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Psychiatry > Child and Adolescent Psychiatry > Flashcards

Child and Adolescent Psychiatry Flashcards

1
Q

As humans, how do we make sense of behaviour?

A

Through narrative and story

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2
Q

What is behaviour a product of?

A

Brain biology

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3
Q

Define developmental psychopathology

A

Genetic, environmental and parenting factors that influence the trajectory of a child’s mental wellbeing

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4
Q

How do we know that psychopathology has a strong genetic determinism?

A

Twin studies (comparing DZ and MZ twins)

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5
Q

Give examples of psychiatric disorders in children that are highly genetic

A

ADHD, autism

Depression, anxiety also substantially genetic

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6
Q

What are increasingly used to identify genetic risk factors for psychiatric disorders?

A

Genome wide association studies

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7
Q

What do the genome wide association studies show?

A

Many genes are implicated but each gene has a small effect

Many implicate micro-RNA and epigenetic modulation

Genetic factors serving modulation of gene expression are likely to be important (these control the influence of environmental factors on genetic expression)

Genes controlled synapse formation, neurotransmission and modification implicated

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8
Q

Alongside genetic factors, what other mechanisms in the body have been linked to psychiatric disorders?

A

Inflammatory and autoimmune mechanisms

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9
Q

How do genes interact with their environment?

A

Having certain alleles of a gene will make a child more likely to develop a psychiatric condition based on their environment

e.g. lower activity allele for monoamine neurotransmitters gene (like NA, DA) more likely to develop antisocial behaviour in response to maltreatment

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10
Q

The likelihood of developing stressful responses is influence by which polymorphism of which gene?

A

Serotonin transporter gene

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11
Q

What are the IU and perinatal factors affecting developmental psychopathology?

A

Maternal health (e.g. antibrain antibodies, obesity, diabetes)
Substance misuse (alcohol, marijuana (inc. risk of depression later in life)
Toxins - lead, mercury, PCBs
Drugs, e.g. psychotrophics/anti-elipetics
Epigenetics - folate controlled methylation
Endocrine, esp. androgens
Immune development
Premature birth/perinatal complications
Twinning
Impressive levels of resilience (i.e. may have impaired brain growth but this isn’t associated with learning difficulties)

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12
Q

What does sodium valproate taken during pregnancy cause?

A

Apart from NTDs

Increases risk of autism and ADHD

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13
Q

What do excess circulating androgens in the mother cause to the baby?

A

More likely to develop autism

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14
Q

Why are twins more likely to develop psychiatric disease?

A

As they are competing for IU resources

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15
Q

What are the physical signs of foetal alcohol syndrome?

A 
Growth retardation (head, body, brain & cerebellum, eyes
Absent philtrum, thin upper lip
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16
Q

What neurodevelopmental defects are associated with foetal alcohol syndrome?

A

Sensorimotor
Cognitive development
Executive function
Language

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17
Q

What psychiatric disorders are people with foetal alcohol syndrome more at risk of?

A

LDs, ADHD, DCD

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18
Q

What is white matter important for?

A

Functions requiring interplay between brain areas, e.g. working memory between hippocampus and anterior cingulate

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19
Q

What is low white matter connectivity associated with?

A

Poorer integration of function –> cognitive instability

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20
Q

What results from low white matter connectivity?

A

ADHD - poor concentration and distractibility

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21
Q

What happens if the gyri don’t develop properly in a child?

A

Flat brain will have cognitive effects as SA of brain is less

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22
Q

What are characteristic of conduct disorders?

A

Frequent loss of temper, arguing, becoming easily angered or annoyed
Showing vindictive or other negativistic behaviours

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23
Q

What are the environmental factors affecting psychological development during childhood?

A 
Child-carer relationship (attachment) 
Parenting skills/parental mental health 
Marital harmony, family function 
Nutrition, poverty, deprivation 
Abuse, neglect
Discipline (too much) 
Day-care and schooling
Peer relationships Life events
Physical disability
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24
Q

What is the attachment theory?

A

Infant seeks contact with parent when frightened, injured or ill

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25
Q

How is attachment described and measured?

A

Described as secure/insecure based on direct observation of behaviour strange situation

I.e. secure - run to parent when something bad happens

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26
Q

What is the issue with the attachment theory?

A

Little evidence of poor attachment causing harm

Stigmatises mothers and causes unnecessary worry

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27
Q

The brain responds similarly to what kinds of stress?

A

Physical and mental

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28
Q

How does the body respond to stress?

A

Interplay between brain and body with low grade peripheral inflammation

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29
Q

What does early life stress influence?

