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Yr4 - Psych > CAMHS > Flashcards

CAMHS Flashcards

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1
Q

Factors affecting when a child may present to CAMHS

A 
Age
Frequency 
Severity
Individual characteristics or temperament
Impact on others
Family/social circumstance
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2
Q

Biological factors affecting children’s mental health

A 
Temperament
Genetic
Neurodevelopmental
Biochemical
Appearance
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3
Q

Developmental factors affecting children’s mental health

A

Attachment - most occurs between 18 months to 3 years
Learning
Cognitive
Emotional

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4
Q

Social/environmental factors affecting children’s mental health

A 
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
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5
Q

Significant influences children’s mental health

A 
Parents and family
- type of parenting
- what constitutes good parenting
- family structure
School
- academic success/failure
- friendships
- bullying
Culture
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6
Q

Protective factors for children

A 
Temperament
Coping strategies
Problem-solving
Self-esteem
Stability
Secure relationships
Friendships
Achievement
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7
Q

Aetiology of children’s mental health problems

A 
Multifactorial
Cumulative effect
Risk - vulnerability and predisposing factors
Precipitating and perpetuating factors
Inter-related
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8
Q

Factors affecting consultations with children

A 
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
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9
Q

Common disorders of childhood and adolescence

A 
GAD
Separation anxiety disorders
Phobic disorders
OCD
PTSD
Depression
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10
Q

Features of GAD in children

A 
Free floating anxiety
Fears of death or loss
Somatic manifestations
- nausea, abdo pain, sickness, headaches, sweating, palpitations, tension
Panic attacks
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11
Q

Features of separation anxiety

A

Anxiety that manifests upon separation from attachment figures

  • somatic
  • nightmares with separation themes
  • school refusal
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12
Q

Features of OCD in children

A 
Persistently re-experiencing trauma
Avoidance of associated stimuli or numbing of responsiveness
Increased arousal 
- sleep disturbance
- irritability
- poor concentration
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13
Q

Treatment of anxiety disorders

A 
Behaviour therapy
- systemic desensitisation
- flooding
- response prevention
Psychotherapies
- brief psychodynamic
- family 
- CBT
Anxiolytics
- fluoxetine - SSRI
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14
Q

Features of depressive disorders in children

A 
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
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15
Q

Treatment of depressive disorders

A

CBT
Antidepressants - SSRIs
Manage underlying or comorbid problems

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16
Q

Features of oppositional disorder

A 
Uncooperative
Unwilling to comply with requests
Frequent temper tantrums
Wilful, defiant may also be aggressive
Tends to escalate unless managed
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17
Q

Features of conduct disorders

A

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

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18
Q

Risk factors of conduct disorders

A

Lack of clear boundaries and inconsistent parenting
Rejection
Family conflict - witnessing violence and aggression
Child abuse
Child temperament
Comorbid learning or developmental difficulties

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19
Q

Treatment of conduct disorders

A

Consistent care and parenting
Behavioural therapy
School-based interventions
Community interventions

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20
Q

Key features of Attention Deficit Hyperactivity Disorder in children

A

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

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21
Q

Treatment of ADHD in children

A

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

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22
Q

Key features of Autism Spectrum disorders in children

A

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

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23
Q

Treatment of autism spectrum disorders in children

A 
No definitive treatment
Approaches
- psycho-education
- stress reduction
- environmental changes
- treat co-morbidities
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24
Q

Key features of eating disorders in children

A 
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
25
Q

Define autism

A

Pervasive developmental disorder characterised by triad of

  • impairment in social interaction
  • impairment in communication
  • restricted, stereotyped interests and behaviours
26
Q

Aetiology of autism

A 
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
27
Q

Risk factors for autism

A 
Male
Genetics/family history
Advancing parental age
Parental psychiatric disorders
Prematurity
Maternal medicine use
28
Q

Clinical features of autism

A

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

29
Q

Onset of autism

A

50% of parents have concern by 12-18 months

Onset before age of 5

30
Q

ICD-10 criteria for diagnosis of autism

A

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

31
Q

Features of Asperger’s syndrome

A

Similar to autism with abnormalities in social interaction and restricted, stereotyped, repetitive interests and behaviours
No impairment in language, cognition or intelligence

32
Q

Features of Rett’s syndrome

A

Severe, progressive disorder starting in early life
Language impairment, repetitive stereotyped hand movements, loss of fine motor skills, irregular breathing and seizures
MECP2 gene

33
Q

Features of childhood disintegrative disorder

A

Characterised by 2 years of normal development followed by loss of previously learned skills

34
Q

Management of autism

A

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

35
Q

Bio-psycho-social management of autism

A 
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
36
Q

Define hyperkinetic disorder

A

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

37
Q

Aetiology of ADHD

A

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

38
Q

Risk factors ADHD

A 
Male
FH
Environmental factors
- social deprivation
- family conflict
- parental cannabis
- alcohol exposure
39
Q

Core features of ADHD

A

Inattention
Hyperactivity
Impulsivity

40
Q

ICD-10 criteria for ADHD

A

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

41
Q

Differential diagnosis of ADHD

A 
Learning disability
Dyslexia
Oppositional defiant disorder
Conduct disorder
Autism
Sleep disorders
Mood disorders
Anxiety disorder
Hearing impairment
42
Q

Management of ADHD

A

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

43
Q

Side effects of CNS stimulants

A

Headache
Insomnia
Loss of appetite
Weight loss

44
Q

Define learning disability

A

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

45
Q

ICD-10 criteria for learning disabilities

A 
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
46
Q

Features of learning diability

A

Low intellectual performance
Onset at birth or early childhood
Wide range of functional impairment

47
Q

Aetiology of learning diability

A 
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
48
Q

Clinical features of learning diabilities

A

Motor disabilities
Epilepsy
Impaired hearing / vision
Incontinence

49
Q

Features of Down’s syndrome

A

Trisomy 21

Characterised by LD, dysmorphic facial features and multiple structural abnormalities

50
Q

Physical features of Down’s syndrome

A 
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
51
Q

Medical problems associated with Down’s syndrome

A

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

52
Q

Features of fragile X syndrome

A

Sex-linked disorder with developmental, physical and behavioural problems

53
Q

Physical features of fragile X syndrome

A 
Large, protruding ears
Long face
High arched palate
Flat feet
Soft skin
Lax joints
54
Q

Medical problems associated with fragile X syndrome

A

Mitral valve prolapse

55
Q

Features of Prader-Willi syndrome

A

Due to deletion of chromosome 15
Characterised by hypotonia and developmental delay as an infant and obesity, hypogonadism and behavioural problems in later years

56
Q

Features of Cri du chat

A

Caused by partial deletion of chromosome 5

Those affected have a high-pitched cry like a cat

57
Q

Common psychiatric co-morbidities in LD

A 
Alzheimer's disease
Schizophrenia
Anxiety
Hyperkinetic disorder
Eating disorders
Personality disorders
58
Q

Management of learning disorders

A

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

Yr4 - Psych (13 decks)

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