CAMHS 2 Flashcards
Duration and age onset for diagnosis of enuresis
Child must exhibit a developmental or chronological age
of at least 5 years. Duration of disorder is at least 3 months.
When does voluntary micturition begin
15-18 months
How many children have daytime wetting at age of 5?
1%
Prevalence of nocturnal enuresis in 7 year olds
22% boys
7-15% girls
M:F ratio of enuresis
2:1
Most important predictor of primary nocturnal enuresis
FHx of noenuresis
Predictors of enuresis
Delay in control over bedwetting Adverse life events UTI Constipation Low socioeconomic background Large families and overcrowded
Which psychiatric disorder are children with enuresis at higher risk of?
ADHD
Treatment of enuresis
R/o organic cause Review toilet training Psychoeducation - avoid punishment Record keeping - for baseline and as reinforcer in following progress Behavioural intervention Meds
What are the behavioural interventions in enuresis?
Ball and pad - useful in 60%
Enuresis alarm
Star chart
Meds for enuresis
Imipramine
Desmopressin intranasal spray
SEs of desmopressin
Headache
Nasal congestion
Abdominal pain
Epistaxis
Age of onset and duration for diagnosis of encopresis
4 or older
Occurs once a month for 6/12
M:F ratio of encopresis
6:1
Prevalence of encopresis in >4
5%
How many children with encopresis show evidence of chronic constipation
75%
Organic causes to r/o in Encopresis
Constipation Hirschprungs Anorectal pathology Neuro problems Nutrition disorders Medication SEs
In which children is encopresis more common in?
Sexual abuse
Maternal hostility
Harsh parenting
Recent stress
First line treatment of encopresis
Medical assessment and evacuation of stool
Treatment of encopresis
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
What characterises Pica?
> 1 month of eating non-nutritive substances at a developmentally inappropriate age i.e. >1 year, at least twice a week
Most common age of onset of pica
2-3
In which children is pica common in?
Developmental disability
Potential causes of pica
Hunger Malnutrition Nutritional deficiencies Psychosocial stress Hypothalamus lesion
Consequences of pica
Toxicity
Infection
GIT obstruction and ulceration
What characterises pervasive, developmental disorders?
Tried of deficit in social skills, communication/language and behaviour.
Disorders in PDD
Autism, Aspergers, Retts, Childhood disintegrative disorder and PDD-NOS
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.
Age of onset of childhood autism
<3
M:F ratio of autism
4:1
Recurrence rate in siblings of children with ASD
2-8%
How many children with childhood autism have LD
80%
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
How many people with ASD will be unable to lead an independent life?
At least 60%
Outcomes of ASD
12 - very good 10% - good 19% - fair 46% - poor 12% - very poor
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.
What can SSRI help with in ASD?
Restricted, repetitive behaviour - lower dose than for depression
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
What happens in childhood disintegrative disorder/Hallers
Marked regression in several areas of functioning after at least 2 years of apparently
normal development.
How many children have learning disorders?
5%
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
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
What increases tics in tourettes?
Stress
Anxiety
Fatigue
Prevalence of tourettes in children
1%
M:F ratio of tourettes
3-4:1
Possible biological aetiology of tourettes
Excess dopamine and role of NA hypothesised as antipsychotics and clonidine can help with symptoms
Comorbidity in children with tourettes
33-66% OCD
50% OCD
Depression
CD
Management of tourettes
Psychoeducation including school
CBT with ERP - relaxation, exposure and response prevention, massed practice and habit reversal (movements incompatible with tics)
When should meds be considered in Tourettes?
If tics disabling and therapies not helping
First line med for tourettes
Clonidine - alpha 2 agonist
SEs of Clonidine
Hypotension
Sedation
Meds used for tourettes
Clonidine Haloperidol Risperidone Pimozide Sulpride
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
Prevalence of transient tic disorder
5-20%
How many children with transient tic disorder outgrow tics by adulthood
80%
What characterises chronic tic disorder?
Persistent of tics for >1 year with motor or vocal tics but not both.
