CAMHS Flashcards
1
Q
What is the most effective treatment for children with conduct disorder?
A
Multimodal therapy
Including CBT, functional family therapy, multi-systemic therapy
2
Q
1st degree relatives of patients with ADHD are prone to which mental disorders?
A
depression and BPAD
3
Q
Is dependence common with Methyphenidate?
A
no
4
Q
What are some of the side effects of Methylphenidate?
A
- delays physical growth
- suppresses appetite
- sleep disturbance (if taken late in the day)
- cramps
- headaches
- increased HR/blood pressure
- tics
5
Q
What is better than placebo for treating tics in ADHD?
A
Methylphenidate + clonidine
But clinidine should be avoided in children
6
Q
What must be done to facilitate growth in patients taking Methylphendiate?
A
A drug holiday
7
Q
What % of children with autism have associated ADHD?
A
50%
8
Q
Which genes have been implicated in ADHD?
A
polymorphism of DAT1 gene, Dopamine D4, Snap-25, genes 5/6/11
- siblings have 2-3x increased risk
- heritability - 80%
9
Q
What are some biological factors iplicated in the aetiology of coduct disorder?
A
- high testosterone
- hx of head injury
- low plasmma serotonin level
- low plasma dopamne level
10
Q
What percentage of children with ADHD go on to develop substance misuse?
A
15-20%
11
Q
Age of onset of oppositional disorder?
A
Before 8 years old
12
Q
Which medication can be used for the management of aggression in conduct disorder?
A
Risperidone
13
Q
Which features support a diagnosis of Asperger’s?
A
- restricted and repetitive behaviours
- marked clumsiness
- socially withdrawn
- worries about the welfare of others
14
Q
Which non stimulant medications are recommended in ADHD?
A
- Clonidine
- Atomoxetine
- Bupropion
- Imipramine
15
Q
What % of people with conduct disorder develop ASPD?
A
40%
16
Q
What significantly increases on using melatonin?
A
Sleep duration
- shorten the time to fall asleep (reduces latency)
- improves total rapid-eye movement (REM) duration (reduces REM latency)
- reduces the number of sleep interruptions
17
Q
What % of children sleepwalk?
A
20%
- typically between the ages of 4 and 8
- seems to run in families
- person usually has no recollection of the episode the following morning
- injury may occur
- Eyes are usually wide open and talk is incoherent with communication usually impossible
- If awakened during the episode, they are confused and disorientated.
18
Q
What’s the first line treatment in mild to moderate cases of ADHD?
A
In mild to moderate cases of ADHD, the first line treatments are usually behaviour therapy and education.
19
Q
What are first line medication options for severe ADHD?
A
Methylphenidate or lisdexamfetamine (try for 6 weeks)
if above ineffective, consider switching to to the alternative first-line option
Consider dexamfetamine for those responding to lisdexamfetamine but who cannot tolerate the longer effect profile
Offer atomoxetine or guanfacine for those who can’t tolerate methylphenidate or lisdexamfetamine
20
Q
What are the risk factors for ADHD?
A
- prenatal exposure to benzodiazepines, alcohol and nicotine
- prenatal and perinatal complications
- Low birth weight and prematurity
- poor attachment and severe early deprivation
- institutional rearing
- head injury at >2 years of age
21
Q
What’s the increment of delinquency in people with ADHD?
A
4x
22
Q
which of the cildhood disorders tends to peak in severity around the age of 11?
A
Tourettes
23
Q
Which ADHD medication should be avoided in liver disease?
A
Atomoxetine should be avoided in children with preexisting liver disease. Parents should be warned of the possibilities of liver diesase emerging and advised of the possible features they might notice.LFTs monitoring is needed.
24
Q
Which factors are associated with enuresis?
A
Stressful life events, UTI, constipation, low socioeconomic background, FHx of enuresis, large families or overcrowded conditions.
25
Growth in chilren with ADHD on stimulants
- small but detectable reduction in overal growth in children on stimulant
- loss of growth is maximal in the first year on stimulantss
26
What are the three mediators of the effect of parental mental illness on children according to Rutter?
