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Mental Health > Child Psychiatry > Flashcards

Child Psychiatry Flashcards

1
Q

In child psychiatry how are disorders usually categorised?

A

Behavioural
Neurodevelopmental
Emotional

Although there is often overlap

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2
Q

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

A

Up to 25%

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3
Q

What distinguishes child from adult psychiatry?

A
  • 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
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4
Q

What may affect when children present?

A 
Age
Frequency
Severity
Individual characteristics or temperament 
Impact on others
Family/ social circumstances
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5
Q

What child mental health services are there?

A

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

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6
Q

What biological factors influence child mental health?

A

Temperament
Genetics
Neurodevelopment
Biochemical

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7
Q

What psychological/developmental factors influence child mental health?

A

Attachment
Learning
Cognition
Emotional

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8
Q

What social factors influence child mental health? (Acute)

A 
Acute stressors:
Trauma
Accident
Illness
Death
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9
Q

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

A 
Socio economic 
Parental mental illness
Parental loss
Family conflict 
Parenting 
Abuse - physical, sexual, emotional 
Exposure to community violence 
School - academics, friendships, bullying
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10
Q

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

A

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

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11
Q

What child/adolescent factors should be considered when communicating?

A 
Feeling safe/secure
Willingness to engage
Family or carers present/ not present 
Cognitive ability 
Language/ communication problems 
Emotional development
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12
Q

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

A 
Setting enough time
Appropriate language use
Appropriate non verbal communication 
Using right method for the situation 
Avoid being patronising 
Try not to sound rehearsed
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13
Q

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

A

Increase

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14
Q

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

A

Parents having anxiety

Levels of reassurance

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15
Q

What are some characteristics associated with GAD in children?

A

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

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16
Q

What are some key characteristics of separation anxiety?

A

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

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17
Q

Approximately what age is the youngest presentation of OCD?

A

12 years old

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18
Q

How are anxiety disorders treated in children?

A

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

19
Q

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

A

True

20
Q

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

A

True

21
Q

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

A

Anger

22
Q

What are some characteristics of depressive disorders in children?

A

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

23
Q

How are depressive disorders treated in children?

A

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

24
Q

What is another term for behavioural problems?

A

Oppositional disorder

25
Q

What characteristics are associated with behavioural problems?

A

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

26
Q

What are the 2 types of conduct disorder?

A

Socialised and unsocialised

27
Q

What are some character of conduct disorder

A

Lying, stealing, truanting, violence to people and animals

28
Q

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

A

Socialised

Tends to be phasic in nature

29
Q

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

A

Antisocial personality disorder

30
Q

What are the risk factors for conduct disorder?

A

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

31
Q

What are the broad outline for treating conduct disorder?

A

Consistent care and parenting
Behavioural therapy
School based interventions
Community interventions

32
Q

What percentage of children does attention deficit hyperactivity disorder affect?

A

3-5%

33
Q

What are the key features of ADHD?

A

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

34
Q

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

A

2/3

35
Q

ADHD commonly occurs with other neurodevelopmental disorders such as what?

A

Dyslexia - 50% of those with ADHD have dyslexia

36
Q

In adults with ADHD what characteristics are more notable?

A

Emotional volatility

Anxiety

37
Q

What are the key principles when treating ADHD?

A

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

38
Q

Autistic spectrum disorder affects approximately what percentage of children?

A

1%

39
Q

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

A 
Anxiety
ADHD
Sleep problems 
OCD
Learning difficulties
40
Q

What are the key features of autistic spectrum disorder?

A

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

41
Q

What treatment approaches are used for autistic spectrum disorder?

A

No definitive treatment

Psycho- education
Stress reduction
Environmental changes
Treat co-morbidities

42
Q

What neurotransmitters are considered to be low in ADHD?

A

Dopamine

Noradrenaline

43
Q

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

A

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

Mental Health (13 decks)

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