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Child Psych Flashcards

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1
Q

is this normal or abnormal:
3 year old throwing tantrums, won’t eat or sleep when told, tiring out mother

A

normal

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2
Q

is this normal or abnormal:
7 year old disrupting class, doesn’t finish school work, blurts out answers too quickly

A

can be normal or abnormal - ADHD type picture but could be behavioural

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3
Q

is this normal or abnormal:
12 year old, seen 18 times in past 3 months with various physical health issues. Worries a lot about school work.

A

Abnormal - ?somatisation of anxiety

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4
Q

is this normal or abnormal:
16 year old boy truanting and hanging out with gangs. always angry, drinking alcohol. charged with arson, theft and assault and can’t seem to control his actions

A

Abnormal

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5
Q

Describe general CAMHS Mx

A
  • emphasis on psychological therapy
  • liase with school / family / social services
  • less emphasis on medication
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6
Q

medication for hyperkinetic disorder

A

methylphenidate

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7
Q

medication for OCD

A

sertraline / SSRIs

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8
Q

medication for depression

A

fluoxetine

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9
Q

medication for psychoses

A

atypical anti psychotics

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10
Q

medication for bipolar

A

mood stabilisers / anti psychotics

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11
Q

describe normal anxiety development in children

A

9 months-3 years = separation anxiety
3-6 years = animals / darkness / monsters
6-12 years = performance anxiety
12-18 years = social anxiety
adulthood = illness / death

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12
Q

prevalence & typical age of onset of separation anxiety

A

3%
<6 years

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13
Q

prevalence & typical age of onset of specific phobias

A

3%
>6 years

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14
Q

prevalence & typical age of onset of social anxiety

A

5%
11 to 15

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15
Q

prevalence & typical age of onset of generalised anxiety

A

3%
Increases through teens

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16
Q

prevalence & typical age of onset of panic disorder

A

5%
late teens

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17
Q

prevalence & typical age of onset of OCD

A

2%
early childhood or late teens

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18
Q

Mx of anxiety

A

psycho-education for children / parents / family
CBT
medication 2nd line = SSRIs
liaison with school eg for school phobia

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19
Q

prognosis of childhood anxiety

A

do not persist into adulthood but most adult anxiety are proceeded by anxiety in adolescence

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20
Q

list remission rates of different anxiety disorders from most likely to remiss to least likely

A

seperation > phobias > generalised > panic > OCD

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21
Q

when would a child with sadness be classified with depressive disorder

A

prolonged episode / recurrent episodes

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22
Q

other depressive sx children present with

A

somatic sx
irritability
social withdrawal / school refusal / change in academic performance

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23
Q

is depression common in prepubertal children? post pubertal?

A

no
yes - 5%

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24
Q

comorbid conditions that present with depression

A

anxiety
conduct disorder
hyperkinetic disorders

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25
Q

key mx points of depression

A

psychoeducation
advice on sleep /exercise / diet
mange environmental stressors - eg work with schools if bullying

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26
Q

mx of mild depression

A

watchful waiting for 2 weeks by GP / counsellor / social worker
3 months CBT

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27
Q

mx of moderate-severe depression

A

referral to CAMHS
3 months CBT / family therapy / psychodyanmic psychothgerapy / interpersonal / brief psychosocial intervention
then switch psychological therapy or SSRI

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28
Q

what is the ONLY SSRI approved for tx of depression in children / adolescents
why is it the only one?

