Child Psychiatry

Question 1

What is the first line medical management of ADHD in children?

Answer 1

Methylphenidate

Question 2

What is the only licensed antidepressant for children?

Answer 2

Fluoxetine

Question 3

What is the second line medical management of ADHD in children?

Answer 3

Lisdexamfetamine

Question 4

What is the defintion of ADHD?

Answer 4

A condition where people have problems with hyperactivity and problems with attention that have significant impact in more than one setting

Question 5

What is the criteria for diagnosis of ADHD?

Answer 5

Symptoms present before the age of 12
Several symptoms present in more than one setting
The symptoms interfere with day to day life
The symptoms are not better explained by another diagnosis
Six or more symptoms of inattention
Six or more symptoms of hyperactivity

Question 6

What is the aetiology of ADHD?

Answer 6

ADHD is associated with reduced activity in the frontal lobe, resulting in problems with executive function

Question 7

What are the features of ADHD?

Answer 7

Short attention span
Quickly moving from one activity to another
Losing interest in tasks - not being able to finish tasks
Constantly moving or fidgeting
Impulsive behaviour
Disruptive behaviour or rule-breaking

Question 8

What are the management options for ADHD?

Answer 8

Educational support
Parental and child education
Behavioural techniques
Food diaries to identfy triggers such as colourings
Healthy diet and exercise

Question 9

What is Autism Spectrum Disorder?

Answer 9

ASD is a spectrum of disorder characteristed by deficits in social interaction, communication and flexible behaviour

Question 10

What are the some of the social interaction deficits in ASD?

Answer 10

Lack of eye contact
Delay in smiling
Avoids physical contact
Unable to read verbal cues
Difficulty in initiating friendships
No desire to share i.e during play with others

Question 11

What are some of the communication deficits in ASD?

Answer 11

Delay, absence or regression in language skills
Lack of appropriate non-verbal communication
Difficulty with imagination
Repetitve speech

Question 12

What are some of the behavioural features of ASD?

Answer 12

Greater interest in numbers, patterns or things, rather than people
Special interests
Repetitve movements
Distress with changes in routine
Restricted food preferences

Question 13

What is involved in the management of autism?

Answer 13

CAMHS
Dietitians
Paediatricians
Special school environments
Charities - national autistic society
SALT
PTOT

Question 14

What is anorexia?

Answer 14

An eating disorder characterised by weight loss, sustained and initiated by the patient, with clear concern regarding their weight and shape

Question 15

What is bulimia?

Answer 15

An eating disorder characterised by binge eating, followed by purging (by vomiting or taking laxatives)

Question 16

What are the features of anorexia?

Answer 16

Excessive weight loss
Amenorrheoa
Lanugo hair - thinning hair
Change in mood, depression and anxiety
Hypotension
Hypothermia
Hypokalaemia
Body image distorsion

Question 17

What are the risk factors for anorexia?

Answer 17

Dieting
Maternal encouragement of weight loss
Family history of eating disorders
Personal history of anxiety, depression or OCD
Perfectionistic traits
Profression that is heavily body focussed

Question 18

What is the management of anorexia?

Answer 18

Antidepressants
CBT
Family therapy
Diet advice
Supervised weight gain

Question 19

What are the features of bulimia?

Answer 19

Binge eating
Purging - vomiting or laxatives
Normal BMI
Dental erosion
Parotid gland swelling
Scarring on fingers from inducing vomiting - Russell’s sign
GORD
Mouth ulcers

Question 20

What is the management of bulimia?

Answer 20

CBT - first line
Antidepressants
Family therapy
Diet advice

Question 21

What is refeeding syndrome?

Answer 21

Electrolyte imbalances that occur when patients have been in a nutritional deficit for an extended period of time, start eating again

Question 22

How does refeeding syndrome occur?

Answer 22

When a patient starts to eat food again, the cells need to process protein, fats and glucose - this leads to phosphorus, magnesium and potassium being used up

Question 23

What electrolye imbalances occur in refeeding syndrome?

Answer 23

Hypomagnesaemia
Hypokalaemia
Hypophosphataemia

Question 24

What are the side effects of methylphenidate?

Answer 24

Stunted growth
Abdominal pain
Nausea
Dyspepsia

Question 25

What physiological abnormalities may be seen in anorexia?

Answer 25

Hypokalaemia
Low FSH, LH and oestrogen
Raised growth hormone and cortisol
Impaired glucose tolerance
Hypercholesterolaemia