Child Psychiatry Flashcards by Kirsty Sutherland

In child psychiatry how are disorders usually categorised?

Behavioural
Neurodevelopmental
Emotional

Although there is often overlap

How well did you know this?

Not at all

Perfectly

Approximately what percentage of young people suffer from mental health disorders?

Up to 25%

How well did you know this?

Not at all

Perfectly

What distinguishes child from adult psychiatry?

Development is more marked
Children have to be viewed in context of their families whom they generally depend on
cultural context very important and may be mismatch with carers
most often patient is presented by others

How well did you know this?

Not at all

Perfectly

What may affect when children present?

Age
Frequency
Severity
Individual characteristics or temperament 
Impact on others
Family/ social circumstances

How well did you know this?

Not at all

Perfectly

What child mental health services are there?

Health services - specialist or universal
Local authority - school based or community based
Voluntary sector

How well did you know this?

Not at all

Perfectly

What biological factors influence child mental health?

Temperament
Genetics
Neurodevelopment
Biochemical

How well did you know this?

Not at all

Perfectly

What psychological/developmental factors influence child mental health?

Attachment
Learning
Cognition
Emotional

How well did you know this?

Not at all

Perfectly

What social factors influence child mental health? (Acute)

Acute stressors:
Trauma
Accident
Illness
Death

How well did you know this?

Not at all

Perfectly

What social factors influence child mental health? (Chronic adversity)

Socio economic 
Parental mental illness
Parental loss
Family conflict 
Parenting 
Abuse - physical, sexual, emotional 
Exposure to community violence 
School - academics, friendships, bullying

How well did you know this?

Not at all

Perfectly

What environmental factors should be considered when communicating with children and adolescents?

Privacy
Suitability - noisy/ overstimulating, access to toys, age appropriate
Intimidating
Correct for what is being assessed

How well did you know this?

Not at all

Perfectly

What child/adolescent factors should be considered when communicating?

Feeling safe/secure
Willingness to engage
Family or carers present/ not present 
Cognitive ability 
Language/ communication problems 
Emotional development

How well did you know this?

Not at all

Perfectly

What clinician factors should be considered when communicating with children/ adolescents?

Setting enough time
Appropriate language use
Appropriate non verbal communication 
Using right method for the situation 
Avoid being patronising 
Try not to sound rehearsed

How well did you know this?

Not at all

Perfectly

Anxiety disorders are a common presentation in children of all ages. Does the prevalence increase or decrease with age?

Increase

How well did you know this?

Not at all

Perfectly

Anxiety disorders in children can be influenced by a number of things including…

Parents having anxiety

Levels of reassurance

How well did you know this?

Not at all

Perfectly

What are some characteristics associated with GAD in children?

Free floating anxiety - may not be able to say why
Fears of death or loss
Somatic manifestations more common in children - nausea, abdo pain, headaches, sweating, palpitations, tension
Panic attacks - sudden onset extreme fear

How well did you know this?

Not at all

Perfectly

What are some key characteristics of separation anxiety?

Anxiety manifesting upon separation from attachment figures - usually a parent and in particular mother
Somatic manifestations
Nightmares with separation themes
School refusal

How well did you know this?

Not at all

Perfectly

Approximately what age is the youngest presentation of OCD?

12 years old

How well did you know this?

Not at all

Perfectly

How are anxiety disorders treated in children?

Behaviour therapy - systemic desensitisation, flooding, response prevention
Psychotherapies - brief psychodynamic, family and cognitive therapy
Anxiolytics - most commonly fluoxetine (if moderate to severe)

Mood disorders become more common with increasing age. True or false?

True

In children with depressive illness the low mood may not be pervasive. True or false?

True

In boys in particular, mood disorders can be masked by what?

Anger

What are some characteristics of depressive disorders in children?

Low mood which is persistent but not necessarily pervasive
Anhedonia/ low levels of enjoyment
Appetite and sleep may not be affected
Concentration and motivation generally worse
Can occur with anxiety symptoms

How are depressive disorders treated in children?

First line = CBT
Antidepressants - SSRIs: fluoxetine then sertraline
Managing underlying or comorbid problems

What is another term for behavioural problems?

Oppositional disorder

What characteristics are associated with behavioural problems?

Uncooperative, unwilling to comply with requests, frequent temper tantrums Wilful, defiant, may be aggressive Unless managed tend to escalate

What are the 2 types of conduct disorder?

Socialised and unsocialised

What are some character of conduct disorder

Lying, stealing, truanting, violence to people and animals

Socialised or unsocialised conduct disorder is considered to be less serious?

Socialised Tends to be phasic in nature

Unsocialised conduct disorder can lead to a later diagnosis of what?

Antisocial personality disorder

What are the risk factors for conduct disorder?

Lack of clear boundaries, inconsistent parenting Rejection Family conflict - especially witnessing violence Child abuse Child temperament Comorbid learning or developmental difficulties

What are the broad outline for treating conduct disorder?

Consistent care and parenting Behavioural therapy School based interventions Community interventions

What percentage of children does attention deficit hyperactivity disorder affect?

3-5%

What are the key features of ADHD?

Poor attention and concentration Physical overactivity Impulsivity Needs to occur in more than one environment Diagnosis after 6 years but symptoms present before

In what fraction of cases do symptoms of ADHD persist into adulthood?

2/3

ADHD commonly occurs with other neurodevelopmental disorders such as what?

Dyslexia - 50% of those with ADHD have dyslexia

In adults with ADHD what characteristics are more notable?

Emotional volatility | Anxiety

What are the key principles when treating ADHD?

Mild and moderate: parenting and school interventions first Severe: medication first line Methylphenidate (ritalin)- short or long acting stimulant Lisdexamphetamine Atomoxetine Guanfacine Treat comorbid anxiety, behavioural problems, substance use

Autistic spectrum disorder affects approximately what percentage of children?

Autistic spectrum disorder is associated with an number of comorbid conditions such as...

``` Anxiety ADHD Sleep problems OCD Learning difficulties ```

What are the key features of autistic spectrum disorder?

Socio/ communication difficulties - verbal or non verbal Sensory processing problems Effects on thinking - lack of flexibility, social imagination, theory of mind, generalisation Needs to occur in more than one environment Symptoms must be present before 3 years of age

What treatment approaches are used for autistic spectrum disorder?

No definitive treatment Psycho- education Stress reduction Environmental changes Treat co-morbidities

What neurotransmitters are considered to be low in ADHD?

Dopamine | Noradrenaline

What is the difference between stimulants used in ADHD and illicit stimulants?

Stimulants used in ADHD increase dopamine release slowly in contrast to fast release in illicit stimulants