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Psych > Child psychiatry > Flashcards

Child psychiatry Flashcards

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1
Q

What is autism

A

Pervasive developmental disorder

Triad of complications

  • Difficulty in social interactions
  • Impaired communication
  • Restricted, stereotyped interests and behaviours
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2
Q

What are the prenatal causes of autism

A

Genetics

Parental age (mothers >40)

Drugs (sodium valproate)

Infection (rubella)

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3
Q

What are the antenatal causes of autism

A

Obstetric complications

Low gestational age at birth

Low birthweight

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4
Q

What are the postnatal causes of autism

A

Toxins (mercury, lead)

Pesticide exposure

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5
Q

What are the risk factors for autism

A

Male

Genetics

Advanced parental age

Parental psychiatric disorders

Prematurity

Maternal medication use

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6
Q

What are the clinical features of autism

A

Most parents have concerns by 12-18 months

Onset before age 3 for diagnosis (otherwise atypical)

Asocial
- Few social gestures, lack of eye contact, no smiling, no response to name, no interest in others, no emotional expressions, limited awareness of social rules

Behaviour restricted
- Rocking, twisting, upset at change of routine, prefer certain foods/clothes…, obsessively pursue interests, fascination with sensory things

Communication impaired
- Distorted and delayed speech, echolalia (repetition of words)

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7
Q

What are the investigations for autism

A

Full developmental assessment

Sensory tests

Screening tools (CHAT)

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8
Q

What are the differentials for autism

A

Asperger’s syndrome

Rett’s syndrome

Childhood disintegrative disorder

Learning disability

Deafness

Childhood schizophrenia

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9
Q

What is the management for autism

A

CBT

Daily living skills training

Access to education

Melatonin
- For sleep disorders despite behavioural intervention

Play-based strategies

Interventions for challenging behaviour

  • Modify environment
  • Antipsychotics
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10
Q

What is hyperkinetic disorder

A

Aka ADHD

Early onset persistent pattern of

  • Inattention
  • Hyperactivity
  • Impulsivity

Present in more than one situation

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11
Q

What are the causes of hyperkinetic disorder

A

Genetic

Neurochemical
- Abnormal dopaminergic pathway

Neurodevelopmental
- Abnormal pre-frontal cortex

Social
- Social deprivation, family conflict, parental substance use

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12
Q

What is the epidemiology of ADHD

A

3 times more common in males

Onset usually 3-7

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13
Q

What criteria need to be met for a diagnosis of ADHD

A

Onset begore age 7

> 6 months duration

IQ >150

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14
Q

What are the investigations for ADHD

A

Bloods
- Routine, TFTs

Hearing test

Rating scales

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15
Q

What are the differentials for ADHD

A

Learning disability/dyslexia

Oppositional defiant disorder

Conduct disorder

Autism

Sleep disorder

Mood disorders

Anxiety disorder

Hearing impairment

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16
Q

What is the management for ADHD

A

Support parents and teachers
- Normally picked up at school

Pre-school
- Parent training and education (reinforce positive behaviour)

School-goers

  • Psychoeducation, CBT, social skills training
  • Severe cases: methylphenidate (CNS stimulant, side effects headaches, insomnia, loss of appetite)
17
Q

What is a learning disability

A

State of arrested or incomplete development of the mind

Triad of

  • Low intellectual performance
  • Onset at birth/during childhood
  • Wide range of functional impairments
18
Q

What are the classifications of severity of learning disabilities

A

Mild

  • IQ 50-70
  • Mental age 9-12

Moderate

  • IQ 35-49
  • Mental age 6-9

Severe

  • IQ 20-34
  • Mental age 3-6

Profound

  • IQ <20
  • Mental age <3
19
Q

What are the causes of learning disability

A

Genetic

Antenatal
- Congenital infections, nutritional deficiency, intoxication, endocrine disorders, physical damage antepartum haemorrhage, pre-eclampsia

Perinatal
- Birth asphyxia, haemorrhage, neonatal sepsis

Neonatal
- Hypoglycaemia, meningitis, infection

Postnatal
- Infection, metabolic abnormality, cerebral palsy

Environmental
- Neglect, non-accidental injury, malnutrition, socioeconomic deprivation

Psychiatric
- Autism, Rett’s syndrome

20
Q

What are the investigations for learning disabilities

A

Before birth

  • Amniocentesis, chorionic villus sampling, genetic testing and karyotyping
  • For Down’s syndrome: b-HCG, PAPP-A, nuchal translucency

After birth

  • Bloods
  • CT/MRI head
  • IQ test
21
Q

What is the management for learning disabilities

A

Treat physical health problems

Antipsychotics for challenging behaviour

CBT

Encourage positive behaviour

Family education programmes

Genetic counselling

Antenatal diagnosis

Psych (11 decks)

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