CAMHS Flashcards
What is anhedonia?
Lack of pleasure in activities
What key questions need to be asked in a depression history?
Potential triggers (e.g. loss of a family member) Home environment Family relationships Relationship with friends Sexual relationships 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 use History of abuse or neglect
How is mild depression/ low mood associated with single negative event managed?
Watchful waiting
Advice about healthy habits
Follow up in 2 weeks
How is moderate- severe depression managed?
CAMHS referral:
Phsycological therapy
Antidepressants
What physchological therapies may be used to help depression?
CBT
Non-directive supportive therapy
Interpersonal therapy
Family therapy
What is the first line antidepressant and dose in children?
Fluoxetine 10mg (max 20mg)
What are the second line antidepressants in children?
Sertraline
Citalopram
If a child responds to antidepressants, how long should they continue after remission is achieved?
6 months
What is used to assess progress when monitoring depression?
MFQ (Mood and feelings questionnaire)
What is GAD?
Generalised anxiety disorder- excessive and disproportional anxiety that impacts a patients daily activities
How are children assessed for GAD?
GAD-7 anxiety questionnaire
Assess for co-morbid mental health problems and environmental triggers
How is mild anxiety managed?
Watchful waiting and advice about self-help strategies
How is moderate-severe anxiety managed?
CAMHS referral
Counselling
CBT
Medical management
What is the first line medical management of GAD?
SSRI (Sertraline)
What are obsessions in OCD?
Unwanted and uncontrolled thoughts and intrusive images that are very difficult to ignore
What are compulsions in OCD?
Repetitive actions that the person feels they must do
What is the OCD cycle?
Obsessions lead to anxiety, which leads to compulsive behaviour, which leads to a temporary improvement in the anxiety and the cycle repeats
What other mental health issues is OCD strongly related to?
Anxiety Depression Eating disorders ASD Phobias
How is mild OCD managed?
Education
Self help resources
How is severe OCD managed?
CAMHS referral
Patient/ carer education
CBT
SSRI medications
What is aspergers syndrome now known as?
Part of the autistic spectrum disorder
What is affected in ASD?
Deficit in social interaction, communication and flexible behaviour
At what age are features of ASD usually observable?
Before age of 3
What features may be seen in the social interaction aspect of ASD?
Lack of eye contact Delay in smiling Avoids physical contact Unable to read non-verbal cues Difficulty establishing friendships No desire to play with others
What features may be seen in the communication aspect of ASD?
Delay, absence or regression in language development
Lack of appropriate non-verbal communication (smiling, eye contact)
Difficulty with imaginative behaviour
Repetitive use of words/ phrases
What features may be seen in the behavioural aspect of ASD?
More interested in objects/ numbers/ patterns than people
Stereotypical repetitive movements (hand-flapping, rocking)
Intense interests
Repetitive behaviour
Anxiety/ distress with experiences outside normal routine
Restricted food preferences
How is autism diagnosed?
By a specialist in autism using detailed history and assessment
How is autism managed?
MDT
What is ADHD?
Attention deficit hyperactivity disorder
What are the key features of ADHD?
Very short attention span Quickly switching between activities and not finishing tasks Constantly moving/ fidgeting Impulsive behaviour Disruptive or rule breaking
How is ADHD diagnosed?
Detailed assessment by specialist in childhood behavioural problems
How is ADHD managed?
Healthy diet & exercise
Parental and school education
Medication in severe cases
What medication can be used in ADHD?
CNS stimulants:
Methylphenidate
Dexamfetamine
Atomoxetine
What are the features of anorexia nervosa?
Excessive weight loss Amenorrhoea Lanugo hair Hypokalaemia Hypotension Hypothermia Changes in mood Solitude
What is lanugo hair?
Fine, soft hair across most of the body
What are the worst complications of anorexia?
Cardiac complications (arrhytmia, cardiac atrophy, sudden cardiac death)
What are the key features of bulimia nervosa?
Alkalosis Hypokalaemia Erosion of teeth Swollen salivary glands Mouth ulcers GORD Russell's sign
Why do you get alkalosis in bulimia?
Due to vomiting hydrochloric acid from the stomach
What is Russell’s sign?
Calluses on the knuckles where they have been scraped across the teeh
What would be the typical presentation of bulimia?
Teenage girl with normal body weight that presents with swelling to the face/ jaw, calluses on knuckles and alkalosis on blood gas. Presenting complaint may be abdo pain or reflux
How are paediatric eating disorders managed?
Self help resources Counselling CBT May need admission for observed feeding SSRI medication
What causes refeeding syndrome?
When people who have been in a severe nutritional deficit for an extended period start to eat again
What increases the risk of refeeding syndrome?
BMI <20
Longer the period of malnutrition
What happens in refeeding syndrome?
Metabolism in the cells and organs dramatically slows during prolonged periods of malnutrition. When they start to process foods again, they use up magnesium, potassium and phosphorus
What does refeeding syndrome lead to?
Hypomagnesaemia
Hypokalaemia
Hypophosphataemia
= Risk of cardiac issues
How is refeeding syndrome managed?
Slowly reintroducing food Magnesium, potassium, phosphate and glucose monitoring Fluid balance monitoring ECG monitoring Supplementation
What causes personality disorders?
Combination of genetic and environemental factors
How might personality disorders present?
Strong, intense emotions Emotional instability Anger Low self esteem Impulsive behaviour Substance abuse Poor sense of identity Difficulty maintaining relationships Risky behaviour Violence/ aggression Self harm
What are the three main categories of personality disorder?
Anxious
Suspicious
Emotional/ impulsive
What are the 3 types of anxious personality disorders?
Avoidant
Dependent
Obsessive compulsive
What is avoidant personality disorder?
Severe anxiety about rejection or disapproval and avoidance of social situations or relationships
What is dependent personality disorder?
Heavy reliance on others to make decisions and take responsibility for their lives
What is obsessive compulsive personality disorder?
Unrealistic expectations of how things should be done by themselves and others, and catastrophising about what will happen if these expectations are not met
What are the 3 types of suspicious personality disorder?
Paranoid
Schizoid
Schizotypal
What is paranoid personality disorder?
Difficulty in trusting or revealing personal information to others
What is schizoid personality disorder?
Lack of interest or desire to form relationships with others
What is schizotypal personality disorder?
Unusual beliefs, thoughts and behaviours with social anxiety
What are the 3 types of emotional/ impulsive personality disorder?
Borderline
Histrionic
Narcissistic
What is borderline personality disorder?
Fluctuating strong emotions and difficulties with identity and maintaining healthy relationships
What is histrionic personality disorder?
Need to be the centre of attention and have to perform in order to maintain that attention
What is narcissistic personality disorder?
Feeling that they are special and need others to recognise this or they get upset. Put themselves first
How might personality disorders be managed?
Patient/ carer education
CBT
Psychotherapy
What is Tourette’s syndrome?
Severe tics that are persistent for over a year
What are premonitory sensations?
Strong urge before a tic
When do tic’s usually present?
Around or after 5
What are some examples of simple tics?
Clearing throat Blinking Head jerking Sniffing Grunting Eye rolling
What are some examples of complex tics?
Physical movements (e.g. twirling)
Copropraxia
Coprolalia
Echolalia
What is copropraxia?
Making obscene gestures
What is cophrolalia?
Saying obscene words
What is echolalia?
Repeating other people’s words
How are mild-moderate tics managed?
Reassurance & monitoring
Reduce triggers and stress
How can severe tics be managed?
Habit reversal training
Exposure with response prevention
Medications with severe cases
Treat comorbid conditions
What conditions are commonly associated with tics?
OCD
ADHD
