Child and Adolescent Psychiatry Flashcards
1
Q
What do Genome Wide Association Studies (GWAS) show?
A
Identify genetic risk factors for psychiatric disorders
- many genes invloved with small effect
- micro-RNA + epigenetic modulation
- genetic factors for modulation of gene expression
- control influence of environmental factors on genetic expression
- inflammatory and autoimmune mechanisms + genes controlling; synapse formation, neurotransmission, modification
2
Q
What are intrauterine and perinatal factors that affect psychiatric disorders?
A
- maternal health- antibodies, obesity, diabetes
- alcohol, marijuana
- toxins- lead, mercury, PCB
- drugs- psychotropics, antiepiletics
- epigenetics- folate controlled methylation
- endocrine environment- androgens
- immune environment
- premature birth, perinatal complications
- twinning
- impressive levels of resilience
3
Q
What is poor white matter connectivity associated with?
A
- more neural ‘noise’ in the system, intra-individual variability, ‘cognitive instability’
- in developing brains, associated with ADHD- poor concentration, distractibility
4
Q
What are common outcomes of low white matter connectivity?
A
- highly variable clinical picture
- learning difficulties
- conduct disorders- ODD
- combined ADHD or ADD or hyp-imp subtypes
- anxiety disorders
5
Q
What are environmental factors during childhood that affect psychiatric disorders?
A
- carer-child relationship
- parenting skill, parental mental disorder
- marital harmony, family function
- nutrtion, poverty, deprivation
- abuse, neglect
- discipline
- day-care, schooling
- peer relationships
- life events
- physical disability
6
Q
How does the brain respond to stress?
A
- similar to body response to stress
- involves interplay or brain + body
- early life stress affects limbic circuit inc. amygdala
- determines later stress responses
- early life stress influences mood
7
Q
What biopsychosocial factors are assessed?
A
- biological - genetic predisposition, neurodevelopmental insults, illness
- psychological- temperament, attachment style, psychological attributes (e.g. impulsivity, low self-esteem)
- social- family/peer relationships, hobbies, faith, neighbourhood, school, rural/urban, criminality, finances
8
Q
What are the features of conduct disorders?
A
- repititive persistant patterns of; antisocial, agressive or defiant behaviours, violate age-appropriate societal norms
- persistant disorder
- inc. risk of early death
- social exclusion
- poor school achievement
- long-term unemployment
- criminal acitivty
- adult mental health problems
- poor interpersonal relationships
9
Q
What is the management for conduct disorders?
A
- parent training program
- modification of school environment
- functional family therapy
- multi-systemic therapy
- child interventions
- social skills, problem solving, anger management, confidence building
- treat comorbidity
- address child protection concerns
10
Q
What are the features of hyperkinetic disorders (HKD or ADHD)?
A
- developmentally abnormal inattention, hyperactivity, impulsivity
- highly comorbid (LD, ASD, CD, tics, motor coordination problems, substance misuse, anxiety, depression)
- majority symptomatic into adulthood
- dec. academic + employment success, inc. criminal activity, inc. adult mental health problems
11
Q
What is the managment for ADHD?
A
- psychoeducation
- medication
- behavioural interventions
- parent training
- school interventions
- treat comorbidity
- voluntary organisations
- benefits
12
Q
What medications are used for ADHD?
A
- methylphenidate
- symptomatic treatment
- SA: appetite, weight, sleep, BP
- acts on NAd, DA systems
- atomoxetine
13
Q
What is self harm?
A
- coping mechanism
- harms their physical self to deal with emotional pain or to break feelings of numbness by arousing sensation
- self poisoning, cutting, burning, etc.
- psychiatric disorder or significant psychosocial problems
14
Q
What factors increase the risk of suicide?
A
- persistant suicidal ideas
- previous suicidal behaviour
- high lethality of method used
- high suicidal intent + motivation
- ongoing precipitating stresses
- mental disorder
- poor physical health
- impulsivity, neuroticism, low self-esteem, hopelessness
- parental psychopathology + suicidal behaviour
- physical + sexual abuse
- disconnected from support systems
15
Q
What is the management for suicide?
A
- admit to age appropriate ward after serious attempt for medical treatment + psychosocial assessment
- mental health and risk assessment by specially trained staff member with ready access to psychiatric opinion
- confidentiality (with exceptions)
- further referral to appropriate agencies
24
Q
What is the range of the autism spectrum?
A
