Child and Adolescent Psych

Question 1

Aspergers syndrome Mx

Answer 1

Support
Advice
Routine
Social skills training

Question 2

Depression in children Mx

Answer 2

1st line: CBT
Antideps in severe (fluox safest)
good prognosis

Question 3

Anxiety disorders (Inc. separation and school refusal)

Answer 3

psyhch therapies

Question 4

Encopresis mx

Answer 4

laxatives in constipated
Reassure, address stress and r/v toilet training
Star charts

Question 5

Conduct disorder

Answer 5

Family education (inc. how they may accidentally reinforce)
Parent management training (teaches good behaviour rewarding, constructive mx of negative behaviour)
Family therapy
Educational support
Anger Mx
Mx comorb eg ADHD
Prog: 50% will develop substance misuse or dissocial personality disorder as adults

Question 6

Tic disorders

Answer 6

Reassure, stress management
Clonidine (a2 agonist)
Haloperidol

Question 7

Personality disorders in children

Answer 7

Treatable
Encourage individual to take responsibility
Boundaries are essential
Psychotherapy
Medication
Treat comorb
Prognosis: although persistent severity may fluctuate

Question 8

Psychotherapy in PD in children

Answer 8

1. CBT
2. DBT (CBT for those who experience emotion very intensely, focus on changing unhelpful behaviour and accepting your self)
3. Cognitive analytical therapy
4. Mentalisation (integrates psychodynamic, CBT, systemic approach)
5. Therapeutic communities
6. Psychodynamic and psychoanalytical psychotherapy

Question 9

Medication in PD in children

Answer 9

Antipsych: may reduce impulsivity and aggression (eg risperidone)
Antidepressants: may reduce impulsivity and anxiety
Mood stabilisers: if labile affect (not evidence based)

Question 10

Emotionally unstable Personality Disorder in children Mx

Answer 10

Formulate long and short term goals and a crisis plan
1st line DBT
alt. mentalisation based therapy, therapeutic communites, arts therapies
?SSRI if impulsive
Check for insomnia

Question 11

DBT in Emotionally unstable Personality Disorder in children

Answer 11

Focus on factors contributing to emotional instability
- being emotionally vulnerable and sensitive to stress
- Growing up in an environment where your emotions are dismissed
Leads to cycle of intense emotions making you feel worthless making you do things which make you upset
2 key concepts:
1. Validation: accepting your emotions are acceptable
2. Dialetics: showing you things in life are rarely black/white, helping you to be open to ideas that contradict your own

Question 12

Mentalisation based therapy inEmotionally unstable Personality Disorder in children

Answer 12

Ability to think about thinking
Take a step back and scrutinise impulses and thoughts
Recognising other peoples thought patterns and accepting you might not be right
Lasts 18m
some places recommend inpt Mx

Question 13

Treating a crisis in Emotionally unstable Personality Disorder in children

Answer 13

Provide out of hours contact to:
community mental health nurse
Social worker
Local crisis resolution team
?sedative antihistamines

Question 14

PACES Emotionally unstable Personality Disorder in children

Answer 14

Dx: increased sens. to emotions and linked to stressful life experiences and circumstances
Explain are often undiagnosed (up 10% may have PD, around 2% EUPD)
DBT (helps understand thought processes, teaches not black+white)
Use of therapeutic communitie
Crisis Mx
Mind.co.uk

Question 15

Chronic insomnia in children

Answer 15

Difficulty getting to sleep or maintaining sleep for 3+ nights/wk for 3m
Sleep diary, ?actigraphy
Identify potential cause eg depression/anx.
Sleep hygiene
Advise not drive while tired
Consider hypnotics if ma. day time impairment:
- short acting BZ (loraz) or Z-drug
Lowest poss dose lowest time
r/v 2 wks and consider CBT