CAMHS Flashcards
Name some risk factors for ASD?
Valproate exposure in pregnancy
FHx - 8x if sibling, 2x if cousin
Older maternal age
Born prematurely or with low birth weight
What are the most common types of child abuse?
- Neglect
- Physical abuse and non-accidental injury
- Emotional abuse
- Sexual abuse
- 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
Define encoparesis
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)
Outline the structure of the WISC
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)
What percentage of those with conduct disorder going onto develop anti-social PD as adults?
50%
NICE guidelines state for chronic fatigue syndrome symptoms have to persist for?
3 months
Describe the diagnostic criteria for tourette’s?
- 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
Name some features of childhood/adolescent onset bipolar disorder that may differentiate it to the adult condition?
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
What percentage of individuals with ASD have mild - moderate ID?
New study suggests 33%
SPMM says 70 - 80%
Name some maternal risk factors for ADHD in children
Substance misuse (tobacco / alcohol)
Prematurity
Head injury
What is the most common method of suicide in adolescents?
Hanging
What percentages of teenagers in the UK report suicidal ideation in a year?
15%
What is the most common co-morbidity with children and young people with Bipolar Disorder?
ADHD - 53%
ODD - 43%
Anxiety disorder - 23%
For children and young people with oppositional defiance disorder where are symptoms invariably present?
At home
- often in many environments but for some symptoms may not be present in company of other adults or peers
How often do most newborns sleep for in a day?
14 - 17 hours (from 0 - 3 months)
Low CSF serotonin (5-HIAA) is associated with what in children/young people?
Aggressive behaviour
What percentage of ten year olds experience nocturnal enuresis at any one time?
10%
What proportion of 15-year olds have reported to ever self-harmed?
15% according to Health Behaviour in School-aged Children 2014 study
What proportion of children have separation anxiety disorder?
3.5%
0.8% of adolescents have too
What percentage of children with conduct disorder go onto develop ASPD?
50%
For Heller’s syndrome / childhood disintegrative disorder there is a marked regression of development after how many years of normal development?
2 years of normal development
In ASD which impairments/symptoms seem to be less sensitive to change from early behavioural interventions?
Ritualistic and repetitive behaviours
What is the general onset of ODD in children?
3 - 8 years
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
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
Which treatment for nocturnal enuresis is available as a nasal spray?
Desmopressin
What proportion of individuals with nocturnal enuresis have a first degree relative with the same problem?
75%
NICE recommend which SSRI for the treatment of BDD and OCD in young people?
Fluoxetine
The prevalence of conduct disorder in boys aged 5-10 years in the UK is….
5 - 10%
To meet the diagnostic threshold for enuresis the frequency must be at least
Twice weekly for 3 months
How does the DSM-5 symptom criteria for ADHD vary between adults and children?
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
Outline the management of ADHD in CYP?
< 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
Outline the diagnoses of conduct disorder?
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
How does ODD differ to conduct disorder?
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
How does NICE recommendations for management of behaviour issues of childhood vary with age?
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.
Who devised transference focussed psychotherapy?
Otto Kernberg
What is the
- 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)
Which type of family therapy uses task setting and goal setting?
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
In RCTs was IPT shown to be more or less efficacious than imipramine?
Equal efficacy to imipramine in severe depression
Name some organic causes for encoparesis?
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)
