Child and Adolescent Psychiatry Flashcards
what are genome wide association studies used for?
identifying genetic risk factors for psychiatric disorder
how can GWAS help identify risk factors for psychiatric disorder?
They can indicate
that many genes are implicated, mostly of small effect. Many implicate micro-RNA and epigenetic
modulation. Genetic factors serving modulation of gene expression are likely to be important. They
control influence of environmental factors on genetic expression. Inflammatory and autoimmune
mechanisms are being implicated as well as genes controlling synapse formation, neurotransmission
and modification
intrauterine and perinatal factors leading to development of psychiatric disorders
- Maternal health – Maternal antibodies, obesity, diabetes
- Substance misuse – alcohol, marijuana (no initial effects but tendency to depression later on)
- Toxins – lead, mercury and PCB’s
- Drugs – esp. psychotropics/antiepileptics (lipid soluble)
- Epigenetics – folate-controlled methylation
- Endocrine environment – esp. androgens
- Immune environment
- Premature birth/ Perinatal complications
- Twinning
- Impressive levels of resilience
how does foetal alcohol syndrome affect growth?
body head brain (inc cerebellum) eyes (small wideset eyes) thin upper lip and absence of philtrum
neurodevelopmental effects of alcohol during pregnancy
sensorimotor
cognitive development
executive function
language
white matter connectivity and ADHD
White matter connections are important for functions that require interplay between brain areas e.g.
working memory between the hippocampus and anterior cingulate. Low connectivity is associated
with more neural “noise” in the system, intra-individual variability and “cognitive instability.” In
developing brains this is typically associated with ADHD – poor concentration and distractibility.
Poorer overall integration of function results in cognitive instability.
common outcomes of foetal alcohol syndrome
variable learning difficulties conduct disorders inc oppositional defiant disorder combined ADHD or ADD or hyp-imp subtypes anxiety disorders
conduct disorders associated with foetal alcohol
frequent loss of temper, arguing, becoming easily angered or annoyed, showing vindictive or other negativistic behaviours
what is ADD?
distractibility, sustaining attention to tasks that don’t provide high level of stimulation or frequent rewards, distractibility and problems with organization.
what are hyp-imp subtypes?
difficulties with remaining still, most evident in situations that require behavioural self-control. Impulsivity is a tendency to act in response to immediate stimuli, without deliberation or consideration of the risks and consequences.
anxiety disorders associated with foetal alcohol
panic
phobic
separation
GAD
environmental factors during childhood associated with psychiatric disorders
- Carer - child relationship (attachment)
- Parenting skill and parental mental disorder e.g. post-natal depression, substance misuse
- Marital harmony, family function
- Nutrition, poverty, deprivation
- Abuse, neglect
- Discipline
- Day-care and schooling
- Peer relationships
- Life events
- Physical disability
describe the brains response to stress
The brain responds similarly to physical and mental stress. The response to stress involves interplay
of brain and body. Early life stress influences the function of the limbic circuit including the amygdala.
It determines subsequent patterns of stress response. Early life stress influences mood and patterns
of response to threat including withdrawal and/or aggressive response.
Experience of adversity trains the brain to adapt to a hostile environment:
1. Perceived behaviour and aggression
2. Limbic response and heightened amygdala activity
3. Cortical response and preparation of aggressive response
4. Behavioural response and aggression
concepts in psychological development
reward based learning executive function delay-aversion sharing emotion and empathy expressed emotion
describe executive and cortical control
- Taking control over ‘automatic’ and learned behaviours
- Applied in Cognitive Behavioural Therapy.
- Inhibit prepotent responses
- Intentional decision-making and forward planning.
- Requires self-awareness and capacity to self-monitor.
temporal lobe epilepsy can present as what? why?
psychosis
auditory hallucinations
what are conduct disorders?
Conduct disorders are characterised by repetitive and persistent patterns of antisocial, aggressive, or
defiant behaviours which violate age-appropriate societal norms. Course and outcome: 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.
core symptoms of ADHD
hyperactivity
impulsivity
inattention