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Phase 2 Psychiatry > CAMHS > Flashcards

CAMHS Flashcards

1
Q

Describe the professionals and roles of the different tiers of CAMHS services (1-4)

A
  1. any professional who sees children every day; supported by primary mental health workers to refer a child into CAMHS
  2. individual CAMHS therapists
  3. CAMHS therapists working in specialists teams
  4. Regional or national services (includes inpatient services)
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2
Q
  1. why can assessment of a child be difficult?
  2. In what context should a child be assessed?
  3. Name things that it is important to ask about when assessing a child for a mental health problem
A
  1. may not necessarily acknowledge the need for help/agree to referral
    may be a reluctant attendee to referral, experiencing emotions that make it difficult to develop rapport
    children may not be able to express themselves as eloquently as adults
  2. context of their developmental age
  3. family composition and family hx
    school, hobbies, interests, friends
    developmental hx
    substance use and forensic hx (adolescents)
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3
Q

Describe 4 common presentations of mental health problems in children

A
  1. somatic - headaches; tummy pains
  2. behavioural - tantrums, arguments etc
  3. problems with peer and adult interactions
  4. decreased school performance/school refusal
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4
Q

Name other parties who may provide a useful collateral hx about a child

A
  • other family members
  • GP
  • teachers
  • social workers
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5
Q 
GROSS MOTOR DEVELOPMENT
describe the main milestones at the following ages:
1. 6 weeks
2. 6 months
3. 9 months
4. 12 months
5. 2 years
6. 3 years
A
  1. raises head
  2. sits without support
  3. crawling; standing unsupported
  4. walking
  5. climbs stairs
  6. runs and jumps
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6
Q 
FINE MOTOR & VISUAL DEVELOPMENR
describe the main milestones at the following ages:
1. 6 weeks
2. 6 months
3. 9 months
4. 18 months
5. 2 years
6. 3 years
A
  1. follows moving object with head
  2. palmar grasp
  3. transfers objects from hand to hand
  4. makes marks with crayon; eats with spoon
  5. draws line; builds tower of 6
  6. draws circle and a cross
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7
Q 
SPEECH DEVELOPMENT
describe the main milestones at the following ages
1. 6 weeks
2. 6-9 months
3. 12 months
4. 18 months
5. 2 years
6. 3 years
A
  1. begins to vocalise
  2. babbles
  3. 2-3 word vocab
  4. 6-10 word vocab
  5. simple phrases
  6. 3-4 word sentences
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8
Q

SOCIAL AND EMOTIONAL DEVELOPMENT

  1. 6 weeks
  2. 6 months
  3. 12 monts
  4. 18 months
  5. 2 years
  6. 3 years
A
  1. smiles
  2. develops stranger and separation anxiety
  3. understands name
  4. prone to temper tantrums
  5. symbolic play
  6. achieves continence; parallel play; turn taking
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9
Q
  1. What is attachment?
  2. Why is positive attachment important?
  3. Name 3 features of attachment behaviour that is demonstrated at 6-36 months
A
  1. deep and enduring emotional bond that connects people across space and time
  2. crucial to an infant’s neurodevelopment, and helps them get a sense of who they are, explore the world around them and develop a positive internal working model of a relationship
  3. proximity seeking to attachment figure, particularly when threatened
    use of attachment figure as a secure base from which to explore environment
    separation from attachment figure leads to separation protest by the infant
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10
Q

What is attachment disorder?

A

an umbrella term used to describe disorders of mood, behaviour, and social relationships, arising from a failure to form normal attachments to primary caregivers in early childhood

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11
Q

Describe the 4 attachment styles:

  1. secure
  2. insecure-avoidant
  3. insecure-ambivalent
  4. disorganised
A
  1. distressed by separation, but quickly soothed on reunion
  2. seems unconcerned about separation or reunion. independent of caregiver. Associated with unresponsive parenting
  3. distress at separation and resistance to comfort on caregiver return. Clingy and dependent behaviour towards caregiver but rejects caregiver during interaction. Associated with inconsistent parenting
  4. confused and at times contradictory behaviour; may seek out comfort but fears close proximity with cate giver; associated with maltreatment or parental trauma
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12
Q

How may children with the following attachment styles act?

