Child and adolescent psychiatry Flashcards
when are the features of autism usually observable in a child?
< 3 years old
what is the prevalence of autism in males vs females?
M:F
3:1
What are the distinctive features of autism?
social reciprocity and communication;
reduced/ inability for reciprocal conversation and showing emotional concern non-verbal communication - declarative pointing - modulating eye-contact - unable to recognise facial expressions
repetitive behaviours;
- obsessions, preoccupation and interests
- may be out of enjoyement or a way to cope with anxiety
- routines, rituals
what two factors affect the variation in the features of autism in each individual?
age
IQ
what clinical problems are associated wit autism?
learning disability sutured sleep and eating habits hyperactivity high levels of anxiety and depression OCD school avoidance aggression temper tamtrums self-injury suicide
what congenital & genetic disorders are associated with autism?
rubella callosal agenesis down syndrome fragile X tuberous sclerosis
how is autism managed?
recognition, description and acknowledgement of the disability
establishing needs
appreciating their cant’s and wonts
decrease the demand / expectations
psychopharmacology (for irritability, hyperactivity, aggression)
what are the differences between oppositional defiant disorder and ADHD?
ODD relates to temperament where ADHD relates to hyperactivity and inattention
behaviour is learned in ODD where ADHD has a strong genetic component
ODD behaviours are enacted to sustain a desired goal where ADHD they have poor cognition and inability to sustain a goal
ODD more likely to result from poor parenting
ODD often shows vindictive acts where ADHD show remorse
what are the management options for hard to manage children?
parent training programme
multi-systemic therapy
what are hard to manage children i.e. ODD at risk of in adult life?
ADHD
antisocial behaviour
long-term mental health problems
what is the role of the amygdala and generalised anxiety disorder in children and adolescents?
we manage to control our emotions through connections with the amygdala and the ventrolateral cortex
these connections are lost in GAD so they become anxious when they can’t control emotions
what are the management options for GAD in adolescents/children?
behavioural therapy
CBT
medication - SSRI
psychoeducation
what are the 2 main types of anxiety disorders in children/adolescents?
separation anxiety
social phobia
what mental health problems are associated with being out of school?
depression anxiety OCD conduct disorder autism
what are the features of ADHD?
abnormal inattention
hyperactivity
impulsivity
present across time and situations
what are the management options for ADHD?
psychopharmacology i.e. methylphenidate
parenting training
psychoeducation
school interventions
what co-morbid problems are found along side ADHD?
depression and anxiety
motor coordination problems
substance misuse
what is the 1st line and 2nd line medication treatments for ADHD?
methylphenidate
atomoxetine
what is methylphenidate used to treat and what are the side effects?
ADHD
weight loss
appetite suppression
insomnia
what are the features of conduct disorder?
repetitive, persistant patterns of antisocial, aggressive or defiant behaviours which violate age-appropriate norms
what are the management options for conduct disorder?
parenting training programme modification of school environment family therapy anger management multi-systemic therapy
if a child/ adolescent tried to commit suicide, what would be the management steps?
admit to the ward for medical treatment and psychosocial assessment
mental health and risk assessment
referral to agencies i.e. CAMHS, child protection
what factors increase the risk of suicide?
depression persistant suicidal thoughts high lethality of method used high suicidal intent and motivation ongoing precipitating illness poor physical health mental disorder impulsivity, narcissism, low self esteem parental psychopathology and suicidal behaviour physical and sexual abuse disconnection from support systems
which regards to white matter connectivity, how does this influence the development of ADHD?
in ADHD, the white matter connectivity between the hippocampus and anterior cingulate is reduced
this results in more noise in the system resulting in poor concentration and distractibility
what is delay-aversion?
inability to wait and maintain attention in the absence of immediate reward
associated with ADHD
