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Psychiatry > Children and Adolescent Psychiatry > Flashcards

Children and Adolescent Psychiatry Flashcards

1
Q

When do mental health problems start?

A

Childhood

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2
Q

Pre-conception factors influencing mental health

A

Genetics

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3
Q

Which mental health problems are highly genetic?

A

ADHD

autism

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4
Q

Which mental health problems are substantially genetic?

A

Depression

Anxiety

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5
Q

Post conception factors influencing mental health

A

Maternal health
- antibodies
- obesity
- DM
Substance misuse (alcohol, marijuana)
Toxins (lead, mercury)
Drugs (esp psychotropics, antiepileptics)
Epigenetics (folate controlled methylation)
Endocrine environment - especially androgens
Immune environment
Premature birth / perinatal complications
Twinning

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6
Q

What substance is linked to depression later on in childhood?

A

marijuana

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7
Q

In an androgen environment, what is more likely to develop?

A

Autism

ADHD in boys

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8
Q

What is premature birth / perinatal complications related to?

A

impaired development of attention and cognition - those being associated with ADHD

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9
Q

Presentation of foetal alcohol syndrome

A 
Growth retardation (body, head, brain (inc. cerebellum), eyes 
Sensorimotor effects
cognitive development effects
executive function effects
language effects 
characteristic appearance
- short palpebral fissure length in eyes 
- thin upper lip
- smooth / absent philtrum 
Grey matter gyrification 
- increased cortical complexity
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10
Q

Outcomes of foetal alcohol syndrome

A 
Highly variable clinical picture 
Learning difficulties 
Conduct disorders (ODD)
Combined ADHD or ADD or hyp-imp subtypes 
Anxiety disorders
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11
Q

What does ODD stand for?

A

Oppositional defiant disorder

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12
Q

Presentation of ODD

A 
Frequent loss of temper
Arguing
becoming easily angered or annoyed
showing vindictive, spiteful or other negativistic behaviours
Behaviour is learned - enacted to obtain a desired result 
Oppositional defiance 
Refused to obey adults request 
Deliberately annoys people
Touch of easily annoyed by others
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13
Q

Presentation of ADHD

A 
Distractibility 
sustaining attention to tasks that provide high level of stimulation or frequent rewards
problems with organisation
Impulsive aggression 
Poor cognition 
often remorseful  
resistant to pure behaviour management
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14
Q

Presentation of Hyp-imp subtypes disorders

A

Difficulties with remaining still - more evident in situations that require behavioural self control
Impulsivity

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15
Q

What is white matter connectivity important for?

A

Functions that require interplay between brain areas e.g. working memory between hippocampus and anterior cingulate

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16
Q

What is low connectivity of white matter associated with?

A

More ‘neural noise’ in the system
cognitive instability
Poor integration of function

===»> ADHD

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17
Q

Environmental factors during childhood influencing mental health

A 
Carer-child relationship (attachment)
Parenting skills 
Parental mental disorder 
Marital harmony / family function 
Abuse / neglect 
Discipline (too much is associated with mental health problems)
Day care and schooling
Peer relationships 
life events
physical disability
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18
Q

What does early life stress influence in the brain?

A

The function of the limbic circuit including amygdala and determines the subsequent patterns of stress response (resilient or flight)

mood and patterns of response to threat including withdrawl and/or aggressive response

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19
Q

What does experience of adversity do?

A

Trains the brain to adapt to a hostile environment

  • limbic response and heightened amyglada activity
  • cortical response and preparation of aggressive response
  • behavioural response and aggression
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20
Q

What happens in reward based learning?

A

Dopamine neurones fire when you associate an action with a subsequent reward

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21
Q

Association between early adversity and reward based learning

A

early adversity decreases DA response - so have to behave a bit more to get the reward = the hypoactive reward response

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22
Q

What does the hypoactive reward response underpin?

A

underpins a variety of conditions e.g. addiction (obesity, drugs, alcohol, gambling, porn) and increases delay aversion

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23
Q

Features of executive function and cortical control

A

Taking control over automatic and learned behaviours
inhibit prepotent responses
intentional decision making and forward planning
requires self awareness and capacity to self monitor

