Child/Adolescent Psychiatry Flashcards
What are Genome Wide Association Studies used for?
To identify genetic risk factors for psychiatric disorder
What intra-uterine/perinatal factors may contribute to mental health?
- Maternal health – Maternal antibodies, obesity, diabetes
- Substance misuse – alcohol, marijuana
- Toxins – lead, mercury and PCB’s
- Drugs - esp psychotropics/antiepileptics (lipid soluble)
- Epigenetics – folate controlled methylation
- Endocrine environment – esp androgens
- Immune environment
- Premature birth/ Perinatal complications
- Twinning
What condition is low white matter connectivity associated with?
ADHD
What environmental factors during childhood may affect mental health?
- Carer - child relationship
- Parenting skill and parental mental disorder
- Marital harmony, family function.
- Nutrition, poverty, deprivation.
- Abuse, neglect,
- Discipline
- Day-care and schooling
- Peer relationships,
- Life events,
- Physical disability
What does stress influence in the brain?
- Influences function of limbic circuit (Amydala)
- Determines subsequent patterns of stress response
- Influences mood and patterns of response to threat
What does operant condition refer to?
Dopamine neurons fire when you associate an action with a subsequent reward
What does early adversity do to dopamine response?
Reduces dopamine response
What model is thought to contribute to reward seeking behaviours - ‘addiction’ - later in life?
Reward deficiency model
AKA Hypoactive Reward Response
What model is thought to help explain ADHD?
Delay-aversion and delayed gratification
Roughly what age does intentional smiling begin?
6 weeks
Roughly what age are we able to recognise and label emotions?
24 months
Roughly what age do we exhibit self-awareness of emotion?
3-4 yrs
What is a test of the ability to understand false belief?
Theory of mind
Failure to understand this commonly seen in ASD
What biological factors contribute to child psychiatric illness?
- Genetic predispositions
- Neurodevelopmental Insults
- Illness
What psychological factors contribute to child psychiatric illness?
- Attachment style
- Psychological attributes (Impulsivity, low self esteem, perfectionism)
- Belief system
What social factors contribute to child psychiatric illness?
- Family relationships
- Peer relationships
- Hobbies/interests
- Religious faith
- Neighbourhood
- School
- Rural/urban
- Criminality
- Finances
What receptors does methylphenidate act on?
- Noradrenaline
- Dopamine
List some factors that increase the risk of suicide?
Persistent suicidal ideas Previous suicidal behaviour High lethality of method used High suicidal intent and motivation Ongoing precipitating stresses Mental disorder Poor physical health Impulsivity, neuroticism, low self esteem, hopelessness Parental psychopathology and suicidal behaviour Physical and sexual abuse Disconnection from support systems
What is the management for suicidal behaviour?
- Take it seriously
- Usually admit to age appropriate medical ward after serious attempt for medical treatment and psychosocial assessment.
- Mental health and risk assessment by specially trained staff member with ready access to psychiatric opinion.
- Confidentiality (with exceptions).
- Further referral to agencies as appropriate e.g. CAMHS, child protection
List some mental health problems associated with being out of school
- Anxiety
- Conduct disorder
- Autism
- Depression
- Obsessional compulsive disorder
What are some features of anxiety disorders in children?
- Anxious thoughts and feelings
- Autonomic symptoms
- Avoidant behaviour
What motivational factors may affect school attendance?
- Learning difficulties
- Lack of friends and relationships
- Bullying
- Lack of parental attention or concern
- Maternal depression
What treatments may be used for anxiety disorders in children?
Behavioural management
Medication - eg SSRIs
What is involved in CBT in children?
- Parents as collaborators in the team
- Step-wise approach: the ladder to success
- Externalisation: disorder is not a matter of blame.
- Overcoming barriers to change: problem solving
- Psychoeducation
- Goal setting
