Child psychiatry Flashcards
What is autism?
Pervasive developmental disorder characterized by:
- Impaired social interaction
- Impaired communication
- Restricted, stereotyped interests and behaviours
What are the risk factors for autism spectrum disorders?
- Male
- Family history
- Parental psychiatric disorder
- Obstetric complication e.g. hypoxia
- Advancing parental age
- Prematurity (born before 35 weeks gestation)
- Maternal medication use (e.g. sodium valporate in particular)
What are the features of autism?
At what age does autism onset?
Before 3 years
What conditions are associated with autism?
Epileptic seizures
Visual impairment
Hearing impairment
Infections
What are the investigations for autism?
- Full developmental assessment (FH, birth complications, developmental milestones, assessment of communication)
- Hearing tests
- Screening tools
What are some differentials to autism?
Asperger’s syndrome = Similar to autism but no impairment in language, cognition or IQ
Rett’s syndrome = severe progressive disorder starting in early life, nearly always girls, genetic component
Childhood disintegrative disorder = 2 years of normal development followed by loss of previously learned skill (language, social and motor)
Learning disability
Deafness
Childhood schizophrenia
What is the general management of autism?
- Diagnosed by a specialist
- Assigned key worker by local autism team (with paediatricians, psychiatrists, speech and language therapists, OTs)
- CBT if verbal and cognitive ability
- Life skills training
- Families / carers offered personal, social and emotional support
- Special schooling
- Melatonin for sleep disorders which persist
What is the biopsychosocial treatment of autism?
Bio = antipsychotics (e.g. risperidone) for challenging behaviour, melatonin
Psycho = psychoeducation for families or carers, CBT
Social = modification of environmental factors, social communication intervention, special schooling
What is hyperkinetic disorder?
Aka ADHD, early onset, persistant pattern:
Inattention
Hyperactivity
Impulsivity
What are the risk factors for hyperkinetic disorder?
- Male
- Family history
- Social deprivation
- Parental cannabis / alcohol exposure
When does hyperkinetic disorder have to onset? How long for? What IQ?
Before 7 years old
At least 6 months
IQ above 50
Give some examples of inattention, hyperactivity and impulsivity?
What are some investigations for hyperkinetic disorder?
Blood tests including TFTs (to rule out thyroid disease)
Hearing tests
What are some differentials for hyperkinetic disorder?
Learning disability
Oppositional defiant disorder
Conduct disorder
Autist
Sleep disorder
Mood disorder (bipolar)
Anxiety disorder
Hearing impairment
What is conduct disorder?
Repetitive and severe antisocial behaviour including aggression, deceitfulness, violations of age-appropriate social expectations
Name some risk factors for conduct disorder?
Male
Abuse as child
Poor socioeconomic status
What is oppositional defiant disorder?
Defiant and disruptive behaviour against authoritative figures but is less severe than conduct disorder in that violations of law and physical abuse of others is less common
How is hyperkinetic disorder managed?
- Keep a food diary for dietician (as there is a link between food / drink consumed and behaviour)
- Parent training and education programmes (psychoeducation)
- CBT
- CNS stimulant methylphenidate (ritalin) or atomoxetine if this fails
Name some side effects of CNS stimulants?
Headache
Insomnia
Loss of appetite
Weight loss
What is a learning disability?
Incomplete development of the mind causing an impairment of skills contributing to intelligence
- Low intellectual performance (below 70)
- Onset at birth or during early childhood
- Wide range of functional impairment
Name some causes of learning difficulties?
Genetic = down’s syndrome, fragile X syndrome, Prader-Willi, Cri du chat
Antenatal = congenital infection (rubella, CMV, toxoplasmosis), nutritional deficiency, intoxication
Perinatal = birth asphyxia, neonatal sepsis
Neonatal = hypogylcaemia, meningitis
Postnatal = Infection (meningitis, encephalitis)
Environmental = neglect, socioeconomically deprived
Psychiatric = autism, Rett’s syndrome
What is the most common risk factor for a LD?
Positive family history
What are the features of a LD?
- Motor disabilities (ataxia, spasticity)
- Epilepsy
- Impaired hearing / vision
- Incontinence
- Limited language
What is Down’s syndrome?
A genetic disorder (trisomy 21) causing LD, dysmorphic facial features, structural abnormalities
What are the physical features of Down’s syndrome?
Palpebral fissure (slanting up)
Round face
Occipital and nasal flattening
Low set, small ears
Protruding tongue
What are the medical problems with Down’s syndrome?
Heart defects (ventricular and atrial septal)
Hearing loss
Visual problems
Increased incidence of Alzheimer’s
What is fragile X syndrome?
Second most common cause of LD
Sex linked
Large, protruding ears, long face, high arched palate, flat feet, soft skin
Mitral valve prolapse
What is Prader-Willi?
LD due to deletion of part of chromosome 15, causes hypotonia and developmental delay as an infant, obesity, hypogonadism and behavioural problems (compulsive eating) in later years
What is cri du chat?
Caused by a partial deletion of chromosome 5 - with high-pitched cry like a cat
Low birth weight and feeding difficulties
What are the investigations for LD?
Before birth: amniocentesis, chorionic villus sampling, genetic testing, karyotyping
After birth: FBC (infection), TFTs (hypothyroidism), glucose (hypoglycaemia), serology (ToRCH infections)
CT head / MRI
IQ test
What is the managament of learning difficulties?
- Involve psychiatrist, speech and language therapist, specialist nurses, psychologist, OT, social worker
- Involve GP as physical health problems are common
- Antipsychotics for challenging behavior but are overused
- Applied behavioural analysis, CBT
- Family education is essential, with support needed through educational programmes
