Child and adolescent psychiatry Flashcards
When do we get involved with children’s mental health?
1 - some kind of probably mental illness
2 - functional impairment or risk
What risks are we worried about in younger people?
Suicide Self harm Alcohol abuse Drug abuse Abuse toward the person Groomed Running away
What function do we look at?
Grades
Friends
What is a hallucination?
Perception of a stimulus in absence of a stimulus
Does children hearing voices mean psychosis?
Not necessarily - imaginary friend, etc
What neurological conditions can cause hearing voices?
Complex temporal seizures
Brain tumours
What non neurological conditions can cause low mood and depressive symptoms?
Anaemia
Endocrine disorders - hypothyroid
What should be asked about in personal history?
Ask about school they go to Moving houses How they get on with friends and family Life events - death of parent, parental separation, breakups, major physical illness Bullying
What should you ask about the patient’s future?
Ask about their goals and family’s goals
Check what their expectations of progress are
Formulate a plan
What are the 4 p factors?
Predisposing factors
Precipitating factors
Perpetuating factors
Protective factors
Is mental state examination past or present?
Present
What is developmental psychopathology?
Science underpinning psychiatry
How can we find genetic factors in psychopathology?
Twin studies, adoption studies
Calculate %of variance due to environment and % due to genetics
What psychiatric conditions are highly genetic?
Autism
ADHD
What factors come into play in psychiatry?
Environmental and genetic factors together
What intra-uterine/perinatal factors can contribute to psychiatric health?
Maternal health - antibodies, obesity, diabetes Substance misuse - alcohol, marijuana Toxins - lead, mercury Drugs - psychotropics/antiepileptics Epigenetics - folate controlled methylation Endorine environment Immune environment Premature birth Twinning Impressive levels of resilience
What are features of fetal alcohol syndrome?
Growth retardation - head, brain, eyes, body
Facial features
Neurodevelopmental defects - sensorimotor, cognitive, executive function, language
What are facial features in fetal alcohol syndrome?
Short palpable fissure length in orbit
Thin upper lip
Smooth philthrum
What is white matter connectivity?
Functions that require interplay between brain areas
What is low white matter connectivity linked to?
ADHD, poor concentration, distractability
What are outcomes of fetal alcohol syndrome?
Learning difficulties
Conduct disorders
Combined ADHD and ADD
Anxiety disorders
What are environmental factors during childhood that can affect psychiatry?
Carer - child relationship Parenting skill and parental mental disorder Marital harmony, family function Nutrition, poverty, deprivation Abuse, neglect Discipline Day-care and schooling Peer relationships Life events Physical disability
How does the brain respond to stress?
Development and function of limbic circuit and amygdala
What happens if children experience early adversity?
The brain is trained to adapt to a hostile environment Increases perceived aggression Increased limbic response Preparation of aggressive response Aggression
How does head injury affect behaviour?
Behavioural regulation is diminished
What is executive control?
Taking control over automatic and learned behaviours
What is required for executive control?
Self-awareness and capacity to self-monitor
What is delay aversion?
An inability to wait and maintain attention in the absence of immediate reward
What is expressed emotion?
Increased worry and stress from carer increase risk of relapse of conditions in child
What is the difference between school refusal and truancy?
School refusal is a fear of leaving home or going to school, truancy is unwilling to go
What mental health problems are associated with being out of school?
Anxiety Conduct disorder Autism Depression OCD
What are effects of mental health problems on school attendance and performance?
Learning difficulties due to poor attention Co-morbid or specific learning problems Difficulty controlling emotion Anxiety Lack of energy Difficulties joining in Sensory problems Preoccupation Associations between mental health and learning difficulties ie dyslexia
What are motivational factors for school attendance?
Learning difficulties Lack of friends Bullying Lack of parental attention or concern Being encouraged to stay at home - maternal depression
What physiologically causes anxiety disorders?
Amygdala is suppressed by right ventrolateral amygdala
How can anxiety disorders be treated?
Behavioural - learning alternative patterns of behaviour Desensitisation Overcoming fear Managing feelings SSRI
What is feeding fear and escalation?
A child has a physical anxiety symptom and is allowed by parents and/or doctor to avoid the cause, the child becomes more comfortable through avoiding it and anxiety becomes worse
What are long term effects of behavioural treatment?
The patient successfully overcomes a challenge, which increases self confidence, leading to increased resilience allowing the patient to challenge themself further
What are long term effects of no behavioural treatment?
Challenge leads to avoidance
Avoidance leads to lower self confidence
Lower self confidence leads to vulnerability
Vulnerability leads to the challenge being worse
How do we do CBT with children?
Children are less likely to have cognitive awareness
Parents are collaborators in the team
Step-wise approach
Overcome barriers to change
How can we overcome barriers in CBT in children?
Psychoeducation - explain the problem so it makes sense to everyone
Goal setting - setting reasonable objectives
Motivating
Externalising - taking blame, guilt, and anger out of the equation
How is autism spectrum disorder defined?
A syndrome of distinctive behavioural abnormalities
How long does autism last?
Life
Are men or women more susceptible to autism?
Men
What is pathophysiology of autism?
Synaptic protein abnormalities
What changes within the brain going along the autism spectrum?
Effects on synaptic function, neural migration, and brain development
What are distinctive social features of autism?
Reciprocal conversation
Expressing emotional concern
Non-verbal communication
What non-verbal communication features are in autism?
Declarative pointing
Modulated eye contact
Other gestures
Facial expression
What repetitive behaviours are seen in autism?
Mannerisms and stereotypes
Obsessions
Preoccupations
Rigid and inflexible patterns of behaviour - routines, rituals
What are 3 domains of autism?
Reciprocity
Language
Obsessions
What is the difference between people lower on the autism spectrum compared to higher?
Can see more than one perspective
Can give something divided attention
Flexible learning
Social understanding
What are clinical problems in autism?
Learning disability Disturbed sleep and eating Hyperactivity High levels of anxiety and depression OCD School avoidance Aggression Temper tantrums Self injury Suicidal behaviour
What is the main cause of autism?
Genetic
What genetic disorders are co-morbid with autism?
Rubella Callosal agenesis Down's Fragile X Tuberous sclerosis
How is autism managed?
Recognition and acknowledgement Establishing needs Appreciating can't and won't Broken leg metaphor Decrease demands - reduce stress and improve coping Medication
What are features of oppositional defiant disorder?
Refusal to obey adults request Often argues with adults Often loses temper Deliberately annoys people Touchy or easily annoyed by others Spiteful or vindictive
What is the main difference between oppositional defiant disorder and ADHD?
ODD is mainly learned/ environmental, ADHD is heavily genetic
What are outcome risks for hard to manage children?
Antisocial behaviour
Substance misuse
Long-term mental health problems
How do we train parents?
Inform by social learning theory
Focus on positive reinforcement of desired behaviour and developing positive parent-child relationships
