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Y5 - Psychiatry > Child Psych > Flashcards

Child Psych Flashcards

1
Q

What is the prevalence of child psychiatric issues in primary care?

A

30%

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2
Q

What would be an early indicator of child problems?

A

Failure to meet developmental miletsones

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3
Q

What is the mainstay of treatment in child psychiatry?

A

Psychological therapy

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4
Q

What is the Yerkes Dodson curve?

A

Theory of how you adapt to adverse stimuli and come to accpt them

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5
Q

What medication would you use in childhood hyperkinetic disorder (ADHD)?

A

Methylphenidate

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6
Q

What medication would you use in childhood OCD?

A

Sertraline

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7
Q

What medication would you use in childhood depression?

A

Fluoxetine

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8
Q

What medication would you use in childhood psychosis?

A

Atypical antipsychotics

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9
Q

What medication would you use in childhood BPAD?

A

Mood stabilisers or anti-psychotics

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10
Q

What are the two main theories of autism?

A

Executive dysfunction - decreased prefrontal activity
Theory of mind - can’t conceive of others as having thoughs / feeling different to their own

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11
Q

What is the incidence of Autism?

A

1:10k

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12
Q

What is the M:F ratio in autism?

A

01:04

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13
Q

Is autism heritable?

A

Yes, 90%

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14
Q

What are the aetiological theories of autism?

A

Genetics
Obstetric complications
Perinatal infection
Genetic disorders: tuberose sclerosis, down’s, fragile X

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15
Q

What are the key features of autism?

A

Poor reciprocal social interaction
Communication abnormalities
Restricted behaviour / routines
Normally low IQ

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16
Q

What are the social abnormalities you would expect to see in autism?

A

Not interested in other people
Appears aloof
Tendency to play alone
Doesn’t develop relationships
Can’t read emotions
No mutuality / warmth
Avoidant eye contact / looks through you
Poor social smiling
Poor facial expression range
Decreased sharing

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17
Q

What are the communication abnormalities you would expect to see in autism?

A

Delayed expressive speech and comprehension
Ideas are taken literally (concrete thinking)
Absent gestures
Monologous speech with interminable questions
Echolalia
I/me confused with he/she

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18
Q

What behaviours / routines would you expect to see in autism?

A

Repetitive / stereotyped behaviour
Little imaginative play
Unusual sensory interests
Stereotyped motor mannerisms
Adherence to routines
Unusual preoccupations / interests
Small change in routine causes tantrums

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19
Q

What organic brain disease occurs in tandem with autism?

A

Epilepsy

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20
Q

What are the differential diagnoses for autism?

A

Deafness
Specific language disorder - delayed speech, otherwise normal
learning disability - poor IQ, normal social skills
Childhood schizophrenia
Rett’s syndrome
Neglect

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21
Q

What investigations would you order in a ?autistic child?

A

Hearing tests
SLT assesssment
Neuropsychological testing

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22
Q

How would you manage an autistic child?

A

Psycho-education of family
Behaviour therapy to reinforce positive behaviour
MDT with SLT and special education
Treat any comorbidities
Medication if extremely aggressive / hyperactive

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23
Q

What is the F:M ratio for asperger’s?

A

01:08

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24
Q

What are the main symptoms of aspergers?

A

Poor social skills
Normal language and IQ
Tendency to be literal

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25
Q

What is the management for Aspergers?

A

Advice, support, routines and social skills training

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26
Q

What is the typical age for separation anxiety?

A

<6y

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27
Q

What is the typical age for specific phobias?

A

> 6y

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28
Q

What is the typical age for social anxiety?

A

11-15y

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29
Q

What is the typical age for generalised anxiety disorder?

A

teenage

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30
Q

What is the typical age for panic disorder?

A

late teens

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31
Q

What is the typical age for OCD?

A

Early or late teens

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32
Q

What is the management for anxiety disorders in children?

A

CBT!

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33
Q

Does childhood anxiety persist to adulthood?

A

No, not normally.

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34
Q

How do you diagnose depression in children?

A

Sufficiently sad for sufficiently long with functional impairment

35
Q

What are the common symptoms of depression in children?

A

Somatic Sx
Irritability
Social withdrawal
School refusal
Change in academic performance

36
Q

What is the treatment for mild depression in children?

A

Watch and wait!

37
Q

What is the treatment for moderate-severe depression in children?

A

Refer to CAMHS
CBT, family therapy, IPT
2nd line psychological therapy or fluoxetine

38
Q

What is primary enuresis?

A

Toilet training never mastered

39
Q

What are the causes of primary enuresis?

A

Delayed maturation
Stress
Excessively relaxed / strict toilet training

40
Q

What is secondary enuresis?

A

Dryness achieved for a year and then lost

41
Q

What is the cause of secondary enuresis?

A

Stress

42
Q

How do you treat enuresis?

A

Organic - refer to paeds
Reassure
Positive reinforcement
Bell and pad
Imipramine or desmopressin

43
Q

What is encopresis?

A

Inappropriate defecation after age 4

44
Q

What are the main causes of encopresis?

A

Overflow incontinence caused by:
Dehydration
Painful defecation
Fear of punishment
Toilet fears
Hirschsprungs disease

45
Q

What are the secondary causes of encopresis?

