CAMHS

Question 1

Name some risk factors for ASD?

Answer 1

Valproate exposure in pregnancy
FHx - 8x if sibling, 2x if cousin
Older maternal age
Born prematurely or with low birth weight

Question 2

What are the most common types of child abuse?

Answer 2

1. Neglect
2. Physical abuse and non-accidental injury
3. Emotional abuse
4. Sexual abuse
5. Fabricated or induced illness

n.b.
- 20% who abused were abused as children
- boys more likely to experience physical abuse
- girls more likely to experience sexual abise

• men more likely to be perpetrators of sexual abuse
• female perpetrators more associated with neglect and medical neglect

75% of perpetrators of childhood abuse are female

Question 3

Define encoparesis

Answer 3

Passage of stools in inappropriate places beyond the age of 4 - for at least three months and must happen at least once a month

Can be primary - never toilet trained
Or secondary - toilet trained

Can be non-retentive or retentive (overflow)

Question 4

Outline the structure of the WISC

Answer 4

For children aged 6 - 17 years

Performance IQ
- Block design
- Picture completion
- Picture assembly
- Object assembly
- Coding
(supplementary - mazes and symbol search)

Verbal IQ
- Vocabulary
- Information
- Arithmetic
- Similarities
- Comprehension
(supplementary - digit span)

Question 5

What percentage of those with conduct disorder going onto develop anti-social PD as adults?

Answer 5

50%

Question 6

NICE guidelines state for chronic fatigue syndrome symptoms have to persist for?

Answer 6

3 months

Question 7

Describe the diagnostic criteria for tourette’s?

Answer 7

• Multiple motor tics and at least one verbal tic for 12 months
• Mean age of onset is 7 years but can range from 2 - 21 years

Treatment:
- Habit reversal training
- Comprehensive behavioural intervention for tourette’s
- ERP
- Self-hypnosis

Question 8

Name some features of childhood/adolescent onset bipolar disorder that may differentiate it to the adult condition?

Answer 8

Manic episodes may have atypical/mixed features

May be more chronic non-episodic patter/chronic OR ultra-rapid cycling

n.b for childhood onset M > F whereas for adolescents M = F. The treatment is the same as the adult condition

Question 9

What percentage of individuals with ASD have mild - moderate ID?

Answer 9

New study suggests 33%

SPMM says 70 - 80%

Question 10

Name some maternal risk factors for ADHD in children

Answer 10

Substance misuse (tobacco / alcohol)
Prematurity
Head injury

Question 11

What is the most common method of suicide in adolescents?

Answer 11

Hanging

Question 12

What percentages of teenagers in the UK report suicidal ideation in a year?

Answer 12

15%

Question 13

What is the most common co-morbidity with children and young people with Bipolar Disorder?

Answer 13

ADHD - 53%

ODD - 43%
Anxiety disorder - 23%

Question 14

For children and young people with oppositional defiance disorder where are symptoms invariably present?

Answer 14

At home

• often in many environments but for some symptoms may not be present in company of other adults or peers

Question 15

How often do most newborns sleep for in a day?

Answer 15

14 - 17 hours (from 0 - 3 months)

Question 16

Low CSF serotonin (5-HIAA) is associated with what in children/young people?

Answer 16

Aggressive behaviour

Question 17

What percentage of ten year olds experience nocturnal enuresis at any one time?

Answer 17

10%

Question 18

What proportion of 15-year olds have reported to ever self-harmed?

Answer 18

15% according to Health Behaviour in School-aged Children 2014 study

Question 19

What proportion of children have separation anxiety disorder?

Answer 19

3.5%

0.8% of adolescents have too

Question 20

What percentage of children with conduct disorder go onto develop ASPD?

Answer 20

50%

Question 21

For Heller’s syndrome / childhood disintegrative disorder there is a marked regression of development after how many years of normal development?

Answer 21

2 years of normal development

Question 22

In ASD which impairments/symptoms seem to be less sensitive to change from early behavioural interventions?

Answer 22

Ritualistic and repetitive behaviours

Question 23

What is the general onset of ODD in children?

Answer 23

3 - 8 years

Question 24

What are the male to female ratio of the following conditions?

a) Dyslexia
b) Autistic spectrum disorder
c) Asperger’s
d) Tourette’s syndrome
e) ADHD (children)
f) ADHD (adults)
g) Major depression
h) Bipolar type 1
i) Panic with agoraphobia
j) Panic without agoraphobia
k) Generalised anxiety disorder
l) Obsessive compulsive disorder
m) Specific phobia
n) Conversion disorder
o) Anorexia nervosa
p) Bulimia nervosa
q) Borderline personality disorder

Answer 24

a) Reading disorder 3-4:1

b) Autistic spectrum disorder 4-5:1

c) Asperger’s 5:1

d) Tourette’s syndrome 2-5:1

e) ADHD (children) 2:1

f) ADHD (adults) 1.6-1

g) Major depression 1:2

h) Bipolar type 1 1:1

i) Panic with agoraphobia 1:3

j) Panic without agoraphobia 1:2

k) Generalised anxiety disorder 1:2

l) Obsessive compulsive disorder 1:1

m) Specific phobia 1:2

n) Conversion disorder 1:2-10

o) Anorexia nervosa 1:9

p) Bulimia nervosa 1:9

q) Borderline personality disorder 1:3

Question 25

Which treatment for nocturnal enuresis is available as a nasal spray?

