child and adolescent - mentor & more 4 Flashcards
Purpose of camberwell Family interview (CFI)
to assess ‘expressed emotion’ (EE) within families
what is ‘expressed emotion’ (EE)?
a measure of the family environment based on family members’ discussions about the individual with a mental health condition during the interview.
key components identified by the CFI
critical comments, hostility, and emotional over-involvement which are quantified to measure EE
A high level of EE within a family, characterised by
frequent critical comments and emotional over-involvement
A high level of EE within a family associated with?
a higher risk of relapse in conditions such as schizophrenia
How long CFI last?
1-2 hours
Another benefit of CFI?
It helps psychiatrists identify family stressors affecting recovery and guides interventions like family therapy. This is crucial for preventing relapse and managing chronic psychiatric conditions that rely on family support.
Types of child abuse
- Neglect
- Emotional abuse
- Physical abuse and non-accidental injury
- Sexual abuse
causal contribution (Cohen’s d=0.31) of childhood maltreatment to mental health problems
Small
effects of childhood maltreatment on which mental disorders?
internalizings, externalizing and psychosis
subtypes of maltreatment are associated with mental health problems
all but emotional abuse and institutional neglect most
most contact Child sexual abuse (CSA) is perpetrated by
a person whom the child knows and trusts (and almost always male perpetrator)
what portion of CSA do not go on to commit CSA themselves
great majority of victims of CSA
is ethinicity a predictor of csa?
no
Are most individuals convicted of sexual offences reconvicted of further sexual offences?
No
Child maltreatment is?
Any recent act or failure by a parent or caregiver that leads to death, serious harm, sexual abuse, exploitation, or poses imminent risk of serious harm to a child under 18.
% of individuals experience maltreatment during childhood (self report)
40%
Association (not necessarily causative) found between child maltreatment and In young children:
o lower cognitive skills
o anxious, depressed, withdrawn, and aggressive behaviours
o poor emotional, social, and school functioning
Association (not necessarily causative) found between child maltreatment and In adolescence:
o poor mental health
o substance use behaviours
o violent victimization and perpetration
o chronic conditions such as asthma, diabetes, pain, and obesity
Risk factors: child maltreatment on individual level
age <1 year
Child with disability
Risk factors: child maltreatment on Interpersonal level
o poverty
o parental mental health and substance use disorders
o intimate partner violence
‘ontogenetic parade’
Marks 1987
the rise and disappearance of certain fears in a predictable sequence during children’s development
In middle childhood, fears of
physical danger, bodily injury, and school performance
during adolescence, youths more often report fears
about social evaluations and interactions.
Strangers, heights, and emergence of separation anxiety
Towards the end of the first year
Being alone, the dark, animals
Preschool (3-4)
Bodily injury, illness, social situations, supernatural phenomenon, failure and criticism
School years (4-12)
Death, economic and political concerns
Begins early and persists through to late adolescence
The Mental Health of Children and Young People in England surveys
- Data on UK children’s mental health collected since 2017.
- Methodology: Robust assessments across age groups.
- Covers ages 8 to 25 in England.
- 2017 survey focused on ages 2 to 19; follow-ups expanded ages.
- 2023 survey included 2,370 participants from the original cohort, tracking changes.
Key Points Over the Years: of MHCYPE survey
- Rising youth mental health disorders - Emotional disorders, especially anxiety and depression, are increasing, particularly in older adolescents and girls.
- Stable rates of hyperactivity and behavioral disorders, more common in boys.
- Socioeconomic factors linked to mental health; lower-income children face higher risks.
- Notable rise in eating disorders. - COVID-19 heightened emotional distress, with long-term mental health effects observed.
Chronic Fatigue Syndrome (CFS), also known as
Myalgic Encephalomyelitis (ME)
The aetiology of CFS (chronic fatigue sydnrome)
ranging from viral infections to psychological stress, immune dysfunction, and metabolic disturbances.
Diagnosis of CFS
primarily clinical and one of exclusion,
Management of CFS
- Multidisciplinary approach
- Individualized treatment
- Focus on symptom relief and quality of life
- Includes:
- Graded exercise therapy
- Cognitive behavioral therapy
for CFS NICE suggest a diagnosis be made when symptoms last for…
3 months
NICE symptoms for CFS?
- Severe fatigue, worsens with activity; not due to exertion; minimal relief from rest.
- Post-exertional malaise: delayed symptom onset; disproportionate to activity; prolonged recovery (hours to weeks).
- Unrefreshing sleep: fatigue upon waking; broken/shallow sleep or hypersomnia.
- Cognitive issues: ‘brain fog’, word/number retrieval problems, slow response, short-term memory loss, concentration difficulties.
symptoms common but not exclusive of CFS?
- Orthostatic intolerance: dizziness, palpitations, fainting, nausea when standing or sitting upright.
- Temperature hypersensitivity: sweating, chills, hot flushes, or feeling very cold.
- Neuromuscular symptoms: twitching, myoclonic jerks.
- Flu-like symptoms: sore throat, tender glands, nausea, chills, muscle aches.
- Intolerance to alcohol, certain foods, and chemicals.
- Heightened sensory sensitivities: light, sound, touch, taste, smell.
- Pain: myalgia, headaches, eye pain, abdominal pain, joint pain without redness, swelling, or effusion.
mild CFS according to NICE?
- People with mild ME/CFS manage light tasks with occasional support.
- Mobility can be challenging.
- Many continue working or studying.
- Typically, they forgo leisure and social activities.
- They often reduce work hours, take days off, and rely on weekends for recovery.
Moderate CFS according to NICE?
People with moderate ME/CFS experience limited mobility and daily activity restrictions, often requiring daytime rest and suffering from poor sleep quality.
Very severe CFS according to NICE?
Severe ME/CFS patients are bedbound, reliant on care for hygiene and eating, and may require tube feeding due to swallowing difficulties.
Management:
General advice (NICE) for CFS
- Energy management *not to push too much
- Routine adjustment
- Balanced diet
Principles of management: in CFS?
- Energy management: Self-managing activities to stay within energy limits, with healthcare support.
- Personalised physical activity: Establishing and adjusting a safe activity baseline under physiotherapist guidance.
- CBT
is graded exercise therapy still recommended for CFS?
No
what is graded exercise?
- Graded exercise therapy establishes a baseline for physical activity.
- Involves gradual increases in activity levels.
- Based on theories that:
- ME/CFS is exacerbated by physical deconditioning.
- Avoidance of exercise creates a cycle of increased perception of effort and inactivity.
