CAMHS Flashcards
Differences in childhood/adolescent presentation of common psychiatric disorders: depression
equal sex ratio before puberty
somatic sx e.g. headache, tummyache
irritability, reduced school performance
mx:
1st medication = fluoxetine (prescribed by specialist after MDT discussion)
1st tx (mild, 4 weeks) = CBT
antidepressant medication only offered in combination with psych therapy
prognosis generally good, severe episodes likely to occur
Differences in childhood/adolescent presentation of common psychiatric disorders: anxiety disorders
9-32% period prevalence
equal sex ration
many commence in adolescence
may present with somatic sx
Differences in childhood/adolescent presentation of common psychiatric disorders: self-harm
all <16 y/o who self-harm must be reviewed by a CAMHS specialist before discharge and admitted to a paediatric warm to facilitate this if necessary
Differences in childhood/adolescent presentation of common psychiatric disorders: psychosis
very rare in children before puberty
poor prognosis, disrupted social development
important to exclude ASD and organic causes (e.g. autoimmune disorders)
Differences in childhood/adolescent presentation of common psychiatric disorders: eating disorders
may present with faltering growth/delayed puberty
expect body weight calculations consider sex, age, and height on centile charts
Normal development
developmental delays can be referred to CAMHS
further assessment is always needed when developmental milestone attainment is delayed beyond the upper ;limit, with consideration of risk factors
Separation anxiety disorder
excessive fear of separation from specific attachment figures → significant distress/functional impairment
sx = thoughts of harm coming to their parent, reluctance to attend school/sleep apart, marked distress at separation, and nightmares about separation
threatened/unmourned loss
mx = family support, child’s anxiety with behavioural therapy, gradually increased separation periods
School refusal
Unconcealed school absence
common during transition e.g. new school/sibling
bullying, fear of failure, unsympathetic teacher
may occur in families with so-called precious children (following difficulty conceiving/sibling’s death) or vulnerable parents (experiencing life-threatening illness or agoraphobia)
tummy aches before school (never on weekends or holidays)
mx = family support, school support, rapid return to full attendance is best prognosis, check for parental depression and separation anxiety, get young person to talk separate from parents
Enuresis
repeating voiding of urine into clothing/bed by day/night above age of expected urinary continence (5 y/o) in the absence of organic causes
FHx
primary = toilet training not mastered
secondary = dryness is lost after at least a year’s continence (usually stress-related)
nocturnal enuresis = more common in boys
diurnal enuresis = more common in girls
Enuresis mx
reassure (common and nobody’s fault)
refer organic causes to a paediatrician e.g. epilepsy, UTI, constipation and diabetes
address stressors and review toilet training received so far
restrict fluids before bed
use star charts to celebrate each dry night (positive reinforcement)
Bell and pad ‘underpants alarm’: clips onto pyjamas, waking the child if moisture is detected, to retrain voiding
Medication e.g. imipramine (tricyclic antidepressant) combined with desmopressin (synthetic antidiuretic hormone) may be considered when all other ex’s have failed
Encoparesis: definition and causes
repeated defecation in inappropriate places above 4 years in absence of organic causes, commoner in boys, primary/secondary
mostly due to overflow incontinence due to:
- dehydration
- painful defecation (e.g. anal fissure)
- fear of punishment
- toilet fears (e.g. monsters in the toilet)
- Hirschsprung disease (rare: bowel obstruction due to aganglionic section of the colon)
When constipation absent, incontinence due to:
- diarrhoea
- disorders of intellectual development
- hostility (e.g. angrily defecating in a parents shoe)
Punitive toilet training → strsss → trigger secondary incontinence
Encoparesis: mx
laxatives and stool softeners for constipation
treat physical causes
reassure, address stress, and review toiler training
star charts to reinforce continence
GOOD prognosis 60-90% become continent within a year
Selective mutism: definition, symptoms, tx
consistent selective speech in specific social situations but not others, lasting at least a month, not limited to the first month of school, to the extent of disrupting education
talkative at home but painfully shy and silent elsewhere, tx involves reassurance; stress and behavioural mx
Autism spectrum disorder: epidemiology
masked by imitating socially expected behaviours
- strong genetic basis
- older parental age
- maternal infections in pregnancy
- obstetric complications leading to hypoxia
highly comorbid with other conditions
- disorders of intellectual development
- epilepsy
- tuberous sclerosis = rare genetic condition that causes mainly non-cancerous (benign) tumours to develop in different parts of the body.
- Down syndrome
- Rett syndrome = affects brain development
- fragile X syndrome
ASD: clinical presentation
struggle to initiate and sustain reciprocal social interaction and social communication
restricted, repetitive, inflexible interests and behavioural patterns
sx often identified first 3 years of life
severe enough to impact educational/occupational and other functioning
associated with a range of intellectual and language abilities and its functional impact varies across the spectrum
