Child Psychiatry

Question 1

What are the biopsychosocial factors?

Answer 1

• Consider both those which are contributing to the problem, and those which promote resilience.
• All interact in a dynamic way.
• Biological: genetic predispositions; neurodevelopmental insults; illness etc.
• Psychological: temperament; attachment style; psychological attributes e.g. impulsivity, low self esteem, perfectionism; belief systems etc.
• Social: family relationships; peer relationships; hobbies/ interests; religious faith; neighbourhood; school; rural/ urban; criminality; finances etc.

Question 2

What are conduct disorders?

Answer 2

• Characterised by repetitive and persistent patterns of antisocial, aggressive or defiant behaviours which violate age-appropriate societal norms.
• Course and outcome: persistent disorder, associated with increased risk of early death, often by sudden or violent means.
• Also at increased risk of social exclusion, poor school achievement, long-term unemployment, criminal activity, adult mental health problems, and poor interpersonal relationships including those with their own children.

Question 3

What is the management of conduct disorders?

Answer 3

Will be based on biopsychosocial assessment and is likely to need multiagency communication and cooperation. Possible components:

• Parent training programme (12 or younger) e.g. The Incredible Years
• Modification of school environment eg behavioural support
• Functional family therapy
• Multi-systemic therapy
• Child interventions: social skills, problem-solving, anger management, confidence building
• Treat comorbidity
• Address child protection concerns

Question 4

What are hyperkinetic disorders (ADHD)?

Answer 4

• Characterised by core features of developmentally abnormal inattention, hyperactivity and impulsivity present across time and situations.
• Highly comorbid (50-80%). Specific LD, ASD, CD, tics, motor coordination problems, substance misuse, anxiety, depression.
• Majority are symptomatic into adulthood, especially inattention. Associated with reduced academic and employment success, increased criminal activity and increased adult mental health problems.

Question 5

What is the management of ADHD?

Answer 5

• Psychoeducation
• Medication – stimulants, atomoxetine, guanfacine
• Behavioural interventions e.g. realistic expectations, contingency management
• Parent training - PinC
• School interventions
• Treat comorbidity
• Voluntary organisations
• Benefits

Question 6

What is the medication management of ADHD?

Answer 6

• Indicated for treatment of ADHD or ADD
• Methylphenidate
• Closely related to amphetamine – taken orally
• Similar principle to aspirin
  
  • Non-addictive
  • Purely symptomatic treatment
  • Last 4 hours and wears off
• Side effects: appetite, weight, sleep (BP a little)
• Acts on NAd and DA systems
• 2nd line: Atomoxetine – non stimulant also acts on NAd systems

Question 7

What is the management of a suicidal child?

Answer 7

• The safety of the young person is the first priority
• Take it seriously
• Usually admit to age appropriate medical ward after serious attempt for medical treatment and psychosocial assessment.
• Mental health and risk assessment by specially trained staff member with ready access to psychiatric opinion.
• Confidentiality (with exceptions).
• Further referral to agencies as appropriate e.g. CAMHS, child protection