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Mental Health > Child and Adolescent Psychiatry > Flashcards

Child and Adolescent Psychiatry Flashcards

1
Q

What is Tourette’s syndrome?

A

Neuropsychiatric syndrome characterised by motor and vocal tics which run a fluctuating course, and an increased association with behavioural abnormalities and other psychological conditions.

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2
Q

What is the typical age of onset of Tourettes?

A

5-6 years

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3
Q

Are men or women more likely to have Tourette’s?

A

Men, by 3-4 times.

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4
Q

Does Tourette’s have a genetic element?

A

Yes - there are strong familial links with Tourette’s and OCD and other tic syndromes. Likely to be sue to combination of a number of genes interacting.

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5
Q

What is a tic?

A

Sudden, purposeless, repetative, non-rhythmic stereotyped movement or vocalisation.

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6
Q

Other than motor or vocal tics, what are some symptoms that may be seen with Tourette’s?

A

Echolalia (repeat others’ words); paplilalia (repeat own words); Coprolalia (compulsive saying of swear/dirty words); copropraxia (obscene gestures); echopraxia (copy others’ movements); difficulty concentrating/easily distracted

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7
Q

What % of people with Tourette’s have concurrent ADD?

A

50%

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8
Q

What % of people with Tourette’s have concurrent OCD?

A

30-50%

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9
Q

What % of people with Tourette’s have concurrent behavioural problems?

A

80%

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10
Q

A parent brings their 6 year old to you because of concerns regarding unusual movements. What questions should you ask about family history if you are concerned about Tourette’s?

A

FHx of other movement disorders including Huntington’s, Wilson’s disease, epilepsy, and tics, as well as FHx of thyroid disease.

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11
Q

What history is important to ilicit when a patient presents with tics?

A

Age of onset, progression or pattern, do they wax and wane?

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12
Q

What are some genetic causes of tics that would rule out Tourette’s?

A

Huntington’s chorea; Kleinfelter’s syndrome

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13
Q

What are some acquired causes of tics that would ruel out Tourette’s?

A

Encephalitis, CVA, hyperthyroidism, CO poisoning, streptococcus-induced autoimmune tourette’s syndrome.

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14
Q

What drugs can cause tics to occur?

A

Cocaine; amfetamines; lithium; antipsychotics; antidepressants; antihistamines; opiates

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15
Q

What can exacerbate tics in Tourette’s syndrome?

A

Anxiety, stress, fatigue, and stimulants.

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16
Q

How should Tourette’s be managed?

A

Depends on the particular set of symptoms the patient gets and their needs.

Educational support.
Education of parents, patient, and schools.
Treat any underlying pathology.
Counselling
Some long term therapies can be used to reduce tics

17
Q

What pharmacological therapy can be used for severe Tourette’s?

A

Antipsychotic risperidone.

Neuroleptics e.g. haloperidol, initiated by specialists.

18
Q

What is the prognsis like for Tourette’s?

A

Peaks usually in early teenage years.

1/3 are symptoms free as adults, 1/3 have mild tics, and 1/3 require clinical attention.

19
Q

What is ADHD?

A

A persistent and pervasive pattern of inattention, hyperactivity, and impulsivity, which interferes with functioning and/or development.

20
Q

What does pervasive mean, in the context of ADHD?

A

Occuring across different aspects of the childs life i.e. with family, at school, in social settings etc.

21
Q

How long do symptoms of inattention have to be apparent for for a diagnosis of ADHD?

A

6 months or more

22
Q

What are some symptoms of inattention?

A
  • Failure to concentrate on work at school
  • Trouble sticking to one task or activity
  • Doesn’t seem to listen when spoken to drectly
  • Failure to follow-through with simple tasks
  • Difficulty organising tasks
  • Appearance of being forgetful
23
Q

What are some symptoms of hyperactivity and impulsivity?

A
  • Fidgeting/squirms in seat
  • Leaving a situation when expected to stay
  • Running/climbing when it is not appropriate
  • Unable to play etc quietly
  • “Driven by a motor”
  • Talks excessively
  • Trouble waiting their turn
  • Interupts or intrudes on others
24
Q

When do symptoms need to be apparent for a child to be diagnosed with ADHD?

A

Before age 12 - however sometimes the diagnosis is made much later due to lack of recognition.

25
Q

Is ADHD more common in boys or girls?

A

It is more commonly diagnosed in boys, but is thought to be under-recognised in girls/women.

26
Q

What are some of the risk factors for a child developing ADHD?

A
  • Low birth-weight/preterm
  • Maternal smoking in pregnancy
  • Epilepsy
  • Acquired brain injury
  • Maternal mental health issues
  • Substance misuse
27
Q

If a child with ?ADHD comes to the GP, who should make the diagnosis of ADHD?

A

A specialist psychiatrist or paediatrician., or CAMHS.

28
Q

What tools can aid the diagnosis of ADHD?

A

Strengths and Difficulties questionnaires

Conner’s rating scale (done by teachers and parents)

29
Q

What is the most important thing to assess when a child has ?ADHD?

A

The impact on their life - can they make and keep friends? School achievement? Family relationships? Trouble with law? Ability to look after themselves? Emotional state? Substance misuse?

30
Q

How should ADHD be managed, in general terms?

A
  • Explanation and support, both written and verbal.
  • Specialist input
  • Lifestyle - balanced diet, nutrition, exercise
  • Pharmacological Rx
  • Psychosocial Rx
31
Q

What is recommended first line for pre-school children?

A

ADHD-focused group parent-training programmes

32
Q

Is medication recommended for children of school age?

A

Only if lifestyle modifications haven’t worked and the symptoms are causing significant problems in the child’s life.

33
Q

Which medication is used for ADHD?

A

Methylphenidate

34
Q

What medication can be used if methylphenidate is not tolerated?

A

Lisdexamfetamine, dexamfetamine, or atomoxetine

35
Q

What parameters need to be checked before commencing methylphenidate?

A
  • HR
  • BP
  • Weight and height
  • Cardiovascular assessment
36
Q

How frequently does height need to be checked for a child on ADHD medication?

A

Every 6 months

37
Q

How frequently does weight need to be checked for a child on ADHD medication?

A

3 monthly if under 10

6 monthly if over 10 (plus once at 3 months after initiation)

38
Q

If an older child has benefited from medication for ADHD but is still significantly affected by the symptoms, what can be useful as an add-on therapy?

A

CBT

Mental Health (17 decks)

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