A

Function of limbic circuit, incl. amygdala - determining subsequent patterns of response to threat (incl. withdrawal and aggression)

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30
Q

What happens during times of stress in the body?

A

HPA axis activated - adrenaline released from adrenal gland

ANS activated –> increased activity of immune system and feedback on limbic system

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31
Q

Physical/brain disorders ARE/ARE NOT strongly associated with psychiatric conditions

A

ARE

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32
Q

What is the relationship between head injuries, life events and behaviour?

A

Children with behavioural issues tend to be in an adverse environment where they are more likely to get into fights and sustain head injuries

Head injuries affect subsequent behaviours

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33
Q

Define operant conditioning

A

Learning process through which behaviour is modified via reinforcement/punishment

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34
Q

How does operant conditioning work?

A

Firing of DA neurones when you associated an action with a subsequent reward

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35
Q

How does early adversity affect DA response?

A

Early adversity –> reduced DA functioning so decreased reward sensitivity

36
Q

A hypoactive reward system is more likely to lead to what?

A

Addiction (obesity, drugs, alcohol, gambling, porn)

Increased delay aversion

37
Q

What loops in the brain are associated with learned behaviours and reward?

A

Corticostriatal loops

38
Q

What are the social skills learned in neonatal period, 6 weeks, 24 months and 3-4 years?

A

Neonatal: emotional contagion
6 weeks: sensorimotor control emerging, smiling intentionally
24 months: secondary representation, able to recognise and label emotions
3-4 years: metarepresentation: self-awareness of emotion, able to deceive, understands and feels, understanding of motive and context

39
Q

What is delay aversion?

A

A theory to explain ADHD whereby there is an inability to wait and maintain attention in absence of immediate reward

THINK marshmallow test

40
Q

What is understanding false belief?

A

A test of ability to represent other’s thought as different to ones own

41
Q

How does expressed emotion affect a child’s mental health?

A

Carer negative emotion predicts relapse from chronic illness (mental and physical!)

Illness causes worry and stress –> negative relationships at home –> impacts more on patient –> relapse

42
Q

How do you differentiate between truancy and school refusal?

A

Truancy = lack of motivation, unwilling to leave house and go to school

School refusal = fear, fear of leaving home and going to school

43
Q

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

A 
Anxiety
Conduct disorder
Autism
OCD
Depression
44
Q

What are the effects of mental health problems on school attendance/learning?

A 
LDs due to poor concentration 
Comorbid learning problems
Difficulty controlling emotions --> conflict 
Anxiety
Lack of motivation/energy
Difficulties joining in (feels different, alone, unable to make friends) 
Sensory problems - too noisy
Preoccupation, e.g. fear of germs
Associated LDs, e.g. dyslexia
45
Q

How do you differentiate between social anxiety and separation anxiety?

A

Separation anxiety = fear of leaving parents/home –> problems on the DOORSTEP (don’t like parents going out/sleep with parents)

Social phobia = fear of joining groups –> problems at SCHOOL GATE

46
Q

What are the 3As of anxiety disorders?

A 
Anxious thoughts/feelings
Autonomic symptoms (tingling fingers, churning stomach, diarrhoea, breathing, palpitations) - SNS
Avoidant behaviour
47
Q

What motivational factors may affect school attendance?

A

LDs
Lack of friends and relationships
Bullying
Lack of parental attention Encouragement to stay at home (e.g. by depressed mother)

48
Q

How does the amygdala activity in adolescents with GAD differ from adolescents without GAD?

A

More activation in GAD than control population

NB - activity supressed by right ventrolateral amydgala when labelling emotions

49
Q

How do we treat anxiety disorders in children?

A

Behaviour -

  • Learning alternative patterns of behaviour
  • Densensitisation
  • Overcoming fear
  • Managing feelings
  • CBT in a way the child can understand (e.g. climbing a mountain together)

Important not to feed fears and return to school ASAP

Medication
- SSRIs, e.g. fluoxetine

50
Q

What is emotional contagion in childhood anxiety?

A

Everyone around child becomes anxious over child being anxious (part of empathy)

51
Q

What are the long term effects of successful behavioural treatment?

A

Child changes maladaptive behaviour and successfully beats challenge, child has confidence and resilience to face another challenge

52
Q

What is involved in CBT for children?

A

Mostly B and T
Stepwise approach
Externalisation - disorder is not a matter of blame
Overcoming barriers to change by problem solving
Psychoeducation: explaining the problem in terms that make sense to everyone
Goal setting: reasonable goals that can be met
Motivating: creating a buy in so goals can be achieved

53
Q

Autism is/is not defined by low IQ

A

Not defined by low IQ but associated with it (not all cases)

54
Q

Autism is a pervasive condition, what does this mean?

