CAMHS Flashcards
How is a behavioural disorder defined?
A persistent and repetitive behavioural pattern which significantly deviates from socially acceptable norms for a person’s age and situation
Give 2 examples of behavioural disorders
Conduct disorders
Oppositional defiant disorders
What is conduct disorder?
Persistent antisocial behaviour which is outside the age-appropriate social norms.
List some possible behavioural violations a young person with conduct disorder may manifest
Disregard for people in authority
Aggression towards people and animals
Antisocial behaviour: Including theft, truancy, vandalism, provocative/disobedient behaviour
What is the diagnostic criteria for conduct disorder?
At least 3 behavioural criteria must have ben exhibited within the last 12 months, with at least one being within the last 6 months
What is oppositional defiant disorder?
A subsection of conduct disorder…it involves persisting negative, hostile and defiant behaviour without serious violation of societal norms or the rights of others
List some possible behavioural violations a young person with oppositional defiant disorder may manifest
Temper Defying adult orders Arguing with parents Anger / resentment Deliberately annoys others Shifts blame Easily annoyed
What are the 3 main treatment options for children with behavioural disorders?
Parent training programme
Cognitive therapy (for older children with conduct disorder)
Multi-systemic treatment
What 3 features are present in a child with ADHD?
Inattention
Hyperactivity
Impulsivity
How might ‘hyperactivity’ manifest itself in ADHD?
Fidgeting
Difficulty remaining seated
Running around or excessively climbing in situations where it is inappropriate
Unduly noisy when playing
How might ‘impulsivity’ manifest itself in ADHD?
Answering questions before they are finished
Interrupting or intruding on others
Inability to wait turn
Talking excessively, outside of social appropriate restraints
How might ‘inattention’ manifest itself in ADHD?
Difficulty concentrating Failure to sustain attention Appears not to be listening Difficulty following instruction Poor organisation Avoiding tasks requiring effort Often loses things Distracted by external stimuli
What is the diagnostic criteria for ADHD?
All the symptoms of ‘inattention, hyperactivity and impulsivity’ must have been present for at least 6 months, having started before the age of 7. They must be pervasive (present in more than one situation) and cause clinically significant distress to impairment in social, academic or occupational functioning
True / False: ADHD can present and be diagnosed for the first time in adulthood
True - However, the symptoms must have been present since before the age of 7
Which medications are available for ADHD?
Methylphenidate (Ritalin)
Atomoxetine
What is anxiety?
A combination of emotions (fead, dread), physical symptoms (palpitations, difficulty breathing, headache), thoughts (intrusive worries) and behaviours (avoidance) which are a continuum of normal experience but can be considered a mental health problem if they cause significant impairment or distress
List 3 anxiety disorders unique to childhood
Separation anxiety disorders
Phobic disorder of childhood
Social anxiety disorder of childhood
Give 3 core features and 7 ‘other’ features of depression
Core features: Low mood, anhedonia (Little pleasure in doing things), reduced energy
‘Other’ features: Guilt, poor concentration, disturbed sleep, poor appetite, low self esteem/confidence, thoughts of self harm/suicide, psychomotor retardation/agitation
What are the diagnostic criteria for depression?
Mild = 2 core features and additional features up to a total of 4, limited functional implication Moderate = 2 core and additional features up to a total of 6 Severe = 3 core and additional features up to a total of 8
If psychotic features present, depression is always severe
What is the treatment for depression in childhood?
Psycho-education Liaison with school Advice about sleep and exercise Self help guidance Watch and wait for 4 weeks Psychological therapy: CBT, interpersonal therapy, family therapy Antidepressants: Fluoxetine
What type of drug is fluoxetine?
Selective seratonin reuptake inhibitor (SSRI)
What is somatisation?
Manifestation of psychological stressors as physical symptoms
List some features of anorexia nervosa
- Self-induced weight loss resulting in low BMI
- Distorted perception of normal weight, which increases as dieting persists
- Excessive effort to avoid gaining weight e.g. excessive exercise, induction of vomiting, avoiding food, laxative abuse
- Returning to a pre-pubertal state e.g. with amenorrhoea
- Beginning to dream of food, making a huge struggle to continue with dieting
- Physical effects of weight loss
What is the management of anorexia nervosa?
