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Psychiatry > Child and Adolescent Psychiatry > Flashcards

Child and Adolescent Psychiatry Flashcards

1
Q

What are some of the biological factors that influence paediatric psychiatry?

A

Genetic predispositions
Neurodevelopmental insults
Illness

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2
Q

What are some of the psychological factors that influence paediatric psychiatry?

A

Temperament
Attachment style
Psychological attributes (Impulsivity, low self esteem, perfectionism, belief systems)

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3
Q

What are the social factors that influence paediatric psychiatry?

A 
Family relationships 
Peer relationships 
Hobbies/interests 
Religious faith 
Neighbourhood 
School (rural/urban) 
Criminality 
Finances
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4
Q

What is a conduct disorder?

A

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

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5
Q

What are the possible complications of conduct disorders?

A 
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
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6
Q

What is the management pathway for conduct disorders?

A

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

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7
Q

What are hyperkinetic disorders?

A

Characterised by core features of developmentally abnormal inattention, hyperactivity and impulsivity present across time and situation

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8
Q

What are the management options for ADHD?

A 
Psychoeducation 
Medication (stimulants, atomoxetine, guanfacine) 
Behavioural interventions 
Parent training 
School interventions 
Treat comorbidity
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9
Q

What are the medications for ADHD?

A

Methylphenidate (1st line)

Atomoxetine (2nd line)

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10
Q

What are the side effects of ADHD medication?

A

Apetite suppression
Weight loss
Sleep disrupted
BP increased

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11
Q

What are the factors that increase the risk of suicide?

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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12
Q

What are the management options for self harm and suicide?

A

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)

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13
Q

What are the intra-uterine and perinatal factors that may influence paediatric mental health?

A 
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
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14
Q

What are the psychosocial influences wit regards to head injury and behaviour?

A 
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
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15
Q

What is reward based learning?

A

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

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16
Q

In what areas can the reward deficiency model be applied?

A

Obesity (food and sugar addiction)
Drugs and alcohol
Gambling
Porn

17
Q

How does the reward deficiency model of addiction work?

A 
Early adversity, reduced DA function 
Decreased reward sensitivity 
Increased behaviour to elicit reward; increased reward required for satiety 
Increased tolerance 
Increased behaviour
18
Q

What are the features of hyperkinetic disorders?

A

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

19
Q

What are the effects of hyperkinetic disorders?

A

Worse relationships with peers, teachers
Poor school performance
Increased abuse: physical, emotional, sexual
Novelty seeking, aberrent peer relationships, drug and alcohol misuse

20
Q

What mental health problems are associated with being out of school?

A 
Anxiety 
Conduct disorder 
Autism 
Depression 
OCD
21
Q

What are the effects of mental health problems on education?

A 
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
22
Q

What is the treatment for anxiety disorders in children?

A

SSRI

Behavioural (densensitisation, overcoming fear, managing feelings)

23
Q

What are the long term effects of successful behavioural treatment?

A

Resilience
Success
Self-confidence

24
Q

What are the long term effects of no behavioural treatment?

A

Vunerability
Low self-confidence
Avoidance

25
Q

What is autistic disorder?

A

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

26
Q

What are the clinical features of autistic spectrum disorder?

A

Increased rigidity, sameness, fixed learning patterns and technical understanding
Decreased self-other perspective taking, sharing/ divided attention, flexible learning and social understanding

27
Q

What are the qualitative impairments in reciprocal social interaction?

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

28
Q

What are the qualitative impairments in communication?

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

29
Q

What are the non-specific features of autistic spectrum disorder?

A 
Learning disability – mild to severe
Self-injury
Aggression
Temper tantrums
Hyperactivity
Disturbed sleep and eating habits
Developmental Motor Coordination Disorder
30
Q

What restricted, repetitive and stereotyped patterns of behaviour, interests and activities is present in autistic spectrum disorder?

A 
Unusual Preoccupations
Circumscribed interests
Verbal rituals
Adherence to routines, rigid habits and resistance to change.
Unusual sensory interests
Motor stereotypies
31
Q

What co-morbid conditions are associated with autistic spectrum disorder?

A 
Learning disability (delayed milestones, poor verbal IQ)
Depression
Social anxiety
Obsessional-compulsive disorder
Attention-Deficit-Hyperactivity-Disorder
Conduct disorder
32
Q

When is a diagnosis of autistic spectrum disorder made?

A

Many symptoms are present
Present since age 3
Symptoms are pervasive

33
Q

What are the causes of autistic spectrum disorder?

A

Mostly idiopathic genetic

34
Q

What are the key features of appositional 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
35
Q

What are the management options for Hard to Manage (H2M) children?

A

Parent training programmes

Multi-Systemic therapy

Psychiatry (17 decks)

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