CAMHs Flashcards
what are the four tiers of support for children?
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
what are some clinical features of depression in children?
grumpy, irritable, anhedonia
loss of self esteem, confidence, concentration
reduced energy, sleep, appetite
what are questions to ask directly to children when depressed?
alcohol and drug use
bullying
suicidal thoughts
abuse
what is the treatment for mild depression ?
tier 1/2 with up to 4 weeks watchful waiting
- if unresponsive can refer to CAMHs
what is the treatment for moderate/severe depression ?
fluoxetine and psychological therapies
address sources of distress
follow up is essential
what antidepressants should be avoided in <18yrs?
citalopram, sertaline
paroxetine
for early onset schizophrenia for how long do symptoms need to be present for?
> 4 weeks
what symptoms might a child with psychosis present with?
non specific symptoms
mistrust of others, magical thinking, odd beliefs
decline in school functioning
what are risk factors for psychosis in children ?
family history of schizophrenia
marked psychotic symptoms
what psychotic symptoms require urgent attention?
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
state some causes of odd ideas?
substance abuse psychosis anxiety depression hypomania head injury epileptic aura SLE anti NMDA receptor antibody encephalitis (limbic encephaitis) alice in wonderland syndrome
what is the management of psychosis in children?
early intervention
create treatment plan with a named worker and incorporate antipsychotics if indicated
psychoeducational work
pyschotherapy (individual CBT and facility interventions)
what are the two categories of reactive attachment disorders?
inhibited (extremely withdrawn, emotional detached, hyper vigilant)
disinhibited (seeking comfort from anyone even strangers, extremely dependant and immature)
what is the management for reactive attachment disorder?
psychological therapy (family and play therapy) parenting skills education
what are common behavioural problems in children?
disruptive
oppositional defiant disorder
conduct disorder
what is conduct disorder ?
defiance of will of authority aggression antisocial behaviour (property damage, vandalism, theft)
more severe than oppositional defiant disorder
what is oppositional defiant disorder ?
negative, defiant, hostile behaviour without serious violation of societal norms
what is the treatment for oppositional defiant disorder ?
parent training programs (triple P, webster stratton courses)
individual cognitive therapy for older children
multi system therapy (patient, family, teachers, criminal justice system)
how many children with oppositional defiant disorder will develop anti social personality disorder?
40%
what are the risk factors for school refusal?
emotional overprotected
high social class
neurotic parents
school work of high standard
what are the risk factors for truancy?
low social class absent parents
what should be suspected when there is sleepiness associated with extrapyramidal symptoms, oculogyric crisis, myoclonus, inversion of diurnal rhythms, obsessions and mood change?
encephalitis lethargicans
very rare
state some arousal disorders?
sleepwalking
night terrors
confusional arousal
state some REM sleep parasomnias ?
sleep paralysis
REM sleep associated nightmares
hallucinations
what does the mutation in nacroplexy, cataplexy and sleep paralysis cause?
lead to loss of hypothalamic hypocretin containing neurons via autoimmune destruction
what is the treatment for nacroplexy, cataplexy and sleep paralysis?
- methylphenidate
- modafinil
- gamma-hydroxybutyrate
what are some medication that can be used for antiparasomniacs?
bedtime clonazepam, amitriptyline, carbamazepine
what is the management for sleep hygiene ? SLEEP?
schedule limit caffeinated drinks or alcohol eliminate factors which create hostile sleeping environment exercise during the day psychotherapy (CBT)
what gene is associated with autism?
Chr 11p12 neurexin
what are the three broad categories that autistic clinical features fall into?
impaired reciprocal social interaction
impaired imagination
poor range of activities and interests
state some impaired reciprocal social interaction features
lack of empathy abnormal response to getting hurt (doesn't come for comfort, stereotyped response) impaired imitation repetitive play bad at making friends
state some impaired imagination features seen in autism
few facial expressions in infancy avoids mutual gaze stiffens when held no pretend play odd speech (echolalia) difficulty initiating communication
state some poor range of activities and interests features seen in autism
preoccupation with parts of objects
marked distress over minor changes
insists in following routines in precise detail
narrow fixations
what is the management of autism?
early intensive behavioural intervention parent training social skills support SALT diet - gluten free benefits - disability living allowance
what are the three core diagnostic criteria for ADHD?
inattention
impulsivity
hyperactivity
what are DD for ADHD?
age appropriate behaviour
low IQ
hearing impairment
behavioural disorder
what rating scale can be used in ADHD?
connors questionnaire
what medication can be used for ADHD?
methylphenidate (not to be given at weekends or holidays as it suppresses appetite)
Atomoxetine (takes 6 weeks to reach efficacy)
what is the management of ADHD?
parent education
CBT in older children
medication
