Child and adolescent psychiatry Flashcards
ADHD and conduct disorders
Characterised by repetitive and persistent patterns of antisocial, aggressive or defiant behaviours which violate age-appropriate societal norms.
CD Mx
Will be based on biopsychosocial assessment and is likely to need multiagency communication and cooperation. Possible components: Parent training programme (12 or younger) e.g. The Incredible Years, Modification of school environment eg behavioural support, Functional family therapy, Multi-systemic therapy, Child interventions: social skills, problem-solving, anger management, confidence building. Treat comorbidity, Address child protection concerns
what are hyperkinetic disorders/ADHD characterised by?
Characterised by core features of developmentally abnormal inattention, hyperactivity and impulsivity present across time and situations. Highly comorbid (50-80%). Specific LD, ASD, CD, tics, motor coordination problems, substance misuse, anxiety, depression. Majority are symptomatic into adulthood, especially inattention. Associated with reduced academic and employment success, increased criminal activity and increased adult mental health problems.
ADHD Mx
Psychoeducation, Medication – stimulants, atomoxetine, guanfacine, Behavioural interventions e.g. realistic expectations, contingency management, Parent training - PinC, School interventions, Treat comorbidity.
ADHD Medication
Methylphenidate (Closely related to amphetamine – taken orally, Similar principle to aspirin)
Non-addictive, Purely symptomatic treatment, Last 4 hours and wears off , Side effects: appetite, weight, sleep (BP a little), Acts on NAd and DA systems
2nd line: Atomoxetine – non stimulant also acts on NAd systems
self harm
Self injury is a coping mechanism. An individual harms their physical self to deal with emotional pain, or to break feelings of numbness by arousing sensation.
Self poisoning, cutting, burning etc.
Can indicate psychiatric disorder, or significant psychosocial problems.
Many risk factors for self harm are shared with those for suicide.
Autism spectrum disorder
only effects synaptic function
autism with LD
effects on synaptic function, neural migration and brain development
distinctive features
Reciprocity: Reciprocal conversation, Expressing emotional concern, Non-verbal communication, Declarative pointing, Modulated eye-contact, Other gestures.
Obsessions: Facial expressionMannerisms and stereotypies, Obsessions, preoccupations and interests, Rigid and inflexible patterns of behaviour, Routines, Rituals, Play
causes : strongly genetic
Co-morbid with congenital or genetic disorders: e.g Rubella, Callosal agenesis, Down’s syndrome, Fragile X, Tuberous sclerosis.
GWAS identifying genetic modulators
Mx
Recognition, description and acknowledgement of disability, Establishing needs, Appreciating the can’t and the won’t. The broken leg metaphor , Decrease the demands -> reduce stress ->improve coping, Psychopharmacology.
H2M (Hard to manage) children - Oppositional deficancy disorder (ODD) key features…
Refusal to obey adults request Often argues with adults Often loses temper Deliberately annoys people Touchy or easily annoyed by others Spiteful or vindictive
ODD vs ADHD
ODD: •Relates to temperament – irritable and ‘headstrong’
•Behaviour is learned
•Enacted to obtain a desired result
•More likely to result from impaired parenting
•Associated with adversity
ADHD: •Aggression is impulsive, (and aggression may not be a feature).
•Poor cognitive control and ability to sustain a goal
•Often remorseful
•Resistant to pure behavioural management
•Stronger genetic component.
Mx
Caused by many factors: in child (e.g. temperament, ADHD, neurodevelopment) and parent (e.g. overcrowding, poverty, depression)
Especially lack of positive experience of being parented.
Remember lecture 1 – effects of psychosocial adversity and experience of hostility
Parent Training programmes are effective (NICE guidance, 2006)
Multi-Systemic Therapy (MST) attempts to correct all causes.
Outcome risks: antisocial behaviour, substance misuse, long-term mental health problems
what are Genome wide association studies? GWAS
Increasingly used to identify genetic risk factors for psychiatric disorder, Indicate that many genes are implicated, mostly of small effect, Many implicate micro-RNA and epigenetic modulation