1. Direct pernicious impact of exposure
2. Indirect impact due to altered interpersonal behaviour and parenting capacity
3. Mediator variables i.e. social adversity, genetic or constitutional factors
27
What are the consequences of maternal depression on a growing child?
Pre-natal: poor nutrition, higher risk of preterm birth, low birth weight, pre-eclampsia
Infant: passivity, withdrawal, reduced attention, lower IQ
Toddler: passive non-compliance, reduced expression of autonomy, reduced social interaction
School aged: reduced adaptive functioning, affective anxiety and conduct disorders
Adolescent: affective disorders, anxiety disorders, phobias, panic disorders, substance abuse, alcohol dependence
28
What is the most common childhood adversity?
Death of a parent
29
Which mental health disorders are seen in children with a history of sexual abuse?
Depression, PTSD, conduct disorders, somatisation, suicidal behaviour
30
Which gender is more likely to be a victim of sexual abuse?
Girls - 4 to 1 (average age 9-11)
31
What percentage of sexual abusers are male?
90%
32
What is the most prevalent form of child abuse?
Neglect (60% of cases)
| 20% = physical, 10% = sexual
33
What are the risk factors for physical abuse (usually begins in adolescence)?
Parents: young age, low IQ, criminal record, poor parenting skills, experience of abuse as a child themselves, psychiatric problems
Children: prematurity, congenital malformation, LD, chronic illness, difficult temperament
Also correlated with: poverty, financial stress, lower parental education levels and underemployment, poor housing, welfare reliance, single parenting
34
What is the most common relationship in which sexual abuse occurs?
Stepfather - stepdaughter
35
What is ADHD?
Characterised by hyperactivity, inattention and impulsivity evident in more than one setting,
Some symptoms must have been present before age 12.
Must be pervasive and result in functional impairment
AKA hyperkinetic disorder (ICD10)
36
Which questionnaire is used to obtain information from school teachers on ADHD symptoms?
Connor's Questionnaire
37
What is the prevalence of ADHD?
5% (DSMV), 1-2% (ICD10)
| M:F = 3:1
38
Which areas of the brain are affected by ADHD?
Prefrontal cortex
Striatum
Cerebellum
39
What percentage of children with ADHD have a comorbid psychaitric disorder?
50-80%
| Commonly ODD, anxiety, conduct disorder, tics
40
What percentage of children with ADHD continue to meet diagnostic criteria at age 25?
15%
41
What's the increment of substance abuse in people with ADHD?
2x
42
What are the SEs of atomoxetine?
- reduced appetite
- weight loss
- GI symptoms
- fatigue
- dizziness
- slowing of growth
43
What are the four categories of behaviour associated with conduct disorder?
1. Physical aggression or threats of harm to people and cruelty to people and animals
2. Destruction of property (their own or others')
3. Theft or acts of deceit
4. Frequent and serious violation of age-appropriate rules
44
How is conduct disorder diagnosed?
At least one associated behaviour present for at least 6 months (ICD10)
45
What are the risk factors for conduct disorder?
```
Family dysfunction
Parental mental illness
Low income
Criminality of father
Overcrowding/large family size
Institutional care
Chronic marital discord
Maternal smoking during pregnancy
Harsh and inconsistent parenting
DV in family
Early loss and deprivation
Poor school achievement
Low IQ
Brain injury
Genetic factors (clusters in families)
Low CSF serotonin, autonomic under-arousal, low salivary cortisol levels
```
46
What is the prevalence of conduct disorder?
5-7% in the UK
| 4:1 M:F
47
Which adult problems are predicted by conduct disorder?
```
Antisocial PD (50% of children with conduct disorder go on to have ASPD)
Homelessness
Drug/ETOH dependence
Poor physical health
Suicidal behaviour
```
48
What is oppositional defiant disorder?
An enduring pattern (at least 6 months) of negative, hostile, disobedient and defiant behaviour without serious violations of societal norms or the rights of others
Usually diagnosed by 8 years of age
M>F
49
What is the prevalence of depression in children?
