child and adolescent - mentor & more 9 Flashcards
1
Q
What is the general definition of self-harm?
A
Any act of self-poisoning or self-injury carried out by an individual irrespective of motivation.
2
Q
Which types of harm are excluded from the definition of self-harm?
A
Excessive alcohol or drug consumption, starvation from anorexia nervosa, or accidental harm to oneself.
3
Q
What are the most common methods of self-harm?
A
- Overdose
- Cutting
- Burning
- Hitting or mutilating body parts
- Attempted hanging or strangulation
4
Q
What demographic shows higher rates of self-harm?
A
Younger people, particularly girls.
5
Q
What percentage of boys and girls reported self-harming in the HSBC study?
A
- 11% of boys
- 32% of girls
6
Q
What is the prevalence rate of self-harm among 15-year-olds in England according to the HBSC Study?
A
22%
7
Q
What is the estimated lifetime risk of self-harm among adolescents in OECD countries?
A
13%-18%
8
Q
At what ages are self-harming behaviors most likely to occur?
A
Between 12 and 15 years.
9
Q
What is the lifetime prevalence of self-harm in Goth subcultures?
A
53%
10
Q
What is the annual prevalence of self-harm across all age groups?
A
Approximately 0.5%.
11
Q
By how much does self-harm increase the likelihood of eventual suicide?
A
50 to 100-fold above the rest of the population in a 12-month period.
12
Q
What percentage of self-harm patients repeat within one year according to one systematic review?
A
16%
13
Q
What proportion of people who self-harm have visited their GP in the previous month?
A
Approximately half.
14
Q
What percentage of people engage in self-harm at some point in their lives?
A
6%
15
Q
What types of psychiatric problems are associated with self-harm?
A
- Borderline personality disorder
- Depression
- Bipolar disorder
- Schizophrenia
- Drug and alcohol-use disorders
16
Q
What must be considered when assessing older people who self-harm?
A
They often have a suicidal intent and it must be taken very seriously.
17
Q
List some risk factors for non-fatal repetition of self-harm.
A
- Previous self-harm
- Personality disorder
- Hopelessness
- History of psychiatric treatment
- Schizophrenia
- Alcohol abuse/dependence
- Drug abuse/dependence
18
Q
What are the risk factors for suicide following an act of self-harm?
A
- Previous episodes of self-harm
- Suicidal intent
- Poor physical health
- Male gender
19
Q
True or False: Psychosocial assessment should be delayed until after medical treatment is completed.
A
False
20
Q
What does NICE recommend regarding the use of breath or blood alcohol levels in psychosocial assessments?
A
Do not use them to delay the psychosocial assessment.
21
Q
What are risk assessment tools described as by NICE?
A
‘Crude’ and NOT recommended for predicting future suicide or repetition of self-harm.
22
Q
What is the recommended approach to managing self-harm in emergency departments?
A
Do not use mechanical restraint.
23
Q
What type of psychological intervention is recommended for adults who self-harm?
A
Structured, person-centred, cognitive behavioural therapy (CBT)-informed intervention.
24
Q
When should follow-up be arranged for a person who has self-harmed?
A
Within 48 hours of discharge from hospital.
25
What is the role of activated charcoal in poison management?
It can bind to the poison and prevent absorption.
26
What are some contraindications for using activated charcoal?
* Unprotected airway
* High threat of GI perforation or hemorrhage
* Likely endoscopy
* Intestinal obstruction
* Known non-adsorption of the ingested toxin
27
What are some examples of drugs that require emergency measurement of plasma or serum concentration?
* Carbamazepine
* Digoxin
* Ethanol
* Iron
* Lithium
* Paracetamol
* Salicylate
28
What should be done in cases of paracetamol poisoning?
Levels should be measured no earlier than 4 hours after ingestion.
29
What is the percentage of acute presentations with poisoning that involve paracetamol?
30 to 40%
30
What is a significant risk factor for paracetamol toxicity?
Conversion to a benzoquinonimine metabolite due to inducing drugs or chronic alcohol use.
31
What is the treatment of choice for paracetamol overdose?
Intravenous acetylcysteine.
32
When should acetylcysteine treatment commence?
In patients whose plasma-paracetamol concentration falls on or above the treatment line on the paracetamol treatment graph.
33
What is the time frame for administering acetylcysteine after ingestion of more than 150 mg/kg of paracetamol?
