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Psychiatry > Child and adolescent psychiatry | > Flashcards

Child and adolescent psychiatry | Flashcards

1
Q

What is the prevalence of mental health difficulties in children?

A

10%

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2
Q

What % of primary emotional or behavioural presentations go to GPs or paediatricians?

A

GP - 50%

Paeds - 30%

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3
Q

What are some causes of mental health difficulties in children?

A
  1. Mental health impact on development, education, relationships
  2. Parental mental illness, child as carer
  3. Sibling mental illness
  4. Family difficulties
  5. Adversity/poverty
  6. Domestic violence/abuse
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4
Q

What is the attachment theory?

What are the 3 categories?

A

Psychological model that attempts to describe the dynamics of long-term and short-term interpersonal relationships between humans.

3 categories:

  • Secure attachment
  • Anxious-ambivalent insecure attachment
  • Anxious-avoidant insecure attachment
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5
Q

Why is attachment in infants important?

A
  1. It can lead to an internal model of the self as unlovable and inadequate, and of others as unresponsive and punitive
  2. It may also predict a person’s reaction to loss or adversity, and his pattern of relating to peers, engaging in relationships and parenting children
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6
Q

What are the normal stages of attachment in the following age groups:

  1. Newborn
  2. 9 month
  3. 18 month
  4. 3-4 years
  5. 5 year
  6. Adolescent
A

Newborn: Lack of selective attachments and stranger anxiety

9-month: Stranger anxiety, selective attachments begin

18-month Peak of proximity seeking with distressed/anxious behavior

3-4 years Separates more easily from parents

5-year More stable “internal representations” of parents/relationships

Adolescent Culturally dependent; western culture-minimal dependency needs

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7
Q

How does mental health impact their development and family functioning?

A
  1. May halt development as young person preoccupied with illness rather than growing up
  2. Child may show delay/regression in achieving normal social/emotional developmental milestones
  3. Separation out of “normal” adolescent development from illness
  4. Makes it difficult for parents to let go
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8
Q

What is the prevalence of autism?

A

Widest possible definition (complete spectrum) 1 in 100

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9
Q

What is the prevalence of ASD in boys vs girls?

A

4:1

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10
Q

What is the triad of difficulties in ASD?

A
  1. Socialisation
  2. Communication
  3. Repetitive behaviour
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11
Q

What are the 3 main causes of ASD?

A
  1. Genetics
  2. Biological: neurotransmitters, brain injury
  3. Psychological/social factors affect how problem presents and how patient copes with it
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12
Q

What is the prevalence of ADHD?

A

1-5%

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13
Q

What is the prevalence of ADHD in boys vs girls?

A

3:1

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14
Q

Before what age does ADHD start?

A

<7 years

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15
Q

To be diagnosed as ADHD, symptoms have to be persistent, what does this mean?

A

Symptoms occur in more than 1 setting e.g. home and school

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16
Q

What are the 3 core symptoms of ADHD?

A
  1. inattention
  2. hyperactivity
  3. impulsivity
17
Q

What are the aetiology of ADHD (3)?

A
  1. Genetic
  2. Biological, neurotransmitters, brain injury, ? certain foods
  3. Psychological/social
18
Q

What is the prevalence of dyslexia:

  1. most severe type
  2. widest possible definition
A
  1. 4%

2. 10%

19
Q

What is the prevalence of dyslexia among boys vs girls?

A

4:1

20
Q

How do children with dyslexia often first present to services?

A

often presents to CAMHS with secondary behaviour problems at any age

21
Q

What are symptoms of dyslexia?

A

Persistent difficulties in processing and producing written material out of keeping with the persons other abilities

22
Q

What is the aetiology of dyslexia (3)?

A
  1. genetic
  2. biological, neurotransmitters, brain injury,
  3. psychological/ social factors affect how problem presents and how patient copes with it.
23
Q

What are important principles in the assessment of child and adolescent mental health?

A
  1. Always include family (unless young person refuses) - especially for older children, you may want to speak to the child before their parents
  2. Remember to consider risk and any underlying mental illness
  3. Social context is even more vital than it is in adults, children can’t choose where they live or go to school, they get what the adults around them supply
  4. Always seek help and advice if you are not sure!
24
Q

What are the 3 aspects of the assessment of mental health in a child/adolescent?

