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CAMHS Flashcards

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1
Q

What is anhedonia?

A

Lack of pleasure in activities

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2
Q

What key questions need to be asked in a depression history?

A 
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
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3
Q

How is mild depression/ low mood associated with single negative event managed?

A

Watchful waiting
Advice about healthy habits
Follow up in 2 weeks

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4
Q

How is moderate- severe depression managed?

A

CAMHS referral:
Phsycological therapy
Antidepressants

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5
Q

What physchological therapies may be used to help depression?

A

CBT
Non-directive supportive therapy
Interpersonal therapy
Family therapy

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6
Q

What is the first line antidepressant and dose in children?

A

Fluoxetine 10mg (max 20mg)

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7
Q

What are the second line antidepressants in children?

A

Sertraline

Citalopram

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8
Q

If a child responds to antidepressants, how long should they continue after remission is achieved?

A

6 months

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9
Q

What is used to assess progress when monitoring depression?

A

MFQ (Mood and feelings questionnaire)

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10
Q

What is GAD?

A

Generalised anxiety disorder- excessive and disproportional anxiety that impacts a patients daily activities

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11
Q

How are children assessed for GAD?

A

GAD-7 anxiety questionnaire

Assess for co-morbid mental health problems and environmental triggers

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12
Q

How is mild anxiety managed?

A

Watchful waiting and advice about self-help strategies

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13
Q

How is moderate-severe anxiety managed?

A

CAMHS referral
Counselling
CBT
Medical management

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14
Q

What is the first line medical management of GAD?

A

SSRI (Sertraline)

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15
Q

What are obsessions in OCD?

A

Unwanted and uncontrolled thoughts and intrusive images that are very difficult to ignore

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16
Q

What are compulsions in OCD?

A

Repetitive actions that the person feels they must do

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17
Q

What is the OCD cycle?

A

Obsessions lead to anxiety, which leads to compulsive behaviour, which leads to a temporary improvement in the anxiety and the cycle repeats

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18
Q

What other mental health issues is OCD strongly related to?

A 
Anxiety
Depression
Eating disorders
ASD
Phobias
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19
Q

How is mild OCD managed?

A

Education

Self help resources

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20
Q

How is severe OCD managed?

A

CAMHS referral
Patient/ carer education
CBT
SSRI medications

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21
Q

What is aspergers syndrome now known as?

A

Part of the autistic spectrum disorder

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22
Q

What is affected in ASD?

A

Deficit in social interaction, communication and flexible behaviour

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23
Q

At what age are features of ASD usually observable?

A

Before age of 3

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24
Q

What features may be seen in the social interaction aspect of ASD?

A 
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
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25
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
26
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
27
How is autism diagnosed?
By a specialist in autism using detailed history and assessment
28
How is autism managed?
MDT
29
What is ADHD?
Attention deficit hyperactivity disorder
30
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 ```
31
How is ADHD diagnosed?
Detailed assessment by specialist in childhood behavioural problems
32
How is ADHD managed?
Healthy diet & exercise Parental and school education Medication in severe cases
33
What medication can be used in ADHD?
CNS stimulants: Methylphenidate Dexamfetamine Atomoxetine
34
What are the features of anorexia nervosa?
``` Excessive weight loss Amenorrhoea Lanugo hair Hypokalaemia Hypotension Hypothermia Changes in mood Solitude ```
35
What is lanugo hair?
Fine, soft hair across most of the body
36
What are the worst complications of anorexia?
Cardiac complications (arrhytmia, cardiac atrophy, sudden cardiac death)
37
What are the key features of bulimia nervosa?
``` Alkalosis Hypokalaemia Erosion of teeth Swollen salivary glands Mouth ulcers GORD Russell's sign ```
38
Why do you get alkalosis in bulimia?
Due to vomiting hydrochloric acid from the stomach
39
What is Russell's sign?
Calluses on the knuckles where they have been scraped across the teeh
40
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
41
How are paediatric eating disorders managed?
``` Self help resources Counselling CBT May need admission for observed feeding SSRI medication ```
42
What causes refeeding syndrome?
When people who have been in a severe nutritional deficit for an extended period start to eat again
43
What increases the risk of refeeding syndrome?
BMI <20 | Longer the period of malnutrition
44
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
45
What does refeeding syndrome lead to?
Hypomagnesaemia Hypokalaemia Hypophosphataemia = Risk of cardiac issues
46
How is refeeding syndrome managed?
``` Slowly reintroducing food Magnesium, potassium, phosphate and glucose monitoring Fluid balance monitoring ECG monitoring Supplementation ```
47
What causes personality disorders?
Combination of genetic and environemental factors
48
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 ```
49
What are the three main categories of personality disorder?
Anxious Suspicious Emotional/ impulsive
50
What are the 3 types of anxious personality disorders?
Avoidant Dependent Obsessive compulsive
51
What is avoidant personality disorder?
Severe anxiety about rejection or disapproval and avoidance of social situations or relationships
52
What is dependent personality disorder?
Heavy reliance on others to make decisions and take responsibility for their lives
53
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
54
What are the 3 types of suspicious personality disorder?
Paranoid Schizoid Schizotypal
55
What is paranoid personality disorder?
Difficulty in trusting or revealing personal information to others
56
What is schizoid personality disorder?
Lack of interest or desire to form relationships with others
57
What is schizotypal personality disorder?
Unusual beliefs, thoughts and behaviours with social anxiety
58
What are the 3 types of emotional/ impulsive personality disorder?
Borderline Histrionic Narcissistic
59
What is borderline personality disorder?
Fluctuating strong emotions and difficulties with identity and maintaining healthy relationships
60
What is histrionic personality disorder?
Need to be the centre of attention and have to perform in order to maintain that attention
61
What is narcissistic personality disorder?
Feeling that they are special and need others to recognise this or they get upset. Put themselves first
62
How might personality disorders be managed?
Patient/ carer education CBT Psychotherapy
63
What is Tourette's syndrome?
Severe tics that are persistent for over a year
64
What are premonitory sensations?
Strong urge before a tic
65
When do tic's usually present?
Around or after 5
66
What are some examples of simple tics?
``` Clearing throat Blinking Head jerking Sniffing Grunting Eye rolling ```
67
What are some examples of complex tics?
Physical movements (e.g. twirling) Copropraxia Coprolalia Echolalia
68
What is copropraxia?
Making obscene gestures
69
What is cophrolalia?
Saying obscene words
70
What is echolalia?
Repeating other people's words
71
How are mild-moderate tics managed?
Reassurance & monitoring | Reduce triggers and stress
72
How can severe tics be managed?
Habit reversal training Exposure with response prevention Medications with severe cases Treat comorbid conditions
73
What conditions are commonly associated with tics?
OCD | ADHD

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