Medical i.e. re-feeding (may require NG tube)
Psychological i.e. family therapy
How is a diagnosis of ADHD made?
In depth, multi source assessment - from child, parent, school, etc. Connor’s questionnaire can be used to gather information, although is not diagnostic.
What is the Connor’s questionnaire?
A structured questionnaire used in the assessment of possible ADHD. There are versions for the child, teacher and parent that give standardised scores in a number of relevant dimensions. It is not diagnostic but useful for information gathering and establishing the likelihood of there being an underlying diagnosis.
What type of medication is ritalin
Ritalin (methylphenidate) is a stimulant drug - it is a type of amphetamine
What monitoring is required for a child on ritalin?
Height and weight every 3/12 initially then every 6/12
BP and HR every 3/12
Medication holidays needed at least once yearly due to growth suppression
Withdraw slowly, don’t come off suddenly
List some side effects of ritalin
Headache Insomnia GI upset Appetite / weight loss HTN Growth restriction Increased frequency of tics Psychiatric disturbance - psychosis, mania, irritability
True / False: Ritalin needs to be taken lifelong
False - It is usually discontinued after puberty
What is the triad of features in autism?
Impaired reciprocal social interaction
Impairment of social communication
Restricted, repetitive interests
How does ‘impaired reciprocal social interaction’ manifest in autism?
Difficulty seeing things from another’s perspective
Difficulty understanding unwritten social norms
Hard to form relationships
Lack of eye contact
Inability to read facial expressions
Inability to understand when someone is upset or angry
Lack of shared enjoyment
How does ‘impairment of social communication’ manifest in autism?
Delayed language development
Language abnormalities including unusual voice tone, echolalia, palilalia
Unable to recognise ‘figure of speech’ e.g. ‘pull your socks up’ is taken literally
Pedantic
Focussed on details
Lack of facial expression or babbling in early infancy
No fantasy or imagination
What is ‘echolalia’?
Repeating what is heard
What is palilalia?
Repeating oneself
How might ‘restricted, repetitive interests’ manifest in autism?
Stereotyped movements e.g. rocking, arm flapping
Unusual sensory preference e.g. hypo- or hyper-sensitive to noise, smell, tactile sensations
Unusual and intense preoccupations
Distressed about changes in the most simple things e.g. the placing of an object
At what age do abnormalities in autism usually appear?
Usually before age 3
What is ‘theory of mind’ and how does it relate to autism?
- Having social imagination
- Able to attribute mental states (such as beliefs, intents, desires) to oneself and others
- The understanding that others have beliefs, desires, intentions, etc. might be different from one’s own
Children with autism lack theory of mind.
Give 3 neuropsychological tests which might be done on a child to assess whether they might have autism
ADOS: Autism Diagnostic Observation Schedule
ADi-R: Autism Diagnostic Interview (Revised)
DISCO: Diagnostic Interview for Social and Communication Disorders
What is the pattern of inheritance of Rett’s syndrome and which children does it affect?
X-linked dominant
Affects females almost exclusively
What is Rett’s syndrome?
Regression of development in children aged 6-18 months, when autism-like features begin to develop
Give some possible treatment suggestions for chronic fatigue syndrome
Symptomatic control e.g. of myalgia, anxiety, etc.
Graded exercise therapy
CBT
What is the recommended treatment for nocturnal enuresis?
- Reassurance and advice
- Decrease fluid / caffeine intake before bed
- Reward charts for meeting goals
- Enuresis alarm (triggered by the onset of micturition)
- Desmopressin tablets
What might be the symptoms of depression in a child?
Mood: Less pervasively low than in adults, child might complain of boredom etc.
Sleep: Hypersomnia, middle insomnia
Irritability: Behavioural problems, substance misuse
Somatic symptoms: Abdominal pain
Anxiety
What is the drug of choice for depression in children / adolescents?
SSRI - Fluoxetine
What is the treatment (conservative and medical) for ADHD?
Psycho-education Put together a comprehensive treatment plan (psychological, behavioural , educational and occupational needs) Group parent training programme Ritalin Alternative = Atomoxetine