A
  1. History
  2. Mental state exam
  3. Risk assessment
25
Q

What are important things to consider in the risk assessment of a child/adolescent?

A
  1. Remember risk to self and others
  2. One particular concern is child protection/safeguarding children
    - Physical
    - Sexual
    - Emotional
    - Neglect
  3. You need to be aware that abuse may underlie presenting symptoms
  4. There is a duty of all professionals to protect children and the role of social/children services in safeguarding
26
Q

What are the biological management options of mental health disorders in children and adolescents?

A

Generally less common as 1st line
But:
1. Antidepressants for depression in adolescents
2. Medication for hyperactivity (ADHD)

27
Q

What are the psychological management options of mental health disorders in children and adolescents?

A

Usually

  1. CBT
  2. Family therapy

(depending on disorder)

28
Q

What are the social management options of mental health disorders in children and adolescents?

A

Social very important - Links to wider network especially education, social services

29
Q

What are the concerns with use of antidepressants in adolescents?

A
  1. Concerns over suicidal behaviour in teens taking SSRI
    - should be prescribed by child psychiatrist only
    - Only fluoxetine should be used
  2. Less evidence that antidepressants are effective compared to adults
30
Q

What is the NICE stepped-care model of treating adolescents with depression and where are they managed?

A
  1. Detection
    - Risk profiling
  2. Recognition
    - Identification in presenting children or young people
    - Refer to CAMHS
  3. Mild depression (including dysthymia)
    - Watchful waiting
    - Non‑directive supportive therapy/group cognitive behavioural therapy/guided self‑help
    - Manage in 1o care and community
  4. Moderate to severe depression
    - Brief psychological therapy +/– fluoxetine
    - Tier 2/3 CAMHS
  5. Depression unresponsive to treatment/recurrent depression/psychotic depression
    - Intensive psychological therapy +/– fluoxetine, sertraline, citalopram, augmentation with an antipsychotic
    - Consider inpatient care
31
Q

What is the biological treatment of ADHD?

A

Medication:

  1. Stimulants - methylphenidate
    - Ritalin, Concerta
  2. Non-stimulants - Atomoxetine
32
Q

What is the psychological treatment of ADHD?

A

Parenting course

33
Q

What is the social treatment of ADHD?

A

Liason with education e.g. special needs

34
Q

According to GMC, what are the definitions of:

  1. Children
  2. Young person/people
  3. Adults
A
  1. Those younger children who lack the maturity and understanding to make important decisions for themselves
  2. Older or more experienced children who can make important decisions themselves
  3. Aged above 18
35
Q

At what age is it legally presumed that children have the ability to make decisions about their own care?

A

over 16 years old

36
Q

What are the principles of using the Mental Health Act/Mental capacity on children and adolescents?

A
  1. No age restriction for Mental Health act, but can only be used in treatment of mental disorder, (not physical unless it manifests with mental health symptoms)
  2. Mental Capacity Act generally only applies to individuals above 16.
    However, the principle of assessing capacity as in the Mental Capacity Act can be used at any age. If consent is needed below aged 16, consider parental consent.
  3. If you are not sure, seek professional and legal advice!
37
Q

What is Gillick competence/Fraser guidelines?

A

Widely used to help assess whether a child has the maturity to make their own decisions and to understand the implications of those decisions.

38
Q

What are the principles of confidentiality and disclosure around mental health in children/adolescents?

A
  1. The same duties of confidentiality apply when using, sharing or disclosing information about children and young people as about adults.
  2. Largely dependent on whether the child or young person has capacity in consenting for disclosure/confidentiality
  3. If a child or young person does not agree to disclosure there are still circumstances in which you should disclose information:
    - When there is an overriding public interest in the disclosure
    - When you judge that the disclosure is in the best interests of a child or young person who does not have the maturity or understanding to make a decision about disclosure
    - When disclosure is required by law
39
Q

According to GMC, if a child who lacks capacity to consent shares information with you on the understanding that their parents are not informed, what should you do?

A
  1. Try to persuade the child to involve a parent in such circumstances.
  2. If they refuse and you consider it is necessary in the child’s best interests for the information to be shared (for example, to enable a parent to make an important decision, or to provide proper care for the child), you can disclose information to parents or appropriate authorities.
  3. You should record your discussions and reasons for sharing the information.

Psychiatry (16 decks)

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