A

Diarrhoea
Learning difficulties
Hostility

46
Q

What is habit disorder?

A

Inability to master basic tasks causing distress or impairment.

47
Q

What is conduct disorder?

A

Repetitive / persistent patterns of defiant behaviour with frequency and severity beyond norms.
Truanting, stealing, initiating fights / muggings, destruction of property

48
Q

What is oppositional defiant disorder?

A

Conduct disorder in children. Tantrums, active defiance and anger.

49
Q

How do you treat conduct disorder?

A

Involve MDT services to treat risk factors
Parenting training

50
Q

What is ADHD?

A

Triad of inattention, hyperactivity and impulsivity

51
Q

What is the likely aetiology of ADHD?

A

Underfunctioning DRD4 dopamine receptors or DAT1 transporter

52
Q

What is the management for ADHD?

A

Parenting training
Psycho-education
Diet
Medication if resistant

53
Q

What medication is used in ADHD?

A

Stimulants: Methylphenidate (ritalin)
Non-stimulants: Atomoxetine

54
Q

What is the definition of a learning difficulty?

A

IQ<18)

55
Q

What are the classes of learning difficulty?

A

Profound = IQ 0-20
Severe = IQ 20-34
Moderate = IQ 35-49
Mild = IQ 50-69

56
Q

What are the two assessment tools used in LD?

A

Wechsler adult intelligence scale
Adaptive behaviour assessment system

57
Q

Does mild LD have a specific cause?

A

Not normally

58
Q

What are the typical causes of severe LD?

A

Brain damage
Genetic abnormalities
Hypothyroidism

59
Q

What are the prenatal causes of LD?

A

Chromosomal
Maternal infection
Environmental factors - ETOH, drugs, medication, smoking

60
Q

What are the perinatal causes of LD?

A

Hypoglycaemia
Neonatal hypoxia
Trauma
Prematurity

61
Q

What are the postnatal causes of LD?

A

Malnutrition
Infections / intoxicants
Head injury

62
Q

What is the cause of Downs’ syndrome?

A

Trisomy 21

63
Q

What are the physical features of downs syndrome?

A

Upslanting palpebral fissure
Epicanthal folds
Macroglossia
Single transverse palmar crease
Hypotonia
Stunted growth
Short neck
Flattened nose
Shortened hands
Bracycephaly
Strabismus
Brushfield spots (spots on iris)

64
Q

What are the physical issues associated with downs’ syndrome?

A

Heart defects
Hypothyroidism
Epilepsy
Leukaemia

65
Q

What are the mental issues associated with downs’ syndrome?

A

Depression
Alzheimers

66
Q

Why are downs’ syndrome patients predisposed to alzheimers?

A

The plaque gene is on chromosome 21

67
Q

What is the affected site in Fragile X syndrome?

A

Xq27.3

68
Q

What is the genetic abnormality in Fragile X syndrome?

A

More than 200 CGG repeats at Xq27.3

69
Q

What is interesting about inheritance Fragile X syndrome?

A

Shows anticipation

70
Q

What are the features of Fragile X syndrome?

A

Broad forehead
Elongated face
Large prominent ears
Strabismus
High arched palate
Hyperextensibility
Hand calluses from self harm
Pectus excavatum
Mitral valve prolapse
Enlarge testicles
Hypotonia
Soft, fleshy skin
Flat feet
Seizures

71
Q

What are the social problems associated with Fragile X syndrome?

A

Hyperactivity
Social deficits
Speech disorders
Autistic type behaviour

72
Q

What is Leish-Nyhan syndrome?

A

Chromosome 16 deletions
Show lots of self harming behaviour

73
Q

What is tuberous sclerosis?

A

Fibromas found at various sites around the body causing problems including LD:
Facial angiofibromas
Cortical tubers

74
Q

What are the characteristic features of fetal alcohol syndrome?

A

Wide palpebral fissure
Smooth philtrum
Thin top lip
Behavioural difficulties
Growth retardation
Neurological abnormalities

75
Q

What are the common mental health problems associated with LD?

A

Schizophrenia
Mood disorders
Autistic spectrum disorder

76
Q

Which epilepsy drug causes behavioural disturbances?

A

Levitracitam

77
Q

What are the typical presentations of mental illness in LD?

A

Aggression
Self injury
Withdrawal

78
Q

What are typical psychotic Sx in LD?

A

Simple and fleeting:
Single words
Isolated false beliefs
Change in behaviour

79
Q

What problems are encountered in diagnosis of mental illness in LD? (“Take 5”)

A

Intellectual distortion
Psychosocial masking
Cognitive disintegration
Baseline exaggeration
Diagnostic overshadowing

80
Q

What is intellectual distortion?

A

Difficulty in assessing abstract thinking, receptive/expressive language skills due to deficits

81
Q

What is psychosocial masking?

A

Limited social experience affecting symptoms (e.g. mania presenting as belief they can drive)

82
Q

What is cognitive disintegration?

A

Decreased tolerance for stress, causing anxiety induced decompensation

83
Q

What is baseline exaggeration?

A

Increased severity / frequency of maladaptive behaviour after onset of psychiatric illness

84
Q

What is diagnostic overshadowing?

A

Misattributing physical symptoms to LD

Y5 - Psychiatry (4 decks)

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