  1. avoidant
  2. ambivalent
A
  1. isolate themselves; show unprovoked outbursts of aggression
  2. clingy and passive
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13
Q
  1. What is conduct disorder?
  2. In what groups are conduct disorders more common?
  3. name some associations/risk factors for conduct disorder
A
  1. repetitive and persistent pattern of antisocial, aggressive or defiant behaviours that violate age appropriate social norms
  2. males and urban populations
3. social disadvantage
    parenting - parental criminality, psychiatric disorder, substance use; domestic violence; neglect and maltreatment
    perinatal complications
    low IQ
    neurodevelopmental problems
    attachment problems
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14
Q
  1. Name some clinical features of conduct disorder

2. what other psych disorders are often co-morbid with conduct disorders?

A 
1. aggression
   cruelty to others
   destruction of property
   bullying
   decietfulness/lying/blaming others
   theft
   arson
   truancy/running away from home
  1. ADHD; learning difficulties; depression; anxiety disorder
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15
Q

What is the prognosis/course of conduct disorder?

A
  • can be a persistent disorder (particularly with you ger onset)
  • antisocial personality disorder in adulthood
  • increased risk of substance abuse and other psychiatric disorder in adulthood
  • increased risk of social exclusion
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16
Q

How is conduct disorder managed?

A
  • parent management training
  • functional family therapy
  • multisystem therapy
  • child interventions
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17
Q

What is oppositional defiant disorder

A

an enduring pattern of negative, hostile and defiant behaviour, without serious violations of societal norms or the rights of others

18
Q

Describe ABC of behaviour monitoring

A

A- antecedent
B- behaviour
C- consequence

19
Q

What are the 3 core deficits of ADHD?

How might these deficits manifest?

A

INATTENTION

  • fails to sustain attention
  • appears not to listen
  • fails to finish tasks
  • poor self-organisation
  • forgetful

HYPERACTIVITY

  • fidgets with hands and feet
  • leaves seat in class
  • always on the go
  • can’t play quietly

IMPULSIVENESS

  • talks excessively
  • blurts out answers
  • can’t wait turn
  • interrupts others
20
Q
  1. Which neurotransmitter and brain areas are thought to be implicated in ADHD?
  2. Name 4 groups in which rates of ADHD are higher
A
  1. DA in frontal and pretemporal brain regions
  2. low birthweight babies
    babies born to mothers who used drugs, alcohol and tobacco during pregnancy
    following head injury
    some genetic and metabolic disorders
21
Q

Name 5 problems that are commonly comorbid with ADHD

A
  1. specific LD
  2. motor co-ordination problems
  3. ASD
  4. tic disorders
  5. conduct disorder
22
Q

What happens to symptoms of ADHD as the patient continues into adulthood?

A
  • over activity lessens; impulsivity, poor concentration and risk taking can worsen
  • co-morbid depression, anxiety and drug misuse are common
23
Q
  1. What medication is used to treat ADHD? What is its MOA?

2. What behavioural interventions can be used in the management of ADHD?

A
  1. methylphenidate (ritalin) - CNS stimulant
  2. positive reinforcement for desired behaviours using small, immediate rewards
    consistent approach across school and home
    break down tasks
    reduce distraction
24
Q

What is the triad of impairment in ASD?

A
  1. impairment in social interaction
  2. abnormalities in patterns of communication
  3. restricted, stereotyped and repetitive repertoire of interests and activities
  4. sensory impairment
25
Q

Name common comorbid problems associated with ASD

A
  • learning disability
  • epilepsy
  • depression
  • anxiety
  • bipolar disorder
  • psychosis
  • OCD
  • ADHD
  • tic disorders
26
Q

What rating scale can be useful in the assessment of ADHD?

A

Connor’s Rating Scale

27
Q

Which diagnostic tool can be useful in the assessment of ADHD?

A

Autism Diagnostic Interview (ADI-R)

28
Q
  1. Which 2 anxiety disorders tend to have an onset in early childhood?
  2. Which anxiety disorders tend to occur in later childhood and asolescence?
A
  1. Separation anxiety disorder and specific phobias

2. OCD, social phobia and panic disorder

29
Q

How might children with anxiety disorders present?