A

fluoxetine
only one with favourable risk:benefit profile

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29
Q

when would you admit a child with depression

A

LAST RESORT
- high risk
- poor home supervision / support
- intensive assessment required

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30
Q

key side effect to monitor of fluoxetine

A

increased suicidality (DSH, suicidal thoughts)

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31
Q

how does Mx of depression in children differ from adults

A

children
- focus on multiple psychotherapy 1st line
- only use fluoxetine
- rarely use fluoxetine alone
- much more intensive monitoring initially
adults
- first line is CBT
- can offer SSRI alone

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32
Q

prognosis of untreated depression

A
  • 1/3 remit in 2 months
  • 10% depressed after 1 year
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33
Q

proportion of children with depression who relapse

A

1/3 relapse

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34
Q

what are children with depression at higher risk of in adulthood

A

increased long term risk of suicide attempts / bipolar / hospitalisation

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35
Q

what does bipolar diagnosis in children involve

A

clear manic episode with euphoria over several days

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36
Q

Sx of bipolar

A

irritability
behavioural problems
impulsivity
disinhibition
grandiosity
paranoia

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37
Q

how do bipolar symptoms overlap with other disorders / normal development

A

normal teenage behaviour / depression / drugs / conduct = irritability, behavioural problems
ADHD / normal teenage behaviour = impulsivity, disinhibition
ego-centrisim is part of normal childhood development = grandiosity, paranoia

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38
Q

how is bipolar differentiated from ADHD

A

ADHD is continuous, bipolar is phasic

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39
Q

how does psychosis differ in children from adults

A

children do not have systematic or complex delusions
children’s delusions may reflect concerns specific to child’s development eg monsters
children might not have vocab to express delusion

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40
Q

DDx of child with first onset psychosis

A

prodromal phase can look like autism
substance misuse
social isolation
PTSD / trauma
age appropriate experiences / behaviours

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41
Q

what is EIP

A

Early intervention in psychosis

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42
Q

rationale of EIP

A

intensive early intervention and treatment of psychosis improves outcome

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43
Q

challenges of EIP

A

prodromal symptoms can look like other conditions so diagnosis is difficult
younger people are more sensitive to side effects of anti psychotics

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44
Q

how is cannabis related to psychosis

A

dose dependent relationship between cannabis use and schizophrenia / psychosis
if use skunk/other more potent cannabis, or start younger, or smoke more often or FHx of psychosis with cannabis use (increased susceptibility of psychosis when using cannabis) –> massive increase in psychosis risk

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45
Q

why does cannabis cause psychosis in 15-16 year olds more

A

pruning occurring in brain at this age, so has greater affect on perception and psychosis risk

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46
Q

morbidity of substance misuse in teenagers

A

8% of deaths in 15-19 year olds

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47
Q

Mx for substance misuse

A

motivational intervention

48
Q

behavioural disorders in pre school children

A

difficulty sleeping / eating / continence

49
Q

what defines a disorder

A

distress / impairment caused by problem

50
Q

aetiological factors of behavioural disorders

A

child - developmental delay, physical disorders
family - poor routine setting / abuse / poor relationships between child and parents / parental psych issues
environment - stress eg social deprivation

51
Q

1st Mx of behavioural disorder

A

rule out physical disorder
eg OSA for sleep, reflux for eating, Hirschrpungs for continence

52
Q

2nd Mx of behavioural disorder

A

set up conducive enviroment to formation of desirable habit
classical conditioning - child should associate environment with habit

53
Q

how do preschoolers learn

A

CONDITIONING
classical conditioning or operant conditioning

54
Q

when is medication used in behavioural disorder
give 2 examples of medications used

A

LAST RESORT
- melatonin for sleep / vasopressin for enuresis

55
Q

what years are the peaceful years

A

school age

56
Q

what is the difference between school refusal and truancy

A

school refusal
- 5 to 12year old
- parents know child is at home
- related to anxiety / fears

truancy
- adolescence
- parents unaware
- conduct disorder

57
Q

how do you treat truancy vs school refusal

A

school refusal
- treat underlying psych disorder & anxiety Mx
- early graduated school return / liaison with education welfare officer

truancy
- effective boundary setting by parents / school
- support needs at school, liaise with EWO

