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Psychiatry > Child and Adolescent Psychiatry > Flashcards

Child and Adolescent Psychiatry Flashcards

1
Q

Core symptoms of ADHD

A

Difficulty concentrating
Hyperactivity
Impulsivity (action without foresight)
Pervasive Condition

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2
Q

Core symptoms of OCD

A

Obsession - thoughts
Compulsion - the behaviour following the thoughts
This results in functional impairment

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3
Q

Core symptoms areas of Autism Spectrum Disorder

A

Difficulty with social interaction
Language Difficulties
Restrictive and repetitive behaviours
Pervasive condition

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4
Q

How do you want the input from in a presenting complaint of children with mental health problems

A

Parents
Child
School

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5
Q

What else should be asked about when taking a psychiatric history from a child

A

Past psychiatric history
Past medical history (temporal lobe epilepsy and head injuries, anaemia, hypothyroidism)
Medications and allergies
Social history and habits (remember to ask about legal highs)
Family history (psychiatric and appropriate medical history)
Personal history (schools, housing, life events, relationships, bullying, abuse)
Developmental History (birth until now)

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6
Q

Biological predisposing factors

A

Genetic predispositions, neurodevelopmental insults, illness

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7
Q

Psychological predisposing factors

A

temperament; attachment style; psychological attributes e.g. impulsivity, low self-esteem, perfectionism; belief systems etc.

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8
Q

Social predisposing factors

A

family relationships; peer relationships; hobbies/ interests; religious faith; neighbourhood; school; rural/ urban; criminality; finances etc.

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9
Q

How are conduct disorders characterised

A

repetitive and persistent patterns of antisocial, aggressive or defiant behaviours which violate age-appropriate societal norms.

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10
Q

Course of conduct disorders

A

persistent disorder, associated with increased risk of early death, often by sudden or violent means. Also at increased risk of social exclusion, poor school achievement, long-term unemployment, criminal activity, adult mental health problems, and poor interpersonal relationships including those with their own children.

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11
Q

Management of conduct disorders

A

Parent training programme (12 or younger) e.g. The Incredible Years
Modification of school environment eg behavioural support
Functional family therapy
Multi-systemic therapy
Child interventions: social skills, problem-solving, anger management, confidence building
Treat comorbidity
Address child protection concerns

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12
Q

Core features of hyperkinetic disorders

A

developmentally abnormal inattention, hyperactivity and impulsivity present across time and situations.

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13
Q

Symptoms of hyperkinetic disorders

A

Specific LD, ASD, CD, tics, motor coordination problems, substance misuse, anxiety, depression.

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14
Q

Hyperkinetic disorders are associated with

A

reduced academic and employment success, increased criminal activity and increased adult mental health problems

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15
Q

Management of ADHD

A 
Psychoeducation
Medication – stimulants, atomoxetine, guanfacine
Behavioural interventions e.g. realistic expectations, contingency management
Parent training - PinC
School interventions
Treat comorbidity
Voluntary organisations 
Benefits
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16
Q

Medication treatment of ADHD

A

Methylphenidate (ritilin) which is closely related to amphetamine.

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17
Q

Side effects of methylphenidate

A

Reduced appetite, weight loss and sleep

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18
Q

Methylphenidate acts on what neurotransmitters

A

NAd and DA systems

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19
Q

2nd line treatment of ADHD

A

Atomoxetine – non stimulant also acts on NAd systems

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20
Q

Self Harm

A

Self injury is a coping mechanism. An individual harms their physical self to deal with emotional pain, or to break feelings of numbness by arousing sensation

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21
Q

What can self harm behaviour indicate

A

Psychiatric disorder or significant psychosocial problems

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22
Q

Factors increasing the risk of suicide in children

A 
Persistent suicidal ideas
Previous suicidal behaviour
High lethality of method used
High suicidal intent and motivation
Ongoing precipitating stresses
Mental disorder
Poor physical health
Impulsivity, neuroticism, low self esteem, hopelessness
Parental psychopathology and suicidal behaviour
Physical and sexual abuse
Disconnection from support systems
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23
Q

Management of suicide in children

A

Usually admit to age appropriate medical ward after serious attempt for medical treatment and psychosocial assessment.
Mental health and risk assessment by specially trained staff member with ready access to psychiatric opinion.
Confidentiality (with exceptions).

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24
Q

Disorders that are highly heritable

A

Autism and ADHD

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25
Q

Genetic risk factors for mental health problems

A

Mostly polygenetic inheritance. Polymorphisms: DAT gene, 5-HTTP, FRAX gene, MAO genes.

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26
Q

Intrauterine and perinatal risk factors for mental health problems

A 
maternal stress - cortisol exposure
Substance misuse – alcohol, marijuana
Toxins – lead, mercury and PCB’s
Drugs - esp psychotropics/antiepileptics (lipid soluble)
Epigenetics – folate controlled methylation
Endocrine environment – esp androgens
Immune environment
Premature birth/ Perinatal complications
Twinning
Impressive levels of resilience
27
Q

Early experiences

A 
Carer-child relationship
Parenting skill
Parental mental disorder
Marital Harmony
Nutrition 
Discipline
28
Q

Later experiences that increase the risk of mental health problems in children

A 
Schooling
Peer relationships
Family functioning
Discipline
Abuse
Life events -
29
Q

Head injuries are more likely to have problems with

A

Behaviour, then more likely to experience adverse life events, the more likely they are to get head injuries and exhibit exotic behaviour

30
Q

Turning points

A

Changing life-trajectory as a result of life-event e.g. Young person brought up in care developing close confiding relationship.

