CAMHS Flashcards
What is Lennox-Gastaut syndrome (LGS)?
LGS is severe form of epilepsy that typically presents in childhood and is characterised by multiple types of seizures, intellectual disability, and an abnormal electroencephalography (EEG) pattern. The syndrome’s hallmark is the presence of slow spike-and-wave complexes on EEG at a frequency of 2.5 Hz or slower, along with tonic, atonic, absence and myoclonic seizures.
Appears between age 2-6
What is the risk of lithium in pregnancy?
How is it monitored?
Freely crosses placenta
Risk highest in 1st trimester
10-20x relative risk of Ebstein’s anomaly (1/1000 absolute risk)
Frequent monitoring - every 4 weeks, and weekly from week 36
AVOID breastfeeding
Antidepressants in pregnancy and breast feeding:
1) TCAs in 3rd trimester
2) SSRIs
3) MAOI
4) initiating post-partum (first line? If TCA?)
1) Use of TCAs in the third trimester is well known to produce neonatal withdrawal effects: agitation, irritability, seizures, respiratory distress and endocrine and metabolic disturbances. These are usually mild and self-limiting.
2) use sertraline (least placental exposure) or fluoxetine
3) AVOID - risk of congenital malformations or hypertensive crisis
4) sertraline or mirtazapine (or paroxetine), if TCA (first line in breastfeeding), avoid doxepin, use imipramine or norpriptaline
Antipsychotics in pregnancy and breastfeeding:
Pregnancy:
Quetiapine, olanzapine, risperidone - most evidence
Less evidence for clozapine, ziprasidone and aripiprazole
Breastfeeding:
Use same drug as in pregnancy EXCEPT clozapine
If initiating post-partum, use olanzapine or quetiapine
Risks to baby of drug types in pregnancy:
1) SSRI
2) Antipsychotics
3) Valproate
4) steroids
5) Lithium
6) Alcohol
7) Carbamazapine
8) Diazepam
1) Some concerns about cardiac malformation and persistent pulmonary hypertension of the newborn (PPHN) but not proven to be significant in larger studies
2) No strong evidence as teratogen
3) Significant associations have been reported for spina bifida, atrial septal defects, cleft palate, hypospadias, polydactyly and craniosynostosis
4) Craniofacial defects (evidence not convincing BNF)
5) Cardiac (Ebstein’s) anomalies have long been considered to result from lithium use but the evidence is weak
6) left lip / palate, foetal alcohol syndrome
7) spina bifida
8) Craniofacial defects (Palmieri, 2008), (specifically cleft lip/ palate), although not a replicated finding
Primary vs secondary enuresis:
Enuresis = no urinary continence by age 5 (2x week, for 3 months)
Prim: has never had it
Secondary: has had period of dryness of >6 months
What is PICA? Time scale, age and stats; 3 causes
Pica is defined as persistent eating of non-nutritive substances for at least one month. It must be developmentally inappropriate, not culturally sanctioned, and sufficiently severe to merit clinical attention.
> Age 2
Up to 15% of those with LD
3 causes include:
Mental disorders (autism, schizophrenia)
Iron and zinc deficiency (such reports are rare and it is not clear if this is cause of effect)
Pregnancy
What is the treatment of choice in CFS?
How long before diagnosis can be made?
CBT - treatment of choice
Principles of management:
1) Energy management / pacing - A self-management strategy that involves a person with ME/CFS managing their activities to stay within their energy limit, with support from a healthcare professional.
2) Personalised physical activity (overseen by a physiotherapist in an ME/CFS specialist team) - involves establishing their physical activity baseline at a level that does not worsen their symptoms, initially reducing physical activity to be below their baseline level, maintaining this successfully for a period of time before attempting to increase it, then making flexible adjustments to their physical activity (up or down as needed) to help them gradually improve their physical abilities while staying within their energy limits.
3) Cognitive behavioural therapy
Period of 3 months of symptoms
Note: NOT GRADED EXERCISE THERAPY
When can you try clozapine in a child?
Before starting clozapine, a patient should have tried at least two different antipsychotics. The NICE guidelines stipulate that at least one of the drugs should be a second-generation (atypical) antipsychotic.
Clozapine is a uniquely beneficial second-line agent for treating children with refractory schizophrenia (Gogtay 2008), and some argue for its early use in first-episode psychosis (Agrid 2007).
Note: more side effects than in adults
4 types of child abuse in decreasing order of frequency:
What types are most related to future MH problems?
1) Neglect
2) Emotional Abuse
3) Physical/ NAI
4) Sexual abuse
All subtypes of maltreatment are associated with mental health problems (Baldwin, 2023). However, emotional abuse and institutional neglect are more strongly associated with mental health problems than some other types of maltreatment (might occur because parental criticism becomes internalized and directly leads to negative self-views and distress).
7 risk factors for ADHD:
1 Family history
2 Maternal smoking during pregnancy
3 Maternal alcohol consumption during pregnancy
4 Maternal heroin use during pregnancy
5 Low birth weight
6 Foetal hypoxia
6 Severe early psychosocial adversity
What are the 3 electrolyte disturbances in re-feeding syndrome?
Hypophosphataemia
Hypomagnesemia
Hypokalaemia
How does the treatment for anorexia differ between adults and children?
For adults with anorexia nervosa, consider one of:
1) Individual eating-disorder-focused cognitive behavioural therapy (CBT-ED)
2) Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)
3) Specialist supportive clinical management (SSCM)
If individual CBT-ED, MANTRA, or SSCM is unacceptable, contraindicated or ineffective for adults with anorexia nervosa, consider eating-disorder-focused focal psychodynamic therapy (FPT).
For children and young people (0-18) consider:
Anorexia-nervosa-focused family therapy (FT-AN)
If FT-AN is unacceptable, contraindicated or ineffective for children or young people with anorexia nervosa, consider individual CBT-ED or adolescent focused psychotherapy for anorexia nervosa (AFP-AN).
Do not offer medication as the sole treatment for anorexia nervosa.
What is the first line treatment for bulimia in
1) Adults
2) Children
1) For adults, the first step is an evidence-based self-help programme.
If bulimia-nervosa-focused guided self-help is unacceptable, contraindicated, or ineffective after 4 weeks of treatment, consider individual eating-disorder focused cognitive behavioural therapy (CBT-ED).
2) For children and young people offer bulimia-nervosa-focused family therapy (FT-BN).
If FT-BN is unacceptable, contraindicated or ineffective, consider individual eating-disorder-focused cognitive behavioural therapy (CBT-ED) for children and young people with bulimia nervosa.
Do not offer medication as the sole treatment for bulimia nervosa.