A

Present across lifespan (onset <3y) and across several settings

55
Q

In which gender is autism more common?

A

3 more common in men

56
Q

What is the incidence of autism?

A

1%

57
Q

What is the aetiology of autism?

A

Many genes implicated

Many are for synaptic proteins, particularly around regulation of GABA and glutaminergic neurones

58
Q

What is the autism spectrum?

A

Normal IQ where effects are ONLY on synaptic function

Autism with LD - effects on synaptic function, neural migration, brain development

59
Q

What are the distinctive features of autism?

A

Social - reciprocity and communication

Repetitive behaviour/obsessions

60
Q

What may be different in terms of the social function of someone with autism?

A

Unable to have reciprocal conversation, express emotional concern and engage in nonverbal communications (e.g. declarative pointing, modulated eye contact and facial expressions)

61
Q

What repetitive behaviours may be exhibited in someone with autism?

A

Mannerisms/stereotypies
Obsessions, preoccupations, interests
Rigid and inflexible patterns of behaviour (which when interrupted can lead to great distress)

62
Q

What things are decreased in ASD?

A 
Self-other perspective taking
Shared/divided attention 
Flexible learning
Social understanding 
Emotional responses
63
Q

What things are increased in ASD?

A

Rigidity
Sameness
Fixed learning patterns
Technical understanding

64
Q

What problems may come along with autism?

A 
LD
Disturbed sleep/eating habits
Hyperactivity
Anxiety/depression 
OCD
School avoidance
Aggression 
Temper tantrums
Self=harm
65
Q

How many times more common in suicide in ASD?

A

6

66
Q

Autism is strongly genetic, what other factors may cause it?

A

Rubella, Callosal agenesis (partial/complete absence of corpus callosum)
Down’s (most common single gene disorder ASD)
Fragile X
Tuberosclerosis

67
Q

How do you manage ASD?

A

Recognition, description, acknowledgement of disability
Establishing needs
Appreciating can’ts and won’ts
Decreased demands to decrease stress and improve coping
Psychopharmacology

68
Q

What features are consistent with ODD?

A

Oppositional defiance (refusal to obey adults, arguing with adults, losing temper, deliberately annoying others, easily annoyed by others, spiteful/vindictive)

69
Q

In ODD, behaviour is learned.

True or false

A

True

But also more likely to result from impaired parenting

70
Q

What may cause hard to manage children?

A

Temperament, ADHD, neurodevelopment, overcrowding, poverty, parental depression

71
Q

How can you manage hard to manage children?

A

Parent training

Multi-systemic therapy

72
Q

Unmanaged H2M children are more likely to run into what problems in the future?

A

Antisocial behaviour
Substance misuse
Long term mental health problems

73
Q

What does parent training focus on?

A

Positive reinforcement of desired behaviour and developing positive child-parent relationships

NB - programme 1-2h/wk for 8-12wks

74
Q

What are the three core symptoms of ADHD?

A

Inattention
Hyperactivity
Impulsivity
Present over all time and situations

75
Q

What is thought to cause ADHD?

A

Poor executive function - executive function regulates impulses and signals, if not controlled properly –> increased motor activity, unable to focus on one thing

Low levels of NA/DA, NA involved in attention and arousal, DA involved in reward

76
Q

What are obsessions?

A

Repetitive thoughts

77
Q

What are compulsions?

A

Behaviours resulting from obsessions

78
Q

Where should you gather information from when assessing a child?

A

School, parents, carers etc.

79
Q

What can masquerade as psychosis in children?

A

Temporal lobe epilepsy (auditory hallucinations)

80
Q

Define conduct disorder

A

Repetitive, persistent patterns of antisocial, aggressive or defiant behaviours which violate age appropriate societal norms

81
Q

How do you treat ADHD?

A 
Psychoeducation 
Medication 
Behaviour interventions
Parent training
School interventions
etc.
82
Q

What medications are used for ADHD?

A

1st line - methylphenidate (similar to amphetamine)

2nd line - atomoxetine

83
Q

How does methylphenidate work?

A

Acts on NAd and DA systems

84
Q

What are SEs of methylphenidate?

A

Appetite suppression, weight loss, sleep problems, BP problems

85
Q

How does atomoxetine work?

A

Acts on NAd system

86
Q

If risk of suicide, what should you do?

A

Detain, refer

Psychiatry (26 decks)

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