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Psychiatry (2) > Child and Adolescent Psychiatry > Flashcards

Child and Adolescent Psychiatry Flashcards

1
Q

What does CAMHS stand for?

A

Child and Adolescent Mental Health Services

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2
Q

What is an impairment?

A

Loss of structure or function – including physiological function

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3
Q

What is disability?

A

Restriction/lack of ability to perform an activity within ‘normal’ range

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4
Q

What is a handicap?

A

disadvantage preventing fulfilment of normal role resulting from an impairment or disability

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5
Q

What is a learning disability?

A

Umbrella term for a significantly reduced ability to understand and acquire knowledge (understand new/complex information), impaired intelligence (new skills), impaired social functioning (coping independently) which started prior to adulthood and has a lasting effect on development

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6
Q

What formal, standardised assessment can be used to classify learning disabilities?

A

IQ test

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7
Q

A child scores 84 on his IQ test, what category is he?

A

Normal (70-130)

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8
Q

A child scores 72 on his IQ test, what category is he?

A

Normal (70-130)

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9
Q

A child scores 63 in his IQ test, what category is he?

A

Mild (50-69)

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10
Q

A child scores 54 in his IQ test, what category is he?

A

Mild (50-69)

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11
Q

A child scores 45 in his IQ test, what category is he?

A

Moderate (35-49)

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12
Q

A child scores 39 on his IQ test, what category is he?

A

Moderate (35-49)

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13
Q

A child scores 32 on his IQ test, what category is he?

A

Severe (20-34)

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14
Q

A child scores 18 on his IQ test, what category is he?

A

Profound (<20)

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15
Q

A child scores 14 on his IQ test, what category is he?

A

Profound (<20)

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16
Q

Give 5 risk factors for a learning disability in children

A
  • FHx
  • Psychological Trauma
  • Prenatal and Neonatal Risks: SGA/IUGR/Infection/Alcohol/Drugs/ Delivery
  • Psychological trauma
  • Physical trauma: TBI/CNS infection
  • Environmental exposure: Toxins e.g. Pb/ Drugs/ Alcohol/ Smoking
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17
Q

What is ADHD?

A

Chronic neurodevelopmental disorder characterised by inattention, hyperactivity and impulsivity which is present in early childhood and persists into adult life

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18
Q

What is the Sx triad of ADHD?

A

Hyperactivity, Inattention and Impulsivity

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19
Q

Give 3 RFs for ADHD

A
  • Nicotine
  • Alcohol
  • Prematurity
  • SGA/IUGR
  • Hypoxia
  • Emotional neglect
  • Brain insult
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20
Q

A 13 year old child presents with hyperactivity. His mother recently says he has had difficulty sustaining attention. Additionally, he is disobedient and has been distracted by other tasks, avoids completing tasks. Additionally, he fidgets with his hands and feet, leaves seats and climbs lots of apparatus in class such as desks and chairs. The aforementioned behaviour has lead to him getting punished in class and numerous meetings with the school teachers.

Give your DDx and Tx

A

Attention Deficit Hyperactivity Disorder

• Stimulant: Methylphenidate
–> MOA: Inhibit reuptake of DA/NE = increased DA/NE activity
±
• Behavioural therapy: Behavioural parenting training (younger)/Behaviour management programme (Older)

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21
Q

A 13 year old child presents with hyperactivity. His mother recently says he has had difficulty sustaining attention. Additionally, he is disobedient and has been distracted by other tasks, avoids completing tasks. Additionally, he fidgets with his hands and feet, leaves seats and climbs lots of apparatus in class such as desks and chairs. The aforementioned behaviour has lead to him getting punished in class and numerous meetings with the school teachers. Additionally, he gets anxious in social situations which precipitates this behaviour.

Give your DDx and Tx

A

ADHD

Atomoxetine/Guanfacine
±
Methylphenidate

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22
Q

What investigation should be carried out should a child be prescribed Atomoxetime?

A

LFTs due to potential liver damage

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23
Q

Give a SE of Methylphenidate

A

appetite suppression/insomnia/mood swings/hypertension/dizziness/headache

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24
Q

What is conduct disorder?

A

Behavioural child psychiatric condition typified by persistent difficult behaviour outside of social norms

25
Q

Conduct disorder involving peers at the same level is termed as?

A
  • Socialised conduct disorder
26
Q

Conduct disorder involving not peers at the same level is termed as?

