CAMHS Flashcards
Which anxiety disorder will see in under 3s
Separation
Which anxiety disorder seen in 3-6 year olds
Phobias
Monsters
How does depression present in a child
Irritability as opposed to low mood
Somatic symptoms
Social withdrawal
Management of anxiety in a child
1st line- psychoeducation, Group CBT
Second line- fluoxetine or sertaline if OCD
Liaise with school if pertinent to presentation
What is SSRI for OCD in children
Sertaline
What required for diagnosis of BPAD in children in the UK
1 epidose of manic episode
What is encopresis
Voluntarily letting out stool into clothes
What are examples of behaviour disorders
Sleep disorder
Encopresis
Enuresis
Feeding disorder
Management principles of behaviour disorders
- Rule out physiological cause
- Behavioural therapy based around conditioning and positive behaviour rewards
- eg if sleeping disorder look at sleep environment and hygiene, if encopresis look at using toilet after meals - Last line medication like melatonin for sleep and desmopressin for enuresis
What is difference between school refusal and truancy
School refusal the parents are aware
Truancy the child skips school and the parents have no idea
Difference in age presentation of school refusal versus truancy
School refusal- 5-12
Truancy- teenagers
What can cause school refusal
Underlying mental disorder- anxiety and depression
Somatisation
Bullying
What is truancy related to
Conduct disorder
What can normally cause truancy
Academically unable
Large/disorganised families
What are key features of conduct disorders
Repetitive and persistent pattern of defiant behaviour for over 6 MONTHS
Beyond appropriate age norms
What are features of conduct disorder as opposed to opposional defiant disorder
ODD
- severe tantrums
- defiance and refusal to comply with rules
Conduct disorder
- truancy
- stealing
- physical fights
Behavioural management of conduct disorder and ODD
Identify triggers or pre-emptive factors and sort these out
Reward positive behaviour consitently and repetitively
Ignore negative behaviour and have clear boundaries with explicit consequences
What is triad for ADHD
Impulsivity
Inattention
Hyperactivity
Criteria for ADHD versus hyperkinetic disorder
ICD 10 did not formally identify ADHD as a condition instead hyperkinetic disorder
ICD-10 for hyperkinetic disorder
- symptoms over 6 months
- present under age of 6
- combination of inattention and hyperactivity present in at least 2 settings
DSM-V for ADHD
- present under 12
- for 6 months
- presence of 6 inattention symptoms and 6 hyperactivity
- NOT better explained by conduct disorder
Difference in ADHD in adults (17 and over) versus children (16 and under)
Children
- present under age of 12
- at least 6 months
- presence of 6 symptoms
Adult
- at least 6 months
- presence of 5 inattention symptoms and 5 hyperactivity
What is main neurological pathology behind ADHD
Prefrontal cortex hypoactivity
Imaging findings in ADHD
Frontal cortex atrophy
Reduced blood flow fMRI
Risk factors for ADHD
Foetal alcohol syndrome
Low birth weight
Prematurity
Management of ADHD
Refer to specialist to make diagnosis
First line is family education and training
Second line methyphenidate if symptoms still severe
Third line if does not work- lisdexamfetamine
Fourth line if does not work- dexamfetamine
Can also consider Atmoxetine
If medication unsuccessful use CBT
MLD
Who is pharmacotherapy only given to in ADHD
Over 5s
Those who family education does not work
Functional impairment severe
Side effects of methylphenidate
Arrythmias
Insomnia
Anorexia
Hypertension
Tics
Side effects of amfetamines in ADHD
Arrythmias
Insomnia
Anorexia
Hypertension
What needs to be monitored with methylphenidate and amfetamines
Baseline ECG and BP
Monitor growth
Class of atmoxetine
SNRI
Side effects of atmoxetine
Suicidal thoughts
Anorexia
GI upset
Difficulty starting work
Physical conditions associated with causing autsm
Frgaile X
Tuberous sclerosis
Downs syndrome
Management of autism
Psycho-education of family
MDT- specialist schools, occupational therapy, SALT
Behaviour management
What does IQ stand for
Intelligence quotient
Ranges for IQ
Normal - above 70
Mild- 50-69
Moderate- 35-49
Severe- 20-34
Profound is less than 20