CAMHS, and Learning disability Flashcards
CAM: common conditions
intellectual disability
developmental disorders: Rett’s, Autism
acquired disorders: ADHD, conduct, emotional
acquired ‘adult’ disorders: mood, psychoses, anx
CAM - treatments
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
LD - features
- 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
LD - stats
1-3%; M>F; lower socioeco for mild/borderline;
mil 1.5-3%
mod/severe 0.3-0.5%
profound 0.05%
LD - aetiology
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
LD - characteristics
- 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
LD - examples
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
LD - prevention
primary: counsel/screen (e.g. AFP); early detect/Rx
secondary: prevent development e.g. treat hypothy
tertiary: minimise effect; max effort
LD - MDT and services
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
LD - family response
- 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
LD - assoc. physical illness
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
LD - assoc. psych illness
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
LD - depression
FHX behavioural: wandering, observed anx diurnal variation aversion to change poor planning of SI/depressive ideas
LD - mania
FHX challenging behaviour, excitement inappropriate masturbation or exposure less elaborate delusion less 'infectious'
LD - psychosis/schizophrenia
more common with severe LD but hard to Dx if IQ
LD - challenging behaviour
abn behaviour, threatening safety, limiting access to facilities
aetio: socio/enviro, MH, meds SE, illness
Rx: underlying cause; behaviour analysis and ABC approach
Autism - features (3)
- socialisation: smile, solitary play, poor non-verbal skills
- communication: delayed speech, less sharing
- repetitive behaviour: rituals, restricted/compulsive, change aversion
Autism - Kanner’s
aloof, repetitive, poor speech little maternal interaction or eye contact no imaginative play, frequent tantrums agile but clumsy when copying 67% have LD
Autism - Asperger’s
good speech but literal, monotonous, and elaborate
good memory but clumsy
lacking common sense
borderline/high IQ
Autism - management (general)
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
RAAMP
Risk assessment and management plan
risks evidence triggers/context consequences strategies to minimise risk behaviours
LD psychiatric role
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
Dyslexia
10%, most severe form 4%; M>F (4x); variable onset
struggle with written language
CAMHS - assessment
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)
CAMHS - epidemiology
10% of kids have MH; only 10% have specialist contact
emotional/behavioural commonest: 50% of GP presentations, 30% of new Paediatrician presentations
Autism - epi/aetio
Kanner 0.1%; any ASD 1%; 70% have LD
M>F (4x); onset pre-birth
genetic, biological (NT/brain injury), psychosocial (stressors)
ADHD - epi/aetio
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)
ADHD - treatment
biological: stimulants (dexamph, Ritalin), non stimulants (atomoxetine NARI)
- titration and monitoring
psycho: parenting courses, attention aids
social: education liaison
CAMHS - other Dx
*more detail (one-liners)
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;
Autism - management (behaviour)
- 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
Autism - outcome
life-long, normal LE
some improve with age
better prognosis if early speech and higher IQ
CAMHS meds
fluoxetine for depression
sertraline for OCD
ritalin/dexamphet for ADHD
adolescent MH
decreased: enuresis/ecno, sep anx, ADD
same: phobia
late presentation: Asperger’s, Turner’s
increased: schizo, BAD, depp, OCD, social phobia, panic, substance, AN