A

Behavioural changes

  • inattention
  • sleep disturbance
  • regression
  • withdrawal
  • school refusial
  • ritualistic behaviours
  • somatisation
30
Q

What is the sex difference in prevalence of depression in:

  1. pre-pubertal patients
  2. post-pubertal patients
A
  1. no sex difference

2. more common in famles

31
Q

How may a child with depression present?

A
  • mood changes - sadness, irritable, anhedonia
  • thought changes - reduced self esteem, confidence, concentration and self efficacy
  • physical and behavioural changes - reduced energy, motivation, self care, withdrawal, appetite and sleep changes
  • reduced school performance
32
Q
  1. How is mild depression in children managed?
  2. How is moderate to severe depression in children managed?
  3. Which medication is indicated for depression in children?
  4. Why must medication be prescribed with care in children?
A
  1. Tier 1/2 CAMHS; up to 4 weeks waitful watching; 2-3 months of psychologocal therapy
  2. tiers 2-4 CAMHS; individual psychotherapy; consider alternative psychotherapy or medication if unresponsive
  3. fluoxetine
  4. SSRIs can cause/increase suicidal ideation in young people
33
Q
  1. What is the onset of psychosis in children?

2. Describe clinical features of psychosis in children

A
  1. insidious; up to 12 months prodromal phase
  2. associated with poor premorbid function with developmental delay
    negative symptoms often precede positive symptoms and are prominent
    strong family hx
34
Q
  1. Name some causes of psychosis in children

2. How is psychosis in children managed?

A 
1. normal experience
   organic conditions
   mood disorder
   pervasive developmental disorder/autism
   OCD
   schizophrenia
   Bipolar
   dissociative disorder
  1. risperidone
35
Q
  1. What is enuresis?
  2. What is primary eneuresis?
  3. What is secondary eneuresis?
A
  1. repeated involuntary voiding of urine in the absence of organic cause after the chronological and mental age of 5
  2. if continence has never been achieved
  3. if continence has been achieved preceding the period of incontinence
36
Q
  1. Name common organic causes of eneuresis that must be excluded as a cause
  2. What reassurance is important to give parents?
A
  1. UTI, constipaiton, structural urinary tract abnormalities, diabetes
  2. that the condition is common, rarely intentional and that no-one is to blame;
    children are likely to suffer hostile attitudes and behaviours and as a result may come to feel undesired
37
Q
  1. What is encoporesis?
  2. What is retentive encoporesis?
  3. What is primary non-retentive encoporesis?
  4. What is secondary non-retentive encoporesis?
A
  1. repeated involuntary passage of faeces into places not appropriate for that purpose in children over the chronological and mental age of 4
  2. results from both physical and psychological causes
  3. encoporesis in children who have never previously achieved faecal continence; results from poor social training
  4. encoporesis in children who have previously achieved faecal continence; typically results from emotional stress or defiance
38
Q

How is encoporesis managed?

A
  • exclusion of organic causes (anal fissure, diarrhoea, constipation, hirschprung’s disease)
  • explanation and reassurance
  • removal of stressors and re-training
  • manage with caution - children are likely to suffer hostile attitudes and behaviours and as a result may come to feel undesired
39
Q

Describe presentations/indications of physical abuse

A
  1. delay in seeking help
  2. inconsistent hx
  3. parent unconcerned, hostile, paranoid, pre-occupied
  4. suspicious injuries
40
Q

Describe presentations/indications of sexual abuse

A
  1. disclosure
  2. local trauma
  3. early sexualised contaxt
  4. STI
  5. pregnancy
  6. self harm
  7. emotional effects - poor concentration; soiling and wetting; low mood; eating disorder; drug and alcohol abuse
41
Q

Describe presentations/indications of neglect

A
  1. malnourished or dirty
  2. inadequate supervision
  3. substandard medical care
  4. presentations of insecure attach,enr
  5. irregular school attendance
  6. developmental delay
  7. eating problems (may steal or hoard food)
  8. poor attention and emotional immaturity
  9. frequent A&E attendance

Phase 2 Psychiatry (11 decks)

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