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Psychiatry > Children and Adolescent Psychiatry > Flashcards

Children and Adolescent Psychiatry Flashcards

1
Q

List the sections of the mental state exam

A
  • Appearance
  • Behaviour
  • Speech
  • Mood
  • Thoughts
  • Perceptions
  • Cognition
  • Risk
  • Insight
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2
Q

Which genes are associated with psychiatric disorders?

A
  • Those that implicate micro-RNA and epigenetic modulation

- Genetic factors serving modulation of gene expression

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3
Q

Which intra-uterine and perinatal factors influence mental health?

A
  • Maternal health
  • Substance misuse
  • Toxins: lead, mercury and PCBs
  • Drugs
  • Epigenetics
  • Endocrine environment
  • Immune environment
  • Premature birth/perinatal complications
  • Twinning
  • Impressive levels of resilience
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4
Q

Describe the features of fetal alcohol syndrome

A
  • Growth retardation (body, head, brain and eyes)
  • Multiple neuro-developmental effects: sensorimotor, cognitive development, executive function and language
  • ADHD, DCD and LD
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5
Q

Why is white matter connectivity important and what can happen when it is low?

A
  • 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
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6
Q

What are the common outcomes of reduced grey matter gyrification?

A
  • Learning difficulties
  • Conduct disorders
  • Combined ADHD or ADD or Hyp-imp subtypes
  • Anxiety Disorders
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7
Q

List the environmental factors during childhood which can affect mental health

A
  • 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
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8
Q

Describe the brain’s response to stress

A
  • 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
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9
Q

How does experiences of adversity train the brain to adapt to a hostile environment?

A
  • Perceived behaviour and aggression
  • Limbic response and heightened amygdala activity
  • Cortical response and preparation of aggressive response
  • Behavioural response and aggression
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10
Q

What is executive and cortical control and how does it work?

A
  • 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
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11
Q

How does sharing emotion and empathy develop with age?

A

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
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12
Q

Describe the factors that influence aggressive patterns of behaviour

A
  • 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
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13
Q

Which mental health disorders are associated with being out of school?

A
  • Anxiety
  • Conduct disorder
  • Autism
  • Depression
  • OCD
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14
Q

Which mental health problems may have an effect on school attendance and learning?

A
  • 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
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15
Q

What is the difference between separation anxiety and social phobia?

A
  • Separation anxiety: fear of leaving parents and home (problems on the doorstep)
  • Social phobia: fear of joining group (problems at the school gate)
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16
Q

What are the features of anxiety disorders?

A
  • Anxious thoughts and feelings
  • Autonomic symptoms
  • Avoidant behaviour
17
Q

Which motivational factors affect school attendance?

A
  • 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
18
Q

How can a child’s anxiety be treated?

A
  • Behavioural: learning alternative patterns of behaviour, desensitisation, overcoming fear and managing feelings
  • Medication: serotonin reuptake inhibitors e.g. fluoxetine
19
Q

What is psychoeducation?

A

Explaining the problem in terms that make sense to everyone

20
Q

Describe the features of Autism spectrum disorder

A
  • 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
21
Q

What are the causes of autism spectrum disorder?

A
  • 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
22
Q

List the common clinical problems in ASD

A
  • 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)
23
Q

List the key features of oppositional defiant disorder

A
  • Refusal to obey adults request
  • Often argues with adults
  • Often loses temper
  • Deliberately annoys people
  • Touchy or easily annoyed by others
  • Spiteful or vindictive
24
Q

List the key features of ADHD

A
  • Aggression is impulsive
  • Poor cognitive control and ability to sustain a goal
  • Often remorseful
  • Resistant to pure behavioural management
  • Stronger genetic component
25
Q

How can hard to manage children be managed?

A
  • Parent training programmes

- Multi-systemic therapy

Psychiatry (16 decks)

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