Child and Adolescent Psychiatry Flashcards
(37 cards)
What factors interplay to make us as we are, mentally?
- genetics
- biological e.g. intrauterine life
- experiential
- disorders
What are intra-uterine and perinatal factors that may have impact on later mental health?
- maternal stress e.g. exposure to cortisol
- substance misuse
- toxins e.g. lead, mercury
- drugs e.g. anti epileptics
- epigenetics e.g. folate controlled methylation
- endocrine environment
- immune environment
- premature birth/perinatal complications
- twinning
- impressive levels of resilience
What are 3 concepts that contribute to development of ‘theory of mind’?
- joint attention
- understanding false belief
- social reciprocity and understanding
What is ‘joint attention’?
learning to judge what someone else thinks
What is meant by ‘understanding false belief’?
test of the ability to represent other’s thoughts as different to one’s own (maybe predict what someone else might do based on what you know of them)
What is meant by ‘social reciprocity and understanding’?
- having empathy
- spotting deception
- predicting behaviour
- self reflection etc
Conditioned response.
learn that something is good by having rewarding stimulus associated with it e.g. bell rung and food comes—bell gives pleasure as it means food (increase dopamine pathways)
What are 4 features of ADHD?
- hyperactivity
- distractibility
- impulsivity
- strong genetic component
What can ‘aggravate’ ADHD?
- lower IQ
- brain damage
What is the ‘simple-view’ of why ADHD might happen?
failure of development of cortico-striatal and cortico-limbic regulation
What are some adverse effects of having a hyperkinetic disorder such as ADHD?
- worse relationship with peers, teachers. Stigmatisation, self identity, self esteem.
- poor school performance
- Increased abuse: physical, emotional, sexual.
- novelty seeking, aberrant peer relationships, drug and alcohol misuse
How would you consider a problem in child/adolescent psychiatry?
in terms of biological, psychological and social aspects, and identify predisposing, precipitating, maintaining and protective factors
What characterises conduct disorders?
repetitive and persistent patterns of antisocial, aggressive or defiant behaviours which violate age-appropriate societal norms
What course and outcome do many conduct disorders tend to have?
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.
How can we manage conduct disorders?
multifaceted approach involving some of:
- parent training programme
- modification of school environment e.g. behavioural support
- functional family therapy
- multi-systemic therapy
- child interventions: social skills, problem solving, anger management, confidence building
- treat comorbidity
- address child protection concerns
How is ADHD (hyperkinetic disorders) characterised?
-developmentally abnormal inattention
-hyperactivity
-impulsivity
present across time and situations
How is ADHD managed?
- psychoeducation
- medication e.g methylphenidate
- behavioural interventions e.g. realistic expectations, contingency management
- parent training
- school interventions
- treat comorbidity
- voluntary organisations
- benefits
What are side effects of methylphenidate?
- appetite loss
- weight difficult to gain
- insomnia
- changes in BP
What drug is second line for treating ADHD?
atomoxatine
What are 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
- disconnection from support systems
How would you manage a patient you were worried was at risk of committing suicide?
- take it seriously
- 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
- further referral to agencies as appropriate e.g. child protection, CAMHS
What are mental health problems associated with being out of school?
- anxiety
- conduct disorder
- autism
- depression
- obsessional compulsive disorder
What are some effects of mental health problems on education?
- Learning difficulties due to poor attention
- Co-morbid specific (or general) learning problems
- Difficulty controlling emotion e.g. frustration, escalation of anger, frequent conflict.
- Anxiety (see below)
- Lack of energy, motivation
- Difficulties joining in – wanting to be alone or unable to make friends (feeling different).
- Sensory problems – too noisy
- Fear of germs and contamination
What are the 3 As of anxiety disorders?
- anxious thoughts and feelings (e.g. impending doom)
- autonomic symptoms
- avoidant behaviour
