Child and Adolescent Psychiatry Flashcards
What service is used for young people?
How many tiers are there?
CAMH’s - Child and Adolescent Mental Health Services
4
T1 - professionals whose main training and role is not CAMH (e.g. GP)
T2 - CAMH specialists working in teams in the community (e.g. psychologist)
T3 - Multidisciplinary CAMH team in a specialised service for more severe, complex, or persistent disorders (e.g. CAMH psychiatrist, nurse, OT)
T4 - Essential tertiary services such as intensive community treatment services, day units and inpatient units (e.g. eating disorders or secure wards)
HEEADSSS - what does mneumonic stand for?
Home and environment
Education and Employment
Eating
Activities and hobbies
Drugs, alcohol and tobacco
Sex and relationships
Self-harm, depression and self image
Safety and abuse
Q’s to ask for:
- Home and environment
Who lives at home with you?
Do you have your own room?
Who do you get on with best and/or fight with most?
Who do you turn to when you’re feeling down?
Q’s to ask for:
- Education and employment
Are you in school/college at the moment?
Which year are you in?
What do you like the best/least at school/college?
How are you doing at school?
What do you want to do when you finish?
Do you have friends at school?
How do you get along with others at school?
Do you work? How much?
Q’s to ask for:
Eating
Activities and hobbies
Are you worried about your weight or body shape?
Have you noticed any change in your weight recently?
How do you spend your spare time?
What do you do to relax?
What kind of physical activities do you do?
Q’s to ask for:
Drugs, alcohol and tobacco
What do you need to remember to do at this stage?
Does anyone smoke at home?
Lots of people your age smoke.
- Have you been offered cigarettes?
- How many do you smoke each day?
Many people start drinking alcohol around your age. - Have you tried or been offered alcohol?
- How much/how often?
Some young people use cannabis.
- Have you tried it?
- How much/how often?
What about other drugs, such as ecstasy and cocaine?
REASSURE ABOUT CONFIDENTIALITY
Q’s to ask for:
Sex and relationships
Are you seeing anyone at the moment?
Are they a boy or a girl?
Young people are often starting to develop intimate relationships?
How have you handled that part of your relationship?
Have you ever had sex?
What contraception do you use?
Q’s to ask for:
Self-harm, depression, and self image
How is life going in general?
Are you worried about your weight?
What do you do when you feel stressed?
Do you ever feel sad and tearful?
Have you ever felt so sad that life isn’t worth living?
Do you think about hurting or killing yourself?
Have you ever tried to harm yourself?
Q’s to ask for:
Safety and abuse
Do you feel safe at school/at home?
Is anyone harming you?
Is anyone making you do things that you don’t want to?
Have you ever felt unsafe when you’re online or using your phone?
Why are young people prone to mental illness?
What model can be used to illustrate the aetiology?
They begin to develop adult identity (body, dress, responsibilities, sexuality)
Pressure from schools (exams, peers - sex, drugs and socialising)
Parents
Stress-vulnerability model
Depression:
Clinical features - less obvious than in adults:
Mood changes? - 2
Thought changes? - 3
Physical changes? - 4
Grumpy or irritable rather than very sad
Anhedonia
Loss of self-esteem
Loss of confidence
Lack of concentration
Fatigue
Poor sleep
Poor appetite
Self-harming behaviour
Depression:
History - where can you get a good history about the child if they are not cooperative?
Collateral from parents and school
Depression:
Treatment:
What should be done for mild depression?
What should be done for moderate/severe depression? - 2
How can opportunities for self-harm be removed?
If criminality or gang culture involved, what can be offered?
Tier 1/2 - 4 wks of watchful waiting
Antidepressant - SSRI - fluoxetine - only one licensed for use in children
Psychological therapy - CBT etc.
No paracetamol at home
Hide knives
Peer mentorship
Psychosis:
What is considered a sustained psychosis?
Assessment?
> 4wks
Full history
MSE
Physical examination
Drug screen
Psychosis:
What do the symptoms begin interfering with?
Symptoms
Interpersonal and school functioning
Odd beliefs
Mistrust in others - paranoia
Magical thinking