Pre-puberty 1%
Post-puberty 3%
(increasing)
50
What is the prognosis of depression in children?
50% continue to have symptoms 12 months after diagnosis but most will recover within 2 years
51
How long do features need to be present for a diagnosis of dysthymia in children?
1 year
52
What are the risk factors for depression in children?
FHx depression, early loss of a parent, parental separation/divorce or marital conflict, stressful life events, hx of abuse
53
How should mild depression be managed?
2 weeks of watchful waiting, then supportive therapy/self help/group CBT
Consider advice on exercise, sleep hygiene and anierty management
54
How should mod-severe depression be managed?
CAMHS review +/- 3 months individual CBT/IPT/Family therapy
Consider combination treatment (with medication) in all cases - 1st line = SSRIs (fluoxetine --> sertraline or citalopram)
55
What were the findings of the TAD study?
CBT alone is no better than placebo in treating depression, but CBT + fluoxetine is
56
What proportion of adolescent deaths are due to suicide?
12% (3rd leading cause of death after accidents and homicides)
57
What percentage of adolescents who attempt suicide do so again within a year?
10%
58
What is Pica?
Pica is defined as persistent eating of non-nutritive substances at a developmentally inappropriate age - at least twice a week for at least one month.
Usually occurs between 2 and 3 years of age and involves substances such as paper, plastic, dirt, stones, hair, faeces, wood
Common in children with LD
59
What are some of the recognised causes of Pica?
```
Mental disorders (autism, schizophrenia)
Iron and zinc deficiency (such reports are rare)
Pregnancy
Hunger/malnutrition
Psychosocial stressors
```
60
The ingestion of what substance is associated with zinc deficiency?
Clay
61
What is the most common somatoform disorder seen in children?
Persistent somatoform pain disorder
62
What are the categories of somatoform disorders in the ICD10?
Somatisation disorder
Undifferentiated somatoform disorder
Hypochondriacal disorder
Somatoform autonomic dysfunction
Persistent somatoform pain disorder
Other somatoform disorder
Somatoform disorder unspecified
63
What are most common somatic symptoms in peristent somatoform pain disorder?
The most common somatic symptoms are recurrent abdominal pain, musculoskeletal pain and headaches, but multiple symptoms can coexist
The pain tends to be worse during the day and does not occur at night or in school holidays.
64
Risk factors for somatoform disorders?
Somatoform disorders are believed to occur more often in less sophisticated or less educated populations and lower socio-economic status groups
65
What are the DSMV categories of ADHD?
The DSM-V recognises three subtypes of the condition
Predominately inattentive
Predominately hyperactive-impulsive
Combined
66
Which ADHD is not a controlled drug?
Atomoxetine
67
What % of 15-16 year olds have self harmed in the last year?
15-16 years estimated that more than 10% of girls and more than 3% of boys had self-harmed in the previous year.
68
What's the lifetime prevalence of self harming in Goths?
53%
69
How much does self harm increase the risk of suicide?
Self-harm increases the likelihood that the person will eventually die by suicide by between 50- and 100-fold above the rest of the population in a 12-month period.
70
Risk factors for suicidal in adolescents
male gender
alcohol and substance misuse
medical severity of the act
hopelessness
violent methods (hanging, jumping, etc.)
parental separation/divorce or death
parental mental disorder
restricted educational achievement
71
What is encopresis?
Encopresis is the voluntary or involuntary passage of normal faeces in inappropriate places in the absence of an organic cause. The diagnostic threshold is at least once per month for 3 consecutive months. Sexual abuse is a risk factor.
72
What's the difference between primary and secondary encopresis?
```
Primary = unsuccessful toilet training
Secondary = after a period of normal bowel control
```
73
What's the minimum age to diagnose encopresis?
4 years
74
What % of chronic encopresis is thought to be functional?
90%
75
What % of 4 year olds and 10 year olds does encopresis affect?
It is estimated to affect 3% of 4 year olds and 1.6% of 10 year olds.
76
What are some medical causes of encopresis?
Anal fissure, Hirschprung's disease
77
What is Hirschsprung disease?
