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Year 4 Psychiatry > Child Psychiatry > Flashcards

Child Psychiatry Flashcards

1
Q

Define Autism

A

Pervasive developmental disorder characterised by triad of: impairment in social interaction, communication and restricted/stereotyped interests

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2
Q

Give three PRENATAL risk factors for Autism

A

Genetics
Parental Age >40
Sodium Valproate usage

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3
Q

Give three ANTENATAL risk factors for Autism

A

Hypoxia at birth
Prematurity
Low birth weight

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4
Q

Give a POSTNATAL risk factors for Autism

A

Toxins such as lead/mercury/pesticides

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5
Q

How might the ‘Asocial’ component of the Autism triad present?

A

Few social gestures, lack of eye contact, lack of emotional expression

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6
Q

How might the ‘Restricted Behaviour’ component of the Autism triad present?

A

Repetitive and stereotyped
Upset at any change in routine
Obsessively pursued interests

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7
Q

How might the ‘Impaired Communication’ component of the Autism triad present?

A

Distorted and delayed speech

Echolalia (repeated words)

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8
Q

Name three conditions associated with Autism

A

Epileptic seizures
Visual impairment
OCD

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9
Q

Describe the ICD10 criteria A-E for Autism

A

A - Presence of abnormal/impaired development before the age of three
B - Qualitative abnormalities in social interaction
C- Qualitative abnormalities in communication
D - Restrictive/Repetitive stereotyped behaviours
E - Clinical picture not attributable to anything else

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10
Q

Describe the Appearance, Speech and Thought of a patient with suspected Autism

A

Appearance - ritualised/stereotyped behaviours, clapping, rocking, poor eye contact

Speech - delayed, repetitive, unusual rate and rhythm

Thought - Obsessions and Compulsions, intense preoccupations

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11
Q

Describe the expected Perception, Cognition and Insight of a patient with suspected Autism

A

Perception - may be sensitive to noise/touch/ smell
Cognition - Impaired attention but can concentrate on special interests
Insight - may be poor

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12
Q

At what age should a child turn towards sound?

A

3 months

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13
Q

At what age should a child know and respond to own name?

A

12 months

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14
Q

What age should a child combine two words?

A

2 years

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15
Q

At what age should a child be smiling?

A

6 weeks to 10 weeks

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16
Q

At what age should a child play with other children?

A

4 years

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17
Q

Name two investigations you could do for a child with suspected Autism

A

Hearing tests

CHAT - Checklist for Autism in Toddlers

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18
Q

Aspergers Syndrome is a differential for Autism. Describe three clinical features

A

Abnormalities in social interaction
No impairment in language/cognition or intelligence
More prevalent in boys

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19
Q

Rett’s Syndrome is a differential for Autism. Describe three clinical features

A

Severe progressive disorder starting in early life
Language impairment, stereotyped hand movement
Irregular breathing

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20
Q

Hellers Syndrome is a differential for Autism. Describe the clinical features

A

AKA Childhood Disintegrative Behaviour

Two years of normal development followed by loss of previously learned skills

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21
Q

When can a diagnosis of Autism be reliably made?

A

At the age of 3 by a specialist

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22
Q

Describe the Psychological management of Autism

A

CBT (if able to engage and is motivated)

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23
Q

Describe the sociological management of Autism

A

All diagnosed should have a key worker
Specialist schooling if necessary
Families should be offered support

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24
Q

Describe the potential biological managements of Autism

A

Antipsychotics (Risperidone)

Melatonin (Sleeping difficulties)

25
Q

Define Hyperkinetic Disorder/ADHD

A

Early onset persistent pattern of Inattention, hyperactivity and impulsivity

26
Q

When is the typical onset of ADHD?

A

Between ages of 3-7

27
Q

Describe the four potential aetiologies of ADHD

A

Genetic (DRD4 and DRD5 genes)
Neurochemical (Abnormalities in Dopaminergic pathway)
Neurodevelopmental (Abnormalities of Pre-Frontal Cortex)
Social (eg Social Deprivation)

28
Q

Describe the ‘Inattention’ component of the three core symptoms of ADHD

A

Not listening
Highly distractable
Regularly forgetting

29
Q

Describe the ‘Hyperactivity’ component of the three core symptoms of ADHD

A

Restless
Reckless
Running and Jumping in inappropriate places

30
Q

Describe the ‘Impulsivity’ component of the three core symptoms of ADHD

A

Difficulty waiting their turn
Interrupting
Temper Tantrums

31
Q

Describe the ICD10 criteria A-G of ADHD

A

A- Abnormality of attention/activity/impulsivity for age at home
B - The above at school
C - Directly observed A
D- Doesn’t meet criteria for autism, mania, depression or anxiety
E - Onset before 7y
F - Duration >6m
G - IQ>50

