Child and adolescent psychiatry 2 Flashcards
5 main steps in the adolescent psychiatric history
presentation - PC and HPC background - past psych and PMH, social, meds, FH, personal history and developmental MSE - room, school observations formulation - 4 P grid management plan
Other information areas
collateral history
questionnaires
other assessments
4 Pā model
predisposing
precipitating
perpetuating
protective
Biopsychosocial factors
b - genetic, neurodevelopment, illness etc
P - temperament, attachment, perfectionism/beliefs etc
S - peers, hobbies, religion, school, finances
How are conduct disorders categorised?
repetitive and persistent pattern of anti-social, aggressive or defiant behaviours which violate norms
Outcome and risks with conduct disorders
early death - violent social exclusion unemployment adult mental health problems criminal activity
Managing conduct disorders
parent training programme modify school environment functional family therapy address child protection concerns child interventions = anger management, confidence
core features of hyperkinetic disorders
abnormal inattention
impulsivity
hyperactivity
co-morbid traits of hyperkinetic disorders
anxiety and depression
substance misuse
motor co-ordination
learning difficulties
ADHD management
psychoeducation meds - stimulants behavioural intervention parent training benefits
Medication for ADHD
ritalin/methylphenidate oral
Principle of ritalin
non-addictive
purely symptomatic treatment
lasts 4 hours and wears off
side effects of ritalin
appetite, weight, sleep
2nd line medication for ADHD/ADD
atomoxetine
non stimulant
Why do people self harm?
coping mechanism
deal with emotional pain, break feelings of numbness
Factors increasing risk of suicide
persistent suicidal ideas and behaviour high lethality of method mental disorder physical and sexual abuse impulsivity, neuroticism, low self esteem poor physical health
Managing suicide - first priority
safety of young person
Management of suicide
admit to medical ward
medical and psychosocial assessment
CAMHS, child protection