Hirschsprung's disease results from an absence of parasympathetic ganglion cells in rectum, (sometimes also involving the colon and small intestine). This leads to an aganglionic segment which is unable to relax, leading to a colonic obstruction.
Nearly half of all infants with Hirschsprung's disease do not pass meconium within 36 hours
78
What age is enuresis diagnosed from?
5 years
79
How long does involuntary voiding of urine need to be present for diagnosis of enuresis?
The behaviour must occur at least twice weekly for at least 3 months.
80
What is the prevalence of enuresis?
15% of 5 year olds
7% of 7 year olds
5% of 10 year olds
2% of 15 year olds
It is 2x more common in boys than girls.
81
What % children with nocturnal enuresis have a first degree relative who has had the same problem?
75%
82
Treatment options for enureis
Organic causes must be ruled out i.e. UTI, other GU pathology, constipation
Treatment options include:
1. Reassurance and psychoeducation (parents and children)
2. Behavioural measures i.e. enuresis alarms, star charts
3. Medication (if age >7y) including imipramine (TCA), desmopressin (antidiuretic), reboxetine (NAd reuptake inhibitor), oxybutynin (anticholinergic)
83
What can cause mania in children with ADHD and how should it be managed?
Stimulant medications should be discontinued in those with ADHD who develop symptoms of mania
84
Which medication would be indicated in a child with ADHD who develops tics as a result of taking methylphenidate?
Guanfancine
85
What's the prevalence of Tourettes?
1%
86
What is the management of Tourettes?
1st line = behavioural programs (effective for majority)
2nd line = medication (little evidence)
A. Clonidine (an adrenergic alpha-2 agonist)
B. Guanfacine, haloperidol, risperidone, pimozide, sulpiride
87
What is the most common symptom reported by caregivers in Munchausen's syndrome by proxy?
Apneoa
88
Management of conduct disorder
3-11years
Group parent based training programs (or parent AND child training programmes for children with complex needs). If both parents not able to participate then individual training should be offered
9-14years
Child-focused programmes
11-17years
Multimodal interventions with a family focus
89
Most frequent co-morbid problem seen with conduct disorder?
hyperactivity (45-70% of those with conduct disorder have hyperactivity).
90
What's transient tic disorder?
Same general criteria for a tic disorder, but tics do not persist for longer than 12 months.
91
general criteria for a tic disorder, but tics do not persist for longer than 12 months.
6 weeks
92
Regarding pica, amylophagia refers to the abnormal ingestion of what substance?
Starch
93
What's the ADI-R
Autism Diagnostic Interview Revised (ADI-R)
Involves a comprehensive interview with a relative or carer. Can be used to assess both children (aged 2 or over) and adults
94
What's the ADOS?
Autism Diagnostic Observation Schedule (ADOS)
Viewed as the gold standard for observational assessment of autism spectrum disorder. Can be used to assess both children (aged 12 months or over) and adults.
95
What's the DISCO?
Diagnostic Interview for Social and Communication Disorders (DISCO).
Used in both children and adults. Combines developmental history and observation (think of like a combination of the ADI and ADOS)
96
What's the SCQ?
Social Communication Questionnaire (SCQ)
Screening version of the ADI (for autism). Can be used to assess both children (aged 2 or over) and adults
97
What's WISC?
Wechsler Intelligence Scale for Children (WISC)
Used to assess children's intellectual ability. For use in children aged 6-17
98
From what age can the BDI be used?
Minimum age for use in children is 13.
99
What's CY-BOCS
Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS)
Severity of OCD
100
What's the SDQ?
Strength and difficulties questionnaire (SDQ)
Brief behavioural screening questionnaire for 3-17 year olds. Covers areas such as emotional symptoms, conduct problems, hyperactivity/inattention, and peer relationship problems.
101
What's the CBCL?
The Child Behaviour Checklist (CBCL)
Assesses internalising (i.e., anxious, depressive, and overcontrolled) and externalising (i.e., aggressive, hyperactive, noncompliant, and undercontrolled) behaviours. For use in children aged 6-18.
102
What's the CDI?