It should be given to those who present within 8 hours of ingestion if there will be a delay of 8 hours or more in obtaining the paracetamol concentration.
34
What should be done for patients presenting 8-24 hours after ingestion of an acute overdose of paracetamol?
Acetylcysteine should be administered even if the plasma-paracetamol concentration is not yet available.
35
What are the criteria for administering acetylcysteine more than 24 hours after overdose?
If the patient is jaundiced, has hepatic tenderness, ALT is above normal, INR is greater than 1.3, or paracetamol concentration is detectable.
36
How long is acetylcysteine normally administered?
Over 21 hours.
37
What are common side effects of acetylcysteine?
Pseudo-allergic reactions (5-10%) and nausea or vomiting (approx 25%).
38
What is the antidote for opioid overdose?
Naloxone.
39
What type of antagonist is naloxone?
A pure opioid competitive antagonist at all receptor sites (mu, kappa, and delta).
40
What effects does naloxone reverse?
Coma and respiratory depression from all opioids, including partial agonists like buprenorphine.
41
What is flumazenil used for?
To reduce the need for admission to intensive care in benzodiazepine overdose.
42
Who should flumazenil be avoided in?
Patients who may have ingested proconvulsants, those with a history of epilepsy, and patients dependent on benzodiazepines.
43
How does flumazenil work?
It reverses the effects of benzodiazepines by competitive inhibition at the benzodiazepine binding site on the GABA-A receptor.
44
What is the first-line treatment option for superficial uncomplicated skin lacerations of 5 cm or less?
The use of tissue adhesive.
45
What alternative can be used for skin closure if the patient prefers?
Skin closure strips.
46
What are dyssomnias?
Dyssomnias are sleep disorders that affect the quality, timing, and amount of sleep.
47
What are intrinsic sleep disorders?
Intrinsic sleep disorders include narcolepsy, psychophysiologic insomnia, idiopathic hypersomnia, restless leg syndrome, periodic limb movement disorder, and obstructive sleep apnea.
48
What are extrinsic sleep disorders?
Extrinsic sleep disorders include inadequate sleep hygiene and alcohol dependent sleep disorder.
49
What are circadian rhythm disorders?
Circadian rhythm disorders include jet lag syndrome, shift work sleep disorder, irregular sleep-wake pattern, delayed sleep phase syndrome, and advanced sleep phase disorder.
50
What are parasomnias?
Parasomnias are abnormal behaviors or experiences during sleep.
51
What are arousal disorders?
Arousal disorders include sleep walking and sleep terrors.
52
What are sleep-wake transition disorders?
Sleep-wake transition disorders include rhythmic movement disorder, sleep talking, and nocturnal leg cramps.
53
What are parasomnias associated with REM sleep?
Parasomnias associated with REM sleep include nightmares, sleep paralysis, and REM sleep behavior disorder.
54
What are other parasomnias?
Other parasomnias include sleep bruxism.
55
What is obstructive sleep apnoea?
Obstructive sleep apnoea is characterised by repetitive episodes of apnoea or hypopnea caused by upper airway obstruction during sleep, resulting in reductions in blood oxygen saturation and brief arousals from sleep. Excessive sleepiness is a major presenting complaint in many but not all cases.
56
What are common complaints associated with obstructive sleep apnoea?
Common complaints include excessive sleepiness, insomnia, poor sleep quality, and fatigue.
57
How is obstructive sleep apnoea diagnosed in children?
It is diagnosed when the frequency of obstructive events is greater than one per hour, accompanied by signs or symptoms related to the breathing disorder.
58
What are the treatment options for obstructive sleep apnoea?
Treatment options include Continuous Positive Airway Pressure (CPAP) therapy, lifestyle changes, and surgical options in severe cases.
59
What is narcolepsy?
Narcolepsy is a disorder characterised by excessive sleepiness associated with cataplexy and other REM sleep phenomena.
60
What is cataplexy?
Cataplexy is characterised by sudden loss of bilateral muscle tone provoked by strong emotion.
61
What are the treatment options for narcolepsy?
Treatment options include good sleep hygiene, stimulant medications, and sodium oxybate or pitolisant for cataplexy.
62
What is periodic limb movement disorder?
It is characterised by periodic episodes of repetitive limb movements during sleep, often associated with partial arousal or awakening.
63
What are the treatment options for periodic limb movement disorder?
Treatment options include dopaminergic agents and sleep hygiene practices.
64
What is restless legs syndrome?
