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Year 4 Psychiatry > CAMHS > Flashcards

CAMHS Flashcards

1
Q

Mild depression in children can be managed with watchful waiting and advise about healthy habits. (Follow up within 2 weeks is advised) Referral to CAMS should be considered for children with moderate to severe depression.

Treatment options include what?

A

• Full assessment
• Psychological therapy (first line)
• Fluoxetine starting at 10mg max 20mg (first line antidepressant in children; followed by Sertraline and Citalopram)

When they do not respond to medical treatment they may require intensive psychological therapy
Where there is follow up monitoring in secondary care, the mood and feelings questionnaire (MFQ) may be used to assess progress.

Admission may be required where there is high risk of self harm, suicide or self-neglect or where they may be an immediate safeguarding issue.

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2
Q

What are potential psychosocial contributors to depression in children and adolescents

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

What can be used to assess progress in children and adolescents being seen by secondary care for depression

A

mood and feelings questionnaire (MFQ)

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4
Q

How might depression present in children

A

Low mood
Anhedonia, a lack of pleasure in activities
Low energy
Anxiety and worry
Clinginess
Irritability
Avoiding social situations (e.g. school)
Hopelessness about the future
Poor sleep, particularly early morning waking
Poor appetite or over eating
Poor concentration
Physical symptoms such as abdominal pain

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5
Q

What is tourettes?

A

Tourette’s syndrome is characterised by the development of tics that are persistent for over a year.

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6
Q

What is a tic?

A

Tics are involuntary movements or sounds that the child performs repetitively throughout the day.

These tics become more prominent when the person is under pressure or excited. The person may describe an overwhelming urge to perform the tic.

This urge increases the more they suppress it.

They feel they need to complete the tic, often several times, to get relief from that urge.

These feelings are called premonitory sensations.

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7
Q

When do tics tend to develop

A

Around or after 5 years of age

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8
Q

What conditions are tics associated with?

A

Tourette’s
OCD
ADHD

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9
Q

Examples of simple tics

A

Clearing throat
Blinking
Head jerking
Sniffing
Grunting
Eye rolling

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10
Q

Examples of complex tics

A

Performing physical movements, such as twirling on the spot or touching objects

Copropraxia involves making obscene gestures

Coprolalia involves saying obscene words

Echolalia involves repeating other people’s words

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11
Q

Managements of tics/tourettes?

A

Usually tics will improve over time. Mild cases with no signs of underlying disease may only require reassurance and monitoring. Taking measures to reduce stress, anxiety and triggers can be helpful.

More severe or troublesome tics should be referred to a specialist. They may benefit from:

Habit reversal training
Exposure with response prevention
Medications may be tried in very severe cases, usually with antipsychotic medications
Co-morbid conditions such as OCD and ADHD may benefit from treatment.

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12
Q

What distinguishes child from adult psychiatry?

A

That nowhere is development more marked than in childhood and adolescence.

Children have to be viewed in the context of their families on whom they are generally dependent and definitions and compositions of the families are changing all the time.

The cultural context of the child is even more significant as both the first two features are related to this aspect.

Most often the nominated patient does not present themselves but is presented (brought to services)

Cultural mismatches between young people and their carers which may affect presentations to mental health services and how they are managed.

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13
Q

What factors may affect when a child presents to secondary care?

A

Age
Frequency
Severity
Individual characteristics or temperament
Impact on others
Social or family circumstances

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14
Q

How are mental disorders in children generally categorised?

A

Neurodevlopmental
Behavioural
Emotrional

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15
Q

Influences which affect
interaction with children

A

ENVIRONMENT

  • Privacy
  • Suitability
  • Noisy/overstimulating
  • Access to toys/materials
  • Age appropriate
  • Intimidating
  • Correct for what is being assessed

CHILD ADOLESCENCE

  • Feeling safe/secure
  • Willingness to engage
  • Family or carers present/not present
  • Cognitive ability: IQ/processing problems
  • Communication/language problems
  • Emotional development

CLINICIAN FACTORS

  • Setting enough time
  • Appropriate use of language
  • Appropriate non-verbal communication
  • Using the right method for the situation
  • Avoid being patronising/condescending
  • Try not to sound rehearsed
  • (It is easier if you like children)
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16
Q

