Child and Adolescent Mental Health CAMH Flashcards
What is classed as Depression in Children and Adolescents?
Depression is a disorder that causes persistent feelings of low mood, low energy and reduced interest. It can affect people of all ages, including children and adolescents. It is often triggered by life events, although it can happen without any apparent triggers.
Typical symptoms of depression include:
* Low mood
* Anhedonia, a lack of pleasure in activities
* Low energy
* Anxiety and worry
* Clinginess
* Irritability
* Avoiding social situations (e.g. school)
* Hopelessness about the future
* Poor sleep, particularly early morning waking
* Poor appetite or over eating
* Poor concentration
* Physical symptoms such as abdominal pain
There are key points that need to be considered in assessing children and adolescents with depression. Particular attention needs to be given to the ________________ ____________. It is important to ask question in private as well as taking a history with parents or others present.
There are key points that need to be considered in assessing children and adolescents with depression. Particular attention needs to be given to the psychosocial contributors. It is important to ask question in private as well as taking a history with parents or others present.
Name some psychosocial contributors?
- Potential triggers (e.g. loss of a family member)
- Home environment
- Family relationships
- Relationship with friends
- Sexual relationships
- School situations and pressures
- Bullying
- Drugs and alcohol
- History of self harm
- Thoughts of self harm or suicide
- Family history
- Parental depression
- Parental drug and alcohol use
- History of abuse or neglect
Management for Mild Depression in children/asdolescent?
Mild depression or low mood associated with a single negative event (e.g. loss of a family member) can be managed with watchful waiting and advice about healthy habits, such as healthy diet, exercise and avoiding alcohol and cannabis. Follow up within 2 weeks is advised.
Management for moderate to severe depression?
NICE recommend referral to CAMHS for children with moderate to severe depression. CAMHS can then initiate:
- Full assessment to establish a diagnosis
- Psychological therapy as the first line treatment with cognitive behavioural therapy, non-directive supportive therapy, interpersonal therapy and family therapy
- Fluoxetine is the first line antidepressant in children, starting at 10mg and increasing to a maximum of 20mg
- Sertraline and** citalopram** are second line antidepressants
- When the child responds to medical treatment, it should continue 6 months after remission is achieved
- When they do not respond to medical treatment they may require intensive psychological therapy
Where there is follow up monitoring in secondary care, the mood and feelings questionnaire (MFQ) may be used to assess progress.
Admission may be required where there is high risk of self harm, suicide or self-neglect or where they may be an immediate safeguarding issue.
What is Obsessive compulsive disorder (OCD)?
Obsessive compulsive disorder (OCD) is characterised by obsessions and compulsions.
Name some common examples OCD
Examples of this are an overwhelming fear of contamination with** dirt or germs** or violent or explicit images that keep appearing in their mind.
OCD: What is the difference between obsessions and compulsions?
Obsessions are unwanted and uncontrolled thoughts and intrusive images that the person finds it very difficult to ignore. Examples of this are an overwhelming fear of contamination with dirt or germs or violent or explicit images that keep appearing in their mind.
Compulsions are repetitive actions the person feels they must do, generating anxiety if they are not done. Often these compulsions are a way for the person to handle the obsessions. For example, checking that all electrical equipment is turned off to settle the anxiety of obsessing about the house burning down. This is a normal behaviour, but in OCD the person may check every plug in the house 10 times before being able to go to sleep or leave.
What is the cycle in OCD?
There is a cycle in** OCD: **The obsessions lead to anxiety, which leads to the compulsive behaviour, which lea ds to a temporary improvement in the anxiety. Shortly after the temporary improvement in anxiety the obsession reappears, leading to further anxiety, further compulsive behaviour with a temporary relief. This cycle continues and each time gets more engrained in the person’s behaviour. Without doing the compulsions, the person feels they cannot get relief from their anxiety.
OCD is strongly related to other mental health issues:
- Anxiety
- Depression
- Eating disorders
- Autistic spectrum disorder
- Phobias
Management of OCD
Mild OCD may be managed with education and self help resources.
More significant OCD may require:
- Referral to CAMHS
- Patient and carer education
- Cognitive behavioural therapy
- SSRIs medications (under the guidance of a CAMHS specialist)
What is ASD?