Answer 25

Desmopressin

Question 26

What proportion of individuals with nocturnal enuresis have a first degree relative with the same problem?

Answer 26

75%

Question 27

NICE recommend which SSRI for the treatment of BDD and OCD in young people?

Answer 27

Fluoxetine

Question 28

The prevalence of conduct disorder in boys aged 5-10 years in the UK is....

Answer 28

5 - 10%

Question 29

To meet the diagnostic threshold for enuresis the frequency must be at least

Answer 29

Twice weekly for 3 months

Question 30

How does the DSM-5 symptom criteria for ADHD vary between adults and children?

Answer 30

In adults - require at least 5 symptoms from either domain In children - require at least 6 symptoms from either inattentive or hyperactive/impulsive subtypes Both specify for symptoms to affect functioning/be seen in two environments and be present for at least 6 months note - ICD-11 also says symptoms need to be present for 6 months

Question 31

Outline the management of ADHD in CYP?

Answer 31

< 5 years: - ADHD focussed group parent training sessions - If not controlled refer to ADHD specialist - for medication need 2nd opinion - not advised < 5 yrs 5 - 17 years: - ADHD focussed group parent training sessions - If symptoms persist after environmental changes and affect functioning in one domain - medication - CBT if response to medication but still problems Medication - Methylphenidate or Lisdexamfetamine 1st line - If either ineffective switch to other 1st line agent - If Lisdexamfetamine effective but causing insomnia try - dexamfetamine - Then atomoxetine or guanfacine If above not tolerated/ineffective seek support from specialist ADHD service who may advise: - Clonidine - especially if tics - Atypical antipsychotics if behavioural symptoms Monitoring: - Height and weight at start - Weight every 3 months if < 10 and every 6 months if > 10 - Height every 6 months - BP/HR at baseline, every dose change and 6 months

Question 32

Outline the diagnoses of conduct disorder?

Answer 32

Repetitive and repeated pattern of behaviour where the rights of others or age appropriate norms are violated. Many behaviours from the following categories - Aggression (threats, physical or cruelty) to people or animals - Deceitful acts including theft - Destruction of propert - Serious violation of age-appropriate norms (truancy or running away) DSM-V says 3 of 15 behaviours present for 12 months with one behaviour in last 6 months ICD-11 says behaviours need to be present for 12 months

Question 33

How does ODD differ to conduct disorder?

Answer 33

Less severe form that does not involve the dissocial or aggressive acts as conduct disorder Both ICD-11 and DSM-V specify a pattern of 6 months DSM-V specifies 4 symptoms from categories: - Angry/Irritable mood - Defiant/Argumentative behaviour - Vindictiveness

Question 34

How does NICE recommendations for management of behaviour issues of childhood vary with age?

Answer 34

3 - 11: Group-based parental training interventions (parent + child if they have complex needs). If parents can't do together to offer individual training 9 - 14yrs: child focussed programmes 11 - 18 years: multi-modal interventions n.b both group-based parental training interventions and child focussed programmes use social learning theory and involve activities based upon modelling, rehearsal and feedback n.b multi-modal interventions involve family, school, criminal justice and community. 3 - 4 sessions a week for 3 -5 months.

Question 35

Who devised transference focussed psychotherapy?

Answer 35

Otto Kernberg

Question 36

What is the

Answer 36

- Universality (removes group members sense of isolation) - Altruism (the experience of helping anther group member) - Instillation of hope (seeing other members who have progressed in therapy) - Imparting information (learning from others) - Corrective recapitulation of the primary family experience (therapists analysis of transference) - Development of socialising techniques (practicing social skills) - Imitative behaviour (using other members as models) - Cohesiveness (feeling part of the group) - Existential factors (facing the basic issues of life) - Catharsis (relief from expressing emotion) - Interpersonal learning (using feedback from other members) - Self understanding (insight)

Question 37

Which type of family therapy uses task setting and goal setting?

Answer 37

Strategic - Assumes problems in families are due to disrupted hierarchies and dysfunctional and repetitive patterns of communication (vicious cycles). Patterns of behaviour that were aimed at becoming solutions become problems as they under/over address the need - Associated with with Jay Haley and Cloe Madanes

Question 38

In RCTs was IPT shown to be more or less efficacious than imipramine?

Answer 38

Equal efficacy to imipramine in severe depression

Question 39

Name some organic causes for encoparesis?

Answer 39

Drugs: - Iron - Codeine - Antacids Dietary: - Inadequate fiber Neurological: - Cerebral palsy - Hirshbrung's disease (2M:1F, more common in Downs, often diagnosed by age 2 - many do not pass meconium until 36hrs) - Spinal lesions Systemic disease: - Hypo//hypercalcaemia - Hypothyroidism - Diabetes mellitus and insipidus Anal lesions - most common cause if functional (accounts for 90% of cases)