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Psychiatry > Child psychiatry > Flashcards

Child psychiatry Flashcards

1
Q

What is autism?

A

Pervasive developmental disorder characterized by:

  • Impaired social interaction
  • Impaired communication
  • Restricted, stereotyped interests and behaviours
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2
Q

What are the risk factors for autism spectrum disorders?

A
  • 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)
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3
Q

What are the features of autism?

A
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4
Q

At what age does autism onset?

A

Before 3 years

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5
Q

What conditions are associated with autism?

A

Epileptic seizures

Visual impairment

Hearing impairment

Infections

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6
Q

What are the investigations for autism?

A
  • Full developmental assessment (FH, birth complications, developmental milestones, assessment of communication)
  • Hearing tests
  • Screening tools
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7
Q

What are some differentials to autism?

A

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

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8
Q

What is the general management of autism?

A
  • 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
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9
Q

What is the biopsychosocial treatment of autism?

A

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

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10
Q

What is hyperkinetic disorder?

A

Aka ADHD, early onset, persistant pattern:

Inattention

Hyperactivity

Impulsivity

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11
Q

What are the risk factors for hyperkinetic disorder?

A
  • Male
  • Family history
  • Social deprivation
  • Parental cannabis / alcohol exposure
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12
Q

When does hyperkinetic disorder have to onset? How long for? What IQ?

A

Before 7 years old

At least 6 months

IQ above 50

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13
Q

Give some examples of inattention, hyperactivity and impulsivity?

A
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14
Q

What are some investigations for hyperkinetic disorder?

A

Blood tests including TFTs (to rule out thyroid disease)

Hearing tests

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15
Q

What are some differentials for hyperkinetic disorder?

A

Learning disability

Oppositional defiant disorder

Conduct disorder

Autist

Sleep disorder

Mood disorder (bipolar)

Anxiety disorder

Hearing impairment

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16
Q

What is conduct disorder?

A

Repetitive and severe antisocial behaviour including aggression, deceitfulness, violations of age-appropriate social expectations

17
Q

Name some risk factors for conduct disorder?

A

Male

Abuse as child

Poor socioeconomic status

18
Q

What is oppositional defiant disorder?

A

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

19
Q

How is hyperkinetic disorder managed?

A
  • 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
20
Q

Name some side effects of CNS stimulants?

A

Headache

Insomnia

Loss of appetite

Weight loss

21
Q

What is a learning disability?

A

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
22
Q

Name some causes of learning difficulties?

A

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

23
Q

What is the most common risk factor for a LD?

A

Positive family history

24
Q

What are the features of a LD?

A
  • Motor disabilities (ataxia, spasticity)
  • Epilepsy
  • Impaired hearing / vision
  • Incontinence
  • Limited language
25
Q

What is Down’s syndrome?

A

A genetic disorder (trisomy 21) causing LD, dysmorphic facial features, structural abnormalities

26
Q

What are the physical features of Down’s syndrome?

A

Palpebral fissure (slanting up)

Round face

Occipital and nasal flattening

Low set, small ears

Protruding tongue

27
Q

What are the medical problems with Down’s syndrome?

A

Heart defects (ventricular and atrial septal)

Hearing loss

Visual problems

Increased incidence of Alzheimer’s

28
Q

What is fragile X syndrome?

A

Second most common cause of LD

Sex linked

Large, protruding ears, long face, high arched palate, flat feet, soft skin

Mitral valve prolapse

29
Q

What is Prader-Willi?

A

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

30
Q

What is cri du chat?

A

Caused by a partial deletion of chromosome 5 - with high-pitched cry like a cat

Low birth weight and feeding difficulties

31
Q

What are the investigations for LD?

A

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

32
Q

What is the managament of learning difficulties?

A
  • 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

Psychiatry (13 decks)

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