32
Q

Describe the expected Appearance and Behaviour, Speech and Mood for a patient with suspected ADHD

A

Appearance and Behaviour- Fidgety, unable to sit still, replies over parents
Speech - Talks loudly, makes excessive noise
Mood - Normal

33
Q

Describe the expected Thought, Perception, Cognition and Insight for a patient with suspected ADHD

A

Thought - normal
Perception - No hallucinations
Cognition - poor attention, lack of concentration
Insight - poor

34
Q

Name two investigations for suspected ADHD

A

Bloods - TFTs to rule out Thyroid disorder

Hearing tests

35
Q

Name three differentials for a diagnosis of ADHD

A

Learning disability
Oppositional Defiant Disorder (Defiant and Disruptive against authoritative figures)
Conduct Disorder (repetitive Antisocial Behaviour)

36
Q

Name two organisations which can support Parents and Teachers of Children with ADHD

A

Add Up

ADDISS

37
Q

How could you manage a preschool child with ADHD?

A

Psychoeducation and parent training

38
Q

How could you manage a school age child with ADHD?

A

Psychoeducation

CBT

39
Q

How could you manage ADHD Pharmacologically?

A

Methyphenidate (Ritalin)

Atomoxetine

40
Q

Define Learning Disability

A

State of arrested or incomplete development of the mind

Characterised by impairment of skills manifested over the developmental period

41
Q

What is the clinical triad of Learning Disabilities?

A

Low intellectual performance (IQ<70)
Onset at Birth/Early Childhood
Wide range of functional impairments

42
Q

Describe the ICD10 criteria of Learning Disability

A

Mild - IQ 50-70/ mental age 9-12
Mod - IQ 35-49/mental age 6-9
Severe - IQ 20-34/ mental age 3-6
Profound - IQ<20 / mental age <3

43
Q

Name two genetic causes of Learning Disabilities

A

Downs Syndrome

Fragile X Syndrome

44
Q

Describe the physical features of Downs Syndrome using the mnemonic PROBLEMS

A 
Palpebral Fissure
Round Face
Occipital and Nasal Flattening
Brachycephaly
Low set small ears
Epicanthic Folds
Mouth open and protruding tongue
Single Palmar Crease
45
Q

Describe the physical features of Fragile X Syndrome

A

Large protruding ears
Long face
High arched palate
Flat feet

46
Q

Name four Antenatal causes of Learning Difficulties

A

Rubella
Nutritional deficiency
Hypothyroidism
Alcoholism

47
Q

Name four causes in the Neonatal period of Learning Difficulties

A

Neonatal Sepsis
Hypoglycaemia
Hypothyroidism
Birth Asphyxia

48
Q

How would a patient with MILD learning difficulties present?

A

Usually at a later age
Adequate abilities but may struggle with academic work
Most live independently

49
Q

How would a patient with MODERATE learning difficulties present?

A

Able to communicate but language is limited

May need supervision with self care but able to carry out simple work

50
Q

How would a patient with SEVERE learning difficulties present?

A

Marked degree of motor impairment

Little or no speech in early childhood

51
Q

How would a patient with PROFOUND learning difficulties present?

A

Severe motor impairment
Severe difficulties in communication
Little to no self care

52
Q

How would you test for Downs Syndrome during pregnancy?

A

Serum Screening (bHCG or PAPP- A)

Quad Test (bHCG, AFP, Inhibin A, Estriol)

53
Q

How would you investigate Learning Difficulties

A

Full range of bloods
CT head
IQ test

54
Q

Name four occupations involved in the MDT for learning difficulties

A

Psychiatrist
Specialist Nurses
Psychiatrist
Social Worker

55
Q

Name three behaviour techniques used for patients with Learning Difficulties

A

CBT
Applied Behavioural Analysis
Positive Behaviour Support

56
Q

There are four main Primitive Defences. Define Projection

A

Perceiving and reacting to unacceptable impulses as someone else’s fault

57
Q

There are four main Primitive Defences. Define Dissociation

A

Disconnecting self from areas of identity/memory/consciousness to retain illusion of control

58
Q

There are four main Primitive Defences. Define Idealisation

A

Attributing perfect/near perfect qualities to others as a way of avoiding anxiety or negative feelings

59
Q

There are four main Primitive Defences. Define Regression

A

Returning to an earlier phase of development or functioning to avoid conflicts/tension

Year 4 Psychiatry (12 decks)

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