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Psychiatry > CAMHS, and Learning disability > Flashcards

CAMHS, and Learning disability Flashcards

1
Q

CAM: common conditions

A

intellectual disability
developmental disorders: Rett’s, Autism
acquired disorders: ADHD, conduct, emotional
acquired ‘adult’ disorders: mood, psychoses, anx

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2
Q

CAM - treatments

A

bio: less 1st line; less evidence; ADHD/depp
psych: CBT, FIT
social: support

general: language and setting; respect, listen to all; safety, risk, confidentiality; consent/competence

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3
Q

LD - features

A
  • mild LD: IQ 50-69; mental age 9-12y
  • moderate LD: IQ 35-49; mental age 6-9y
  • severe LD: IQ 20-34; mental age 3-6y
  • profound LD: IQ
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4
Q

LD - stats

A

1-3%; M>F; lower socioeco for mild/borderline;
mil 1.5-3%
mod/severe 0.3-0.5%
profound 0.05%

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5
Q

LD - aetiology

A

50% mild = ?cause; 30% all LD known cause
severe LD: 40% chromosomal

50-70% prenatal: infection, APH
10-20% perinatal: asphyxsia, premie
5-10% postnatal: infection, injury, metab

genetics; chromosomal; infection; toxins; trauma

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6
Q

LD - characteristics

A
  • mild: independent, help w/ problems; job, relations
  • mod: some help w/ ADLs; comms, hobbies, housework
  • severe: help w/ ADLs, physical/locomotor; often non-verbal
  • profound: dependent; minimal comms
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7
Q

LD - examples

A 
trisomy 13/18/21 (PED)
sex chromosomes: XYY, XXY, XO
AD: TS, NF, Alpert's
AR: PKU, Tay Sachs
XLD: Lesch-Nyhan, Retts
XLR: fragile X
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8
Q

LD - prevention

A

primary: counsel/screen (e.g. AFP); early detect/Rx
secondary: prevent development e.g. treat hypothy
tertiary: minimise effect; max effort

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9
Q

LD - MDT and services

A

team: psych2, nurses, SALT/SW/OT/PT, music therapy, support workers
residential: lodgings/group homes, ‘assisted living’
day services: day centres/hosp, college/school, clubs, work

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10
Q

LD - family response

A
  • shopping around: denial
  • overprotection or rejection: grief
  • valid and invalid guilt: grief
  • anger at relatives/professionals
  • bargaining and late rejection
  • acceptance and infantilisation
  • over-identification
  • stages: numb, denial, searching/pining, despair, reorganise
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11
Q

LD - assoc. physical illness

A

only 1/3 continent, mobile, no severe behaviour

obesity, heart disease, GI, resp, renal, CNS, MSK, dental

epilepsy common: 15-20% of mild, 30-50% severe; issues with meds

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12
Q

LD - assoc. psych illness

A

prevalence 3x gen pop; lifetime risk 5x higher
severe LD: 47% kids, 37% adults

genetics, psychosocial, abuse, medication

Dx difficult: delusion vs. understanding, halls vs. imaginary friends; comms issues

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13
Q

LD - depression

A 
FHX
behavioural: wandering, observed anx
diurnal variation
aversion to change
poor planning of SI/depressive ideas
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14
Q

LD - mania

A 
FHX
challenging behaviour, excitement
inappropriate masturbation or exposure
less elaborate delusion
less 'infectious'
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15
Q

LD - psychosis/schizophrenia

A

more common with severe LD but hard to Dx if IQ

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16
Q

LD - challenging behaviour

A

abn behaviour, threatening safety, limiting access to facilities

aetio: socio/enviro, MH, meds SE, illness

Rx: underlying cause; behaviour analysis and ABC approach

17
Q

Autism - features (3)

A
  • socialisation: smile, solitary play, poor non-verbal skills
  • communication: delayed speech, less sharing
  • repetitive behaviour: rituals, restricted/compulsive, change aversion
18
Q

Autism - Kanner’s

A 
aloof, repetitive, poor speech
little maternal interaction or eye contact
no imaginative play, frequent tantrums
agile but clumsy when copying
67% have LD
19
Q

Autism - Asperger’s

A

good speech but literal, monotonous, and elaborate
good memory but clumsy
lacking common sense
borderline/high IQ

20
Q

Autism - management (general)

A

personal space, quiet location, normal behaviour
don’t make assumptions
challenging behaviour Mx
organisation: space for rituals, reduces CB
activities within capabilities
treat comorbidities; graded change for obsessions

21
Q

RAAMP

A

Risk assessment and management plan

risks
evidence
triggers/context
consequences
strategies to minimise risk behaviours
22
Q

LD psychiatric role

A 
find reason for dev delay
establish nature and extent of LD
assess long-term social care needs
assess behavioural and psych issues
remember physical problems and comorbidities
23
Q

Dyslexia

A

10%, most severe form 4%; M>F (4x); variable onset

struggle with written language

24
Q

CAMHS - assessment

A 
seek help and advice (seniors)
collateral important, include family
screen for physical illness
risk assessment: protection, abuse, SS
social context important
child's understanding (motivation and concordance)
25
Q

CAMHS - epidemiology

A

10% of kids have MH; only 10% have specialist contact

emotional/behavioural commonest: 50% of GP presentations, 30% of new Paediatrician presentations

26
Q

Autism - epi/aetio

A

Kanner 0.1%; any ASD 1%; 70% have LD
M>F (4x); onset pre-birth

genetic, biological (NT/brain injury), psychosocial (stressors)

27
Q

ADHD - epi/aetio

A

1-5%; M>F (3x); onset 1 location/setting
maladaptive and incorrect dev level
decreases in adolescence
risk of behavioural,antisocial PD/ substances

BPS (?NT, brain, foods)

28
Q

ADHD - treatment

A

biological: stimulants (dexamph, Ritalin), non stimulants (atomoxetine NARI)
- titration and monitoring

psycho: parenting courses, attention aids
social: education liaison

29
Q

CAMHS - other Dx

*more detail (one-liners)

A

oppositional defiant disorder: disobedient, 3-8yo
enuresis and encopresis: >5yo
sleep disorders
hypo/hyperthermia
conduct: dissocial (40%), 5-12yo
emotional disorders: sep anx, phobia, rivalry, somatisation
tics/tourette’s: stereotyped, motor/vocal; peak 7y;

30
Q

Autism - management (behaviour)

A
  • graded change - obsessions
  • reinforcers: immediate; attention and priase
  • Premack principle: will do A if it means getting to do B
  • setting limits: attention, warning, positive direction, concrete explanations
31
Q

Autism - outcome

A

life-long, normal LE
some improve with age
better prognosis if early speech and higher IQ

32
Q

CAMHS meds

A

fluoxetine for depression
sertraline for OCD
ritalin/dexamphet for ADHD

33
Q

adolescent MH

A

decreased: enuresis/ecno, sep anx, ADD
same: phobia
late presentation: Asperger’s, Turner’s
increased: schizo, BAD, depp, OCD, social phobia, panic, substance, AN

Psychiatry (16 decks)

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