Child and adolescent mental health

Question 1

Relative frequency of types of abuse

Answer 1

Neglect > physical > sexual > emotional

Question 2

At-risk groups for abuse

Answer 2

14-17 yo

Learning disability/ASD/other special needs

Foster children

Babies <1yo with bruising

Question 3

Forms of physical abuse

Answer 3

Induced illness (only witnessed by parent)

Bruises/fractures/ano-genital signs

Question 4

Clinical presentations that should raise safeguarding concerns

Answer 4

Unexplained poor school attendance

Fabricated illness

Pregnancy

Poisoning

Apprent life-threatening events (esp if repeatedly)

Question 5

Risk factors for childhood mental illness

Answer 5

Maternal: Separation, mental illness

Home environment: Abuse, domestic abuse, financial/parental instability

Other: Parental loss (<11), poor social network, lack of hobbies/community

Question 6

Brain changes during adolescence

Answer 6

Grey matter increases in size then pruning –> high plasticity + high risk of developing addictive behaviours

Increase in senses precedes increase in executive f(x) –> more risk-taking behaviour

Empathic responding not mature until adulthood

Question 7

Differential for low mood in childhood

Answer 7

• Physical illness (e.g. post-viral depression)
• Medication (e.g. OCP)
• Adjustment disorder:
  
  • School, friendship, relationship, family issues
  • Bereavement
• Psychiatric illness
• Neurodevelopmental disorder (esp ASD)

Question 8

Associations of early depressive episodes in future life

Answer 8

Future depressive episodes

Greater psych + medical comorbidity

Impaired social/occupational f(x)

Question 9

Risk factors for delibarate self-harm in adolescence

Answer 9

Self-harm by friends/family

Low self-esteem

Drug use

Depression, anxiety, impulsivity (esp in females)

Question 10

First-line treatment for depression/anxiety in young people

Answer 10

Specific psychological therapy

Family therapy

Interpersonal therapy

CBT

Question 11

Medication use for depression in children

Answer 11

Limited evidence base, only fluoxetine licensed

Need frequent monitoring ?suicidal risk in first 4w

Question 12

Considerations for anxiety presentations in YP

Answer 12

Acute or chronic?

Triggers?

Severity + impact on f(x)

Family response (Esp encouragement of safety behaviours)

Comorbidity - ED, depression, low mood

Question 13

Clinical features of AN in YP

Answer 13

Weight loss >15% OR failure to gain weight (<5th centile)

Fear of weight gain + attempts to lose weight

Body image distortion

Low mood, poor concentration, withdrawal

Hormonal disturbance (esp amennorhoea)

Question 14

Clinical features of conduct disorder

Answer 14

Persistent/repetitve violent, antisocial, and/or aggressive behaviour that violates age-appropriate societal norms

>=3 behaviours with one for >=6mo

Question 15

Examples of behaviours seen in conduct disorder

Answer 15

Violence/cruelty to animals/others

Property damage

Fire-setting

Forced sexual activity

Truancy

Bullying, deceit

Question 16

Risk factors for conduct disorder

Answer 16

Bio: Neurodevelopmental issues, epilepsy, brain damage, ?genetic component

Psycho: Substance misuse, learning difficulties, depression/anxiety/ASD, child maltreatment or attachment issues

Social: Parental criminality, parental psych disorder, domestic abuse, social disadvantage

Question 17

Aetiology of anxiety in children

Answer 17

Bio: Hyperthyroidism, cardiomyopathy, arrhythmia, genetic predisposition

Psycho: Stressful/traumatic life experiences, insecure attachment, timidness/shyness (predisposed personality)

Social: High social adversity, critical parenting

Question 18

Presentation of anxiety in children

Answer 18

Mainly somatic symptoms (somatization)

Separation difficulty

School refusal

Social withdrawal

Aggression

Sleep disturbance

Inattention, over-activity

Question 19

Management of anxiety in children

Answer 19

Psychoeducation: Of parents and child

CBT: Esp family-based with younger children

Relaxation techniques

Question 20

Comorbidity in social anxiety disorder

Answer 20

30-60% anxiety

20% depression

Substance abuse

Question 21

Gender ratio for depression in children

Answer 21

No difference pre-pubertal

More F post-pubertal

Question 22

Risk factors for childhood depression

Answer 22

Bio: Female, endocrine issues, post-pubertal

Psycho: personal/parental Hx of depression, high neuroticism trait, ruminative style of thinking

Social: Poverty, permanent change in interpersonal relationships, parental loss, bullying, isolation

Question 23

Recovery from childhood depression

Answer 23

10% at 3mths

50% at 1yr

80% at 2yrs

Question 24

Recurrence for childhood depression

Answer 24

30% recurrence within next 5 years

20% progress to diagnosis of bipolar

Question 25

Presentation of childhood depression

Answer 25

Atypical features: Weight gain, hypersomnia, sleep disturbance but not EMW

Mood: Irritable, feeling everything is unfair, withdrawal from school

Somatization: Abdominal pain, headache, fatigue

Question 26

Clinical features of ODD

Answer 26

Oppositional defiance disorder

Recurrent disobediant and defiant behaviour (hostility towards authority figures)

Generally boys <10

Arguments, provocation of others, noncompliance with rules

Not extreme aggression (c.f. CD)

Question 27

Poor prognostic factors for ODD/CD

Answer 27

Male

Co-morbid ADHD

Low IQ

Parental criminality, alcoholism

Poor socioeconomic and educational status

Early onset

Question 28

Management of ODD/CD

Answer 28

Psychoeducation: Child + family

Parent management training: Group-based treatments (e.g. Positive parenting programme)

Treat comorbidity: e.g. ADHD, learning difficulty

Child interventions: Anger management, social skills

Education: Liaise with school

Question 29

Differential/comorbidity for ODD/CD

Answer 29

ADHD/ASD

Adjustment (should resolve by 6 mo)

Depression/anxiety

Substance misuse

LD