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CAMHS 2 Flashcards

1
Q

Duration and age onset for diagnosis of enuresis

A

Child must exhibit a developmental or chronological age

of at least 5 years. Duration of disorder is at least 3 months.

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2
Q

When does voluntary micturition begin

A

15-18 months

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3
Q

How many children have daytime wetting at age of 5?

A

1%

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4
Q

Prevalence of nocturnal enuresis in 7 year olds

A

22% boys

7-15% girls

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5
Q

M:F ratio of enuresis

A

2:1

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6
Q

Most important predictor of primary nocturnal enuresis

A

FHx of noenuresis

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7
Q

Predictors of enuresis

A 
Delay in control over bedwetting
Adverse life events
UTI
Constipation
Low socioeconomic background
Large families and overcrowded
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8
Q

Which psychiatric disorder are children with enuresis at higher risk of?

A

ADHD

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9
Q

Treatment of enuresis

A 
R/o organic cause
Review toilet training
Psychoeducation - avoid punishment
Record keeping - for baseline and as reinforcer in following progress
Behavioural intervention
Meds
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10
Q

What are the behavioural interventions in enuresis?

A

Ball and pad - useful in 60%
Enuresis alarm
Star chart

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11
Q

Meds for enuresis

A

Imipramine

Desmopressin intranasal spray

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12
Q

SEs of desmopressin

A

Headache
Nasal congestion
Abdominal pain
Epistaxis

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13
Q

Age of onset and duration for diagnosis of encopresis

A

4 or older

Occurs once a month for 6/12

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14
Q

M:F ratio of encopresis

A

6:1

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15
Q

Prevalence of encopresis in >4

A

5%

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16
Q

How many children with encopresis show evidence of chronic constipation

A

75%

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17
Q

Organic causes to r/o in Encopresis

A 
Constipation
Hirschprungs
Anorectal pathology
Neuro problems
Nutrition disorders
Medication SEs
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18
Q

In which children is encopresis more common in?

A

Sexual abuse
Maternal hostility
Harsh parenting
Recent stress

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19
Q

First line treatment of encopresis

A

Medical assessment and evacuation of stool

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20
Q

Treatment of encopresis

A

Psychoeducation - correction of misperceptions of soiling
Behavioural approach - operant conditioning with rewards and positive reinforcement
Family therapy - reduce tension about sx and non-punitive atmosphere
Tends to be self-limiting

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21
Q

What characterises Pica?

A

> 1 month of eating non-nutritive substances at a developmentally inappropriate age i.e. >1 year, at least twice a week

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22
Q

Most common age of onset of pica

A

2-3

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23
Q

In which children is pica common in?

A

Developmental disability

24
Q

Potential causes of pica

A 
Hunger
Malnutrition
Nutritional deficiencies
Psychosocial stress
Hypothalamus lesion
25
Consequences of pica
Toxicity Infection GIT obstruction and ulceration
26
What characterises pervasive, developmental disorders?
Tried of deficit in social skills, communication/language and behaviour.
27
Disorders in PDD
Autism, Aspergers, Retts, Childhood disintegrative disorder and PDD-NOS
28
Symptoms in Autism
Qualitative impairment in social interaction o Impairment in communication [language delay is most common cause for initial referral] o Restricted repetitive and stereotyped patterns of behaviour or interests.
29
Age of onset of childhood autism
<3
30
M:F ratio of autism
4:1
31
Recurrence rate in siblings of children with ASD
2-8%
32
How many children with childhood autism have LD
80%
33
Predictors of good prognosis in ASD
Communicative speech by the age of 6 years and higher IQ (>50) Having a skill that is consistent with a secure employment. Early and effective management
34
How many people with ASD will be unable to lead an independent life?
At least 60%
35
Outcomes of ASD
``` 12 - very good 10% - good 19% - fair 46% - poor 12% - very poor ```
36
Psychological treatments for ASD
- Applied Behavioural Analysis program: an intense program [40 hours a week for 3 years] based on operant conditioning, imitation and reinforcement. o TEACCH – Treatment and Education for Autistic and related Communication Handicapped Children program is based on the belief that children are motivated to learn language. Successful in reducing self injurious behaviour, and enhancing life skills.
37
What can SSRI help with in ASD?
Restricted, repetitive behaviour - lower dose than for depression
38
What happens in Retts?
6-18 months head growth decelerates, loss of purposeful hand movement and stereotypic movements like hand wringing, loss of acquired speech, ataxia Seizures in 75% Irregular respiration with episodes of breath holding and hyperventilation
39
What happens in childhood disintegrative disorder/Hallers
Marked regression in several areas of functioning after at least 2 years of apparently normal development.
40
How many children have learning disorders?
5%
41
What characterises tourettes?
Multiple motor and one or mote vocal tics for at least a year, causing distress and impaired function Vocal tics begin 1-2 years after onset of motor symptoms Onset<18 years
42
Duration of tics
Multiple times a day, nearly everyday or intermittently for more than one year, with no tic-free period of more than 3 consecutive months
43
What increases tics in tourettes?
Stress Anxiety Fatigue
44
Prevalence of tourettes in children
1%
45
M:F ratio of tourettes
3-4:1
46
Possible biological aetiology of tourettes
Excess dopamine and role of NA hypothesised as antipsychotics and clonidine can help with symptoms
47
Comorbidity in children with tourettes
33-66% OCD 50% OCD Depression CD
48
Management of tourettes
Psychoeducation including school CBT with ERP - relaxation, exposure and response prevention, massed practice and habit reversal (movements incompatible with tics)
49
When should meds be considered in Tourettes?
If tics disabling and therapies not helping
50
First line med for tourettes
Clonidine - alpha 2 agonist
51
SEs of Clonidine
Hypotension | Sedation
52
Meds used for tourettes
``` Clonidine Haloperidol Risperidone Pimozide Sulpride ```
53
What characterises transient tic disorder
Single or multiple motor and/or vocal tics occurring many times a day or nearly everyday for 4 weeks but for no longer than 12 consecutive months Onset<18 Criteria not met for tourettes or chronic motor or vocal tic disorder
54
Prevalence of transient tic disorder
5-20%
55
How many children with transient tic disorder outgrow tics by adulthood
80%
56
What characterises chronic tic disorder?
Persistent of tics for >1 year with motor or vocal tics but not both.

CASC (16 decks)

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