Child and adolescent psychiatry

Question 1

What are the 3 pervasive developmental disorders?

Answer 1

1. Autism
2. Asperger syndrome
3. Rett syndrome

Question 2

In whom are pervasive developmental disorders more common?

Answer 2

Males - with the exception of Rett syndrome which only affects females

Question 3

What defines the pervasive developmental disorders?

Answer 3

Impairment of language and social skills

Question 4

What medical/physical problem should be ruled out in the assessment of a child with ?pervasive developmental disorder?

Answer 4

Hearing impairment

Question 5

What is the mneumonic for the features of autism?

Answer 5

AUTISTICS

Question 6

What are the features of autism?

Answer 6

A - again and again
U - unusual abilities
T - talking (language) delays
I - IQ subnormal
S - social development poor
T - three year at age of onset
I - inherited component
C - cognitive impairment
S - self-injury

Question 7

Of the disruptive behaviour disorders, how do conduct disorders and oppositional defiant disorder differ?

Answer 7

Patients with oppositional defiant disorder do not violate the rights of others

Question 8

What is the aetiology of a conduct disorder?

Answer 8

1. Male
2. Parenting - single parent; substance abuse; criminality; psychiatric disorder; teenage parents; parenting style; parental conflict
3. Social disadvantage
4. Child - low IQ; neurodevelopment problems; brain damage; epilepsy; poor interpersonal relationships

Question 9

What are the 3 core Sx of ADHD?

Answer 9

1. Inattention
2. Hyperactivity
3. Impulsiveness

Question 10

What are the recognised sub-types of ADHD?

Answer 10

1. Combined subtype - with all 3 core Sx
2. An inattentive subtype (ADD)
3. A hyperactive-impulsive subtype

Question 11

What are the Sx of inattention?

Answer 11

Carless with details, appears not listen, does not complete work, disorganised, loses things, forgetful, easily distracted

Question 12

What are the Sx of hyperactivity?

Answer 12

‘Figidity’, always on the go, leaves chair in class

Question 13

What are the Sx of impulsiveness?

Answer 13

Blurts out answers, interrupts others

Question 14

How is ADHD managed?

Answer 14

Behavioural intervention + medication - methylphenidate (Ritalin)

Question 15

What is a possible long-term consequence of Ritalin?

Answer 15

Growth suppression - long-term use of high doses - this growth monitoring required

Question 16

What is functional enuresis?

Answer 16

The repeated involuntary voiding of urine after an age at which continence is usual and in the absence of any identified physical disorder

Question 17

What is primary/secondary functional enuresis?

Answer 17

Primary = life-long problem
Secondary = occurs after a period of continence

Question 18

At what age do children usually achieve continence (and thus is what the youngest age at which a Dx may be made)?

Answer 18

3-4y/o, and thus 5y/o is the youngest age at which a Dx may be considered

Question 19

How may functional enuresis be managed?

Answer 19

1. Restriction of fluid intake before bedtime
2. Waking the child to pass urine once during the night
3. The use of star charts to reward success

When >6y/o:

4. Enuresis Alarm
5. Treatment with low dose of tricyclic antidepressants (25-50 mg imipramine or amitriptyline at night depending on the age of the child) can reduce bed-wetting