Childrens Depression Inventory (CDI)
28 item Likert scale used in children aged 7-17.
103
What's the CAFAS?
The Child and Adolescent Functional Assessment Scale (CAFAS)
Assess functioning across a range of domains such as school, mood, self-harm, community, substance misuse. For use in children aged 6-17.
104
Night terrors usually occur in which stage of sleep?
Stage 4
105
What proportion of those with autism are estimated to have an IQ below 70?
50%
106
What's the M:F of autism?
The male to female ratio of ASD is estimated to be 4:1
107
What's the prevalence of autism?
The prevalence of ASD is estimated to be 1%.
108
What is the likelihood of having a second child with autism?
2% - 8%
109
What are the maximum doses of antipsychotics in children?
Aripiprazole - up to 10 mg
Olanzapine - up to 10 mg
Risperidone - up to 3 mg
110
NICE guidelines for management of OCD in young people
Mild - Guided self help, if no improvement try CBT with ERP
Moderate / severe - CBT with ERP (first), then consider combined treatments of CBT (including ERP) with SSRI, alternative SSRI or clomipramine
111
What is most suggestive of Munchausen's syndrome by proxy?
Symptoms abate following separation of the child from the caregiver
112
What are the diagnostic criteria for Asperger syndrome?
Social impairments
Narrow interests
Repetitive routines
Speech and language peculiarities
Non-verbal communication problems
Motor clumsiness
113
When does school refusal usually arise?
School refusal usually arises during periods of school transition - age 5-7, 11 and 14+ (incidence = 1-5%)
114
Conclusion of the POT Study?
The study concluded that children and adolescents with OCD should begin treatment with the combination of CBT plus an SSRI (1st line = sertraline) or CBT alone.
115
Which CNS stimulant used in ADHD is ssociated with life-threatening hepatic failure?
Pemoline
116
The lifetime prevalence of attempted suicide in the Goth community is estimated to be?
47%
117
What is Lennox-Gastaut syndrome?
Lennox-Gastaut syndrome (LGS), is a form of epilepsy that most often appears between the second and sixth year of life. It is characterised by frequent seizures and different seizure types. It is often accompanied by developmental delay and psychological and behavioural problems.
118
Which test is most helpful in supporting a diagnosis of PANDAS?
AntiDNAse-B
119
What is PANDAS?
Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections.
children suddenly develop obsessive compulsive disorder (OCD) and/or tic disorders such as Tourette's Syndrome, following strep. infections such as 'Strep throat' and Scarlet Fever.
120
What are the 5 criteria for PANDAS?
Presence of obsessive-compulsive disorder and/or a tic disorder
Pediatric onset of symptoms (age 3 years to puberty)
Episodic course of symptom severity
Association with group A Beta-hemolytic streptococcal infection (a positive throat culture for strep or history of Scarlet Fever)
Association with neurological abnormalities (motor hyperactivity, or adventitious movements, such as choreiform movements - Sydenham's chorea)
121
Which brain area has dysfunction in PANDAS?
PANDAS is associated with basal ganglia dysfunction.
122
Features of disinhibited attachment disorder
Initially (around 2 years of age) - clinging and non-selective focussed attachment behaviour.
Later (around 4 years of age) - diffuse attachments remain but clinging is replaced by attention seeking and indiscriminately friendly behaviour.
In most cases there will be a history of marked inconsistency in early care givers involving multiple changes.
123
What are the features of reactive (inhibited) attachment disorder?
- Ambivalence towards caregivers
- Fearfulness and hypervigilance unresponsive to comforting
- Poor social interactions with peers
- Aggression towards self and others
- Growth failure may occur
Begins before age 5, common in social deprivation and poverty stricken environments
124
What are the two most common symptoms of mania in children?
Elated/euphoric mood
| Irritability
125
What is the prevalence of BPAD in children?
1%
126
What percentage of children with BPAD also have AHD?
70%
127
What percentage of children diagnosed with early onset BPAD have a poor outcome?
50%
128
What is a serious adverse effect of Atomoxetine?
It can increase the risk of suicidal ideation
129
When can activated charcoal be used in overdose?
