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Child Psychiatry Flashcards

1
Q

Define Autism

A

Pervasive developmental disorder characterised by triad of: impairment in social interaction, communication and restricted/stereotyped interests

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2
Q

Give three PRENATAL risk factors for Autism

A
  • Genetics
  • Parental Age >40
  • Drug - particularly Sodium Valproate usage
  • Infection
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3
Q

Give three ANTENATAL risk factors for Autism

A

Hypoxia at birth
Prematurity
Low birth weight

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4
Q

Give a POSTNATAL risk factors for Autism

A

Toxins such as lead/mercury/pesticides

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5
Q

autism triad

A

asocial

behaviour restricted

communication impaired

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6
Q

How might the ‘Asocial’ component of the Autism triad present?

A

Few social gestures, lack of eye contact, lack of emotional expression, response to name, interest in others, sustained relationships and awareness of social rules

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7
Q

How might the ‘Restricted Behaviour’ component of the Autism triad present?

A
  • Restrictive, repetitive and stereotyped behavior - rocking, twisting
  • Upset at any change in routine
    Obsessively pursued interests
  • Prefer same foods, clothes and games
  • Fascination with sensory aspects of environment
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8
Q

How might the ‘Impaired Communication’ component of the Autism triad present?

A

Distorted and delayed speech - often 1st sign
Echolalia (repeated words)

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9
Q

Name three conditions associated with Autism

A
  • Epileptic seizures
  • Visual/hearing impairment
  • Infections
  • Pica - eating inedible objects
  • Constipation
  • Sleep disorders
  • Psychiatric - OCD, depression, BPAD, anxiety, DSH
  • Medical - PKU, fragile X, tuberous sclerosis, congenital rubella, CMV
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10
Q

Describe the ICD10 criteria A-E for Autism

A

A - Presence of abnormal/impaired development before the age of three
B - Qualitative abnormalities in social interaction
C- Qualitative abnormalities in communication
D - Restrictive/Repetitive stereotyped behaviours
E - Clinical picture not attributable to anything else

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11
Q

Describe the Appearance, Speech and Thought of a patient with suspected Autism

A

Appearance - ritualised/stereotyped behaviours, clapping, rocking, poor eye contact

Speech - delayed, repetitive, unusual rate and rhythm

Thought - Obsessions and Compulsions, intense preoccupations

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12
Q

Describe the expected Perception, Cognition and Insight of a patient with suspected Autism

A

Perception - may be sensitive to noise/touch/ smell
Cognition - Impaired attention but can concentrate on special interests
Insight - may be poor

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13
Q

(when is autism typically diagnosed?)

A

50% parents have cause for concern by 12-18 months

onset is before age of 3

atypical autism can be after age of 3

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14
Q

At what age should a child turn towards sound?

A

3 months

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15
Q

At what age should a child know and respond to own name?

A

12 months

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16
Q

What age should a child combine two words?

A

2 years

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17
Q

At what age should a child be smiling?

A

6 weeks to 10 weeks

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18
Q

At what age should a child play with other children?

A

4 years

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19
Q

developmental assessment milestones

A
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20
Q

Name 3 investigations you could do for a child with suspected Autism

A
  • Full developmental assessment
  • Hearing tests
  • CHAT - Checklist for Autism in Toddlers
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21
Q

Aspergers Syndrome is a differential for Autism. Describe three clinical features

A
  • Abnormalities in social interaction and restricted, stereotyped, repetitive interests and behavior
  • No impairment in language/cognition or intelligence
  • More prevalent in boys
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22
Q

Rett’s Syndrome is a differential for Autism. Describe three clinical features

A

Severe progressive disorder starting in early life
Language impairment, stereotyped hand movement, loss of fine motor skills, irregular breathing and seizures
Almost exclusively seen in girls

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23
Q

Hellers Syndrome is a differential for Autism. Describe the clinical features

A

AKA Childhood Disintegrative Behaviour

Two years of normal development followed by loss of previously learned skills

Associated with repetitive, stereotyped interests and behaviors as well as cognitive deterioration

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24
Q

When can a diagnosis of Autism be reliably made?

