Child and Adolescent Psychiatry Flashcards
What are some of the biological factors that influence paediatric psychiatry?
Genetic predispositions
Neurodevelopmental insults
Illness
What are some of the psychological factors that influence paediatric psychiatry?
Temperament
Attachment style
Psychological attributes (Impulsivity, low self esteem, perfectionism, belief systems)
What are the social factors that influence paediatric psychiatry?
Family relationships Peer relationships Hobbies/interests Religious faith Neighbourhood School (rural/urban) Criminality Finances
What is a conduct disorder?
Characterised by repetitive and persistent patterns of antisocial, aggressive or defiant behaviours which violate age-appropriate societal norms
What are the possible complications of conduct disorders?
Increased risk of early death, often by sudden or violent means Increased risk of social exclusion Poor school achievement Long-term unemployment Criminal activity Adult mental health problems Poor interpersonal relationships
What is the management pathway for conduct disorders?
Parent training programme (12 or younger)
Modification of school environment
Functional family therapy
Multi-Systemic therapy
Child interventions (social skills, problem-solving, anger management, confidence building)
Treat comorbidity
Address child protection concerns
What are hyperkinetic disorders?
Characterised by core features of developmentally abnormal inattention, hyperactivity and impulsivity present across time and situation
What are the management options for ADHD?
Psychoeducation Medication (stimulants, atomoxetine, guanfacine) Behavioural interventions Parent training School interventions Treat comorbidity
What are the medications for ADHD?
Methylphenidate (1st line)
Atomoxetine (2nd line)
What are the side effects of ADHD medication?
Apetite suppression
Weight loss
Sleep disrupted
BP increased
What are the factors that increase the risk of suicide?
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
What are the management options for self harm and suicide?
Admit to age appropriate medical ward after serious attempt for medical treatment and psychosocial assessment
Mental health and risk assessment
Further referral to agencies as appropriate (CAMHS, child protection)
What are the intra-uterine and perinatal factors that may influence paediatric mental health?
Maternal stress Substance misuse Toxins (lead, mercury, PCBs) Drugs (psychotropics, anti epileptics) Epigenetics (folate controlled methylation) Endocrien environment Immune environment Premature birth/ perinatal complications Twinning
What are the psychosocial influences wit regards to head injury and behaviour?
Carer-child relationships Parenting skill Parental mental disorder Marital harmony Nutrition Discipline Schooling Peer relationships Family functioning Abuse (physical, sexual, emotional) Life events (losses) Race
What is reward based learning?
Behaviour leads to satisfying drive (friends, food, drink, sex)
Stimulates dopamine release in NA
Experience of pleasure
Conditioned association between behaviour and anticipated pleasurable response
Conditioned association between contextual cues and anticipated pleasurable response
Contextual cues leads to pleasurable response
In what areas can the reward deficiency model be applied?
Obesity (food and sugar addiction)
Drugs and alcohol
Gambling
Porn
How does the reward deficiency model of addiction work?
Early adversity, reduced DA function Decreased reward sensitivity Increased behaviour to elicit reward; increased reward required for satiety Increased tolerance Increased behaviour
What are the features of hyperkinetic disorders?
Hyperactivity
Distractibility
Impulsivity
Present from an early age and across all settings
Strong genetic component
Aggravated by lower IQ and brain damage
Failure of development of cortico-striatal and cortico-limbic regulation
What are the effects of hyperkinetic disorders?
Worse relationships with peers, teachers
Poor school performance
Increased abuse: physical, emotional, sexual
Novelty seeking, aberrent peer relationships, drug and alcohol misuse
What mental health problems are associated with being out of school?
Anxiety Conduct disorder Autism Depression OCD
What are the effects of mental health problems on education?
Learning difficulties due to poor attention Co morbid specific learning problems Difficulty controlling emotions Anxiety Lack of energy, motivation Difficulties joining in (struggle to make friends) Sensory problems (noise) Fear of germs and contamination
What is the treatment for anxiety disorders in children?
SSRI
Behavioural (densensitisation, overcoming fear, managing feelings)
What are the long term effects of successful behavioural treatment?
Resilience
Success
Self-confidence
What are the long term effects of no behavioural treatment?
Vunerability
Low self-confidence
Avoidance
What is autistic disorder?
Qualitative impairments in reciprocal social interaction
Qualitative impairments in communication
Restricted, repetitive and stereotyped patterns of behaviour, interests and activities
What are the clinical features of autistic spectrum disorder?
Increased rigidity, sameness, fixed learning patterns and technical understanding
Decreased self-other perspective taking, sharing/ divided attention, flexible learning and social understanding
What are the qualitative impairments in reciprocal social interaction?
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
What are the qualitative impairments in communication?
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
What are the non-specific features of autistic spectrum disorder?
Learning disability – mild to severe Self-injury Aggression Temper tantrums Hyperactivity Disturbed sleep and eating habits Developmental Motor Coordination Disorder
What restricted, repetitive and stereotyped patterns of behaviour, interests and activities is present in autistic spectrum disorder?
Unusual Preoccupations Circumscribed interests Verbal rituals Adherence to routines, rigid habits and resistance to change. Unusual sensory interests Motor stereotypies
What co-morbid conditions are associated with autistic spectrum disorder?
Learning disability (delayed milestones, poor verbal IQ) Depression Social anxiety Obsessional-compulsive disorder Attention-Deficit-Hyperactivity-Disorder Conduct disorder
When is a diagnosis of autistic spectrum disorder made?
Many symptoms are present
Present since age 3
Symptoms are pervasive
What are the causes of autistic spectrum disorder?
Mostly idiopathic genetic
What are the key features of appositional defiant disorder?
Refusal to obey adults request Often argues with adults Often loses temper Deliberately annoys people Touchy or easily annoyed by others Spiteful or vindictive
What are the management options for Hard to Manage (H2M) children?
Parent training programmes
Multi-Systemic therapy