Activated charcoal should be used ideally within 1 hour of ingestion (2 hours at a push).
130
When should plasma paracetamol levels be measured after overdose?
Plasma paracetamol levels should be measured for risk assessment no earlier than 4 hours and no later than 15 hours after ingestion,
131
How is Schizophrenia in children classified?
Based on onset of psychotic symptoms
'Childhood onset' = before the age of 12
'Early onset' = before age 18
'Very early onset' = before age 13
132
What are the clinical features of schizophrenia in children?
- Children are often socially rejected and clingy with limited social skills and poor school performance despite normal IQ
- Delusions and hallucinations (often visual) are common and can be frightening --> inappropriate laughter/crying which they can't explain
133
Which organic conditions should be ruled out when diagnosing schizophrenia in children?
Temporal Lobe Epilepsy
Thyroid disease
Brain tumour
Wilson's disease
134
What are the risk factors for relapse in child onset schizophrenia?
High expressed emotion by family - overly critical responses
135
What factors affect prognosis of child onset schizophrenia?
- Premorbid level of functioning
- Age of onset
- IQ
- Duration of first episode
- Duration of untreated psychosis
- Presence of negative symptoms
- Family support
136
What is the prevalence of anxiety disorders in children?
5-15%
137
What is separation anxiety?
Developmentally inappropriate/excessive anxiety concerning separation from home or from those to whom the individual is attached
Symptoms must be present for at least 4 weeks and occur before the age of 18 (and usually after 6 years of age, unless 'early onset')
138
What are the symptoms of separation anxiety?
- Anxiety
- Sleep disturbances and nightmares (persistent reluctance to go to sleep without being near attachment figure or nightmares about separation)
- Somatisation
- School refusal
139
What are the features of sibling rivalry disorder?
2 or more of the following which begin within 6 months of the birth of an immediately younger sibling and lasting at least 4 weeks:
- Emotional disturbance demonstrated by anxiety, regression, tantrums, dysphoria
- Sleep difficulties
- Oppositional behaviour
- Attention seeking behaviour
140
What are the differences between school refusal and truancy?
School refusal:
- Presence of emotional symptoms
- FHx neuroses
- Overprotective parenting
- Satisfactory academic achievement
- Small family or being the youngest member
- Parents are aware of child's absence
- No gender difference
- 70% will successfully reintegrate into school
Truancy:
- Presence of antisocial symptoms
- FHx antisocial behaviour
- Inconsistent discipline
- Poor academic achievement
- Large family size
- Child is neither at home nor at school
- Male predominance
141
How is childhood trauma classified?
Type 1 = Classic single acute traumatic event (most common) --> flashbacks - full detailed memories, 'omens', misperceptions
Type 2 = Follows long standing or repeated exposure to extreme external events i.e. chronic abuse --> denial, self hypnosis, depersonalisation, dissociation, rage, self harm, passivity
142
What is the difference between the presentation of OCD in children and adults?
Children often unaware that the associated thoughts or behaviours are unreasonable, but if thy are aware are more likely to be secretive
143
What is the prevalence of OCD in children?
0.5%
144
Which SSRIs are licensed for treatment of OCD in children?
Sertraline and fluoxetine
145
What are three domains of ASD features?
1. Qualitative impairment in social interaction
2. Impairment in communication
3. Restricted and repetitive stereotyped patterns of behaviour
146
What is the heritability of autism?
90%
147
Which genetic disorders are associated with ASD?
Fragile X Syndrome
Tuberous Sclerosis
PKU
148
What biological factors are associated with ASD?
LD (in 80%of people with autism)
Larger brain volumes (possible marker)
Increased size of lateral + 4th ventricles
Hypoplasia of cerebellar vermal lobules 6 & 7
High plasma serotonin concentrations
149
What perinatal factors are associated with ASD?
Congenital rubella infection
150
What is childhood disintegrative disorder (Heller's disease)?
Marked regression in several areas of functioning after at least 2 years of apparently normal development
- Loss of acquired motor, language and social skills
- Stereotypies and compulsions are common
- M>F
- Associated with seizures
151
What percentage of children and adolescents with LD have dyslexia?