A

At the age of 3 by a specialist

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25
Describe the Psychological management of Autism
CBT (if able to engage and is motivated)
26
Describe the sociological management of Autism
All diagnosed should have a key worker Specialist schooling if necessary Families should be offered support
27
Describe the potential biological managements of Autism
Antipsychotics (Risperidone) - challenging behaviour Melatonin (Sleeping difficulties)
28
what can be done to help with behaviour challenges in autism?
treat co-existing physical disorders (epilepsy and constipation) and mental health (anxiety and depression) and behavioural (hyperkinetic disorder) modify environmental factors which initiate or maintain challenging behaviour antipsychotics considered for behavior that challenges when psychosocial interventions are insufficient or if severe
29
Define Hyperkinetic Disorder/ADHD
Early onset persistent pattern of Inattention, hyperactivity and impulsivity that are more frequent and severe than in individuals at a comparable stage of development and are present in more than 1 situation
30
what are some risk factors for having hyperkinetic disorder?
male family history environmental risk factors - social deprivation and family conflict, parental cannabis and alcohol exposure
31
When is the typical onset of ADHD?
Between ages of 3-7
32
Describe the four potential aetiologies of ADHD
* *Genetic** (DRD4 and DRD5 genes) * *Neurochemical** (Abnormalities in Dopaminergic pathway) * *Neurodevelopmental** (Abnormalities of Pre-Frontal Cortex) * *Social** (eg Social Deprivation)
33
Describe the ‘Inattention’ component of the three core symptoms of ADHD
* Not listening * Highly distractable * Reluctant to engage in activities that require persistent mental effort * Regularly forgetting or losing things
34
Describe the ‘Hyperactivity’ component of the three core symptoms of ADHD
* Restless and fidgeting * Reckless * Running and Jumping in inappropriate places * Difficulty engaging in quiet activities * Excessive talking or noisiness
35
Describe the ‘Impulsivity’ component of the three core symptoms of ADHD
* Difficulty waiting their turn * Interrupting * Temper Tantrums * Prematurely blurting answers * Disobedient * Running into street without looking
36
Describe the ICD10 criteria A-G of ADHD
A- Abnormality of attention/activity/impulsivity for age at home B - The above at school C - Directly observed A D- Doesn’t meet criteria for autism, mania, depression or anxiety E - Onset before 7y F - Duration \>6m G - IQ\>50
37
Describe the expected Appearance and Behaviour, Speech and Mood for a patient with suspected ADHD
Appearance and Behaviour- Fidgety, unable to sit still, replies over parents Speech - Talks loudly, makes excessive noise Mood - Normal
38
Describe the expected Thought, Perception, Cognition and Insight for a patient with suspected ADHD
Thought - normal Perception - No hallucinations Cognition - poor attention, lack of concentration Insight - poor
39
Name 3 investigations for suspected ADHD
Bloods - TFTs to rule out Thyroid disorder Hearing tests rating scales - conner's rating scale and the Strengths and Difficulties questionnaire
40
Name three differentials for a diagnosis of ADHD
Learning disability Oppositional Defiant Disorder (Defiant and Disruptive against authoritative figures) Conduct Disorder (repetitive Antisocial Behaviour)
41
Name two organisations which can support Parents and Teachers of Children with ADHD
Add Up ADDISS
42
How could you manage a preschool child with ADHD?
Psychoeducation and parent training (parents being helped to reinforce positive bahaviour and find alternative ways of managing disruptive bahviour) link between food and drink and behaviour so parent should keep a food diary
43
How could you manage a school age child with ADHD?
Psychoeducation CBT severe - drug treatment
44
How could you manage ADHD Pharmacologically?
Methyphenidate (Ritalin) - CNS stimulant 1st line (side effects - headaches, insomnia, loss of appetite and weight loss) Atomoxetine
45
what is conduct disorder?
repetitive and severe pattern of antisocial behaviour including aggression, destruction of property, deceitfulness and major violations of age-appropriate social expectations RF - male, abuse as a child, poor socioeconomic status, parental psychiatric disorders most common psychiatric disorder of childhood
46
what is oppositional defiant disirder?
defiant and disruptive behavior against authoritative figures but less severe than conduct disorder, violations of law and physical abuse of others are far less common
47
Define Learning Disability
State of arrested or incomplete development of the mind Characterised by impairment of skills manifested over the developmental period
48
What is the clinical triad of Learning Disabilities?
Low intellectual performance (IQ\<70) Onset at Birth/Early Childhood Wide range of functional impairments
49
Describe the ICD10 criteria of Learning Disability
Mild - IQ 50-70/ mental age 9-12 Mod - IQ 35-49/mental age 6-9 Severe - IQ 20-34/ mental age 3-6 Profound - IQ\<20 / mental age \<3
50
Name some genetic causes of Learning Disabilities
* Downs Syndrome * Fragile X Syndrome * Prader-Willi * Neurofibromatosis
51
Describe the physical features of Downs Syndrome using the mnemonic PROBLEMS
Palpebral Fissure Round Face Occipital and Nasal Flattening Brachycephaly Low set small ears Epicanthic Folds Mouth open and protruding tongue Single Palmar Crease/Strabismus
52
Describe the physical features of Fragile X Syndrome
* Large protruding ears Long face High arched palate Flat feet * Soft skin * Lax joints
53
Name four Antenatal causes of Learning Difficulties
Rubella Nutritional deficiency Hypothyroidism Alcoholism
54
Name four causes in the Neonatal period of Learning Difficulties
Neonatal Sepsis Hypoglycaemia Hypothyroidism Birth Asphyxia
55
How would a patient with MILD learning difficulties present?
Usually at a later age Adequate abilities but may struggle with academic work Most live independently
56
How would a patient with MODERATE learning difficulties present?
Able to communicate but language is limited May need supervision with self care but able to carry out simple work
57
How would a patient with SEVERE learning difficulties present?
Marked degree of motor impairment Little or no speech in early childhood
58
How would a patient with PROFOUND learning difficulties present?
Severe motor impairment Severe difficulties in communication Little to no self care
59
How would you test for Downs Syndrome during pregnancy?
Serum Screening (bHCG or PAPP- A) Quad Test (bHCG, AFP, Inhibin A, Estriol)
60
How would you investigate Learning Difficulties
Full range of bloods CT head IQ test
61
Name four occupations involved in the MDT for learning difficulties
Psychiatrist Specialist Nurses Psychiatrist Social Sorker
62
Name three behaviour techniques used for patients with Learning Difficulties
CBT Applied Behavioural Analysis Positive Behaviour Support
63
There are four main Primitive Defences. Define Projection
Perceiving and reacting to unacceptable impulses as someone else’s fault
64
There are four main Primitive Defences. Define Dissociation
Disconnecting self from areas of identity/memory/consciousness to retain illusion of control
65
There are four main Primitive Defences. Define Idealisation
Attributing perfect/near perfect qualities to others as a way of avoiding anxiety or negative feelings
66
There are four main Primitive Defences. Define Regression
Returning to an earlier phase of development or functioning to avoid conflicts/tension
67
What is conduct disorder?
group of behavioral and emotional problems that usually begins during childhood or adolescence

Psychiatry (18 decks)

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