A
  • Unsocialised conduct disorder
27
Q

Conduct disorder involving authority is termed as?

A
  • Oppositional defiant disorder
28
Q

A 9 year old child is brought in by his parents due to showing aggression to people. He has recently been in trouble for destroying his teacher’s handbag. Additionally, he persistently disobeys her orders and is very energetic.

Give your DDx and Tx

A

Conduct disorder - Oppositional Defiant Disorder

• Supportive: Parental training/Family therapy/Individual therapy (Counselling/Mindfulness/CBT)

29
Q

A 10 year old child is brought in by his parents due to showing aggression to classmates. He has recently been in trouble for destroying his friend’s toy truck. Additionally, he persistently disobeys orders and is very energetic.

Give your DDx and Tx

A

Conduct disorder - Socialised Conduct Disorder

30
Q

What is Pervasive Development Disorder?

A

Umbrella term for neurodevelopmental disorders of Autism and Autism Spectrum Disorders: Childhood Autism; Atypical Autism; Asperger Syndrome; Rett Syndrome

31
Q

What is Autism Spectrum Disorder?

A

Neurodevelopmental condition typified by impaired social communication, restricted behavioural pattern, interest or activity with abnormal development (speech/regression). The disorder can usually have comorbidities such as epilepsy, ADHD and MHDs.

32
Q

Wat are the risk factors for autism?

A
  • Male Sex (4:1  M:F)
  • Positive FHx
  • Prenatal complications: TORCH infection/cocaine/alcohol/valproic acid
  • Perinatal complications: GDM/ HTN/ High order of birth/ Prematurity/ Antepartum haemorrhage
  • Postnatal complications: PPH/Immunological abnormalities/SGA
33
Q

A 13 year old boy is brought into GP by his parents. They report his asocial tendencies, playing in isolation. Additionally, he has not been understanding social cues which leads to disagreements in the playgrounds. Finally, it is difficult to get him interested in other hobbies, as he sticks to his same routine.

How would you confirm your suspected DDx? What is your DDx?

Give the Tx

A

Child Autism Screening Test (CAST)

Autism Spectrum Disorder

• Applied Behaviour Analysis (ABA): Behavioural programme reinforcing positive behaviour and discouraging negative behaviours

+ Tx for Morbidity

34
Q

What is the main difference between Autism and Aspergers?

A

Aloofness and language delay

35
Q

What is Rett Syndrome?

A

= Neurodevelopmental disorder present in girls only typified by developmental regression at 12 months, macrocephaly, characteristic hand-washing movements

36
Q

What is Disintegrative Psychosis? (Heller Syndrome)

A

Autism + Regression + Retardation

37
Q

What is an elimination disorder?

A

Psychiatric conditions regarding difficulties in toileting (Encopresis; Enuresis) which may be due to underlying developmental disorders

38
Q

An 8 year old child presents with constipation and lack of appetite. He has no haematochezia or weight loss. His bowels work infrequently but regularly he has leakage of stool onto underwear and passage of large stools.

Give your DDx and Tx

A

Encopresis

• Supportive: Behavioural therapy (star charts/regimes)/Family therapy
+
• Dietary: Increased fibre
±
• Oral laxative (stool softener): Magnesium citrate/Polyethylene glycol
-> PEG > Magnesium citrate as tolerance (b/c tasteless)
+
• Oral laxative (stimulant): Senna glycoside

39
Q

An 8 year old child presents with faecal intontinence and lack of appetite. He has no haematochezia or weight loss. His bowels work infrequently but regularly he has leakage of stool onto underwear and passage of large stools.

Give your DDx and Tx

A

• Supportive: Bowel re-training programme (strengthen internal muscles/sphincter via toilet exercises TDS)
±
• Antidiarrheal agent: Loperamide (opioid receptor agonist to increase anal sphincter pressure)

40
Q

What is the MOA of Loperamide?

A

opioid receptor agonist to increase anal sphincter pressure

41
Q

What type of laxative is PEG?

A

Softener

42
Q

What type of laxative is Senna?

A

Stimulant

43
Q

What is the difference between primary and secondary enuresis?

A

1º is bladder control never achieved, 2º is bladder control achieved for 6 months then lost

44
Q

A 9 year old girl is brought into the GP following her recent bed wetting. Additionally, she has urinary incontinence during the day. She has abnormal voiding habits, with the feeling of fullness even after voiding.