75%
152
What percentage of school-aged children are affected by dyslexia?
4% (M:F = 4:1)
153
Name some other learning and communication disorders
```
Disorder of written expression
Maths disorder
Learning disorder NOS
Expressive language disorder
Mixed receptive/expressive language disorder
Phonological disorder
```
154
What is the prevalence of stuttering?
1% (M:F = 3:1)
| 50% recover spontaneously
155
What is Tourettes Syndrome?
A tic disorder characterised by multiple motor tics and at least 1 vocal tic, present for at least 1 year and causing distress and impaired function
156
What is coprolalia?
involuntary and repetitive use of obscene language as a symptom of a disorder or brain injury - present in 1/3 cases
157
What percentage of people with Tourette's syndrome exhibit echolalia or echopraxia?
10%
158
What is the proposed pathology of Tourettes syndrome?
1. Excessive functional dopamine (implicates circuits involving basal ganglia, pre-motor and motor cortices)
2. Post beta haemolytic strep infection
159
What is the difference between transient and chronic tic disorder?
Transient = single or multiple motor +/or vocal tics nearly every day for a period of 4 weeks, with a maximum duration of 12 months
Chronic = motor OR vocal tics for >12 months
160
What percentage of 13 year olds admit to drinking alcohol at least once a week?
30% (binge drinking is the most common pattern)
161
What percentage of 11-16 year olds admit to having used cannabis at least once?
5%
162
What percentage of 11-15 year olds admit to having used cocaine at least once?
0.5%
163
What are Hersov's admission criteria for children?
- Diagnostic work that cannot be carried out on an outpatient basis
- A severe psychiatric disorder with need for treatment by an MDT in a safe setting
- Impaired physical status of the child which required skilled medical and nursing care
- Adverse environmental circumstances that preclude the child's improvement in the home or severely distorted family interaction
- Gross overprotection by parents after a trauma or injury which precludes recovery
164
Which type of empathy is impaired in autism?
Cognitive but not affective empathy is typically impaired
165
What differentiates tics from stereotypy?
Tics lack rhythmicity
166
According to the DoH survey in 1999, which of the following is thought to be the most common disorder in children aged 5-15 living in England?
Conduct disorder
167
What is the estimated prevalence of schizophrenia in children (those below 18)?
1 in 1000
168
What proportion of those who perpetrate Munchausen's syndrome by proxy are female?
80%
169
How long after remission should treatment of OCD continue?
6 months
170
What is the average age of a person (at diagnosis) affected by Munchausen's syndrome by proxy?
4 yeard
171
Empathy skills are most likely to be delayed in which deaf children?.
Deaf children of hearing parents
172
Massed negative practice is used in the treatment of which disorder?
Tourettes
173
What has been the most consistent risk factor for ASD in research studies?
Low broth weight
174
What is closest estimate of the concordance rate for autism in identical twins?
60%
175
Over 80% of babies sleep through the night by age?
6 months
176
The rate of completed suicide in children and adolescents with bipolar disorder is
10%
177
What percentage of children with major depressive episode will later manifest bipolar disorder?
20%
178
This disorder is characterised by sudden jerky and recurrent movements preceded by rising discomfort or urge
Tic
179
There is little evidence that this influencing factor per se is associated with the greater incidence of child psychiatric disorder.
Family structure
180
% children with night terrors that have a family member with similar problem?
50%
181
Which neuropsychiatric syndrome or symptoms is NOT associated with mild Traumatic Brain Injury (mTBI) in children?
Mania
182
At what age does separation anxiety begin?
Begins 7-8 months
183
At what age does fear of strangers, heights begin?
Towards the end of the first year
184
At what age does fear of being alone, the dark, animals begin?
Preschool (3-4)
185
At what age does fear of bodily injury, illness, social situations begin?
Ages 6-12
186
At whats age does fear of death begin?
Begins early and persists through to late adolescence
187
Which psychotic disorder with onset in childhood has the worst prognosis?
Schizophhrenic psychosis
