Child Psychiatry Flashcards
What is the first line medical management of ADHD in children?
Methylphenidate
What is the only licensed antidepressant for children?
Fluoxetine
What is the second line medical management of ADHD in children?
Lisdexamfetamine
What is the defintion of ADHD?
A condition where people have problems with hyperactivity and problems with attention that have significant impact in more than one setting
What is the criteria for diagnosis of ADHD?
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
What is the aetiology of ADHD?
ADHD is associated with reduced activity in the frontal lobe, resulting in problems with executive function
What are the features of ADHD?
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
What are the management options for ADHD?
Educational support
Parental and child education
Behavioural techniques
Food diaries to identfy triggers such as colourings
Healthy diet and exercise
What is Autism Spectrum Disorder?
ASD is a spectrum of disorder characteristed by deficits in social interaction, communication and flexible behaviour
What are the some of the social interaction deficits in ASD?
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
What are some of the communication deficits in ASD?
Delay, absence or regression in language skills
Lack of appropriate non-verbal communication
Difficulty with imagination
Repetitve speech
What are some of the behavioural features of ASD?
Greater interest in numbers, patterns or things, rather than people
Special interests
Repetitve movements
Distress with changes in routine
Restricted food preferences
What is involved in the management of autism?
CAMHS
Dietitians
Paediatricians
Special school environments
Charities - national autistic society
SALT
PTOT
What is anorexia?
An eating disorder characterised by weight loss, sustained and initiated by the patient, with clear concern regarding their weight and shape
What is bulimia?
An eating disorder characterised by binge eating, followed by purging (by vomiting or taking laxatives)
What are the features of anorexia?
Excessive weight loss
Amenorrheoa
Lanugo hair - thinning hair
Change in mood, depression and anxiety
Hypotension
Hypothermia
Hypokalaemia
Body image distorsion
What are the risk factors for anorexia?
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
What is the management of anorexia?
Antidepressants
CBT
Family therapy
Diet advice
Supervised weight gain
What are the features of bulimia?
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
What is the management of bulimia?
CBT - first line
Antidepressants
Family therapy
Diet advice
What is refeeding syndrome?
Electrolyte imbalances that occur when patients have been in a nutritional deficit for an extended period of time, start eating again
How does refeeding syndrome occur?
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
What electrolye imbalances occur in refeeding syndrome?
Hypomagnesaemia
Hypokalaemia
Hypophosphataemia
What are the side effects of methylphenidate?
Stunted growth
Abdominal pain
Nausea
Dyspepsia
What physiological abnormalities may be seen in anorexia?
Hypokalaemia
Low FSH, LH and oestrogen
Raised growth hormone and cortisol
Impaired glucose tolerance
Hypercholesterolaemia
