Child and adolescent psychiatry 2

Question 1

5 main steps in the adolescent psychiatric history

Answer 1

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

Question 2

Other information areas

Answer 2

collateral history
questionnaires
other assessments

Question 3

4 P’ model

Answer 3

predisposing
precipitating
perpetuating
protective

Question 4

Biopsychosocial factors

Answer 4

b - genetic, neurodevelopment, illness etc
P - temperament, attachment, perfectionism/beliefs etc
S - peers, hobbies, religion, school, finances

Question 5

How are conduct disorders categorised?

Answer 5

repetitive and persistent pattern of anti-social, aggressive or defiant behaviours which violate norms

Question 6

Outcome and risks with conduct disorders

Answer 6

early death - violent 
social exclusion 
unemployment
adult mental health problems 
criminal activity

Question 7

Managing conduct disorders

Answer 7

parent training programme
modify school environment 
functional family therapy 
address child protection concerns
child interventions = anger management, confidence

Question 8

core features of hyperkinetic disorders

Answer 8

abnormal inattention
impulsivity
hyperactivity

Question 9

co-morbid traits of hyperkinetic disorders

Answer 9

anxiety and depression
substance misuse
motor co-ordination
learning difficulties

Question 10

ADHD management

Answer 10

psychoeducation 
meds - stimulants
behavioural intervention 
parent training 
benefits

Question 11

Medication for ADHD

Answer 11

ritalin/methylphenidate oral

Question 12

Principle of ritalin

Answer 12

non-addictive
purely symptomatic treatment
lasts 4 hours and wears off

Question 13

side effects of ritalin

Answer 13

appetite, weight, sleep

Question 14

2nd line medication for ADHD/ADD

Answer 14

atomoxetine

non stimulant

Question 15

Why do people self harm?

Answer 15

coping mechanism

deal with emotional pain, break feelings of numbness

Question 16

Factors increasing risk of suicide

Answer 16

persistent suicidal ideas and behaviour 
high lethality of method
mental disorder
physical and sexual abuse
impulsivity, neuroticism, low self esteem
poor physical health

Question 17

Managing suicide - first priority

Answer 17

safety of young person

Question 18

Management of suicide

Answer 18

admit to medical ward
medical and psychosocial assessment
CAMHS, child protection