Children and Adolescent Psychiatry Flashcards
List the sections of the mental state exam
- Appearance
- Behaviour
- Speech
- Mood
- Thoughts
- Perceptions
- Cognition
- Risk
- Insight
Which genes are associated with psychiatric disorders?
- Those that implicate micro-RNA and epigenetic modulation
- Genetic factors serving modulation of gene expression
Which intra-uterine and perinatal factors influence mental health?
- Maternal health
- Substance misuse
- Toxins: lead, mercury and PCBs
- Drugs
- Epigenetics
- Endocrine environment
- Immune environment
- Premature birth/perinatal complications
- Twinning
- Impressive levels of resilience
Describe the features of fetal alcohol syndrome
- Growth retardation (body, head, brain and eyes)
- Multiple neuro-developmental effects: sensorimotor, cognitive development, executive function and language
- ADHD, DCD and LD
Why is white matter connectivity important and what can happen when it is low?
- It is important for functions that require interplay between brain area
- Low connectivity associated with more neural noise in the system
- In developing brains this is typically associated with ADHD - poor concentration and distractibility
What are the common outcomes of reduced grey matter gyrification?
- Learning difficulties
- Conduct disorders
- Combined ADHD or ADD or Hyp-imp subtypes
- Anxiety Disorders
List the environmental factors during childhood which can affect mental health
- Carer-child relationship
- Parenting skill and parental mental disorder
- Marital harmony and family function
- Nutrition, poverty and deprivation
- Abuse and neglect
- Discipline
- Day-care and schooling
- Peer relationships
- Life events
- Physical disability
Describe the brain’s response to stress
- Response involves interplay or brain and body
- Early life stress influences function of limbic circuit including amygdala
- It influences mood and patterns of response to threat including withdrawal and/or aggressive response
How does experiences of adversity train the brain to adapt to a hostile environment?
- Perceived behaviour and aggression
- Limbic response and heightened amygdala activity
- Cortical response and preparation of aggressive response
- Behavioural response and aggression
What is executive and cortical control and how does it work?
- Taking control over automatic and learned behaviour
- Applied in CBT
- Inhibits prepotent responses
- Intentional decision-making and forward planning
- Requires self-awareness and capacity to self monitor
How does sharing emotion and empathy develop with age?
Infant
- Infant mother interaction
- Emotion contagion: picks up emotions from carers
6 Weeks
- Sensorimotor control emerging
- Smiling intentionally
24 months
- Secondary representation
- Able to recognise and label emotions
3-4 Years
- Self-awareness of emotion, able to deceive, understands and feels
- Understanding motive and context
Describe the factors that influence aggressive patterns of behaviour
- Cognitive: self control, empathy and self-awareness
- Environment: social and familial reinforcers and punishers
- Brain development and injury
- Genetics
- Early adversity
- Social conditioning
- Drugs
- Testosterone
Which mental health disorders are associated with being out of school?
- Anxiety
- Conduct disorder
- Autism
- Depression
- OCD
Which mental health problems may have an effect on school attendance and learning?
- Learning difficulties due to poor attention
- Co-morbid specific learning problems
- Difficulty controlling emotions
- Anxiety
- Lack of energy/motivation
- Difficulties joining in, wanting to be alone, unable to make friends and feeling different
- Sensory problems
- Preoccupation
- Associations between mental health and learning difficulties
What is the difference between separation anxiety and social phobia?
- Separation anxiety: fear of leaving parents and home (problems on the doorstep)
- Social phobia: fear of joining group (problems at the school gate)
What are the features of anxiety disorders?
- Anxious thoughts and feelings
- Autonomic symptoms
- Avoidant behaviour
Which motivational factors affect school attendance?
- Affecting willingness: learning difficulties, lack of friends and relationships, bullying and lack of parental attention or concern
- Encouraging them to stay at home: maternal depression
- Maternal depression or psych disorder
- School bullying
- Lack of parental attention or control
How can a child’s anxiety be treated?
- Behavioural: learning alternative patterns of behaviour, desensitisation, overcoming fear and managing feelings
- Medication: serotonin reuptake inhibitors e.g. fluoxetine
What is psychoeducation?
Explaining the problem in terms that make sense to everyone
Describe the features of Autism spectrum disorder
- A syndrome of persistent, pervasive and distinctive behavioural abnormalities
- Often associated with low IQ
- Present across the life span
- Highly heritable
- Males > females
- Reciprocal conversations
- Expressing emotional concern
- Declarative pointing
- Modulated eye contact
- Other gestures and facial expressions
- Repetitive behaviour: mannerisms and stereotypies, obsessions, preoccupations and interests
- Rigid and inflexible patterns of behaviour: routines, rituals and play
What are the causes of autism spectrum disorder?
- Genetic: modulators of genetic expression
- Co-morbid: rubella, callosal agenesis, Down’s syndrome, fragile X and tuberous sclerosis
- Increased rates of depression, OCD, anxiety disorders and language impairment
List the common clinical problems in ASD
- Learning disability
- Disturbed sleep and eating habits
- Hyperactivity
- High levels of anxiety and depression
- OCD
- School avoidance
- Aggression
- Temper tantrums
- Self-injury and self-harm
- Suicidal behaviour (x6 higher risk)
List the key features of oppositional defiant disorder
- Refusal to obey adults request
- Often argues with adults
- Often loses temper
- Deliberately annoys people
- Touchy or easily annoyed by others
- Spiteful or vindictive
List the key features of ADHD
- Aggression is impulsive
- Poor cognitive control and ability to sustain a goal
- Often remorseful
- Resistant to pure behavioural management
- Stronger genetic component
How can hard to manage children be managed?
- Parent training programmes
- Multi-systemic therapy
