of DSH

A

cope with intense emotion
distress
attempt to end life
attempt to save life

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24
Q

biological reason for self harm

A

promotes endorphin release so leads to temp distress reduction
tends to be repeated

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25
features of non-suicidal DSH
``` optimism decrease discomfort chronic intent to relieve emotion uncomfortable with intermittent psychological pain ```
26
features of suicidal DSH
``` hopeless helpless no release of discomfort following injury persistent psychological pain "no other way out" ```
27
managing self harm
educate on signs distress positive coping skills refer for risk assessment
28
what is the autistic triad
social communication, interaction and imagination | associated with repetition
29
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 ```
30
autistic triad - features within social interaction
struggle with non-verbal cues self focused lack empathy struggle to maintain and sustain personal and social relationships
31
autistic triad - features within social imagination
takes things literally hard to apply knowledge and skills with others hard to project themselves in future
32
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
33
why is ASD higher in women with CAH
they have a higher testosterone
34
genetic heritability of ASD
high
35
environmental cause of ASD
teratogens in pregnancy
36
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 ```
37
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 ```
38
ASD diagnosis in adults - social features
``` shy or avoiding contact difficulty fitting in rude or unaware of bluntness takes things literally trouble processing thoughts ```
39
diagnostic tools to autism
developmental and collateral hx screening questionnaires and semi structured interviews ADOS
40
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
41
ASD diagnosis in children - taste
overpowering can lead to ARFID texture causing discomfort
42
ASD diagnosis in children - sound
magnified or distorted | inability to cut out sounds
43
ASD diagnosis in children - touch
painful or discomfort | difficulties washing/brushing hair/haircuts
44
ASD diagnosis in children - smell
can be overpowering
45
ASD diagnosis in children - sight
poor depth perception | focus on one detail
46
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
47
emotional comorbidity in ASD
eating disorders | anxiety/depression
48
neurodevelopmental comorbidity in ASD
``` tourettes ODC ADHD SPD Dyslexia language impairment ```
49
non pharm management of ASD
self and family psychoeducation behavioural therapy, SLT, social skills training family and school based support diet encouragement
50
pharm management ASD
risperidone - severe agression and self injury - SHORT TERM USE Further management of any comorbid disorders
51
features leading to ADHD diagnosis?
inattention hyperactivity impulsivity these must be developmentally inappropriate, pervasive across settings, impair functioning and longstanding from age 5
52
true/false - adult ADHD is more associated with impulsivity and hyperactivity
false - it is more associated with inattention
53
ADHD impact on children?
``` parenting issues increased home level stress poor relationships reckless behaviour poor problem solving poor decision making barrier to learning ```
54
ADHD impact on adults?
increase other psychiatric comorbidity, antisocial behaviour, criminality and substance abuse
55
genetic cause ADHD
tends to aggregate in families
56
perinatal cause ADHD
``` tobacco or alcohol use prematurity and perinatal hypoxia short or long labour foetal distress syndrome pre-eclampsia or low forceps delivery ```
57
psychosocial cause ADHD
``` parenting style low SE class large familties maternal mental health disorder paternal criminality or imprisonment maltreatment emotional trauma ```
58
childhood assessment ADHD?
``` driven by parents or school questionnaires school observation background info and developmental hx attachment style ```
59
Adult assessment ADHD
historical concern longstanding current clinical picture cognitive issues and ability need assessed
60
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
61
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
62
non-pharm management of ADHD in children
parent training social skills training classroom management educational management
63
clinical management ADHD - first line
methylphenidate dexamphetamine lisdexamfetamine
64
clinical management ADHD - second line
atomoxetine
65
clinical management ADHD - third line
alpha agonist - guanfacine, clonidine
66
clinical management ADHD - fourth line
imipramine | risperidone
67
mechanism of action of methylphenidate
increase dopamine by blockage of transporter
68
mechanism of action of dexamphetamine
increase in dopamine by transport block, and increase in 5-HT and NA
69
mechanism of action of atomoxetine
increase NA by blocking transporter - it is an SNRI

MB3 Psychiatry (16 decks)

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