Child and adolescent psychiatry 1 Flashcards
How to determine the link between genetic factors and mental illness
twin studies - MZ and DZ
% variance due to genetics and environment
Variance in PKU
100% genetics
environmental factor is causative factor (PKU)
What have genetic factor studies shown?
ADHD and autism highly genetic
depression and anxiety substantially genetic
GWAS - main findings
genetic risk factors for psychiatric disorder
many genes implicated
micro RNA and epigenetic
synapses
Intra-uterine and perinatal factors
drugs and toxins maternal ab, obesity, diabetes premature birth twinning epigenetics - folate controlled methylation endocrine - androgens alcohol
Signs of fetal alcohol syndrome
small head, eyes, body and brain - cerebellum
smooth philtrum
growth retardation
fetal alcohol syndrome: neuro developmental effects
sensorimotor cognitive developmental executive function language
Working memory white matter connectivity
hippocampus and anterior cingulate
What is low connectivity in the white matter associated with?
neural “noise”
intra-individual variability
cognitive instability
Developing brain low white matter connectivity
ADHD - poor concentration
distractibility
Common outcomes of low white matter connectivity and grey matter gyrification
learning difficulties
conduct disorders eg ODD
combines ADHD or ADD
anxiety disorders
ODD symptoms
frequent loss of temper
arguing
becoming easily angered or annoyed
showing vindictive behaviour
ADD symptoms
distractibility
sustaining attention to tasks that don’t provide stimulation or reward
problems with organisation
Hyp/imp symptoms
difficulties with remaining still
impulsivity
without considering consequences
Examples of anxiety disorders
panic disorder
phobia
separation anxiety
GAD
Environmental factors during childhood
attachment parental mental disorder family/marital function nutrition/poverty/neglect abuse and discipline schooling and peers life events physical disability
Attachment
proximity-seeking behaviour
contact with parent when injured, frightened or ill
How do we classify attachment as secure or insecure?
direct observation of behaviour during “strange situation”
Difference between brains reaction to physical and mental stress
brain responds to stress similarly to both
Early life stress on the brain
function of limbic system mood and patterns of response to threat including withdrawal/aggression
Early experience of adversity outcomes
perceived behaviour/aggression
limbic response, increase amygdala activity
cortical response
triad of head injury and behaviour
head injury
behaviour
life events
When do dopamine neurons fire?
associate an action with reward
Reward deficiency model of adverse experience
reduces DA response decreased reward sensitivity increase behaviour for reward and so increased reward for satiety increase tolerance increase behaviour
Consequence of reward deficiency model
“addiction” - obesity, drugs and alcohol, gambling, porn
increased delay-aversion
Executive and cortical control
CBT
inhibit prepotent response
intentional decision making
requires self awareness
Delay aversion (specific condition implicated in)
theory to explain ADHD - inability to wait and maintain attention in absence of immediate reward
“social brain” - emotion contagion
infant-mother interaction
“social brain” - 6 weeks
sensorimotor control
smiling intentionally
“social brain” - 24 months
secondary representation
able to recognise and label emotions
“social brain” - 3/4 years
metarepresentation
self-aware of emotion
able to deceive
“theory of mind”
A true test of ability to represent other’s thoughts as different to one’s own - autism
Expressed emotion
stress and worry impact patients illness and increase relapse rate of chronic conditions
Modelling development of aggressive
cognitive - self control, empathy environment - social and familial reinforcers drugs testosterone social conditioning early adversity genetics brain development & injury
