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CAMHS Flashcards

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1
Q

Which anxiety disorder will see in under 3s

A

Separation

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2
Q

Which anxiety disorder seen in 3-6 year olds

A

Phobias
Monsters

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3
Q

How does depression present in a child

A

Irritability as opposed to low mood
Somatic symptoms
Social withdrawal

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4
Q

Management of anxiety in a child

A

1st line- psychoeducation, Group CBT
Second line- fluoxetine or sertaline if OCD
Liaise with school if pertinent to presentation

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5
Q

What is SSRI for OCD in children

A

Sertaline

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6
Q

What required for diagnosis of BPAD in children in the UK

A

1 epidose of manic episode

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7
Q

What is encopresis

A

Voluntarily letting out stool into clothes

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8
Q

What are examples of behaviour disorders

A

Sleep disorder
Encopresis
Enuresis
Feeding disorder

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9
Q

Management principles of behaviour disorders

A
  1. Rule out physiological cause
  2. 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
  3. Last line medication like melatonin for sleep and desmopressin for enuresis
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10
Q

What is difference between school refusal and truancy

A

School refusal the parents are aware
Truancy the child skips school and the parents have no idea

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11
Q

Difference in age presentation of school refusal versus truancy

A

School refusal- 5-12
Truancy- teenagers

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12
Q

What can cause school refusal

A

Underlying mental disorder- anxiety and depression
Somatisation
Bullying

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13
Q

What is truancy related to

A

Conduct disorder

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14
Q

What can normally cause truancy

A

Academically unable
Large/disorganised families

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15
Q

What are key features of conduct disorders

A

Repetitive and persistent pattern of defiant behaviour for over 6 MONTHS
Beyond appropriate age norms

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16
Q

What are features of conduct disorder as opposed to opposional defiant disorder

A

ODD
- severe tantrums
- defiance and refusal to comply with rules

Conduct disorder
- truancy
- stealing
- physical fights

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17
Q

Behavioural management of conduct disorder and ODD

A

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

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18
Q

What is triad for ADHD

A

Impulsivity
Inattention
Hyperactivity

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19
Q

Criteria for ADHD versus hyperkinetic disorder

A

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

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20
Q

Difference in ADHD in adults (17 and over) versus children (16 and under)

A

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

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21
Q

What is main neurological pathology behind ADHD

A

Prefrontal cortex hypoactivity

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22
Q

Imaging findings in ADHD

A

Frontal cortex atrophy
Reduced blood flow fMRI

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23
Q

Risk factors for ADHD

A

Foetal alcohol syndrome
Low birth weight
Prematurity

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24
Q

Management of ADHD

A

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

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25
Q

Who is pharmacotherapy only given to in ADHD

A

Over 5s
Those who family education does not work
Functional impairment severe

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26
Q

Side effects of methylphenidate

A

Arrythmias
Insomnia
Anorexia
Hypertension
Tics

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27
Q

Side effects of amfetamines in ADHD

A

Arrythmias
Insomnia
Anorexia
Hypertension

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28
Q

What needs to be monitored with methylphenidate and amfetamines

A

Baseline ECG and BP
Monitor growth

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29
Q

Class of atmoxetine

A

SNRI

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30
Q

Side effects of atmoxetine

A

Suicidal thoughts
Anorexia
GI upset
Difficulty starting work

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31
Q

Physical conditions associated with causing autsm

A

Frgaile X
Tuberous sclerosis
Downs syndrome

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32
Q

Management of autism

A

Psycho-education of family
MDT- specialist schools, occupational therapy, SALT
Behaviour management

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33
Q

What does IQ stand for

A

Intelligence quotient

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34
Q

Ranges for IQ

A

Normal - above 70
Mild- 50-69
Moderate- 35-49
Severe- 20-34
Profound is less than 20

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35
Q

Autistic features
Hypotonia
Microcephaly
Seizures
Abnormal gait

A

Rett syndrome

36
Q

How does rett syndrome present

A

Autistic features
Hypotonia
Microcephaly
Seizures
Abnormal gait

37
Q

Pathophysiology of RETT syndrome

A

X linked autosomal dominant- normally present in girls as boys die
Is progressive neurological condition

38
Q

If sleep difficulties in someone with learning difficulties what give to help sleep

A

Melatonin

39
Q

Learning difficulty versus learning disability

A

Learning disability means would struggle to live independently

40
Q

Management of different IQs in terms of social care

A

Mild- at school with supervidion
All else special schools

41
Q

What is systemic thinking when it comes to psychiatric conditions

A

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

42
Q

What are 4 ps for systematic thinking

A

Predisposing
Precipitating
Perpetuating
Protective

43
Q

What is systemic versus systematic thinking

A

Systemic- thinking about the aetiology from an individual, family and environmental factor
Systematic- thinking about these factors in a structured manner using the 4ps

