Child and adolescent psychiatry Flashcards by Pete McEwan

When do we get involved with children’s mental health?

1 - some kind of probably mental illness

2 - functional impairment or risk

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What risks are we worried about in younger people?

Suicide
Self harm
Alcohol abuse
Drug abuse
Abuse toward the person
Groomed
Running away

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What function do we look at?

Grades

Friends

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What is a hallucination?

Perception of a stimulus in absence of a stimulus

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Does children hearing voices mean psychosis?

Not necessarily - imaginary friend, etc

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What neurological conditions can cause hearing voices?

Complex temporal seizures

Brain tumours

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What non neurological conditions can cause low mood and depressive symptoms?

Anaemia

Endocrine disorders - hypothyroid

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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

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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

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What are the 4 p factors?

Predisposing factors
Precipitating factors
Perpetuating factors
Protective factors

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Is mental state examination past or present?

Present

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What is developmental psychopathology?

Science underpinning psychiatry

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How can we find genetic factors in psychopathology?

Twin studies, adoption studies

Calculate %of variance due to environment and % due to genetics

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What psychiatric conditions are highly genetic?

Autism

ADHD

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What factors come into play in psychiatry?

Environmental and genetic factors together

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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

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What are features of fetal alcohol syndrome?

Growth retardation - head, brain, eyes, body
Facial features
Neurodevelopmental defects - sensorimotor, cognitive, executive function, language

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What are facial features in fetal alcohol syndrome?

Short palpable fissure length in orbit
Thin upper lip
Smooth philthrum

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What is white matter connectivity?

Functions that require interplay between brain areas

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What is low white matter connectivity linked to?

ADHD, poor concentration, distractability

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What are outcomes of fetal alcohol syndrome?

Learning difficulties
Conduct disorders
Combined ADHD and ADD
Anxiety disorders

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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

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How does the brain respond to stress?

Development and function of limbic circuit and amygdala

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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