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Thick Stuff > Level 2 - Emotional and Behaviour Problems > Flashcards

Level 2 - Emotional and Behaviour Problems Flashcards

1
Q

What is anxiety?

A
  • Anxiety is normal human experience to threat or danger
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2
Q

When does anxiety become a problem?

A
  • Mental health issue if response is exaggerated, lasts more than 3 weeks and interferes with daily life
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3
Q

Types of anxiety?

A

o Separation anxiety disorder (SAD)

o Generalised anxiety disorder (GAD)

o Social anxiety disorder

o OCD

o Panic disorder (+/- agoraphobia)

o Phobias o PTSD

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4
Q

Epidemiology of anxiety?

A
  • 2-5% of children
  • SAD and GAD more common
  • Women 2:1 Men
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5
Q

Aetiology of anxiety?

A

o Genetic

o Trauma and adverse life-events

o Stress (work, home, noise)

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6
Q

Risk Factors in anxiety?

A

o Bullying

o Exams

o House moves

o Physical illness

o Abuse

o Bereavement

o Friendship problem

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7
Q

Psychological symptoms in anxiety?

A

 Agitation

 Poor concentration

 Insomnia

 Repetitive thoughts/activities

 Thoughts going around and round

 Impending doom

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8
Q

Biological symptoms in anxiety?

A

 Dizziness

 Faint

 Tachypnoea

 Butterflies

 Nausea

 Sweating

 Muscle tension

 Heart racing

 Palpitations

 Tremor

 Lump in throat

o Panic Attacks

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9
Q

Social symptoms in anxiety?

A

 Reassurance seeking

 Avoidance

 Dependent on person

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10
Q

DDx of anxiety?

A
  • Child Abuse Depression
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11
Q

Assessment of anxiety?

A

MH history

  • Assessment of behaviours

o Antecedents, Behaviours, Consequences

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12
Q

Psychoeducation in anxiety?

A

o Understanding

o Reassurance

o Information leaflet

o Regular exercise

o Meditation

o Relaxation techniques

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13
Q

Management of anxiety?

A

o CBT (First-line) includes:

 Clarity of diagnosis + education to child and parent  Helping child face their fears

 Identification of unhelpful thinking and practicing more functional thinking

 Skills acquisition (progressive muscle relaxation, guided imagery)

 Parents as motivators and behavioural coaches

 Relapse identification - Medication

o SSRIs (after CBT fails)

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14
Q

What is attachment? When does it develop?

A
  • Describes relationship between caregiver & child
  • A process of proximity seeking to an identified attachment figure in situations of perceived distress or alarm for purpose of survival
  • Attachment not seen in humans before 6 months – develop stranger anxiety
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15
Q

Importance of attachment?

A

o Secure attachment linked to better behavioural and academic outcomes in childhood

o Forms basis for working models of future relationships

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16
Q

ICD-10 classification of Reactive attachment disorder?

A

 Abnormal social relationships associated with emotional disturbance due to circumstances

 Examples are fearfulness and hypervigilance, poor social interaction with peers, aggression towards self and others, misery, and growth failure in some children

 Withdrawn behaviour, with a lack of attachment behaviour towards caregivers

 Affected children tend not to seek comfort when distressed and not respond when comfort is offered

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17
Q

ICD-10 definition of disinhibited attachment disorder?

A

 Attention-seeking and indiscriminately friendly behaviour

 Attachment is described as diffuse rather than selectively focused and there are poorly modulated peer interactions

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18
Q

Risk factors of attachment disorderS?

A

o Neglect

o Abuse

o Institutionalism

o Disruption of care

o Separation from primary caregiver

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19
Q

Features of attachment behaviour?

A

o Proximity seeking to attachment figure

o Secure base

o Separation leads to protest by infant

o Permanent separation e.g. bereavement, affects capacity to feel secure & explore.

o Maximal at 18-36 months.

o Modulated by temperament of child.

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20
Q

DDx of attachment?

A

Autism spectrum disorder, PTSD, ADHD, anxiety disorders, selective mutism

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21
Q

Classification of attachment - insecure avoidant?

A

 Attachment behaviour is downplayed by these children and they do not give signals regarding need for comfort

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22
Q

Classification of attachment - insecure ambivalent?

A

 Up-regulation of attachment behaviour, with excessive amounts of distress and/or anger at separation from their caregiver and difficulty in calming the child after reunion

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23
Q

Classification of attachment - secure?

A

 Children can be comforted by their primary caregiver and use that person as a safe base from which to explore their environment

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24
Q

Classification of attachment - disorganised?

A

 Behaviour patterns are disorganised. The caregiver may be the source of the stress as well as the supposedly safe base

