Child and Adolescent Psychiatry Flashcards
What do Genome Wide Association Studies (GWAS) show?
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
What are intrauterine and perinatal factors that affect psychiatric disorders?
- 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
What is poor white matter connectivity associated with?
- more neural ‘noise’ in the system, intra-individual variability, ‘cognitive instability’
- in developing brains, associated with ADHD- poor concentration, distractibility
What are common outcomes of low white matter connectivity?
- highly variable clinical picture
- learning difficulties
- conduct disorders- ODD
- combined ADHD or ADD or hyp-imp subtypes
- anxiety disorders
What are environmental factors during childhood that affect psychiatric disorders?
- 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
How does the brain respond to stress?
- 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
What biopsychosocial factors are assessed?
- 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
What are the features of conduct disorders?
- 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
What is the management for conduct disorders?
- 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
What are the features of hyperkinetic disorders (HKD or ADHD)?
- 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
What is the managment for ADHD?
- psychoeducation
- medication
- behavioural interventions
- parent training
- school interventions
- treat comorbidity
- voluntary organisations
- benefits
What medications are used for ADHD?
- methylphenidate
- symptomatic treatment
- SA: appetite, weight, sleep, BP
- acts on NAd, DA systems
- atomoxetine
What is self harm?
- 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
What factors increase the risk of suicide?
- 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
What is the management for suicide?
- 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
What are some mental health disorders associated with being out of school?
- anxiey
- depression
- conduct disorder
- autism
- obsessive compulsive disorder
What mental health problems can affect school attendance and learning?
- learning difficulties- poor attention
- co-morbid learning problems
- difficulties controlling emotions
- anxiety
- lack of energy, motivation
- difficulties joining in
- sensory problems
- preocupation- e.g. fear of contamination
- association between mental health and learning difficulties- e.g. dyslexia
What is separation anxiety and social phobia?
- fear of leaving parents + home
- problems at doorstep
- fear of joining groups
- problem at school gate
What are the (3As) features of anxiety disorders?
- anxious thoughts + feelings
- autonomic symptoms
- avoidant behaviour
What are motivational factors affecting attendance?
- learning difficulties
- lack of friends and relationships
- bullying
- lack of parental interest/concern
- maternal depression
What is the treatment for anxiety?
- behavioural
- learning alternative patterns of behaviour
- desensitisation
- overcoming fear
- managing feelings
- medication
- SSRIs
What are the long-term effects of receiving vs not receiving behavioural treatment?
- challenge -> success -> self-confidence -> resilience
- challenge -> avoidance -> low self-confidence -> vulnerability
What is autism spectrum disorder?
- syndrome of distinctive behavioural abnormalities
- often associated with low IQ
- highly heritable
- affect 1%
- M:F 3:1
- synaptic proteins implicated (glutaminergic, GABA)
What is the range of the autism spectrum?
What are some distinctive features of autism?
Social:
- reciprocal information
- expressing emotional concern
- non-verbal communication
- declaritive pointing
- modulated eye contact
- other gesture
- facial expression
Repetitive behaviour:
- mannerisms + stereotypes
- obsessions, preoccupations, interests
- rigid + inflexible patters of behaviour
- rituals
- routine
- play
What are clinical features of autism?
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/actions
Older/higher IQ:
- conversation
- empathy
- interests
What are clinical problems of autism?
- learning disability
- disturbed sleep + eating habits
- hyperactivity
- high levels of anxiety + depression
- obsessive compulsive disorder
- school avoidance
- aggression
- temper tantrums
- self-injury, self-harm
- suicidal behaviour (x6)
What are causes of autism?
- strongly genetics
- co-morbid with congenital/genetic disorders
- Down’s syndrome, fragile X, tuberous sclerosis
- GWAS indentifying genetic modulators
- broader phenotype in siblings and parents
- inc. depression, anxiety, OCD, language impairment
- poor set-shifting abilities, inc. visuospatial abilities, career in engineering, computing, mathematics
What is the management for autism?
- recognition, description + acknowledgement of disability
- establishing needs
- appreciating the can’t + won’t
- the broken leg metaphor
- dec. the demands -> dec stress -> improve coping
- psychopharmacology
What are the key features of oppositional defiant disorders?
- refusal to obey adults requests
- often argues with adults
- often loses temper
- deliberately annoys people
- touchy or easily annoyed by others
- spiteful or vindictive
What are causes of hard to manage children (H2M)?
- child + parent
- lack of positive parenting experiences
- psychosocial adversity + hostility
What is the management for hard to manage children (H2M)?
- parent training programs
- multi-systemic therapy (MST)
What are outcome risks for hard to manage children (H2M)?
- antisocial behaviour
- substance misuse
- long-term mental health problems
