Child and Adolescent Psychiatry Flashcards
What intra-uterine and perinatal factors contribute to the development of psychiatric illness?
Maternal health – Maternal antibodies, obesity, diabetes
Substance misuse – alcohol, marijuana
Toxins – lead, mercury and PCB’s
Drugs - esp psychotropics/antiepileptics (lipid soluble)
Epigenetics – folate controlled methylation
Endocrine environment – esp androgens
Immune environment
Premature birth/ Perinatal complications
Twinning
What are the characteristics of oppositional deficit disorder?
Frequent loss of temper
Frequent arguing
Becoming easily angered or annoyed
Displaying vindictive or other negativistic behaviours
What are the characteristics of attention deficit disorder/type 1 ADHD?
Distractibility
Difficulty sustaining attention to tasks that don’t provide high level of stimulation or frequent reward
Problems with organisation
What are the characteristics of type 2 ADHD?
Difficulties remaining still
Impulsivity
What environmental factors during childhood have been linked to development of psychiatric disorder?
Carer - child relationship (attachment) Parenting skill and parental mental disorder e.g. post-natal depression, substance misuse. Marital harmony, family function. Nutrition, poverty, deprivation. Abuse, neglect, Discipline Day-care and schooling Peer relationships, Life events, Physical disability
How are conduct disorders characterised?
Characterised by repetitive and persistent patterns of antisocial, aggressive or defiant behaviours which violate age-appropriate societal norms
What are the potential complications of conduct disorders?
Increased risk of early death (often through violent/sudden means) Increased risk of social exclusion Poor school achievement Long term unemployment Criminal activity Adult mental health problems Poor interpersonal relationships
How are conduct disorders managed?
Parent training programmes 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 common hyperkinetic disorders?
HKD
ADHD
How are hyperkinetic disorders characterised?
By core features of: -Developmentally abnormal inattention -Hyperactivity -Impulsivity That are present across time and situations
With what conditions are hyperkinetic disorders particularly comorbid?
Learning disability Autism spectrum disorder Conduct disorders Tics Motor coordination problems Substance misuse Anxiety Depression
What are the complications of hyperkinetic disorders?
Reduced academic and employment success
Increased criminal activity
Increased adult mental health problems
How is ADHD managed?
Psychoeducation Medication- stimulants (atomoxetine, guanfacine) Behavioural interventions Parent training School interventions Treat comorbidity Voluntary organisations Benefits Medication- methylphenidate (purely symptomatic in treatment, can cause appetite and weight loss and sleep disturbance). Second line is atomoxetine
What factors increase the risk of suicide in children and adolescents?
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 and sexual abuse
Disconnection from support systems (friends, family etc)
What is the difference between separation anxiety and social phobia?
Separation anxiety involves a fear of leaving parents and the home- problems will likely arise leaving the house. Social phobia involves a fear of joining a group- problems will likely arise arriving at school.
