Child Psychiatry Flashcards
What is ADHD?
Hyperkinetic disorder in ICD-10
Attention deficit hyperactivity disorder
Overactive poorly modulated behaviour, marked inattention and lack of persistent task involvement (short attention span and distractibility)
Disorganised, ill-regulated, and excessive activity (overactivity)
Reckless and impulsive, prone to accidents (impulsivity)
What is needed to be diagnosed with ADHD?
Symptoms prior to age 6 and of long duration
Impairment present in 2 or more settings (eg home and school)
What should be excluded when diagnosing ADHD?
Anxiety disorders Mood affective disorders ASD Learning difficulties Hyperthyroidism Poor nutrition-> anaemia Oppositional defiant disorder Hearing impairment
What is the 1st line treatment for ADHD?
Parent training (new forest parenting package) Social learning model (modelling, rehearsal and feedback) Positive reinforcement, time-out, response cost, token economy
What are the 1st line medications for ADHD?
Methyphenidate (amphetamine, stimulant, dopamine agonist, only if over 6yrs old)
Atomoxetine (noradernaline reuptake inhibitor, non stimulant)
What are the second line drugs for ADHD?
Dexamfetamine
Lisdexamfetamine
What needs to be monitored when treating ADHD?
Loss of appetite Worsening sleep pattern Palpitations/chest pain Aggression/irritability Tics/repetitive noises Headaches, stomach aches, unexplained bruising Height/weight & growth Dose too high? Zombies (sadness, withdrawal, depression) Pulse and BP
If medications don’t work, how can you treat ADHD?
Family therapy
CBT
How may adults present with ADHD?
Fidgeting, poor concentration, restlessness
Problems with emotional regulation
Difficulty maintaining relationships/employment
Substance misuse
Depression
What is the neurophysiology explanation of ADHD?
Congulostriatal pathway (is a -ve link dopamine pathway)
Lack of inhibition-> uncontrolled movement
Dopamine agonism increases the inhibition of the cingulostriatal pathway, inhibiting over activity
What are the common childhood psychiatric disorders?
ASD ADHD Conduct disorder OCD Anxiety
What are the common adolescent psychiatric disorders?
Eating disorders
Anxiety
Mood disorders
Psychosis
What is ASD?
Autism spectrum disorder
Difficulties in social communication, social interaction, repetitive/stereotyped activities
Hypersensitive senses, flat affect, facial expression limited, fixated, little eye contact
Difficulty making friends, difficulty understanding their feelings and emotions so can’t express it
Decreased imagination and flexibility of thought
50% have low IQ
What issues may occur in children/adolescents with ADHD?
- Disciplinary trouble because of unthinking breaches of rules rather than deliberate defiance
- Unpopular with other children and may become isolated
- Delays in motor and language development are disproportionately frequent
- Secondary complications include dissocial behaviour and low self-esteem
- Self medication and addiction may occur in teenage years
- School failure
Prevalence of ADHD (HKS)
1-2% according to NICE
ADHD environmental risk factors
Maternal smoking Maternal alcohol use Low birth weight Premature birth Exposure to environmental toxins (e.g.,organo-phosphate pesticides, polychlorinated biphenyls, zinc and lead)
What is conduct disorder?
Repetitive and persistent pattern of dissocial, aggressive, or defiant conduct
More severe than ordinary childish mischief or adolescent rebelliousness
Excessive levels of fighting or bullying; cruelty to animals or other people; severe destructiveness to property; fire-setting; stealing; repeated lying; truancy from school and running away from home; unusually frequent and severe temper tantrums; defiant provocative behaviour; and persistent severe disobedience
What is oppositional defiance disorder?
Characteristically seen in children below the age
of 9 or 10 years. It is defined by the presence of markedly defiant, disobedient, provocative behaviour and by the absence of more severe dissocial or aggressive acts that violate the law or the rights of others
Reactive attachment disorder?
Occurring in infants and young children as a direct result of severe parental neglect, abuse, or serious mishandling Characterised by:
- persistent abnormalities in the child’s pattern of social relationships, which are associated with emotional disturbance and reactive to changes in environmental circumstances
- Fearfulness and hypervigilance that do not respond to comforting
- Poor social interaction with peers
- Aggression towards self and others
- Misery and growth failure occurs in some cases.
What is a tic?
An involuntary, rapid, recurrent, non-rhythmic motor movement (usually involving circumscribed muscle groups)
Or vocal production, that is of sudden onset and serves no apparent purpose
Name 3 childhood and 3 adulthood effects of child abuse
Childhood: emotional disorders, conduct disorders, developmental disorders
Adulthood: depression, personality disorders, DSH
What should be considered as a differential to ASD?
Learning disability
Deafness
Childhood schizophrenia
Outline ASD management
> 25hrs/week with a specialist
-Break down skills into small tasks, taught in a highly structured way
Reward and reinforce positive behaviour
Discourage and redirect inappropriate behaviour
Family support and counselling
Prognosis of ASD
15% achieve fully independent functioning as adults
Outcome better in those with non verbal IQ>70
What personality type is linked with ASD (esp Asperger’s)
Schizoid
ADHD links to which adult disorders?
Eating disorders
depression and anxiety disorders
Hyperkinetic and conduct disorder links to which adult disorders?
Adult antisocial behaviour
Substance misuse
Elective mutism links to which adult disorder?
Social phobia
How common are learning disabilities?
1.5% of the population
IQ<70
Name 2 autosomal dominant conditions that can cause learning disability
Tuberose sclerosis
Neurofibromatosis
Name an autosomal recessive condition that causes learning disability
Autosomal recessive are usually metabolic
Pheylketonuria
Why are pts with a learning disability more likely to have psychiatric disorders?
Genetic
Organic (eg epilepsy)
Psychological (frustration)
Social stigma
Define learning diasbility
A significantly reduced ability to understand new
or complex information or to learn new skills
(impaired intelligence) with a reduced ability to cope independently (impaired social functioning) which started before adulthood, with a lasting effect on development
What somatic issues could seem like ADHD?
-Thyroid disease • Medication adverse effects - antiasthmatics - anticonvulsants - benzodiazepines - antihistamines • Epilepsy • Sleep apnea • Hearing impairment
Name 6 neurodevelopmental disorders
Intellectualdisability Communicationdisorder Autisticspectrumdisorder Attentiondeficitdisorder Specificlearningdisorder Ticdisorder