44
Q

What conditions does high criticism lead to

A

Depression
Schizophrenia
Conduct disorder

45
Q

What anxiety disorder seen between 6-12

A

Performance anxiety

46
Q

What anxiety disorder seen between 12-18

A

Social anxiety

47
Q

Advice for all CAMHS patients with depression

A

Psychoeducation
Advice on sleep, exercise etc
Manage stressors- eg school

48
Q

Mild depression management in children

A

Can offer 2 weeks watchful waiting
or
3 months low intensity psychological therapy, digital CBT, group CBT

49
Q

Moderate- severe depression management in children

A

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

50
Q

When admit for CAMHS depression

A

High risk to self
Poor home supervision
Intensive assessment required

51
Q

Prognosis of anxiety and depression in children

A

Anxiety- most cases will resolve by adulthood
Depression- in 1 year 10% will still be depressed

52
Q

How can mania present in children

A

Irritability- especially in children
Impulsivity
Grandiosity

53
Q

Why is identifying psychosis hard in children

A

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

54
Q

Management of psychosis in an adolescent

A

Early inerevention psychosis delivered by CAMHS
Very important as early management leads to far better outcomes in future

55
Q

Management of substance misuse in adolescents

A

Refer to CAMHS
Rule out underlying causes and identify triggers
Motivational interview

56
Q

Reasons for school refusal

A

Fears
- bullying
- phobia of school
Somatisation

57
Q

Management of school refusal

A

Treat underlying psych disorder
Early graduated return to school
Liaise with education welfare officer

58
Q

Management of truancy

A

Effective boundary setting
Supporting needs at school
Liaise with education welfare officer

59
Q

What are the habits disorders

A

Sleeping
Eating
Bowel and urinary incontinence

60
Q

When are habit disorders seen

A

Pe-school

61
Q

Management of ODD or conduct disorder

A

Treat underlying disorder
Target risk factors
Parenting programmes
Mentoring

62
Q

What underlying mental disorder most often seen in ODD

A

ADHD

63
Q

What is extinction

A

A response to a behaviour fades over time

64
Q

Which conditions in children have massive biological aetiology

A

ADHD
Autism

65
Q

What tests can you use to test prefrontal cortex in ADHD

A

Wisonsin card sorting
Stroop
- colours written out but colour of text different

66
Q

Triad for autism

A

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

67
Q

Co-morbid disorders seen in autism

A

Low IQ
Phobias
ADHD
Epilepsy

68
Q

How is intellectual impairment measured

A

Wechsler adult intelligence scale

69
Q

What does wechsler adult intelligence scale assess

A

Verbal IQ- general knowledge, maths, vocab
Performance IQ- visuospatial, picture

70
Q

How is adaptive/social functioning assessed

A

Adaptive behaviour assessment system II (ABAS) in a clinical interview

71
Q

How is learning diability assessed in children

A

Clinical interview
School reports

72
Q

Causes of severe learning disabilities

A

Brain damage
Genetic abnormalities
Hypothyroidism

73
Q

Physical causes of learning disability

A

Poor diet and obese
Poor eyesight and hearing

74
Q

Management of learning disabilities

A

Psycho
- Family therapy
- CBT
- creative therapies
Social
- skills training
- community inclusion

75
Q

How is autism diagnosed

A

Autism diagnostic inventory

76
Q

How is irritability managed in autism pharmacologically

A

Risperidone and aripiprazole

77
Q

How are obsessional behaviours treated pharmacologically in autism

A

SSRIs

78
Q

How are stereotypical motor behaviours treated in autism

A

Dopamine antagonists

79
Q

What are paediatric autoimmune psychiatric conditions associated with strep infection

A

Post strep infections can get OCD or tic disorder

80
Q

How does childhood disintegrative disorder present

A

Initial period of normal social development then loss of skills and social withdrawal

81
Q

What is difference between tourettes syndrome and tic disorder

A

Tourettes includes both vocal and motor tics
Tic disorderhas only 1 of the 2

82
Q

How long must a tic be there to be classified as tourettes

A

1 year

83
Q

Management of tourettes

A

If mild
- Self help- education about them and identifying triggers
If debilitating
- risperidone
- exposure with response prevention

84
Q

How does methylphenidate OD present

A

HTN
Tachycardic
High fever
Restless
Cant sleep

85
Q

What do if develop tics on methylphenidate

A

Switch medication

Psych (9 decks)

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