child psych part 2 Flashcards

1
Q

What should you think about when taking a MH history from a teen?

A

fear of leaving home
fear of going to school
unwilling to go to school
unwilling to leave home

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2
Q

MH probs associated with being out of school

A
Anxiety
Conduct disorder
Autism
Depression
Obsessional compulsive disorder
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3
Q

Some effects of mental health problems on school attendance and learning

A

Learning difficulties due to poor attention
Co-morbid specific (or general) learning problems
Difficulty controlling emotion e.g. frustration, escalation of anger, frequent conflict.
Anxiety (see below)
Lack of energy, motivation
Difficulties joining in โ€“ wanting to be alone or unable to make friends (feeling different).
Sensory problems โ€“ too noisy
Preoccupation e.g. fear of germs and contamination
Associations between mental health and learning difficulties e.g. dyslexia

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4
Q

what is separation anxiety?

A

โ€“ fear of leaving parents and home. Problems on the doorstep

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5
Q

what is social phobia?

A

โ€“ fear of joining group. Problems at the school gate.

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6
Q

what are the features of anxiety disorders? 3As

A
  • Anxious thoughts and feelings (e.g. impending doom)
  • Autonomic symptoms
  • Avoidant behaviour
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7
Q

what factors affect willingness to go to school?

A

Learning difficulties
Lack of friends and relationships
Bullying
Lack of parental attention or concern (e.g. lack of interest in childโ€™s education)
Encouraging one to stay at home
Maternal depression (enc. Separation anxiety)

Maternal depression or psychiatric disorder.
School bullying
Lack of parental attention or control

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8
Q

what brain activity is seen in teen with GAD

A

Amygdala activity

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9
Q

what suppresses amygdala activity?

A

right ventrolateral cortex when labelling emotions.

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10
Q

what anatomical problem is seen in teens with GAD?

A

Reduced connectivity between right ventrolateral cortex and amygdala

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11
Q

treatment in children for anxiety>

A
Behavioural
Learning alternative patterns of behaviour
Desensitization
Overcoming fear
Managing feelings

Medication
Serotonin reuptake inhibitors e.g. fluoxetine

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12
Q

autism and intelligence?

A

Often associated with Low IQ but not defined by low IQ.

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13
Q

social distinctive features of autism?

A
Reciprocal conversation
Expressing emotional concern
Non-verbal communication
Declarative pointing
Modulated eye-contact
Other gesture
Facial expression
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14
Q

repetitive behaviour examples in autism?

A

Mannerisms and stereotypies

Obsessions, preoccupations and interests

Rigid and inflexible patterns of behaviour
Routines
Rituals
Play

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15
Q

what are the 3 parts of autism

A

reciprocity
obsessions
language

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16
Q

Autism spectrum disporder (ASD) clinical feutres- which are decreased

A
decreased:
Self-other perspective taking
Sharing/ divided attention
Flexible learning
Social understanding
17
Q

Autism spectrum disporder (ASD) clinical feutres- which are increased

A

Rigidity
Sameness
Fixed learning patterns
Technical understanding

18
Q

Autism spectrum disporder (ASD) clinical feutres- seen in younger/lower IQ

A

Joint attention/ attention to others
Emotional responses
Movements/ Actions

19
Q

Autism spectrum disporder (ASD)clinical features- seen in older/higher IQ

A

Conversation
Empathy
Interests

20
Q

causes of ASD

A

strongly genetic

Co-morbid with congenital or genetic disorders:
e.g Rubella, Callosal agenesis, Downโ€™s syndrome, Fragile X, Tuberous sclerosis.

GWAS identifying modulators of genetic expression e.g rbfox1

Also epigenetics

Broader phenotype in siblings and parents:
increased rates of depression, OCD, anxiety disorders, language impairment
Poor set-shifting ability, increased visuospatial ability, careers in engineering, computing or mathematics

21
Q

what proteins are affected in ASD?

A

Many synaptic proteins are implicated mainly glutaminergic but also GABA.

22
Q

autism with normal IQ? pathophysiology. on synapses

A

Only effects on synaptic function and plasticity (e.g. turnover)

23
Q

autism with LD? pathophysiology. on synapses

A

Effects on synaptic function, neural migration and brain development

24
Q

what are the common clinical problems in ASD?

A
Learning disability โ€“ mild to severe
Disturbed sleep and eating habits
Hyperactivity
High levels of anxiety and depression
Obsessional compulsive disorder
School avoidance
Aggression
Temper tantrums
Self-injury, self-harm
Suicidal behaviour (6 x)
25
principles of management?
Recognition, description and acknowledgement of disability Establishing needs Appreciating the canโ€™t and the wonโ€™t. The broken leg metaphor Decrease the demands -> reduce stress ->improve coping Psychopharmacology
26
ODD and tantrums
Relates to temperament โ€“ irritable and โ€˜headstrongโ€™ Behaviour is learned Enacted to obtain a desired result More likely to result from impaired parenting Associated with adversity
27
ADHD and tantrums
Aggression is impulsive, (and aggression may not be a feature). Poor cognitive control and ability to sustain a goal Often remorseful Resistant to pure behavioural management Stronger genetic component.
28
what can be cause behind H2M kids (hard 2 manage)
, caused by many factors: in child (e.g. temperament, ADHD, neurodevelopment) and parent (e.g. overcrowding, poverty, depression) Especially lack of positive experience of being parented.
29
treatment for H2M kids?
Parent Training programmes are effective (NICE guidance, 2006) Multi-Systemic Therapy (MST) attempts to correct all causes.
30
outcome risks of H2M kids
ntisocial behaviour, substance misuse, long-term mental health problems