child and adolescent - mentor & more 4

Question 1

Purpose of camberwell Family interview (CFI)

Answer 1

to assess ‘expressed emotion’ (EE) within families

Question 2

what is ‘expressed emotion’ (EE)?

Answer 2

a measure of the family environment based on family members’ discussions about the individual with a mental health condition during the interview.

Question 3

key components identified by the CFI

Answer 3

critical comments, hostility, and emotional over-involvement which are quantified to measure EE

Question 4

A high level of EE within a family, characterised by

Answer 4

frequent critical comments and emotional over-involvement

Question 5

A high level of EE within a family associated with?

Answer 5

a higher risk of relapse in conditions such as schizophrenia

Question 6

How long CFI last?

Answer 6

1-2 hours

Question 7

Another benefit of CFI?

Answer 7

It helps to 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.

Question 8

Types of child abuse

Answer 8

• Neglect
• Emotional abuse
• Physical abuse and non-accidental injury
• Sexual abuse

Question 9

causal contribution (Cohen’s d=0.31) of childhood maltreatment to mental health problems

Answer 9

Small

Question 10

effects of childhood maltreatment on which mental disorders?

Answer 10

internalizings, externalizing and psychosis

Question 11

subtypes of maltreatment are associated with mental health problems

Answer 11

all but emotional abuse and institutional neglect most

Question 12

most contact Child sexual abuse (CSA) is perpetrated by

Answer 12

a person whom the child knows and trusts (and almost always male perpetrator)

Question 13

what portion of CSA do not go on to commit CSA themselves

Answer 13

great majority of victims of CSA

Question 14

is ethinicity a predictor of csa?

Answer 14

no

Question 15

Are most individuals convicted of sexual offences reconvicted of further sexual offences?

Answer 15

No

Question 16

Child maltreatment is?

Answer 16

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.

Question 17

% of individuals experience maltreatment during childhood (self report)

Answer 17

40%

Question 18

Association (not necessarily causative) found between child maltreatment and In young children:

Answer 18

o lower cognitive skills
o anxious, depressed, withdrawn, and aggressive behaviours
o poor emotional, social, and school functioning

Question 19

Association (not necessarily causative) found between child maltreatment and In adolescence:

Answer 19

o poor mental health
o substance use behaviours
o violent victimization and perpetration
o chronic conditions such as asthma, diabetes, pain, and obesity

Question 20

Risk factors: child maltreatment on individual level

Answer 20

age <1 year
Child with disability

Question 21

Risk factors: child maltreatment on Interpersonal level

Answer 21

o poverty
o parental mental health and substance use disorders
o intimate partner violence

Question 22

‘ontogenetic parade’

Answer 22

Marks 1987

the rise and disappearance of certain fears in a predictable sequence during children’s development

Question 23

In middle childhood, fears of

Answer 23

physical danger, bodily injury, and school performance

Question 24

during adolescence, youths more often report fears

Answer 24

about social evaluations and interactions.

Question 25

Strangers, heights, and emergence of separation anxiety

Answer 25

Towards the end of the first year

Question 26

Being alone, the dark, animals

Answer 26

Preschool (3-4)

Question 27

Bodily injury, illness, social situations, supernatural phenomenon, failure and criticism

Answer 27

School years (4-12)

Question 28

Death, economic and political concerns

Answer 28

Begins early and persists through to late adolescence

Question 29

The Mental Health of Children and Young People in England surveys

Answer 29

- 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.

Question 30

Key Points Over the Years: of MHCYPE survey

Answer 30

- 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.

Question 31

Chronic Fatigue Syndrome (CFS), also known as

Answer 31

Myalgic Encephalomyelitis (ME)

Question 32

The aetiology of CFS (chronic fatigue sydnrome)

Answer 32

ranging from viral infections to psychological stress, immune dysfunction, and metabolic disturbances.

Question 33

Diagnosis of CFS

Answer 33

primarily clinical and one of exclusion,

Question 34

Management of CFS

Answer 34

- Multidisciplinary approach - Individualized treatment - Focus on symptom relief and quality of life - Includes: - Graded exercise therapy - Cognitive behavioral therapy

Question 35

for CFS NICE suggest a diagnosis be made when symptoms last for...

Answer 35

3 months

Question 36

NICE symptoms for CFS?

Answer 36

- Severe fatigue - Post-exertional malaise - Unrefreshing sleep - Cognitive issues: 'brain fog'

Question 37

symptoms common but not exclusive of CFS?

Answer 37

* 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.

Question 38

mild CFS according to NICE?

