Child/Adolescent Psychiatry

Question 1

What are Genome Wide Association Studies used for?

Answer 1

To identify genetic risk factors for psychiatric disorder

Question 2

What intra-uterine/perinatal factors may contribute to mental health?

Answer 2

• 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

Question 3

What condition is low white matter connectivity associated with?

Answer 3

ADHD

Question 4

What environmental factors during childhood may affect mental health?

Answer 4

• 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

Question 5

What does stress influence in the brain?

Answer 5

• Influences function of limbic circuit (Amydala)
• Determines subsequent patterns of stress response
• Influences mood and patterns of response to threat

Question 6

What does operant condition refer to?

Answer 6

Dopamine neurons fire when you associate an action with a subsequent reward

Question 7

What does early adversity do to dopamine response?

Answer 7

Reduces dopamine response

Question 8

What model is thought to contribute to reward seeking behaviours - ‘addiction’ - later in life?

Answer 8

Reward deficiency model

AKA Hypoactive Reward Response

Question 9

What model is thought to help explain ADHD?

Answer 9

Delay-aversion and delayed gratification

Question 10

Roughly what age does intentional smiling begin?

Answer 10

6 weeks

Question 11

Roughly what age are we able to recognise and label emotions?

Answer 11

24 months

Question 12

Roughly what age do we exhibit self-awareness of emotion?

Answer 12

3-4 yrs

Question 13

What is a test of the ability to understand false belief?

Answer 13

Theory of mind

Failure to understand this commonly seen in ASD

Question 14

What biological factors contribute to child psychiatric illness?

Answer 14

• Genetic predispositions
• Neurodevelopmental Insults
• Illness

Question 15

What psychological factors contribute to child psychiatric illness?

Answer 15

• Attachment style
• Psychological attributes (Impulsivity, low self esteem, perfectionism)
• Belief system

Question 16

What social factors contribute to child psychiatric illness?

Answer 16

• Family relationships
• Peer relationships
• Hobbies/interests
• Religious faith
• Neighbourhood
• School
• Rural/urban
• Criminality
• Finances

Question 17

What receptors does methylphenidate act on?

Answer 17

• Noradrenaline

- Dopamine

Question 18

List some factors that increase the risk of suicide?

Answer 18

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

Question 19

What is the management for suicidal behaviour?

Answer 19

• 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

Question 20

List some mental health problems associated with being out of school

Answer 20

• Anxiety
• Conduct disorder
• Autism
• Depression
• Obsessional compulsive disorder

Question 21

What are some features of anxiety disorders in children?

Answer 21

• Anxious thoughts and feelings
• Autonomic symptoms
• Avoidant behaviour

Question 22

What motivational factors may affect school attendance?

Answer 22

• Learning difficulties
• Lack of friends and relationships
• Bullying
• Lack of parental attention or concern
• Maternal depression

Question 23

What treatments may be used for anxiety disorders in children?

Answer 23

Behavioural management

Medication - eg SSRIs

Question 24

What is involved in CBT in children?

Answer 24

• 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

Question 25

What factors are decreased in ASD children?

Answer 25

• Self-other perspective taking
• Sharing/ divided attention
• Flexible learning
• Social understanding

Question 26

What factors are increased in ASD children?

Answer 26

• Rigidity
• Sameness
• Fixed learning patterns
• Technical understanding

Question 27

What may take place in parent training programmes?

Answer 27

• Groups, individuals or self-taught
• Structured
• Informed by social-learning theory
• Focus on positive reinforcement of desired behaviour and developing positive parent-child relationships.