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24
Q

Delay aversion and ADHD

A

Inability to wait and maintain attention in the absence of an immediate reward

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25
What does the social brain reflect?
Increased understanding, reflection and control with age
26
What does carers negative emotion in the clinical predict?
Rates of relapse of chronic illness
27
Mental health issues associated with school
Fear of leaving home Fear of going to school Unwilling to go to school Unwilling to leave home
28
Mental health problems associated with being out of school
``` Anxiety Conduct disorder Autism Depression OCD ```
29
Mental health problems affecting school attendance and learning
Learning difficulties due to poor attention co-morbid specific or general learning problems difficulty controlling emotion (escalation of anger, frequent conflict) Anxiety lack of motivation / energy difficulties joining in sensory problems - too noisy / lots of people preoccupation - fear of germs/contamination etc Associations between mental health and learning difficulties e.g. dyslexia
30
Motivational factors affecting school attendance
``` affecting willingness to go to school - learning difficulties - lack of friendships and relationships - bullying - lack or parental attention / concern Encouraging one to stay at home - maternal depression / maternal psychiatric disorder making them concerned something will happen to the child once they leave the house - separation anxiety - social factors e.g. helping parents make money ```
31
What is separation anxiety?
Fear of leaving parents and home
32
What is social phobia?
Fear of joining the group
33
Features of anxiety disorders - THE 3 AS
Anxious thoughts and feelings (e.g. impending doom) Autonomic symptoms Avoidant behaviour
34
Brain affects in anxiety disorders
Amygdala activity suppressed and reduced connectivity between right ventrolateral cortex and amygdala
35
Treatment of anxiety disorders
``` Behavioural - learning alternative patterns of behaviour - desensitisation - overcoming fear - manging feelings CBT Medication - Serotonin reuptake inhibitors (SSRIs) e.g. fluoxetine Narrative approaches - e.g. tell child "monster inside head" ```
36
Management of child refusing to go to school because of anxiety
Contain anxiety | RETURN TO SCHOOL ASAP
37
Principles of management of anxiety
Psychoeducation - explaining the problem in terms that make sense to everyone Goal setting - choosing reasonable objectives that can be achieved Motivation - getting buy in so the goals can be achieved Externalisation - taking blame, guilt and anger out of the equation
38
Principles of CBT
Thoughts Feelings Behaviour
39
CBT in children
Mostly B and T | Dont expect children to have cognitive awareness
40
Long term effects of CBT in respect to children and school
Successing the challenge (i.e. going to a day of school) will allow some self confidence and resilience and so will allow them to go and tackle the next thing
41
When does ASD present?
Under 3 years
42
What does ASD stand for?
Autistic Spectrum Disorder
43
Who gets ASD?
M > F 3:1
44
The autistic spectrum
Autistic - normal IQ - only effects on the synaptic function AS SEVERITY OF NEUROTRANSMITTER DYSFUNCTION INCREASES Autism with LD - effects on synaptic function, neural migration and brain development
45
Presentation of ASD (varies with age and IQ)
Social - defects in - reciprocal conversation - expressing emotional concern - non verbal communication (eye contact, facial expression, gestures, declarative pointing) Repetitive behaviour - mannerisms - obsessions, preoccupations and interests - rigid and inflexible patterns of behaviour (routines, rituals, play) ``` Learning disability - mild to severe Disturbed sleep and eating habits Hyperactivity High levels of anxiety and depression OCD School avoidance Aggression Temper tantrums Self injury / self harm Suicidal behaviour (6x) ```
46
Features of play in ASD
Repetitive Lined up Same thing
47
Presentation of ASD in young / lower IQ
Joint attention / attention to others Emotional responses Movements / actions e.g. flapping
48
Presentation of ASD in older / higher IQ
Conversation Empathy Interests
49
What congenital or genetic disorders is ASD associated with?
Rubella Downs syndrome Fragile X
50
Increased rates of what in ASD?
Depression OCD Anxiety disorders language impairment
51
Management of ASD
Recognition, description and acknowledgement of disability establishing needs decreased demands -> reduce stress -> improve coping Psychopharmacology
52
What is ODD associated with?
Impaired parenting | Adversity
53
What does a mental state examination represent?
A psychiatric stethoscope at the exact time, not the history A snapshot of the current moment
54
What are conduct disorders characterised by?
Repetitive and persistent patterns of antisocial, aggressive or defiant behaviours, which violate age appropriate societal norms
55
Conduct disorders are associated with increased risk of.....
Early death often by sudden or violent means Social exclusion poor school achievement long term unemployment criminal activity adult mental health problems poor interpersonal relationships including with own children
56
Treatment of conduct disorders
``` Parental training programme (12 or younger) Modification of school environment e.g. behavioural support Functional family therapy Multi systemic therapy Child interventions - social skills - problem solving - anger management - confidence building treat comorbidity address child protection concerns ```
57
What are the hyperkinetic disorders?
ADHD | HKD
58
Pathology of ADHD
Your limbic system is asleep
59
Core features of ADHD
Developmentally abnormal inattention Hyperactivity impulsivity Present across time and situations
60
Symptom pattern in ADHD
Majority are symptomatic into adulthood, especially inattention
61
Associations of ADHD
``` Specific LD ASD CD tics motor coordination problems substance misuse anxiety reduced academic and employment success increased criminal activity increased adult mental health problems ```
62
Management of ADHD
``` Psychoeducation Medication - stimulants, atomoxetine, guanfacine - methylphenidate Behavioural interventions - e.g. realistic expectation Parent training Treat comorbidity school interventions ```
63
Features of medicine management for ADHD
``` Non addictive purely symptomatic closely related to amphetamines taken orally acts on And and DA systems ```
64
Side effects of ADHD medications
Appetite weight sleep BP slightly
65
Why is self harm carried out?
As a coping mechanism - harms them selves to deal with emotional pain or to break feelings of numbness by arousing sensation. it soothes the person that is doing it
66
Modes of self harming
Self poisoning cutting burning
67
Factors increasing risk of suicide
``` Persistent suicidal ideas Previous suicidal behaviour Highly Lethality of method used High suicidal intent and motivation Ongoing precipitating stresses Mental disorder Poor physical health Impulsivity, neuroticism, low self esteem hopelessness Parental psychopathology or suicidal behaviour Physical and sexual abuse Disconnection from support system ```
68
Treatment of attempted suicide
Usually admit to age appropriate medical ward after serious attempt for medical treatment and psychosocial assessment Mental health and risk assessment Further referral to agencies as appropriate e.g. child protection

Psychiatry (63 decks)

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