CAMHS Flashcards
Factors affecting when a child may present to CAMHS
Age Frequency Severity Individual characteristics or temperament Impact on others Family/social circumstance
Biological factors affecting children’s mental health
Temperament Genetic Neurodevelopmental Biochemical Appearance
Developmental factors affecting children’s mental health
Attachment - most occurs between 18 months to 3 years
Learning
Cognitive
Emotional
Social/environmental factors affecting children’s mental health
Acute stressors - abuse - domestic violence - bullying - loss of parent - relationship breakups Chronic adversity - socio-economic - parental mental illness - parental loss - family conflict - violence - parenting - abuse - exposure to community violence
Significant influences children’s mental health
Parents and family - type of parenting - what constitutes good parenting - family structure School - academic success/failure - friendships - bullying Culture
Protective factors for children
Temperament Coping strategies Problem-solving Self-esteem Stability Secure relationships Friendships Achievement
Aetiology of children’s mental health problems
Multifactorial Cumulative effect Risk - vulnerability and predisposing factors Precipitating and perpetuating factors Inter-related
Factors affecting consultations with children
Environmental - privacy - suitability - overstimulating, access to toys, age appropriate - intimidating - correct for what is being assessed Child factors - feeling safe/secure - willingness to engage - family or carers present - cognitive ability - communication/language problems - emotional development Clinician factors - setting enough time - age appropriate language - avoid patronising/condescending
Common disorders of childhood and adolescence
GAD Separation anxiety disorders Phobic disorders OCD PTSD Depression
Features of GAD in children
Free floating anxiety Fears of death or loss Somatic manifestations - nausea, abdo pain, sickness, headaches, sweating, palpitations, tension Panic attacks
Features of separation anxiety
Anxiety that manifests upon separation from attachment figures
- somatic
- nightmares with separation themes
- school refusal
Features of OCD in children
Persistently re-experiencing trauma Avoidance of associated stimuli or numbing of responsiveness Increased arousal - sleep disturbance - irritability - poor concentration
Treatment of anxiety disorders
Behaviour therapy - systemic desensitisation - flooding - response prevention Psychotherapies - brief psychodynamic - family - CBT Anxiolytics - fluoxetine - SSRI
Features of depressive disorders in children
Low mood which persistent but not necessarily pervasive Anhedonia/lower levels of enjoyment Biological symptoms not consistent - appetite/sleep not affected - concentration/motivation worse Can occur with anxiety symptoms
Treatment of depressive disorders
CBT
Antidepressants - SSRIs
Manage underlying or comorbid problems
Features of oppositional disorder
Uncooperative Unwilling to comply with requests Frequent temper tantrums Wilful, defiant may also be aggressive Tends to escalate unless managed
Features of conduct disorders
Socialised
- less serious
- tends to be phasic in nature
Unsocialised
- serious
- potentially leads to criminality and antisocial personality disorder
- features lying, stealing, truanting, violence to people and animals
Risk factors of conduct disorders
Lack of clear boundaries and inconsistent parenting
Rejection
Family conflict - witnessing violence and aggression
Child abuse
Child temperament
Comorbid learning or developmental difficulties
Treatment of conduct disorders
Consistent care and parenting
Behavioural therapy
School-based interventions
Community interventions
Key features of Attention Deficit Hyperactivity Disorder in children
Poor attention and concentration
Physical overactivity
Impulsivity
Needs to occur in more than one environment
Diagnosis after 6 years of age - but symptoms often present before
Treatment of ADHD in children
Mild and moderate - consider parenting and school intervention first
Severe = medication first line
- methylphenidate - short or long acting stimulant
- lisdexamphetamine
- atomoxetine
- guanfacine
Treat co-morbidity anxiety, behavioural problems, substance use
Key features of Autism Spectrum disorders in children
Socio/communication difficulties - verbal/non-verbal
Sensory processing problems difficulties
Effects on thinking - lack of flexibility, social imagination, theory of mind, generalisation
Needs to occur in more than one environment
Symptoms must be present before 3 years of age
Treatment of autism spectrum disorders in children
No definitive treatment Approaches - psycho-education - stress reduction - environmental changes - treat co-morbidities
Key features of eating disorders in children
Rare in pre-adolescent period Increasingly prevalence in adolescence Similar symptoms to adult presentation Delayed puberty and growth are significant issues Prognosis worse if younger or male
Define autism
Pervasive developmental disorder characterised by triad of
- impairment in social interaction
- impairment in communication
- restricted, stereotyped interests and behaviours
Aetiology of autism
Prenatal - genetics - chromosome 7, fragile X syndrome, tuberous sclerosis - parental age - over 40 - drugs - sodium valproate - infection - rubella Antenatal - obstetric complications - hypoxia, small gestational age, low birth weight Postnatal - lead and mercury - pesticide exposure
Risk factors for autism
Male Genetics/family history Advancing parental age Parental psychiatric disorders Prematurity Maternal medicine use
Clinical features of autism
Asocial
- few social gestures
- lack of eye contact, social smile, response to name, interest in others, emotional expression
Behaviour restricted
- restricted repetitive and stereotyped behaviours - rocking and twisting
- upset to change in daily routine
- preference of same foods, clothes and games
- obsessively pursued interests
- fascination with sensory aspects of environment
Communication impaired
- distorted and delayed speech
- echolalia - repetition of words
Onset of autism
50% of parents have concern by 12-18 months
Onset before age of 5
ICD-10 criteria for diagnosis of autism
Presence of abnormal or impaired development before the age of 3