Give your DDx and Tx.

A

Enuresis (2º)

• Supportive: Lifestyle change (reduce intake prior to bed/remove precipitants/toilet training/bladder training)
+
• Alarm Therapy: Bed-wetting alarms -> awaken child
±
• Hormonal: Desmopressin
-> Immediate action; Short-term treatment
±
• Detrusor-relaxing drugs: Oxybutynin (PO 5mg BDS)/ Tolterodine (PO 1mg BDS)
-> Block PSNS ACh to reduce detrusor contraction

45
Q

What is a Tic?

A

Rapid, involuntary, repetitive, stereotyped motor movements or phonic production

46
Q

What is a Simple Tic?

A

Simple ticks (blinks, grunts, sniffs) are transitory occurring in 10% of children and resolve spontaneously

47
Q

What is Tourettes Syndrome?

A

Neurodevelopmental disorder beginning in childhood characterised by tics (motor + vocal) ± other psychiatric problems (OCD/ADHD) with presentation in childhood, persisting for at least 1 year, and attenuating later in adolescence.

48
Q

Give 3 RFs for Tourettes Syndrome.

A
  • Male sex
  • Age: 3-8
  • FHx of TS/Tics
  • Hx of OCD
49
Q

A 6 year old boy is brought to the GP following recent eye blinking and sniffing in a timely but spontaneous way. Additionally, sometimes he repeats the movements of others and displays rude gestures.

O/E you identify blepharospasm, tics, copropraxia and echopraxia.

Give your DDx and Tx

A

Tourettes

• CBT

+ (Tics)
1st
• Alpha agonists: Guanfacine/Clonidine

50
Q

A 4 year old is brought in by his parents due to never speaking. He has normal hearing but has circumstantial speaking, only recognising your presence, and very infrequently his mother’s.

Give your DDx and Tx

A

Elective mutism

• Supportive: SLT/CBT
±
• Anti-depressants (SSRIs): Citalopram/Sertraline/Fluoxetine

51
Q

How may you identify Non-Accidental Injury in Physical Abuse?

A
  • Vague account
  • Incongruent stories
  • Story incompatible to injury
  • Delay in seeking help
  • Parent does not reflect level of caring: Too little or Too much
  • Child’s affect: Sad/Withdrawn/Fearful/Trusting in strangers
52
Q

How may you identify Sexual Abuse in children?

A
  • Persistent/recurrent dysuria
  • HBV/HDV
  • Anogenital warts (HPV)
  • STIs
  • Unusual sexualised behaviours in prepubertal child
53
Q

What is neglect?

A

Maltreatment of children involving lack of provision for a child’s physical, emotional, social and cognitive needs.

54
Q

How may you identify neglect in a child?

A
  • Inadequately fed
  • Poor dress
  • Poor hygiene
  • Deprived of satisfactory contact with parents/guardian
  • Deprived of social contact with friends and children
  • Failure to meet milestones
55
Q

A mother presents with a 8 year old child she is concerned about. She says the child keeps bleeding and she is unsure why. Additionally the child is reported to have a fever, headaches and hearing loss. The child has no notable PMHx and DHx.

O/E the child is haemodynamically stable, has normal observations, normal Rinne’s and Weber’s test of hearing. Additionally the child is pyrexial.

The mother insists that you are the 4th doctor she has seen in the past 3 months with this child. She says she has read a lot on the internet and believes that this is truly a genuine illness.

Give your DDx and Tx

A

Munchausen Syndrome by Proxy

No Tx

56
Q

What is insomnia?

A

sleep disorder by which you have trouble falling asleep ± staying asleep.

57
Q

Give 3 RFs for Insomnia.

A
  • Female sex
  • Advancing age
  • Chronic physical illness
  • Chronic psychological illness
  • Use of alcohol/drugs/stimulants
58
Q

A parent brings in their 14 year old son due to chronic tiredness. The teenager says they are unable to sleep. They take longer to fall asleep, they have numerous awakenings during the night and a reduced sleep time.

What Ix would you run and DDx do you suspect?

A

• Epworth Sleepiness Scale: ≥ 9

PSG: Sleep ∆s

Insomnia

  • CBT-I
  • Sleep hygiene + relaxation techniques
  • Zolpidem 5-10mg PO OD (Z-drugs)

Psychiatry (2) (13 decks)

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