Child psych: assessment and management Flashcards
What are teh prinicples of assesment in child and adolescent psychiatry?
- Biopsychosocial approach
- Engagement
- Multiple perspectives and relationships
- Communication
What aspects of the history are important in child and adult psychiatry?
- Problems
- Family
- Development
- School
- Social
- Interests
- Strengths
- What has been tried
- Hopes
In terms of formulation and management of mental illness in young people what are the important contributing factors?
- Biological
- Psychological
- Social aspects
- Predisposing factors (risk)
- Precipitating Factors
- Maintaining and protective factors
What are some biological factors implicated in the biopsychosocial factors?
- Genetic predisposition
- Neurodevelopmental insults
- Illness
What are some psychological factors implicated in the biopsychosocial factors?
- Temperament
- Attachment style
- Psychological attributes
- impulsivity
- low self-esteem
- perfectionism
- belief system
- Social
- family relationships
- peer relationships
- hobbies/interests
- religious faith
- neighbourhood
- school
- rural/urban
- criminality
- finances
What is a conduct disorder?
- characterised by repetitive and persistent patterns of antisocial, aggressive or defiant behaviours which violate age-appropriate social norms.
What is the course and outcomes of conduct disorders?
- Persistent disorder
- associated with increased risk of early death, often by sudden or violent means.
- Increased risk of:
- social exclusion
- Poor school achievement
- Long term unemployment
- Criminal Activity
- Adult mental health problems
- Poor interpersonal relationships, including with their own children.
What is the management of Conduct Disorders?
Based on biopsychosocial assessment and is likely to need multi-agency communication and cooperation. Possible components:
- Parent training programme
- Modification of school environment
- Functional family therapy
- Multi-systemic therapy
- Child interventions
- Social skills
- Problem solving
- Anger management
- Confidence building
- Treat comorbidity
- Address child protection concerns.
What is a Hyperkinetic Disorder?
- Such as ADHD or HKD
- CHaracterised by core features of developmentally abnormal inattention, hyperactivity and impulsivity present across time and situations.
- Can be highly co-morbid (50-80%).
- Motor coordination problems
- Substance Misuse
- Anxiety
- Depression
- Majority are symptomatic into adulthood, especially inattention.
- Associated with reduced academic and employment success
- Increased criminal activity
- Increased adult mental health problems.
What is the management of ADHD?
- Psychoeducation
- Medication –
- stimulants
- atomoxetine
- guanfacine
- Behavioural interventions e.g. realistic expectations, contingency management
- Parent training - PinC
- School interventions
- Treat comorbidity
- Voluntary organisations
- Benefits
What medication is indicated in the management of ADHD?
-
Methylphenidate
- Closely related to amphetamine - taken orally.
- Similar principle to aspirin
- non-addictive
- wear off after 4 hours
- Purely symptomatic treatment
- Side effects: appetite, weight, sleep
- Acts on Noradrenaline and Dopamine systems
2nd Line Treatment
- Atomoxetine - non-stimulant also acts on NAd systems
Why do individuals self-harm?
How do people often do it?
What is it associated with?
- This is a coping mechanism.
- Individuals harm themselves physically to deal with emotional pain, or to break feelings of numbness by arousing sensation.
- Self-poisoning, cutting, burning etc.
Associated with:
- Psychiatric disorder, or significant psychosocial problems.
- Suicide risk
What factors are strongly associated with suicide?
- Strong association between depression and suicidality.
- The combination of mood disorder, substance misuse and conduct disorder is particularly high risk.
What factors increase the risk of suicide?
- Persistent suicidal ideas
- Previous suicidal behaviour
- Highly lethal method of suicide used
- HIgh suicidal intent & motivation
- Ongoing precipitating stresses
- Mental disorder
- Poor physical health
- Impulsivity, neuroticism (moody?), low self-esteem, hopelessness
- Parental psychopathology and suicidal behaviour
- Physical and Sexual abuse
- Disconnection from support systems
How do you manage suicide/suicide risk?
- Safety of the young person is the priority.
- Take the threat seriously.
- Admit to age-appropriate ward after serious attempt for medical and psychosocial review.
- Mental health and risk assessment by trained staff member - with ready access to psychiatric opinion.
- Confidentiality.
- Further referral to agencies as appropriate.