Autistic spectrum disorder refers to the full range of people affected by a deficit in** social interaction, communication and flexible behaviour**
What is Asperger syndrome?
The autistic spectrum has a significant range. On one end patients have normal intelligence and ability to function in everyday life but displaying difficulties with reading emotions and responding to others. This was previously known as **Asperger syndrome. **
Features of ASD can be noticed from the age of?
3
ASD Social Interaction features?
- Lack of eye contact
- Delay in smiling
- Avoids physical contact
- Unable to read non-verbal cues
- Difficulty establishing friendships
- Not displaying a desire to share attention (i.e. not playing with others)
ASD Communication features?
- Delay, absence or regression in language development
- Lack of appropriate non-verbal communication such as smiling, eye contact, responding to others and sharing interest
- Difficulty with imaginative or imitative behaviour
- Repetitive use of words or phrases
ASD Behaviour Features?
- Greater interest in objects, numbers or patterns than people
- Stereotypical repetitive movements. There may be self-stimulating movements that are used to comfort themselves, such as hand-flapping or rocking.
- Intensive and deep interests that are persistent and rigid
- Repetitive behaviour and fixed routines
- Anxiety and distress with experiences outside their normal routine
- Extremely restricted food preferences
Diagnosis of ASD?
Diagnosis should be made by a specialist in autism. This may be a paediatric psychiatrist or paediatrician with an interest in development and behaviour. A diagnosis can be made before the age of 3 years. It involves a detailed history and assessment of the child’s behaviour and communication.
Management of ASD?
Autism cannot be cured. Management depends on the severity of the child’s condition. Management involves a **multidisciplinary team **to provide the best environment and support for the child and parent:
- Child psychology and child and adolescent psychiatry (CAMHS)
- Speech and language specialists
- Dietician
- Paediatrician
- Social workers
- Specially trained educators and special school environments
- Charities such as the national autistic society
What does ADHD stand for?
Attention Deficit Hyperactivity Disorder
What is ADHD
Attention deficit hyperactivity disorder (ADHD) is at the extreme end of “hyperactivity” and inability to concentrate (“attention deficit“). It affects the person’s ability to carry out everyday tasks, develop normal skills and perform well in school.
ADHD
Features should be consistent across various settings. When a child displays these features only at school but is calm and well behaved at home, this is suggestive of an _____________ _________ rather than an underlying diagnosis
Features should be consistent across various settings. When a child displays these features only at school but is calm and well behaved at home, this is suggestive of an environmental problem rather than an underlying diagnosis
Features of ADHD?
All the features of ADHD can be part of a normal spectrum of childhood behaviour. When many of these features are present and it is adversely affecting the child, ADHD can be considered:
- Very short attention span
- Quickly moving from one activity to another
- Quickly losing interest in a task and not being able to persist with challenging tasks
- Constantly moving or fidgeting
- Impulsive behaviour
- Disruptive or rule breaking
Management of ADHD
A detailed assessment should be carried out by a specialist in childhood behavioural problems before a diagnosis is made. Management should be coordinated by a specialist in ADHD. Parental and child education is essential. This includes education about parental strategies to manage the child.
Establishing a **healthy diet **and **exercise **can offer significant improvement in symptoms. Keeping a food diary may suggest a link between certain foods, such as food colourings, and behaviour. Elimination of these triggers should be done with the assistance of a dietician
Medication is an option after conservative management has failed or in severe cases. This should be coordinated by a specialist. Contrary to what you might think, they are central nervous system stimulants.
Examples of medication used for ADHD?
- Methylphenidate (“Ritalin“)
- Dexamfetamine
- Atomoxetine
Eating Disorders strong correlations?
There is a strong correlation with personality disorders, obsessive compulsive disorder, anxiety and other mental health disorders.
Are Eating disorders more common in girls or boys?
Eating disorders are more common in girls.
Can Eating disorders be genetic?
yes
Personality disorders are thought to result from a combination of ________ and ____________ factors. Patients often have a history of ….
Personality disorders are thought to result from a combination of genetic and environmental factors. Patients often have a history of early childhood trauma and difficult circumstances.
Explain the ACE pyramid