Answer 38

- 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.

Question 39

Moderate CFS according to NICE?

Answer 39

People with moderate ME/CFS experience limited mobility and daily activity restrictions, often requiring daytime rest and suffering from poor sleep quality.

Question 40

Very severe CFS according to NICE?

Answer 40

Severe ME/CFS patients are bedbound, reliant on care for hygiene and eating, and may require tube feeding due to swallowing difficulties.

Question 41

Management: General advice (NICE) for CFS

Answer 41

* Energy management *not to push too much * Routine adjustment * Balanced diet

Question 42

Principles of management: in CFS?

Answer 42

* 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

Question 43

is graded exercise therapy still recommended for CFS?

Answer 43

No

Question 44

what is graded exercise?

Answer 44

- 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.

Question 45

Depression in Young People (NICE Guidelines) NICE Guidelines limit their recommendation to what age?

Answer 45

5-18

Question 46

Mild depression (including dysthymia) - without significant comorbid problems or active suicidal ideas or plans NICE RX

Answer 46

Watchful waiting (no intervention and review in 2 weeks) Digital CBT Group CBT Group IPT Group non-directive supportive therapy (NDST) (If not suitable then individual CBT or attachment-based family therapy)

Question 47

Moderate to severe depression (continued mild depression despite 2-3 months of psychology is treated as moderate / severe) NICE Rx --- 5-11 year olds:

Answer 47

Family based IPT Family therapy (family-focused treatment for childhood depression and systems integrative family therapy) Psychodynamic psychotherapy Individual CBT +/- fluoxetine

Question 48

Moderate to severe depression (continued mild depression despite 2-3 months of psychology is treated as moderate / severe) NICE Rx --- 12-18 year olds

Answer 48

Individual CBT +/- fluoxetine (If not suitable then IPT for adolescents, family therapy (attachment-based or systemic), brief psychosocial intervention or psychodynamic psychotherapy)

Question 49

Treatment resistant depression or depression with psychotic symptoms

Answer 49

Intensive psychological therapy +/- fluoxetine, sertraline, citalopram, augmentation with an antipsychotic

Question 51

Should antidepressant medication be used for the initial treatment of children and young people with mild depression?

Answer 51

No, antidepressant medication should not be used for the initial treatment of children and young people with mild depression.

Question 52

When should antidepressant medication be offered to a child or young person with moderate to severe depression?

Answer 52

Antidepressant medication should not be offered except in combination with a concurrent psychological therapy, unless psychological therapy is declined.

Question 53

What is the recommended antidepressant for children and young people with moderate to severe depression?

Answer 53

Fluoxetine is the recommended antidepressant as it is the only one with clinical trial evidence showing that benefits outweigh risks.

Question 54

What is the starting dose of fluoxetine for children and young people with depression?

Answer 54

The starting dose should be 10 mg daily, which can be increased to 20 mg daily after 1 week if clinically necessary.

Question 55

What should be considered when prescribing fluoxetine to children of lower body weight?

Answer 55

Lower doses should be considered for children of lower body weight.

Question 56

What is the recommendation for continuing fluoxetine treatment after remission?

Answer 56

Fluoxetine should be continued for at least 6 months after remission, defined as no symptoms and full functioning for at least 8 weeks.

Question 57

What are the first-line and second-line antidepressants for children and young people?

Answer 57

Fluoxetine is first-line; sertraline and citalopram are second-line.

Question 58

Which SSRI should not be used for the treatment of depression in children and young people?

Answer 58

Paroxetine and venlafaxine should not be used.

Question 59

Should tricyclic antidepressants be used for the treatment of depression in children and young people?

Answer 59

No, tricyclic antidepressants should not be used.

Question 60

Is St John's wort recommended for the treatment of depression in children and young people?

Answer 60

No, St John's wort should not be prescribed.

Question 61

What is recommended for treating psychotic depression in children and young people?

Answer 61

A second generation antipsychotic should be used.

Question 62

When should ECT be considered for young people?

Answer 62

ECT should only be considered for young people with very severe depression and either life-threatening symptoms.

Question 63

are there negative symptoms in acute and transient psychosis?

Answer 63

No

Question 64

De Lange syndrome

Answer 64

- Child with developmental delay - Intellectual disability - Characteristic facial features: - Arched eyebrows (meet in the midline) - Long eyelashes - Short upturned nose - Thin lips - Limb abnormalities: - Fifth finger clinodactyly - Partial fusion of toes - Confirmed NIPBL gene mutation (associated with Cornelia de Lange syndrome)