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
