Child and Adolescent Psychiatry Flashcards
What are conduct disorders?
Characterised by repetitive and persistent patterns of antisocial, aggressive or defiant behaviours which violate age-appropriate social norms.
Associated with in increased risk of death often sudden or by violent means.
How is conduct disorder managed?
Multiagency communication.
Parent training programme Modification of school environment Functional family therapy Multi-systemic therapy Child interventions - social skills, problem-solving, anger management, confidence building. Treat co-morbidities Address child protection concerns.
What are Hyperkinetic disorders?
Characterised by core features of developmental abnormal inattention, hyperactivity and impulsivity present across time and situations.
Highly co-morbid e.g. motor coordination problems, substance misuse etc.
Majority are symptomatic into adulthood, especially inattention.
What are the management options for ADHD?
Psychoeducation Medication - stimulants, atomoxetine, guanfacine. Behavioural interventions e.g. realistic expectations, contingency management. Parent training School interventions Treat co-morbidity Voluntary organisations Benefits
What medication is indicated for ADHD or ADD?
Methylphenidate. Acts on Nad and DA systems. taken orally. Non-Addictive, purely symptomatic treatment that lasts 4 hours and then wears off. Atomoxetine is 2nd line.
What are the side effects of methylphenidate?
Decreased appetite
Weight loss
Trouble sleeping
BP is also affected a little.
What are some factors that increase the risk of suicide?
Persistent suicidal ideas Previous suicidal behaviour High lethality of method used High suicidal intent and motivation. Ongoing precipitating stresses Mental disorder Poor physical health Impulsivity, neuroticism, low self esteem, hopelessness Parental psychopathology and suicidal behaviour Physical/sexual abuse Disconnection from support systems.
What is involved in twin studies?
Comparison of DZ and MZ twins and calculates the % variance between them due to environment and genetics.
What are some examples of intra-uterine and perinatal factors that affect psychological development?
Maternal health - antibodies, diabetes etc. Substance misuse Toxins - lead, mercury, PCBs Drugs - psychotropic/anti-epileptic drugs Epigenetics Endocrine environment Immune environment Premature birth Twinning Impressive levels of resilience
What are the features of foetal alcohol syndrome?
Growth retardation in Body, head, brain and eyes.
Multiple neuro-developmental effects such as sensorimotor, cognitive development, executive function and language.
How does White matter connectivity affect brain function?
Required for functions that need interplay between brain areas e.g working memory between hippocampus and anterior cingulate nucleus.
Low connectivity is associated with more neural noise, intra-individual variability and cognitive instability. Typically associate with ADHD.
How does early life influence stress response?
Influences function of limbic circuit including amygdala. Determines subsequent patterns of stress response such as withdrawal or aggressive response
What is operant conditioning?
Type of associated learning where behaviour is modified through reward/reinforcement or punishment.
Dopamine neutrons fire when you associate an action with a subsequent reward.
Early adversity decreases the dopamine response.
What is the application of reward deficiency model also called?
Hypoactive reward response.
Addiction or increased delay-aversion.
What is executive and cortical control?
Taking control over automatic and learned behaviours. Applied in CBT.
Inhibits prepotent responses.
Intentional decision making and forward planning but it requires self awareness and capacity to self-monitor
What is delay-aversion?
Inability to wait and maintain attention in the absence of immediate reward.
What are some mental health problems associated with being out of school?
Anxiety Conduct disorder Autism Depression Obsessive compulsive disorder.
What is separation anxiety?
Fear of leaving significant someone or place. Usually fear of leaving parents and the house to go to school.
What are the features of anxiety disorders?
Anxious thoughts and feelings (impending doom).
Autonomic symptoms
Avoidant behaviour.
How is the Amygdala affected in anxiety disorders?
Amygdala activity is surpassed by right ventrolateral amygdala when labelling emotions.
In generalised anxiety disorders there is reduced connectivity between right ventrolateral cortex and amygdala.
What are the long term effects of successful behavioural treatment?
Challenge - Success - self confidence - resilience.
What are the long-term effects of no behavioural treatment?
Challenge - avoidance - Low self confidence - Vulnerability.
What is autism spectrum disorder?
Syndrome of distinctive behavioural abnormalities. Often associated with low IQ but not defined by it. Present across life span and different settings.
Highly heritable.
M>F 3:1.
What are some pathways and proteins that are expected to be affected in Autism Spectrum Disorder?
Glutaminergic proteins
GABA
5-HTT (serotonin transporter)
NMDA and GRIK2 (glutamate receptor subunits).
What is the range of the autistic spectrum?
Least severe is autism that inly effects on synaptic function. Individuals have normal IQ.
More severe is autism with learning difficulties. Effects on synaptic function, neural migration and brain development.
What are some distinctive features of autism?
Reciprocal conversation
Expressing emotional concern
Non-verbal communication - declarative pointing, modulated eye-contact, other gestures, facial expression.
Repetitive behaviour such as mannerisms and stereotypies. Obsessions, preoccupations and interests.
Rigid and inflexible pattern of behaviour - routines, rituals, play.
What are some clinical features of ASD?
Decreased: self-other perspective taking, sharing/divided attention, flexible learning, social understanding.
Increased: rigidity, sameness, fixed learning patterns, technical understanding.
Younger/lower IQ:
Joint attention/attention to others.
Emotional responses
Movements and actions.
Older/higher IQ:
Conversation
Empathy
Interests.
What are some clinical problems in ASD?
Learning disabilities Sleep disturbances Eating disturbances Hyperactivity High levels of anxiety/depression OCD School avoidance Aggression Temper tantrums Self-injury Self-harm Suicidal behaviour (6x more likely).
What are some genetic causes of ASD?
Co-morbid with congenital or genetic disorders e.g. rubella, callosal genesis, Down’s syndrome, Fragile X, Tuberous sclerosis.
Broader phenotype in siblings and parents.
What is the management for ASD?
Recognition, description and acknowledgement of disability.
Establishing needs
Appreciating can’t and won’t.
Decrease the demands to reduce stress and improve coping.
Psychopharmacology.
What are the key features of Oppositional Defiant disorder?
Refusal to obey adults request Often argues with adults Often loses temper Deliberately annoys people Touchy or easily annoyedly others Spiteful or vindictive
What are some key features of ADHD?
Aggression is impulsive and may not even be a feature,
Poor cognitive control and ability to sustain a goal.
Often remorseful
Resistant to pure behavioural management.
Stronger genetic component than ODD.
What is parent training?
Useful in hard to manage children treatment.
1-2hrs a week for 8-12 weeks.
Structured therapy that is informed by social-learning theory.
Focuses on positive reinforcement of desired behaviour and developing positive parent-child relationships.