Qualitative abnormalities in social interaction
Qualitative abnormalities in communication
Restrictive, repetitive and stereotyped patterns of behaviour, interests and activities
Clinical picture is not attributable to other varieties of pervasive developmental disorder
Features of Asperger’s syndrome
Similar to autism with abnormalities in social interaction and restricted, stereotyped, repetitive interests and behaviours
No impairment in language, cognition or intelligence
Features of Rett’s syndrome
Severe, progressive disorder starting in early life
Language impairment, repetitive stereotyped hand movements, loss of fine motor skills, irregular breathing and seizures
MECP2 gene
Features of childhood disintegrative disorder
Characterised by 2 years of normal development followed by loss of previously learned skills
Management of autism
Local autism teams - key workers
CBT - if verbal and cognitive ability
Interventions for life skills - daily living tasks, coping strategies
Ensure physical, mental health and behavioural issues addressed
Families and careers offered personal, social and emotional support
Consider special schooling
Melatonin for sleep disorders
Bio-psycho-social management of autism
Bio - treat co-existing disorders - antipsychotics of behaviour challenges - melatonin Psych - psychoeducation - full assessment - CBT Social - modification of environmental factors - social-communication intervention - self-help groups - special schooling
Define hyperkinetic disorder
Also known as ADHD - attention deficit hyperactivity disorder
Characterised by early onset, persistent pattern of inattention, hyperactivity and impulsivity that are more frequent and severe than in individuals at a comparable stage of development and present in more than one situation
Aetiology of ADHD
Genetic
Neurochemical - abnormality in dopaminergic pathways
Neurodevelopmental - abnormalities of the pre-frontal cortex
Social - association with social deprivation and family conflict as well as parental cannabis and alcohol exposure
Risk factors ADHD
Male FH Environmental factors - social deprivation - family conflict - parental cannabis - alcohol exposure
Core features of ADHD
Inattention
Hyperactivity
Impulsivity
ICD-10 criteria for ADHD
Demonstrate abnormality of attention, activity and impulsivity at home
Demonstrate abnormality of attention and activity at school or nursery
Directly observed abnormality of attention or activity
Does not meet criteria for pervasive, developmental disorder, mania, depressive or anxiety disorder
Onset before 7 years
Duration at least 6 months
IQ above 50
Differential diagnosis of ADHD
Learning disability Dyslexia Oppositional defiant disorder Conduct disorder Autism Sleep disorders Mood disorders Anxiety disorder Hearing impairment
Management of ADHD
Pre-school
- parent-training and education programmes
- reinforce positive behaviour and manage disruptive behaviour
- drug treatment not recommended
School goers
- psychoeducation and CBT and social skills training
- drug treatment first line if severe - CNS stimulant methylphenidate
Side effects of CNS stimulants
Headache
Insomnia
Loss of appetite
Weight loss
Define learning disability
State of arrested or incomplete development of the mind
- characterised by impairment of skills manifested during the developmental period, and skills that contribute to the overall level of intelligence
ICD-10 criteria for learning disabilities
Mild = IQ - 50-70 - mental age 9-12 Moderate = IQ 35-49 - mental age 6-9 Severe = IQ 20-34 - mental age 3-6 Profound = IQ < 20 - mental age < 3 years
Features of learning diability
Low intellectual performance
Onset at birth or early childhood
Wide range of functional impairment
Aetiology of learning diability
Genetic - Down's syndrome, fragile X syndrome, Angelman Antenatal - congenital infection - rubella, CMV, toxoplasmosis - nutritional deficiency - intoxication - endocrine disorders - hypothyroidism, hypoparathyroidism - physical damage Perinatal - birth asphyxia - intraventricular haemorrhage - neonatal sepsis Neonatal - hypoglycaemia - meningitis - neonatal infection Postnatal - infection - anoxia - metabolic - cerebral palsy Environmental - neglect/non-accidental injury - malnutrition - socioeconomically deprived Psychiatric - Autism - Rett's syndrome
Clinical features of learning diabilities
Motor disabilities
Epilepsy
Impaired hearing / vision
Incontinence
Features of Down’s syndrome
Trisomy 21
Characterised by LD, dysmorphic facial features and multiple structural abnormalities
Physical features of Down’s syndrome
Palpebral fissure Round face Occipital and nasal flattening Brushfield spots - pigmented spots on iris Brachycephaly Low-set small ears Epicanthic folds Mouth open and protruding tongue Stabismus (squint) Sandal gap deformity Single palmar crease
Medical problems associated with Down’s syndrome
Heart defects - ventricular and atrial septal defects
Hearing loss
Visual disturbance - cataracts, strabismus, keratonconus
GI problems - oesophageal/duodenal atresia, Hirschsprung’s, coeliac
Hypothyroidism
Haematological malignancies -
Increased incidence of Alzhimer’s
Features of fragile X syndrome
Sex-linked disorder with developmental, physical and behavioural problems
Physical features of fragile X syndrome
Large, protruding ears Long face High arched palate Flat feet Soft skin Lax joints
Medical problems associated with fragile X syndrome
Mitral valve prolapse
Features of Prader-Willi syndrome
Due to deletion of chromosome 15
Characterised by hypotonia and developmental delay as an infant and obesity, hypogonadism and behavioural problems in later years
Features of Cri du chat
Caused by partial deletion of chromosome 5
Those affected have a high-pitched cry like a cat
Common psychiatric co-morbidities in LD
Alzheimer's disease Schizophrenia Anxiety Hyperkinetic disorder Eating disorders Personality disorders
Management of learning disorders
Multidisciplinary approach - psychiatrist, speech and language therapies, specialist nurses, psychologist, occupational therapist, social worker and teachers
GP for physical health problems
Antipsychotics for challenging behaviour
Behavioural techniques - applied behavioural analysis, positive behaviour supports, CBT
Family education
Prevention - through genetic counselling and antenatal diagnosis
