CAMHS

Question 1

List some aetiological factors thought to influence childhood mental health problems

Answer 1

Biological - genetics, temperament, neurodevelopmental

Developmental - attachment, abuse

Family/parenting - family dynamics, pressure, conflict, bereavement

School - bullying

Acute stressors

Chronic adversity

Success/failures

Question 2

List some factors which are thought to be protective against childhood mental health illness

Answer 2

• Coping strategies
• High confidence
• Stability
• Supportive family
• Friends
• Achievement

Question 3

How do anxiety disorders classically present in children?

Answer 3

With somatic symptoms, e.g. tummy ache, nausea

Question 4

How does depression tend to present in children?

Answer 4

• Low mood not a key feature
• Appetite may not be affected
• Anhedonia is key
• Somatic symptoms prominent

Question 5

How is anxiety managed in children and adolescents?

Answer 5

Behaviour therapies, family therapy, non-BZD anxiolytics

Question 6

How is depression managed in children and adolescents?

Answer 6

CBT

SSRI - Fluoxetine is the only one licensed in children

Question 7

What are the two behavioural disorders seen in children/adolescents?

Answer 7

Oppositional Defiant Disorder

Conduct Disorder

Question 8

What is oppositional defiant disorder?

Answer 8

Continuation of “toddler tantrum”-like behaviour beyond age 5, but usually only in one setting, i.e. either school or home.
Behaviour tends to be bad, but not dangerous or violent.

Question 9

What is conduct disorder?

Answer 9

ODD which persists beyond age 10.

Characterised by persistent disruptive/deceptive/aggressive behaviour, e.g. lying, stealing, violence, with NO remorse.

Question 10

Distinguish between socialised and unsocialised conduct disorder.
Which is more worrying?

Answer 10

Socialised - child integrated within peer group. Behaviour episodic, and often just at home.

Unsocialised - child not integrated into peer group. More worrying - often leads to antisocial PD/criminality

Question 11

What is the management for ODD/CD?

Answer 11

Behavioural therapies, psychoeducation for parent, school interventions.

Question 12

Define ADHD and outline the diagnostic criteria

Answer 12

Early onset, persistent pattern of inattention, hyperactivity and impulsivity
For diagnosis:
- Must be present in 2+ settings for 6+ months
- Onset must be before age 7

Question 13

What are the key clinical features of ADHD?

Answer 13

• Poor attention/concentration, e.g. losing things, not listening, not finishing tasks
• Hyperactivity - full of energy, fidgety, noisy
• Impulsivity - impatient, interrupts, tantrums, disobedient, risky behaviours

Question 14

Outline the management for ADHD

Answer 14

• Parent training and psychoeducation if pre-school age
• Psychoeducation +/- CBT if school-age
• If severe, drug treatment may be needed (see pharm)

Question 15

Define Autistic Spectrum Disorder

Answer 15

Pervasive developmental disorder characterised by classic triad of impaired social interaction, impaired communication, and rigidity of behaviour.
Onset before age 3

Question 16

Outline some of the clinical features of ASD

Answer 16

• Impaired social interaction - few gestures, little eye contact, lack of smiling, few friends
• Impaired communication - delayed speech, literal understanding, problems sensing non-verbal cues
• Rigidity of behaviour - rocking, dislike of change, limited imagination, obsessional interests

Question 17

How does Asperger’s differ from ASD?

Answer 17

No impairment of language, cognition or intelligence

Question 18

How is ASD managed?

Answer 18

• Risperidone for challenging behaviour
• Melatonin for sleep
• SALT
• Psychoeducation/CBT
• Social support, special schooling

Question 19

Define “learning disability”

Answer 19

• IQ <70
• Significant functional impairment
• Onset before age 18

Question 20

How is the severity of LD classified?

Answer 20

Mild = IQ 50 - 69
Moderate = IQ 35 - 49
Profound = IQ 34 or under

Question 21

List some possible causes of LD

Answer 21

• Antenatal infection
• Prematurity
• Cerebral palsy
• Genetic condition, e.g. Down’s

Question 22

What is “diagnostic overshadowing”?

Answer 22

Symptoms overlooked as attributed to LD