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
Autistic features
Hypotonia
Microcephaly
Seizures
Abnormal gait
Rett syndrome
How does rett syndrome present
Autistic features
Hypotonia
Microcephaly
Seizures
Abnormal gait
Pathophysiology of RETT syndrome
X linked autosomal dominant- normally present in girls as boys die
Is progressive neurological condition
If sleep difficulties in someone with learning difficulties what give to help sleep
Melatonin
Learning difficulty versus learning disability
Learning disability means would struggle to live independently
Management of different IQs in terms of social care
Mild- at school with supervidion
All else special schools
What is systemic thinking when it comes to psychiatric conditions
Thinking about all of the factors which may contribute to development of the disease from an individual, family and environmental side of things- think of them in systematic way using the 4ps
What are 4 ps for systematic thinking
Predisposing
Precipitating
Perpetuating
Protective
What is systemic versus systematic thinking
Systemic- thinking about the aetiology from an individual, family and environmental factor
Systematic- thinking about these factors in a structured manner using the 4ps
What conditions does high criticism lead to
Depression
Schizophrenia
Conduct disorder
What anxiety disorder seen between 6-12
Performance anxiety
What anxiety disorder seen between 12-18
Social anxiety
Advice for all CAMHS patients with depression
Psychoeducation
Advice on sleep, exercise etc
Manage stressors- eg school
Mild depression management in children
Can offer 2 weeks watchful waiting
or
3 months low intensity psychological therapy, digital CBT, group CBT
Moderate- severe depression management in children
Reviewed by CAMHS
3 months of higher intensity psychological therapy- family therapy, individual therapy, brief psychosocial intervention
2nd line- switch psychological therapy or add fluoxetine
When admit for CAMHS depression
High risk to self
Poor home supervision
Intensive assessment required
Prognosis of anxiety and depression in children
Anxiety- most cases will resolve by adulthood
Depression- in 1 year 10% will still be depressed
How can mania present in children
Irritability- especially in children
Impulsivity
Grandiosity
Why is identifying psychosis hard in children
Have to differentiate from autism, learning difficulties and perceptual abnormalities
There are age appropriate behaviours which could be considered as psychosis such as seeing monsters
Management of psychosis in an adolescent
Early inerevention psychosis delivered by CAMHS
Very important as early management leads to far better outcomes in future
Management of substance misuse in adolescents
Refer to CAMHS
Rule out underlying causes and identify triggers
Motivational interview
Reasons for school refusal
Fears
- bullying
- phobia of school
Somatisation
Management of school refusal
Treat underlying psych disorder
Early graduated return to school
Liaise with education welfare officer
Management of truancy
Effective boundary setting
Supporting needs at school
Liaise with education welfare officer
What are the habits disorders
Sleeping
Eating
Bowel and urinary incontinence
When are habit disorders seen
Pe-school
Management of ODD or conduct disorder
Treat underlying disorder
Target risk factors
Parenting programmes
Mentoring
What underlying mental disorder most often seen in ODD
ADHD
What is extinction
A response to a behaviour fades over time
Which conditions in children have massive biological aetiology
ADHD
Autism
What tests can you use to test prefrontal cortex in ADHD
Wisonsin card sorting
Stroop
- colours written out but colour of text different
Triad for autism
Poor social interactions
- less interest in sharing/time with others
- poor non verbal communication
- no friends
Communication difficulties
- delay in language development
- lack of back and forth chat
Ritualistic
- repeats same behaviour
- likes routine
Co-morbid disorders seen in autism
Low IQ
Phobias
ADHD
Epilepsy
How is intellectual impairment measured
Wechsler adult intelligence scale
What does wechsler adult intelligence scale assess
Verbal IQ- general knowledge, maths, vocab
Performance IQ- visuospatial, picture
How is adaptive/social functioning assessed
Adaptive behaviour assessment system II (ABAS) in a clinical interview
How is learning diability assessed in children
Clinical interview
School reports
Causes of severe learning disabilities
Brain damage
Genetic abnormalities
Hypothyroidism
Physical causes of learning disability
Poor diet and obese
Poor eyesight and hearing
Management of learning disabilities
Psycho
- Family therapy
- CBT
- creative therapies
Social
- skills training
- community inclusion
How is autism diagnosed
Autism diagnostic inventory
How is irritability managed in autism pharmacologically
Risperidone and aripiprazole
How are obsessional behaviours treated pharmacologically in autism
SSRIs
How are stereotypical motor behaviours treated in autism
Dopamine antagonists
What are paediatric autoimmune psychiatric conditions associated with strep infection
Post strep infections can get OCD or tic disorder
How does childhood disintegrative disorder present
Initial period of normal social development then loss of skills and social withdrawal
What is difference between tourettes syndrome and tic disorder
Tourettes includes both vocal and motor tics
Tic disorderhas only 1 of the 2
How long must a tic be there to be classified as tourettes
1 year
Management of tourettes
If mild
- Self help- education about them and identifying triggers
If debilitating
- risperidone
- exposure with response prevention
How does methylphenidate OD present
HTN
Tachycardic
High fever
Restless
Cant sleep
What do if develop tics on methylphenidate
Switch medication
