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Psychiatry Block > Child and Adolescent Psychiatry > Flashcards

Child and Adolescent Psychiatry Flashcards

1
Q

What factors interplay to make us as we are, mentally?

A
  • genetics
  • biological e.g. intrauterine life
  • experiential
  • disorders
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2
Q

What are intra-uterine and perinatal factors that may have impact on later mental health?

A
  • 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
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3
Q

What are 3 concepts that contribute to development of ‘theory of mind’?

A
  • joint attention
  • understanding false belief
  • social reciprocity and understanding
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4
Q

What is ‘joint attention’?

A

learning to judge what someone else thinks

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5
Q

What is meant by ‘understanding false belief’?

A

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)

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6
Q

What is meant by ‘social reciprocity and understanding’?

A
  • having empathy
  • spotting deception
  • predicting behaviour
  • self reflection etc
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7
Q

Conditioned response.

A

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)

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8
Q

What are 4 features of ADHD?

A
  • hyperactivity
  • distractibility
  • impulsivity
  • strong genetic component
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9
Q

What can ‘aggravate’ ADHD?

A
  • lower IQ

- brain damage

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10
Q

What is the ‘simple-view’ of why ADHD might happen?

A

failure of development of cortico-striatal and cortico-limbic regulation

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11
Q

What are some adverse effects of having a hyperkinetic disorder such as ADHD?

A
  • 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
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12
Q

How would you consider a problem in child/adolescent psychiatry?

A

in terms of biological, psychological and social aspects, and identify predisposing, precipitating, maintaining and protective factors

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13
Q

What characterises conduct disorders?

A

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

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14
Q

What course and outcome do many conduct disorders tend to have?

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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15
Q

How can we manage conduct disorders?

A

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
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16
Q

How is ADHD (hyperkinetic disorders) characterised?

A

-developmentally abnormal inattention
-hyperactivity
-impulsivity
present across time and situations

17
Q

How is ADHD managed?

A
  • psychoeducation
  • medication e.g methylphenidate
  • behavioural interventions e.g. realistic expectations, contingency management
  • parent training
  • school interventions
  • treat comorbidity
  • voluntary organisations
  • benefits
18
Q

What are side effects of methylphenidate?

A
  • appetite loss
  • weight difficult to gain
  • insomnia
  • changes in BP
19
Q

What drug is second line for treating ADHD?

A

atomoxatine

20
Q

What are 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
  • disconnection from support systems
21
Q

How would you manage a patient you were worried was at risk of committing suicide?

A
  • 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
22
Q

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

A
  • anxiety
  • conduct disorder
  • autism
  • depression
  • obsessional compulsive disorder
23
Q

What are some effects of mental health problems on education?

A
  • 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
24
Q

What are the 3 As of anxiety disorders?

A
  • anxious thoughts and feelings (e.g. impending doom)
  • autonomic symptoms
  • avoidant behaviour
25
Q

What treatment is available for anxiety disorders?

A
  • medication e.g. SSRI fluoxetine

- behavioural e.g. managing feelings, learning alternative patterns of behaviour, desensitisation

26
Q

What are characteristics of autistic disorders?

A
  • 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
27
Q

What may be decreased in autistic disorder?

A
  • self-other perspective taking
  • sharing/divided attention
  • flexible learning
  • social understanding
28
Q

What may be increased in autistic disorders?

A
  • rigidity
  • sameness
  • fixed learning patterns
  • technical understanding
29
Q

What are examples of qualitative impairments in reciprocal social interaction in autistic spectrum disorder?

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
  • maybe doesn’t develop friends
30
Q

What are examples of qualitative impairments in communication in ASD?

A
  • 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
31
Q

What are examples of 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 stereotypes
32
Q

What are non-specific features of ASD?

A
  • learning disability - mild to severe
  • self-injury
  • aggression
  • temper tantrums
  • hyperactivity
  • disturbed sleep and eating habits
  • developmental motor coordination disorder
33
Q

What are 3 factors that will determine a diagnosis of ASD?

A
  • many symptoms are present
  • been there since age 3
  • symptoms are pervasive
34
Q

What are potential causes of ASD?

A
  • comorbid with congenital or genetic disorders e.g. Down’s syndrome, rubella, tuberous sclerosis
  • mostly idiopathic genetic
35
Q

How would ASD be managed?

A
  • 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
36
Q

What are 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
37
Q

What are differences between ODD and ADHD?

A
  • 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

Psychiatry Block (14 decks)

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