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Psychiatry > Child Psychiatry > Flashcards

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
Q

Describe the Psychological management of Autism

A

CBT (if able to engage and is motivated)

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26
Q

Describe the sociological management of Autism

A

All diagnosed should have a key worker
Specialist schooling if necessary
Families should be offered support

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27
Q

Describe the potential biological managements of Autism

A

Antipsychotics (Risperidone) - challenging behaviour
Melatonin (Sleeping difficulties)

28
Q

what can be done to help with behaviour challenges in autism?

A

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
Q

Define Hyperkinetic Disorder/ADHD

A

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
Q

what are some risk factors for having hyperkinetic disorder?

A

male

family history

environmental risk factors - social deprivation and family conflict, parental cannabis and alcohol exposure

31
Q

When is the typical onset of ADHD?

A

Between ages of 3-7

32
Q

Describe the four potential aetiologies of ADHD

A
  • *Genetic** (DRD4 and DRD5 genes)
  • *Neurochemical** (Abnormalities in Dopaminergic pathway)
  • *Neurodevelopmental** (Abnormalities of Pre-Frontal Cortex)
  • *Social** (eg Social Deprivation)
33
Q

Describe the ‘Inattention’ component of the three core symptoms of ADHD

A
  • Not listening
  • Highly distractable
  • Reluctant to engage in activities that require persistent mental effort
  • Regularly forgetting or losing things
34
Q

Describe the ‘Hyperactivity’ component of the three core symptoms of ADHD

A
  • Restless and fidgeting
  • Reckless
  • Running and Jumping in inappropriate places
  • Difficulty engaging in quiet activities
  • Excessive talking or noisiness
35
Q

Describe the ‘Impulsivity’ component of the three core symptoms of ADHD

A
  • Difficulty waiting their turn
  • Interrupting
  • Temper Tantrums
  • Prematurely blurting answers
  • Disobedient
  • Running into street without looking
36
Q

Describe the ICD10 criteria A-G of ADHD

A

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
Q

Describe the expected Appearance and Behaviour, Speech and Mood for a patient with suspected ADHD

A

Appearance and Behaviour- Fidgety, unable to sit still, replies over parents
Speech - Talks loudly, makes excessive noise
Mood - Normal

38
Q

Describe the expected Thought, Perception, Cognition and Insight for a patient with suspected ADHD

A

Thought - normal
Perception - No hallucinations
Cognition - poor attention, lack of concentration
Insight - poor

39
Q

Name 3 investigations for suspected ADHD

A

Bloods - TFTs to rule out Thyroid disorder
Hearing tests

rating scales - conner’s rating scale and the Strengths and Difficulties questionnaire

40
Q

Name three differentials for a diagnosis of ADHD

A

Learning disability
Oppositional Defiant Disorder (Defiant and Disruptive against authoritative figures)
Conduct Disorder (repetitive Antisocial Behaviour)

41
Q

Name two organisations which can support Parents and Teachers of Children with ADHD

A

Add Up
ADDISS

42
Q

How could you manage a preschool child with ADHD?

A

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
Q

How could you manage a school age child with ADHD?

A

Psychoeducation
CBT

severe - drug treatment

44
Q

How could you manage ADHD Pharmacologically?

A

Methyphenidate (Ritalin) - CNS stimulant 1st line (side effects - headaches, insomnia, loss of appetite and weight loss)
Atomoxetine

45
Q

what is conduct disorder?

A

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
Q

what is oppositional defiant disirder?

A

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
Q

Define Learning Disability

A

State of arrested or incomplete development of the mind
Characterised by impairment of skills manifested over the developmental period

48
Q

What is the clinical triad of Learning Disabilities?

A

Low intellectual performance (IQ<70)
Onset at Birth/Early Childhood
Wide range of functional impairments

49
Q

Describe the ICD10 criteria of Learning Disability

A

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
Q

Name some genetic causes of Learning Disabilities

A
  • Downs Syndrome
  • Fragile X Syndrome
  • Prader-Willi
  • Neurofibromatosis
51
Q

Describe the physical features of Downs Syndrome using the mnemonic PROBLEMS

A

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
Q

Describe the physical features of Fragile X Syndrome

A
  • Large protruding ears
    Long face
    High arched palate
    Flat feet
  • Soft skin
  • Lax joints
53
Q

Name four Antenatal causes of Learning Difficulties

A

Rubella
Nutritional deficiency
Hypothyroidism
Alcoholism

54
Q

Name four causes in the Neonatal period of Learning Difficulties

A

Neonatal Sepsis
Hypoglycaemia
Hypothyroidism
Birth Asphyxia

55
Q

How would a patient with MILD learning difficulties present?

A

Usually at a later age
Adequate abilities but may struggle with academic work
Most live independently

56
Q

How would a patient with MODERATE learning difficulties present?

A

Able to communicate but language is limited
May need supervision with self care but able to carry out simple work

57
Q

How would a patient with SEVERE learning difficulties present?

A

Marked degree of motor impairment
Little or no speech in early childhood

58
Q

How would a patient with PROFOUND learning difficulties present?

A

Severe motor impairment
Severe difficulties in communication
Little to no self care

59
Q

How would you test for Downs Syndrome during pregnancy?

A

Serum Screening (bHCG or PAPP- A)

Quad Test (bHCG, AFP, Inhibin A, Estriol)

60
Q

How would you investigate Learning Difficulties

A

Full range of bloods
CT head
IQ test

61
Q

Name four occupations involved in the MDT for learning difficulties

A

Psychiatrist
Specialist Nurses
Psychiatrist
Social Sorker

62
Q

Name three behaviour techniques used for patients with Learning Difficulties

A

CBT
Applied Behavioural Analysis
Positive Behaviour Support

63
Q

There are four main Primitive Defences. Define Projection

A

Perceiving and reacting to unacceptable impulses as someone else’s fault

64
Q

There are four main Primitive Defences. Define Dissociation

A

Disconnecting self from areas of identity/memory/consciousness to retain illusion of control

65
Q

There are four main Primitive Defences. Define Idealisation

A

Attributing perfect/near perfect qualities to others as a way of avoiding anxiety or negative feelings

66
Q

There are four main Primitive Defences. Define Regression

A

Returning to an earlier phase of development or functioning to avoid conflicts/tension

67
Q

What is conduct disorder?

A

group of behavioral and emotional problems that usually begins during childhood or adolescence

Psychiatry (18 decks)

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