Child Psych Flashcards by David Townsend

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

30%

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What would be an early indicator of child problems?

Failure to meet developmental miletsones

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What is the mainstay of treatment in child psychiatry?

Psychological therapy

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What is the Yerkes Dodson curve?

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

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

Methylphenidate

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What medication would you use in childhood OCD?

Sertraline

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What medication would you use in childhood depression?

Fluoxetine

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What medication would you use in childhood psychosis?

Atypical antipsychotics

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What medication would you use in childhood BPAD?

Mood stabilisers or anti-psychotics

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What are the two main theories of autism?

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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What is the incidence of Autism?

1:10k

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What is the M:F ratio in autism?

01:04

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Is autism heritable?

Yes, 90%

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What are the aetiological theories of autism?

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

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What are the key features of autism?

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

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

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

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

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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What organic brain disease occurs in tandem with autism?

Epilepsy

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What are the differential diagnoses for autism?

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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What investigations would you order in a ?autistic child?

Hearing tests
SLT assesssment
Neuropsychological testing

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How would you manage an autistic child?

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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What is the F:M ratio for asperger’s?

01:08

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What are the main symptoms of aspergers?

Poor social skills
Normal language and IQ
Tendency to be literal

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What is the management for Aspergers?

Advice, support, routines and social skills training

What is the typical age for separation anxiety?

<6y

What is the typical age for specific phobias?

>6y

What is the typical age for social anxiety?

11-15y

What is the typical age for generalised anxiety disorder?

teenage

What is the typical age for panic disorder?

late teens

What is the typical age for OCD?

Early or late teens

What is the management for anxiety disorders in children?

CBT!

Does childhood anxiety persist to adulthood?

No, not normally.

How do you diagnose depression in children?

Sufficiently sad for sufficiently long with functional impairment

What are the common symptoms of depression in children?

Somatic Sx Irritability Social withdrawal School refusal Change in academic performance

What is the treatment for mild depression in children?

Watch and wait!

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

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

What is primary enuresis?

Toilet training never mastered

What are the causes of primary enuresis?

Delayed maturation Stress Excessively relaxed / strict toilet training

What is secondary enuresis?

Dryness achieved for a year and then lost

What is the cause of secondary enuresis?

Stress

How do you treat enuresis?

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

What is encopresis?

Inappropriate defecation after age 4

What are the main causes of encopresis?

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

What are the secondary causes of encopresis?

Diarrhoea Learning difficulties Hostility

What is habit disorder?

Inability to master basic tasks causing distress or impairment.

What is conduct disorder?

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

What is oppositional defiant disorder?

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

How do you treat conduct disorder?

Involve MDT services to treat risk factors Parenting training

What is ADHD?

Triad of inattention, hyperactivity and impulsivity

What is the likely aetiology of ADHD?

Underfunctioning DRD4 dopamine receptors or DAT1 transporter

What is the management for ADHD?

Parenting training Psycho-education Diet Medication if resistant

What medication is used in ADHD?

Stimulants: Methylphenidate (ritalin) Non-stimulants: Atomoxetine

What is the definition of a learning difficulty?

IQ<18)

What are the classes of learning difficulty?

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

What are the two assessment tools used in LD?

Wechsler adult intelligence scale Adaptive behaviour assessment system

Does mild LD have a specific cause?

Not normally

What are the typical causes of severe LD?

Brain damage Genetic abnormalities Hypothyroidism

What are the prenatal causes of LD?

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

What are the perinatal causes of LD?

Hypoglycaemia Neonatal hypoxia Trauma Prematurity

What are the postnatal causes of LD?

Malnutrition Infections / intoxicants Head injury

What is the cause of Downs' syndrome?

Trisomy 21

What are the physical features of downs syndrome?

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)

What are the physical issues associated with downs' syndrome?

Heart defects Hypothyroidism Epilepsy Leukaemia

What are the mental issues associated with downs' syndrome?

Depression Alzheimers

Why are downs' syndrome patients predisposed to alzheimers?

The plaque gene is on chromosome 21

What is the affected site in Fragile X syndrome?

Xq27.3

What is the genetic abnormality in Fragile X syndrome?

More than 200 CGG repeats at Xq27.3

What is interesting about inheritance Fragile X syndrome?

Shows anticipation

What are the features of Fragile X syndrome?

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

What are the social problems associated with Fragile X syndrome?

Hyperactivity Social deficits Speech disorders Autistic type behaviour

What is Leish-Nyhan syndrome?

Chromosome 16 deletions Show lots of self harming behaviour

What is tuberous sclerosis?

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

What are the characteristic features of fetal alcohol syndrome?

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

What are the common mental health problems associated with LD?

Schizophrenia Mood disorders Autistic spectrum disorder

Which epilepsy drug causes behavioural disturbances?

Levitracitam

What are the typical presentations of mental illness in LD?

Aggression Self injury Withdrawal

What are typical psychotic Sx in LD?

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

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

Intellectual distortion Psychosocial masking Cognitive disintegration Baseline exaggeration Diagnostic overshadowing

What is intellectual distortion?

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

What is psychosocial masking?

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

What is cognitive disintegration?

Decreased tolerance for stress, causing anxiety induced decompensation

What is baseline exaggeration?

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

What is diagnostic overshadowing?

Misattributing physical symptoms to LD