Restless legs syndrome is characterised by disagreeable leg sensations prior to sleep onset, causing an urge to move the legs.
65
What are the treatment options for restless legs syndrome?
Treatment options include dopaminergic agents, iron supplements if deficient, and lifestyle changes.
66
What is non 24-hour sleep wake syndrome?
It consists of a chronic pattern of daily delays in sleep onset and wake times, resulting in a sleep-wake pattern out of sync with the 24-hour day.
67
What are the treatment options for non 24-hour sleep wake syndrome?
Treatment options include melatonin supplements and light therapy.
68
What is sleepwalking?
Sleepwalking consists of complex behaviours initiated during slow-wave sleep, resulting in walking during sleep.
69
What are the treatment options for sleepwalking?
Treatment options include ensuring a safe sleep environment, addressing underlying disorders, and medications in severe cases.
70
What are sleep terrors?
Sleep terrors are characterised by sudden arousal from slow-wave sleep with intense fear and autonomic manifestations.
71
What are the treatment options for sleep terrors?
Treatment options include reassurance, addressing underlying disorders, and medications in severe cases.
72
What is rhythmic movement disorder?
It comprises stereotyped, repetitive movements involving large muscles occurring just before sleep onset.
73
What are the treatment options for rhythmic movement disorder?
Treatment options include behavioural interventions and medications if movements cause disruption.
74
What are sleep starts?
Sleep starts are sudden, brief contractions of the legs occurring at sleep onset.
75
What are the treatment options for sleep starts?
They are generally benign and may not require treatment; good sleep hygiene is recommended.
76
What are nocturnal leg cramps?
Nocturnal leg cramps are painful sensations of muscular tightness occurring during sleep.
77
What are the treatment options for nocturnal leg cramps?
Treatment options include stretching exercises, hydration, and quinine in persistent cases.
78
What is REM sleep behaviour disorder?
It is characterised by repeated episodes of sleep-related vocalisation or complex motor behaviours during REM sleep.
79
What are the treatment options for REM sleep behaviour disorder?
Treatment options include ensuring a safe sleep environment, addressing sleep hygiene, and medications.
80
What are nightmares?
Nightmares are frightening dreams that usually awaken the sleeper from REM sleep.
81
What are the treatment options for nightmares?
Treatment options include reassurance, imagery rehearsal, cognitive-behavioural therapy, and good sleep hygiene.
82
What is sleep paralysis?
Sleep paralysis is characterised by transient paralysis of skeletal muscles occurring when awakening from sleep.
83
What are the treatment options for sleep paralysis?
Treatment options include reassurance, improving sleep hygiene, and anxiolytic medications for severe cases.
84
What is deliberate self-harm in the Goth community?
Deliberate self-harm is relatively common among young people, with rates of 7%-14% in the UK.
85
What is the association between the Goth community and self-harm?
Identification with the Goth community is associated with a 53% prevalence of self-harm and 47% for lifetime attempted suicide.
86
What is Tourette's syndrome?
Tourette's syndrome is a tic disorder involving multiple motor tics and one or more vocal tics.
87
What are the characteristics of tics?
Tics are involuntary, rapid, recurrent movements or vocalisations that serve no apparent purpose.
88
What is the typical onset age for Tourette's syndrome?
The mean age of onset is six to seven years, often with a history of motor tics preceding vocal tics.
89
What are common comorbidities with Tourette's syndrome?
Common comorbidities include attention-deficit/hyperactivity disorder (ADHD) and obsessive-compulsive behaviours.
90
What are the first-line treatment options for Tourette's syndrome?
Clonidine is recommended as first-line treatment, with antipsychotics used but less favourably.
91
What is the prevalence of Tourette's syndrome?
The estimated prevalence is 1% of children.
92
What is the 1st line recommendation for Tourette's without ADHD or OCD?
CBIT
93
What is the 2nd line recommendation for Tourette's without ADHD or OCD?
Alpha-2-agonist (e.g. clonidine or guanfacine)
94
What is the 1st line recommendation for Tourette's with ADHD?
Methylphenidate (or dexamfetamine)*
95
What is the 2nd line recommendation for Tourette's with ADHD?
Alpha-2-agonist
96
What is the 3rd line recommendation for Tourette's with ADHD?
Atomoxetine
97
What is the 1st line recommendation for Tourette's with OCD?
CBT
98
What is the 2nd line recommendation for Tourette's with OCD?
SSRI
