Child and Adolescent Psychiatry Flashcards
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
What treatment is available for anxiety disorders?
- medication e.g. SSRI fluoxetine
- behavioural e.g. managing feelings, learning alternative patterns of behaviour, desensitisation
What are characteristics of autistic disorders?
- qualitative impairments in reciprocal social interaction (reciprocity)
- qualitative impairments in communication (language)
- restricted, repetitive and stereotyped patterns of behaviour, interests and activities (obsessions)
- onset before age of 3
- defined behaviourally and not by a stereotyped or a cognitive profile
What may be decreased in autistic disorder?
- self-other perspective taking
- sharing/divided attention
- flexible learning
- social understanding
What may be increased in autistic disorders?
- rigidity
- sameness
- fixed learning patterns
- technical understanding
What are examples of qualitative impairments in reciprocal social interaction in autistic spectrum disorder?
- 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
- maybe doesn’t develop friends
What are examples of qualitative impairments in communication in ASD?
- poor social use of language e.g. conversation
- inflexible of language use e.g. stereotypes
- lack of social-imitative and make believe play
- reduced gesture, eye gaze and modulation of tone, rate or volume of speech
What are examples of restricted, repetitive and stereotyped patterns of behaviour, interests and activities?
- unusual preoccupations
- circumscribed interests
- verbal rituals
- adherence to routines, rigid habits and resistance to change
- unusual sensory interests
- motor stereotypes
What are non-specific features of ASD?
- learning disability - mild to severe
- self-injury
- aggression
- temper tantrums
- hyperactivity
- disturbed sleep and eating habits
- developmental motor coordination disorder
What are 3 factors that will determine a diagnosis of ASD?
- many symptoms are present
- been there since age 3
- symptoms are pervasive
What are potential causes of ASD?
- comorbid with congenital or genetic disorders e.g. Down’s syndrome, rubella, tuberous sclerosis
- mostly idiopathic genetic
How would ASD be managed?
- recognition, description and acknowledgement of disability
- establishing needs
- appreciating the can’t and the won’t
- decrease the demands to reduce the stress and improve coping
What are key features of oppositional 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 differences between ODD and ADHD?
- in ODD the aggression is intentional, whereas in ADHD it is impulsive
- in ODD the behaviour is learned whereas in ADHD there is poor cognitive control and ability to sustain goal
- ADHD often remorseful
- ODD more likely to result from impaired parenting, whereas ADHD has stronger genetic component