CAMHS - considering the parents/carers

A
  • Not the referred person but may need to be
  • Multiple informants
  • Expectations
  • Parental mental health
  • Family dynamics i.e divorce
  • Engagement
  • Ability to leave the child
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17
Q

CAMHs history

A
  • Certain elements have greater relevance
  • Present/Hx presenting complaint
  • Development Hx
  • Family Hx
  • Social Hx
  • School
  • Observation of the child/child and carers
  • Consider these when watching videos
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18
Q

What different types of assessment are different in CAMHS

A
  • Psychometric
  • Sensory assessments
  • School observations
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19
Q

Emotional disorders common in children

A

Generalised Anxiety Disorders
Separation Anxiety Disorders
Phobic Disorders
Obsessive-Compulsive Disorders
Post-Traumatic Stress Disorders
Depression

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20
Q

How might children present with GAD

A

Free floating anxiety
Fears of death, loss (of child or parents)
Somatic manifestations (nausea, abdominal pain, sickness,
headaches, sweating, palpitations, tension)-more common in
children
Panic attacks (sudden onset, extreme fear, physical symptoms,
faintness

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21
Q

How might separation anxiety present in children?

A

Anxiety manifest upon separation (or threat of separation) from
attachment figures (usually parent, particularly mother)

Somatic manifestations

Nightmares with separation themes

School refusal

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22
Q

What are the two main features of OCD

A

OBSESSIONAL THOUGHTS – intrusive persisting, awareness of
their illogicality, resistance to them (e.g. counting, urge to wash
hands or touch wood a certain number of times)

COMPULSIVE ACTIONS – related to the thoughts

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23
Q

General principals behind PTSD

A

Persistently re-experiencing trauma

Avoidance of associated stimuli or numbing of
responsiveness

Increased arousal (sleep disturbance, irritability,
poor concentration)

24
Q

How might anxiety disorders be managed in children?

A

Behaviour therapy (systemic desensitisation, flooding,
response prevention)

Psychotherapies (brief psychodynamic, family and
cognitive therapy)

Anxiolytics-most common fluoxetine (SSRI)

25
Q

How might mood disorders be masked in young boys?

A

Anger

26
Q

How might low mood in depressive illness differ in children to adults?

A

In children with depressive illness the low mood is persistent BUT may not be pervasive

The biological symptoms are not
consistent-appetite/sleep may not be affected.

Concentration/motivation are generally worse

27
Q

Managing depressive illness in children

A

Cognitive-behavioural therapy
Antidepressants (SSRIs)
Managing the underlying or comorbid problems

28
Q

What are the characteristics of oppositional disorder?

A

Uncooperative, unwilling to comply with requests, frequent temper tantrums

Wilful, defiant, may also be aggressive

Unless managed, tends to escalate

29
Q

Features of children with conduct disorder

A

Socialised and unsocialised types

Socialised conduct disorder is usually viewed as less serious and
tends to be phasic in nature

Unsocialised conduct disorder is more serious, and potentially
leads to criminality and a later diagnosis of antisocial personality
disorder

Lying, stealing, truanting, violence to people
and animals

30
Q

Behavioural problems - risk factor

A

Lack of clear boundaries, inconsistent parenting

Rejection Rejection

Family conflict, especially witnessing violence and aggression

Child abuse

Child temperament

Comorbid learning or developmental difficulties

31
Q

Treatment of behavioural issues

A

Consistent care and parenting

Behavioural therapy Behavioural therapy

School-based interventions School-based interventions

Community interventions

32
Q

How often does ADHD persist beyond childhood

A

Symptoms persist into adulthood in approximately 2/3 of
cases

33
Q

Features of ADHD

A

Poor attention and concentration

Physical overactivity

Impulsivity

Needs to occur in more than one environment

Diagnosis after 6 years, but symptoms
present before

34
Q

What is attachment?