58
Q

contrast aetiology of school refusal vs truancy

A

school refusal
- anxious temperament
- overprotective family
- health issues / somatisation
- school transitions
- academically able

truancy
- large disorganised family
- limited academic ability

59
Q

define key features conduct disorder

A
  • repetitive / persistent pattern of defiant behaviour
  • freq / severity beyond age appropriate norms
60
Q

prevalence in boys vs girls

A

4.5% boys, 2% girls

61
Q

what do younger children have vs adolescents in terms of conduct issues

A

younger = ODD - oppositional defiant disorder
older = conduct disorder

62
Q

list types of conduct disorder

A

truanting
stealing
initiating fights / mugging / using weapons
destruction of property / arson

63
Q

list acts consistent with ODD

A

severe tantrums
active defiance and refusal to comply with rules
frequent anger

64
Q

Describe progression of conduct disorder

A

40% of 7-8year olds with CD become recidivist delinquents as teenagers
predictor of antisocial personality disorder

65
Q

mx of conduct disorder

A

treat any psychiatric disorder eg ADHD
target modifiable risk factors at a young age - education/social services
parenting programmes
cognitive problem solving skills training / multi system therapy
mentoring

66
Q

describe parenting skills programmes

A

variety of books / videos
individual or group training sessions

67
Q

4 pillars of parenting programmes

A

house rules be clearly communicated
spend quality time with child
parents to model good behaviour
behavioural management skills using conditioning

68
Q

4 pillars of parenting programmes

A

house rules be clearly communicated
spend quality time with child
parents to model good behaviour
behavioural management skills using conditioning

69
Q

process of behavioural management

A

antecedent –> behaviour –> consequence
- identify triggers
- increase desired behaviour
- reinforce behaviour

70
Q

features of reinforcing good behaviour

A

clear
immediate
consistent
contingent - linked to particular situation, explaining what exactly is right
with attention / praise / stars

71
Q

how can bad behaviour be discouraged

A

extinction - undesired acts ignored
time out from positive reinforcement
distraction / misdirection
clear consequences if boundaries reached

72
Q

triad of ADHD

A

inattention
hyperactivity
impulsivity

73
Q

defintiion of ADHD ICD11

A

> 6 months
inattention and or hyperactivity-impulsivity
pervasive across different situations
onset < 7 years
significant distress or social impairment

74
Q

prevalence of ADHD

A

5%

75
Q

what is hyperkinetic disorder

A

more severe impairment than ADHD

76
Q

male to female ratio ADHD

A

3:1

77
Q

comorbidity with %s of ADHD

A

ODD 50% / conduct disorder 25%
anxiety 25% / depression 15%
LDs 30%

78
Q

describe the ADHD spiral

A

ADHD symptoms
–>
learning difficulties
oppositional behaviour
–>
failure at school academically / social
–>
low self esteem, isolation, delinquent peer group
–> back to top

79
Q

pathophysiology of ADHD

A

prefrontal cortex dysfunction
udnerfunctionung of dopamine system

80
Q

executive functioning tests for ADHD

A

Wiconsin card sorting test
stroop test

81
Q

what is the stroop test

A

list of colours written in different colours, have to say the colour the word is written in, not what colour is written

82
Q

non genetic biological aetiology of ADHD

A

VLBW
prematurity
foetal alcohol syndrome
food additives ?? maybe not

83
Q

parental factors causing ADHD

A

critical comments
maltreatment
physical discipline
lack of sensitivity to childs needs
maternal depression

84
Q

Non drug Mx of ADHD

A

cognitive assessment
psycho education - no one is at fault, what behaviours are good / bad, support groups
diet - food diary to find sensitivity
parent skills training

85
Q

when is drug mx of ADHD used

A

used for persistent significant impairment

86
Q

2 drug mx options of ADHD

A

stimulants
- methylphenidate (sustained or immediate release)

non stimulants
- atomoxetine (NA reuptake inhibitor)

87
Q

how does methylphenidate work

A

block pre synaptic DAT and agonist at postsynaptic DRD4

88
Q

side effects of methylphenidate

A

stunted growth - height and weight
reduced appetite !!
problems with mood - irritability / low mood / anxious
problems sleeping

