CAMHS - Emotional & other disorders

Question 1

what is the management for depression in children and adolescents?

Answer 1

Always:
psychoeducation. advice on sleep, diet, exercise. address environmental stressors eg bullying.

Mild:
watchful waiting for 2 weeks. if no good; self help books/resources.

Moderate-severe:
Refer to CAMHS

1. CBT
2. Anti-depressants; Fluoxetine - in severe cases after referral

Question 2

presentation of depression in children and adolescents?

Answer 2

somatic symptoms more commoneg abdo pain and headache

Question 3

what are the different types of anxiety disorders in children and adolescents?

Answer 3

Separation anxiety
- when separated from parents

School refusal
- bullying, fear of failure etc?

Phobias
Panic disorder
OCD

Question 4

what is the management for anxiety in children and adolescents?

Answer 4

Psychoeducation - explain to child and parent the condition

CBT:
monitor dysfunctional thoughts and feelings using diaries and sclaes
behaviour; systematic desensitisation fomr phobia, relaxation technique (breathing exercises)

2nd line;
Fluoxetine - panic disorder
Sertraline - OCD

other steps: liase with school concerning strategy for phobias etc

Question 5

what is the DSM-5 definition for enuresis?

Answer 5

involuntary wetting during sleep 2 or more x per week

in kids over 5 y/o

where there is NO congenitial or acquired defect

Question 6

types of enuresis?

Answer 6

Enuresis can be primary (toilet training was never mastered) or

secondary (dryness was
achieved for at least a year but has been lost).

Question 7

causes of enuresis?

Answer 7

Fhx

Primary

- delayed maturation
of the bladder’s nervous innervation or more generalized
developmental delay, 
- stress
- excessively
relaxed or strict toilet training 

Secondary
- stress related, e.g. starting
at a new school.

Question 8

Management of enuresis?

Answer 8

1. Refer organic causes of enuresis to paediatrics, e.g.
   epilepsy, urinary tract
2. Reassure the family and the child that the problem is
   common and is no one’s fault. Address stressors and
   review the toilet training received so far.
3. Restrict fluids before bed.
4. Star charts celebrate each dry night (positive
   reinforcement) .
5. Enuresis alarm -> Bell and pad: this ‘underpants alarm’ clips onto pyjamas and wakes the child if moisture is detected, teaching normal voiding. 1st line

2nd line - Alarm + Desmopressin
OR Desmopressin alone 200mcg

Question 9

which drugs can be used for sx relief in enuresis?

Answer 9

imipramine - TCA

or

desmopressin - synthetic adh

Question 10

define encopresis?

Answer 10

inappropriate defecation after 4 years old

Question 11

aetiology of encopresis?

Answer 11

CONSTIPATION
- overflow incontinence

diarrhoea
learning disabilities
anger/hostility -> to get revenge

Question 12

management of encopresis?

prognosis

Answer 12

laxative - for constipation

review toilet training, address stress

star charts

60-90% recover in 1year

Question 13

prognosis of child/adolescence anxiety?

lecture

Answer 13

childhood anxiety: 5x increased risk for adult anxiety, depression, suicide and self harm.

but childhood anxiety froms tend to remit by adolescence. adolescent forms tend to persist into adulthood.

separation anxiety and phobias have the best remission rate. OCD has the worst.

Question 14

name some aetiological factors for childhood depression?

lecture

Answer 14

BDNF- Brain-derived neurotrophic factor; levels low - involved in 5HT pathway, needed for SSRIs to work

5HT1a (receptor) variant

Question 15

prognosis of depression in young people?

lecture + Sofia

Answer 15

prognosis - good but 1/3 relapse - likely if severe

long term risk: bipolar disorder, suicide

untreated cases relapse far more frequent.

Question 16

what is requirement for diagnosis of bipolar in young people?

lecture

Answer 16

clear manic episode with euphoria over at least a week/5 days

careful, kids may normally be:
impulsive, disinhibited, irritable. or it could be due to other conditions like adhd

Question 17

its important not to confuse other visual perceptions with psychotic symptoms. what questions must you ask?

lecture

Answer 17

when did you see the hallucination?
as they were slipping into sleep - hypnogogic
when they are waking up - hypnopompic
these are not psychotic hallucinations

Question 18

how to approach psychosis in the young?

lecture

Answer 18

Early intervention in psychosis is v important:
by CAMHS or EIS

not necessarily to give antipsychotics though.
monitor those with the at risk mental state

Question 19

why dors subatance abuse matter?

Answer 19

8% deaths 15-18 y/o
10% have problems related to this
gateway drugs to harder substances
dependency