CAMHs

Question 1

what are the four tiers of support for children?

Answer 1

T1 = professionals not trained in CAMHs (teacher)
T2 = CAMH specialist (psychologist) 
T3 = MDT in CAMHs 
T4 = tertiary services, intensive community treatment, day units, inpatient units

Question 2

what are some clinical features of depression in children?

Answer 2

grumpy, irritable, anhedonia
loss of self esteem, confidence, concentration
reduced energy, sleep, appetite

Question 3

what are questions to ask directly to children when depressed?

Answer 3

alcohol and drug use
bullying
suicidal thoughts
abuse

Question 4

what is the treatment for mild depression ?

Answer 4

tier 1/2 with up to 4 weeks watchful waiting

- if unresponsive can refer to CAMHs

Question 5

what is the treatment for moderate/severe depression ?

Answer 5

fluoxetine and psychological therapies
address sources of distress
follow up is essential

Question 6

what antidepressants should be avoided in <18yrs?

Answer 6

citalopram, sertaline

paroxetine

Question 7

for early onset schizophrenia for how long do symptoms need to be present for?

Answer 7

> 4 weeks

Question 8

what symptoms might a child with psychosis present with?

Answer 8

non specific symptoms
mistrust of others, magical thinking, odd beliefs
decline in school functioning

Question 9

what are risk factors for psychosis in children ?

Answer 9

family history of schizophrenia

marked psychotic symptoms

Question 10

what psychotic symptoms require urgent attention?

Answer 10

those that are imperative (kill your sister)
those heard unambiguously outside of their head
referring to ideas that the person feels are not their own
multiple voices talking at once

Question 11

state some causes of odd ideas?

Answer 11

substance abuse 
psychosis 
anxiety 
depression 
hypomania 
head injury 
epileptic aura 
SLE
anti NMDA receptor antibody encephalitis (limbic encephaitis) 
alice in wonderland syndrome

Question 12

what is the management of psychosis in children?

Answer 12

early intervention
create treatment plan with a named worker and incorporate antipsychotics if indicated
psychoeducational work
pyschotherapy (individual CBT and facility interventions)

Question 13

what are the two categories of reactive attachment disorders?

Answer 13

inhibited (extremely withdrawn, emotional detached, hyper vigilant)
disinhibited (seeking comfort from anyone even strangers, extremely dependant and immature)

Question 14

what is the management for reactive attachment disorder?

Answer 14

psychological therapy (family and play therapy) 
parenting skills education

Question 15

what are common behavioural problems in children?

Answer 15

disruptive
oppositional defiant disorder
conduct disorder

Question 16

what is conduct disorder ?

Answer 16

defiance of will of authority 
aggression 
antisocial behaviour (property damage, vandalism, theft) 

more severe than oppositional defiant disorder

Question 17

what is oppositional defiant disorder ?

Answer 17

negative, defiant, hostile behaviour without serious violation of societal norms

Question 18

what is the treatment for oppositional defiant disorder ?

Answer 18

parent training programs (triple P, webster stratton courses)
individual cognitive therapy for older children
multi system therapy (patient, family, teachers, criminal justice system)

Question 19

how many children with oppositional defiant disorder will develop anti social personality disorder?

Answer 19

40%

Question 20

what are the risk factors for school refusal?

Answer 20

emotional overprotected
high social class
neurotic parents
school work of high standard

Question 21

what are the risk factors for truancy?

Answer 21

low social class 
absent parents

Question 22

what should be suspected when there is sleepiness associated with extrapyramidal symptoms, oculogyric crisis, myoclonus, inversion of diurnal rhythms, obsessions and mood change?

Answer 22

encephalitis lethargicans

very rare

Question 23

state some arousal disorders?

Answer 23

sleepwalking
night terrors
confusional arousal

Question 24

state some REM sleep parasomnias ?

Answer 24

sleep paralysis
REM sleep associated nightmares
hallucinations

Question 25

what does the mutation in nacroplexy, cataplexy and sleep paralysis cause?

Answer 25

lead to loss of hypothalamic hypocretin containing neurons via autoimmune destruction

Question 26

what is the treatment for nacroplexy, cataplexy and sleep paralysis?

Answer 26

1. methylphenidate
2. modafinil
3. gamma-hydroxybutyrate

Question 27

what are some medication that can be used for antiparasomniacs?

Answer 27

bedtime clonazepam, amitriptyline, carbamazepine

Question 28

what is the management for sleep hygiene ? SLEEP?

Answer 28

schedule 
limit caffeinated drinks or alcohol 
eliminate factors which create hostile sleeping environment 
exercise during the day 
psychotherapy (CBT)

Question 29

what gene is associated with autism?

Answer 29

Chr 11p12 neurexin

Question 30

what are the three broad categories that autistic clinical features fall into?

Answer 30

impaired reciprocal social interaction
impaired imagination
poor range of activities and interests

Question 31

state some impaired reciprocal social interaction features

Answer 31

lack of empathy 
abnormal response to getting hurt (doesn't come for comfort, stereotyped response)
impaired imitation 
repetitive play 
bad at making friends

Question 32

state some impaired imagination features seen in autism

Answer 32

few facial expressions in infancy  
avoids mutual gaze 
stiffens when held 
no pretend play 
odd speech (echolalia)
difficulty initiating communication

Question 33

state some poor range of activities and interests features seen in autism

Answer 33

preoccupation with parts of objects
marked distress over minor changes
insists in following routines in precise detail
narrow fixations

Question 34

what is the management of autism?

Answer 34

early intensive behavioural intervention 
parent training 
social skills support 
SALT 
diet - gluten free 
benefits - disability living allowance

Question 35

what are the three core diagnostic criteria for ADHD?

Answer 35

inattention
impulsivity
hyperactivity

Question 36

what are DD for ADHD?

Answer 36

age appropriate behaviour
low IQ
hearing impairment
behavioural disorder

Question 37

what rating scale can be used in ADHD?

Answer 37

connors questionnaire

Question 38

what medication can be used for ADHD?

Answer 38

methylphenidate (not to be given at weekends or holidays as it suppresses appetite)

Atomoxetine (takes 6 weeks to reach efficacy)

Question 39

what is the management of ADHD?

Answer 39

parent education
CBT in older children
medication