A

lasting psychological connectedness between human beings

(Childs attachment TO the parent)

35
Q

Management of ADHD

A
  • Mild and moderate: consider parenting and school interventions first
  • Severe: medication first line
    – Methylphenidate: short or long-acting stimulant
    – Lisdexamphetamine
    – Atomoxetine
    – Guanfacine
  • Treat co-morbidity-anxiety, behavioural problems, substance use.
36
Q

Autism co-morbidities

A

Associated with a number of co-morbid conditions eg.
– Anxiety
– ADHD
– Sleep problems
– OCD
– Learning difficulties

37
Q

Symptoms of autism

A

Socio/communication difficulties-verbal/non verbal
difficulties

Effects on thinking-lack of flexibility, social imagination, theory of mind, generalisation

Needs to occur in more than one environment

Symptoms must be present before 3 years of age

38
Q

Approaches to managing autism

A

– Psycho-education
– Stress reduction
– Environmental changes
– Treat co-morbidities

39
Q

When are eating disorders rare?

A

Rare in the pre-adolescent period

Increasingly prevalence in adolescence - similar symptoms to adult presentation

Delayed puberty and growth are significant issues

Prognosis worse if younger or male

40
Q

Key significant issue in children with eating disorders

A

Delayed puberty and growth are significant issues

41
Q

Poor prognostic factors in ED

A

Prognosis worse if younger or male

42
Q

Children with psychosis - features

A

Hallucinations

Delusions

Thought disorder

Need to consider substance misuse

Rare before pubertY

43
Q

How might depression present in children?

A

Low mood
Anhedonia, a lack of pleasure in activities
Low energy
Anxiety and worry
Clinginess
Irritability
Avoiding social situations (e.g. school)
Hopelessness about the future
Poor sleep, particularly early morning waking
Poor appetite or over eating
Poor concentration
Physical symptoms such as abdominal pain

44
Q

Initiation of SSRIs in under 18s

A

May be initiated in primary care but must be referred to secondary care for follow up and monitoring

45
Q

CAMHS risk management

A

Personal factors increasing risk:
Cognative impairment, physical or mental health issues, sleep problems, ND conditions, ACRs, criminal judgement system risk, non-engaement, gender issues, nutritional issues, protective factors

Social factors increasing risk:
LAC/adopted child, NEET, academic or work pressures, victim of bullyinh, bullying others, isolation, negative impact of social media, bereavement, concerns about saftey of medication management

Risk of harm to self, others, from others, (past present)
any other risks, driving

46
Q

Social/enviromental stressors in children?

A

Trauma

Accident

Illness

Death

47
Q

Biggest adverse factors that put children at risk developing mental disorders

A

Poverty
Parental mental illness

48
Q

Examples of cihronic adversity

A

Socio-economic
Parental mental illness
Parental loss
Family conflict - violence
Parenting
Abuse (physical secual neglect emotional)
Exposure to community violence

49
Q

Biological factors influencing child mental health?

A
  • Temperament
  • Genetic
  • Neurodevelopmental
  • Biochemical
  • Appearance
50
Q

Developmental/psychological influencing child mental health?

A
  • Attachment-important
  • Learning
  • Cognitive
  • Emotional
51
Q

Significant environmental influences on child mental health?

A
  • Parents and family
    – Type of parenting
    – What constitutes good parenting?
    – Family structure
  • School
    – Academic success/failure
    – Friendships
    – Bullying
  • Culture
52
Q

Protective factors against mental illness in children?

A

Temperament

Coping strategies

Problem-solving

Self-esteem

Stability

Secure relationships

Friendships

Achievement

53
Q

What is Coprolalia

A

Coprolalia refers to uncontrollable outbursts of obscenities or swear words in socially inappropriate settings. This has also been liked to left frontal seizures or strokes, but is most commonly associated with Tourette’s syndrome.

54
Q

What questionaries might be used in ADHD screening?

A

Conners Questionnaire
Dundee Difficult Times of the Day Scale (D- DTODS)
SNAP – IV
Strengths and Difficulties questionnaire

55
Q

What is the GARS questionaries used to screen for?

A

The GARS questionnaire is used to screen for Autism.

56
Q

If a patient had a family history sudden death in a first-degree relative under 40 years of
age suggesting a cardiac disease, what are some important interventions prior to starting
possible ADHD medication?

A

This patient would be referred to the Paediatric Cardiologist for assessment. They would take
a history and perform a clinical examination. They would usually do a blood pressure, EGG,
and echocardiogram. With that family history it would also be useful to do a 24-hour ECG
tape recording

Year 4 Psychiatry (18 decks)

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