31
Q

Steeling

A

Like the bending or stretching of hot soft steel to make it stronger when cold.

32
Q

Developing social and emotional cognition

A

Joint-attention and ‘theory of other minds’
Reward-based learning
Controlling emotional responses “emotional regulation”
Effects of adverse experiences on development of threat and reward response mechanisms.

33
Q

Jont attention (learning to judge what someone else thinks)

A

Attending to the same thing together, checking and directing another person’s attention.

Motivational aspect:
wanting another person to be interested in what interests you.

Cognitive aspect:
How your brain works out and monitors whether another person is looking at the same thing as you. Checking out that you are both attending to the same thing.

Form of mental state understanding involving action representation.

34
Q

Experience of adversity and the reward deficiency model of addiction

A

Early adversity (reduced DA function), decreased reward sensitivity, increased behaviour to elicit reward; increased reward required for satiety, increased tolerance and increased behaviour.

35
Q

Executive and Cortical Control

A

This is the taking control over the automatic and learned behaviours. It requires self-awareness and capacity to self-monitor.

36
Q

Sharing emotion and empathy

A

Infant mother interaction and emotion contagion.
6 weeks sensorimotor control emerging
24 months - secondary representation, able to recognise and label emotions

37
Q

School refusal

A

Fear of leaving home

Fear of going to school

38
Q

School Truancy

A

Unwilling to leave home

Unwilling to go to school

39
Q

Mental health problems associated with being out of school

A

Anxiety, conduct disorder, autism, depression, OCD

40
Q

Effects of mental health problems on education

A 
Learning difficulties due to poor concentration 
Co-morbid specific learning problems
Difficulty controlling emotion 
Anxiety
Lack of energy, motivation 
Difficulties joining in 
Sensory problems - the classroom may be too noisy 
Fear of germs and contamination
41
Q

Separation anxiety

A

Fear of leaving parents and home. Problems occur on the doorstep of the home or the school

42
Q

Social phobia

A

Fear of joining group. The problems occur at the school gate.

43
Q

Features of anxiety disorder

A

Anxious thoughts and feelings
Autonomic symptoms
Avoidant behaviour

44
Q

Medication treatment of anxiety

A

Serotonin re-uptake inhibitors (fluoxetine)

45
Q

Behavioural Treatment of Anxiety

A

Learning alternative patterns of behaviour
Desensitization
Overcoming fear
Managing feelings

46
Q

What is autistic disorder

A

Qualitative impairments in reciprocal social interaction. Qualitative impairments in communication. Restricted, repetitive and stereotypes patterns of behaviour, interests and activities.

47
Q

Onset of autism

A

Before the age of 3

48
Q

Clinical features of ASD

A

Decreased self other perspective sharing, divided attention, flexible learning and social understanding

Increased rigidity, sameness, fixed learning patterns, technical understanding.

49
Q

Younger/lower IQ symptoms of ASD

A

Joint attention, reduced emotional responses and movements and actions (diagnostically significant factors)

50
Q

Older/higher IQ ASD

A

conversation, empathy, interests

51
Q

Qualitative impairments in reciprocal social interaction ASD

A

Failure to appreciate socio-emotional cues
Failure to respond to other’s emotions
No modulation of behaviour according to social situation
Lack of facial expression and social smiling
Failure to direct attention
No seeking to share

52
Q

Qualitative impairments in communication (ASD)

A

Poor social use of language e.g. conversation
inflexible of language use e.g. stereotypies and echolalia
Lack of social-imitative and make believe play
Reduced gesture, eye gaze and modulation of tone, rate or volume of speech.

53
Q

Restricted, repetitive and stereotyped patterns of behaviour, interests and activities

A 
Unusual Preoccupations
Circumscribed interests
Verbal rituals
Adherence to routines, rigid habits and resistance to change.
Unusual sensory interests
Motor stereotypies
54
Q

Non-specific feature of ASD

A 
Learning disability – mild to severe
Self-injury
Aggression
Temper tantrums
Hyperactivity
Disturbed sleep and eating habits
Developmental Motor Coordination Disorder.
55
Q

When is a diagnosis of ASD made

A

Many symptoms are present
Been there since age 3yrs
Symptoms are pervasive.

56
Q

Conditions associated with ASD

A 
Learning disability (delayed milestones, poor verbal IQ)
Depression
Social anxiety
Obsessional-compulsive disorder
Attention-Deficit-Hyperactivity-Disorder
Conduct disorder
57
Q

Causes of ASD

A

Can be comorbid with congenital or genetic disorders (rubella, callosal agenesis, Downs, fragile X, Tuberous sclerosis) but mostly are idiopathic genetic

58
Q

Management of ASD

A

Main thing is the recognition, description and acknowledgement of disability. This can then be adapted to.

59
Q

Key features of oppositional defiant disorder

A 
Refusal to obey adults request
Often argues with adults
Often loses temper
Deliberately annoys people
Touchy or easily annoyed by others
Spiteful or vindictive
60
Q

How does ODD compare to ADHD

A 
Aggression is intentional
(goal-directed)
Behaviour is learned
Enacted to obtain a desired result
May be associated with social modelling
More likely to result from impaired parenting
61
Q

What causes ODD

A

Lack of positive experience of being parented.

62
Q

Management of ODD

A

Parent training programmes and Multi-Systemic Therapy

63
Q

Parent training

A 
Aggression is intentional
(goal-directed)
Behaviour is learned
Enacted to obtain a desired result
May be associated with social modelling
More likely to result from impaired parenting

Psychiatry (20 decks)

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