89
Q

what needs to be monitored with methylphenidate and why

A

height / weight - can reduce appetite and stunt growth
BP - causes HTN
baseline ECG if high risk - cardiac arrhythmias
tic progression if they had tics prior to starting

90
Q

who is recommended for methylphenidate

A

severe / moderate ADHD who have failed to respond to psychosocial intervention

91
Q

second line mx for ADHD

A

dexamfetamine (also a stimulants)

92
Q

non stimulant medication for ADHD

A

guanfacine (alpha adrenergic receptor agonist)
atomoxetine (NARI)

93
Q

when can atomoxetine be used

A

to help with comorbid depression

94
Q

what needs to be monitored in atomoxetine

A

liver failure so do LFTs

95
Q

3 key things to be monitored regularly in methylphenidate

A

growth & BP
suicidal thoughts

96
Q

3rd line Tx for ADHD

A

atomoxetine

97
Q

prognosis of ADHD

A

all patients will get better to some degree, but 2/3rd have some symptoms persisting

98
Q

what % of patients will have ADHD as adults

A

15% have ADHD as adults

99
Q

major complication of untreated ADHD

A

90% conduct disorder if untreated

100
Q

what is aspergers

A

ASD without learning difficulties

101
Q

3 key features of ASD

A

reciprocal social interaction difficulties
communication difficulties
repetitive / restrictive behaviour

102
Q

what is reciprocal social interaction difficulties

A

poor appreciation of social cues
difficulty reciprocating in social interactions - reduced sharing interest/enjoyment with others, reduced proto-declarative pointing
poor non verbal communication - eye contact/social smiling/facial expression range
failure to develop peer relationships

103
Q

what is proto declarative pointing

A

pointing at something interesting to share your interest with someone else

104
Q

what are communication difficulties in ASD

A
  • non verbal: less gestures, variety/spontaneity of pretend play
  • verbal: delay in language development, stereotyped/repetitive speech, lack of chit-chat
105
Q

what are restricted / repetitive behaviour

A

unusual or repetitive play / use of objects
unusual sensory interests
stereotyped motor mannerisms - eg flapping
adherence to routines / rituals
unusual pre-occupations or circumscribed interests

106
Q

other difficulties of ASD

A

lower IQ
fears / phobias / OCD
ADHD / aggression / self injury
epilepsy in 20%

107
Q

when do ASD symptoms present

A

they are present in under 3 year olds, but manifestations change as child ages

108
Q

heritability of ASD

A

90%

109
Q

medical conditions causing ASD

A

Tuberous sclerosis
fragile X
Downs

110
Q

prevalence of ASD

A

autism 0.25%, ASD 1%

111
Q

2 psychological theories of ASD

A
  1. executive dysfunction theory
    - poor flexibility of behaviour to context
  2. theory of mind
    - can’t appreciate that others have thoughts / feelings of their own that may be different to their own
112
Q

what is the sally anne test

A

to test theory of mind

113
Q

Mx of ASD

A

cognitive assessment
psycho-education - no one is at fault, leaflets
MDT - specialist schools, paeds, SLT, OT
behavioural Mx +/- meds for psych disorder

114
Q

prognosis of ASD

A

variable - depending on IQ/language/social skills
10% achieve independent lives / work /relationships

115
Q

what factors/models must you consider in the development of a mental health condition in children

A

4Ps
- predisposing
- precipitating
- perpetuating
- protective

3 areas
- individual
- family
- environment

bio-psycho-social model

116
Q

how can biological processes in the family cause mental health condition

A

genetics - influence all psych conditions, esp autism / ADHD / schizophrenia / BPAD
genetics of personality / resilience
exposure - alcohol/drugs in utero / childhood

117
Q

how can psychological processes in the family cause specific mental health conditions (list them related to the psych factor)

A

parental modelling of:
social boundaries and law - conduct disorder
education - truancy
food - EDs
alcohol / drugs - misuse

poor attachment - anxiety / depression

Y5 Psych (10 decks)

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