Child and Adolescent Psychiatry Flashcards
What should be considered when assessing a paediatric pt?
-It is often useful to first interview the parents with/without the child
present to obtain a list of current concerns as well as a complete
psychiatric, neurodevelopmental, educational and medical history.
This also allows for an indirect evaluation of the parents
personalities, marital relationship and style of parenting which often
gives a different perspective to understanding the context of the
presenting complaint.
• An interview with the child will usually follow although the
information gathered here will usually depend on the age of the
child. Although younger children may not be able to articulate
themselves, it is often useful to observe them in a play situation.
• Obtaining collateral information is extremely important to
understanding the development of the presenting complaint as well
as the child’s premorbid functioning. This will include academic,
educational or psychological reports as well as discussions with
teachers and other agencies involved.
• Finally further information can be gathered by structure and semistructured
interviews as well as parent/teacher rating scales
Disorders of children and adolescence are divided into 4 broad categories, what are they?
- Mental retardation (learning disability)
- Developmental disorders (specific and pervasive)
- Acquired disorders with onset usually in childhood or adolescence
- Acquired ‘adult’ disorders with onset in childhood or adolescence
What is a Learning disability?
- How is cognition measured?
- A value less than what is said be be indicative of a learning disability?
- What are the problems with this scale?
-What does there need to be evidence of to diagnose a learning disability?
- Failure to develop a normal level of cognition
- Cognition is measured by IQ
- IQ > 70
- Doesn’t take into account factors such as sociocultural background, native language and sensory, motor, and communication handicaps
- Significant impairment in adaptive functioning e.g communication, self care, social skills, academia
ICD-10 specifies learning disabilities as mild, moderate, severe and profound according to levels of what?
A Clinical features of the causative process may be?
What other features may be present?
- Intellect and adaptive impairment
- Cardiac septal defects in downs syndrome
- Aggression
- Self injurious behaviour
- Repetitive stereotypical motor movements
- Poor impulse control
What prevalence of people with a learning disability are diagnosed as mild?
- What range does their IQ fall into?
- What are they capable of?
- 85%
- IQ 50-69
- Usually capable of unskilled or semi-skilled manual labour and may be able to live independently
What prevalence of people with a learning disability are diagnosed as moderate?
- What range does their IQ fall into?
- What are they capable of?
- 10%
- IQ 35-49
- Language, self care and comprehension are limited and usually need supervision
- May be able to do some practical work with supervision
What prevalence of people with a learning disability are diagnosed as Severe?
- What range does their IQ fall into?
- What are they capable of?
- 3-4%
- IQ 20-34
- Need substantial care
- Limited motor skills and speech
- Capable of only very basic self care
What prevalence of people with a learning disability are diagnosed as profound?
- What range does their IQ fall into?
- What are they capable of?
-1-2%
-IQ
-
Epidemiology and aetiology
-What is the prevalence of mental retardation in the general population?
-What is its M:F ratio?
In what % of cases is there no clear aetiology?
- 1-2%
- 1.5:1
- 30-40%; these pts may represent the lower end of the normal distribution curve for intellectual functioning
What are some of the major causes of mental retardation?
- Genetic; downs, fragile x, prader-willi
- Prenatal; CMV, rubella, toxoplasmosis, syphilis, VZV, HIV, Aids, substance abuse, pre-eclampsia
- Perinatal; birth trauma, hypoxia, kernicterus
- Environmental; poor, socioculturally deprived, neglect, malnutrition, abuse
- Psychiatric; pervasive developmental disorders
- Medical conditions; meningitis, encephalitis, head injury, toxins
Management and prognosis
-Prevention methods?
-How can adaptive functioning be improved?
- Improved perinatal and child healthcare
- Early detection of metabolic abnormalities
- Genetic counselling
- Therapeutic abortion
- Comprehensive educational and vocational programs
- Family education and support
- Behavioural therapy
- Medication (for aggression, destructive behaviour - antipsychotics, benzodiazepines, lithium and carbamazepine)
- Appropriate residential placement and treatment of co-morbid psychiatric and medical conditions
Developmental disorders
-What are the 2 main types
-Specific and pervasive
What are specific developmental disorders?
-How do these pts compare to those with mental retardation
- Refer to a disturbed acquisition of a specific cognitive or motor function during development e.g language, reading, spelling, arithmetic ect
- Other areas of cognitive function are average or even above average
- Not caused by a lack of opportunity
- Thought to arise from specific biological abnormalities in cognitive processing
- Compared with mentally retarded pts they have less difficulty with overall social and personal functioning
- Teasing and school problems may cause some emotional or behavioural problems
What are pervasive developmental disorders characterised?
- What are they often associated with?
- What is the emphasis on
When do they become evident?
What do these disorders include?
- A severe impairment in social interactions and communication skills
- Restricted stereotyped interests and behaviours
- Behaviours usually affect all areas of a pts functioning
- Often associated with mental retardation, but not necessary for a diagnosis
- Emphasis is on deviant behaviour irrespective of intellectual functioning
-Become evident in 1st few years of pts life
- Autism
- Asperges
- Retts syndrome
- Childhood disintegrative disorder
Autism
What are the 3 characteristic features that manifest within the 1st 3 years of life?
- Impairment of social interaction - poor eye contact, facial expressions, failure to share and enjoy peer relationships
- Impairment in communication - poor spoken language, extreme difficulty initiating and sustaining conversation, lack of imaginative play
- Restricted, stereotyped interests and behaviours; intense preoccupation with interests such as dates, phone numbers, timetables ect, inflexible adherence to routines and rituals, repetitive mmotor movements such as clapping and an unusual interest in parts of hard or moving objects