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25
Advice to give carers and management of attachment?
- Attachment styles can change if care-giver environment changes for the child o Improve child-carer relationship o Parenting programmes o CBT
26
Impact of attachment on adult attachment?
o Adult romantic relationships. o Narrative capacity about our own childhood. o Attachment style with our own children
27
What is ADHD? Pathology behind it?
- Triad of inattention, hyperkinesis and impulsivity - Pathology – frontal lobe under-activity using dopamine
28
Prevalence, sex preference in ADHD?
- Prevalence 3-5% - Boys 3:1 Girls - Presents early
29
Aetiologies of ADHD?
o Genetic o Influence of parenting o Temperamental differences
30
Symptoms of inattention in ADHD?
o Poor attention to tasks o Appears not to listen o Poorly organised o Easily distracted o Does not finish tasks o Forgetful
31
Symptoms of hyperkinesis in ADHD?
o Fidgets and squirms o Leaves seat in class or meals o Runs and climbs rather than walks o Noisy – cannot play or work quietly o Not moderated by social demands
32
Symptoms of impulsivity in ADHD?
o Blurts out answers o Fails to wait turn o Interrupts o Talks excessively o Short tempers, form poor relationships
33
DDX of ADHD?
- Developmentally appropriate - Boisterous personality - Conduct Disorder - Attachment disorder - Anxious inattentiveness - ASD, Bipolar - Drugs (steroids)
34
Diagnosis of ADHD?
o Problems in all areas:  Excessive compared with norms of age  Present from early age  In more than 1 social setting
35
Assessment in child with ADHD?
o Family background o Social situation o Development o Associated behaviours o Medical history
36
Psychological treatment in ADHD?
o Information to parent and child o Family support o Behavioural management o Structured tasks o Simple instructions o Time-outs o School intervention programmes  Encourage quiet self-occupation
37
Drug treatment in ADHD? Effects, SE?
o Methylphenidate (Ritalin)  Effects last a few hours (slow release preparations available)  Does not cure disorder  Improves some symptoms  May need to continue for years  SE: anorexia, slowed growth, tics, poor sleep, abdominal pain o Atomoxetine  Works over 24 hours, but takes 4 weeks to onset
38
What is deliberate self-harm?
- Varies from little actual harm, where there is a wish to communicate distress or escape from situation, to suicide - DSH - self-poisoning or injury, irrespective of the apparent purpose of the act
39
What is suicide?
- Suicide - intentionally taking of one’s life
40
Epidemiology of self-harm?
- 10% of children self-harm - Females 4:1 Males
41
Most common DSH admissions?
o Overdoses (90%) o Laceration (8%)
42
Risk factors of DSH?
o FHx of DSH, learned ‘copycat’ behaviour o Abnormalities in endorphin response and serotonin implicated o Poor early care, abuse, neglect, bullying o Identity problems (cultural, sexual, body image) o Conduct disorder, drug misuse
43
Common methods of suicide?
o Overdose o Inhalation of car exhaust fumes o Hanging o Suffocation o Shooting
44
Common methods of DSH\>?
o Overdose, cutting
45
Common reasons to DSH?
o Communicate message o Emotional immaturity o Inability to cope with stress o Maladaptive coping strategy – short-term feel effective and can become addictive
46
Assessment in a DSH episode?
- Assess capacity and MHA if needed - Assessment o Injuries to self o Potential effects of ingestion of substance o Childs capacity to consent or refuse treatment o Presence or absence of mental illness o Risk of further DSH episodes
47
Management of DSH?
- Psychiatric assessment urgently (CAMHS) - Social services - Counselling and support for person and family
48
What is anorexia?
- Weight loss, leading to at least 15% below expected - Self-induced avoidance of fattening foods - Self-perception of being too fat, with fear of fatness - Amenorrhoea
49
Epidemiology of anorexia and bullaemia?
- Girls 7:1 Boys - Mortality 5-20% - Bulimia more common (40%), Anorexia (10%), ED-NOS (50%)
50
Aetiology of eating disorders? Anorexia and bullaemia?
o No single cause o Biological  Genetics (twin studies), malnourishment o Psychological  Perfectionism, reaction to stress, tendency to anxiety and depression, worry o Environmental  Puberty, stressful life event, bereavement, abuse, stresses
51
Diagnostic criteria for anorexia nervosa?
• Dietary restriction (may be accompanied by vomiting, exercise, laxative abuse, or other weight control methods)  significant and unhealthy self-induced weight loss. BMI of \<17.5) * Intense fear of gaining weight even when severely underweight * Body image distortion with dread of fatness * Amenorrhoea
52
Complications in anorexia? CNS, hair, heart, blood, muscles, kidneys, electrolytes, GI, hormones, skin?
o CNS - Can’t think right, depression, dizziness, fear of gaining weight, sad, moody, irritable o Hair – thin and brittle o Heart – Hypotension, bradycardia, palpitations, heart failure o Blood – Anaemia o Muscles and Joints – Weakness, swollen joints, fractures, osteoporosis o Kidneys – Stones, failure o Electrolytes – Low potassium, magnesium, sodium o GI – Constipation, bloating o Hormones – Amenorrhoea, bone loss, growing problems o Skin – bruise easily, dry skin, fine hair all over body, cold easily, brittle nails
53
Diagnostic criteria for bullaemia?
 Recurrent episodes of overeating (binges). ≥ 2 per week for 3 months  Strong desire or compulsion to eat (craving)  Attempts to counteract the “fattening” effects of food by one or more of: * Self-induced vomiting * Self-induced purging * Alternating periods of starvation * Use of drugs such as appetite suppressants, diuretics or thyroid preparations  Self-perception of being too fat, with fear of fatness • NB can be normal or overweight – atypical bulimia nervosa
54
Complications in bullaemia? CNS, cheeks, mouth, throat, muscles, stomach, skin, hormones, GI, electrolytes, heart , blood?
o CNS – depression, fear of gaining weight, anxiety, dizziness o Cheeks – Swelling, soreness o Mouth – Cavities, tooth erosion, sensitivity o Throat – Sore, irritated, torn o Muscles – Fatigue o Stomach – Ulcers, pain o Skin – Abrasion of knuckles, dry skin o Hormones – Irregular periods o GI – Constipation, bloating, diarrhoea, cramps o Electrolytes – Dehydration, low K, Mg, Na o Heart – Arrhythmias, heart failure, low BP, HR o Blood - Anaemia
55
When to suspect an eating disorder?
o Weight loss, disordered thoughts about food/image, others concerned, socially withdrawn, physical symptoms
56
What is the SCOFF questionnaire? when to use it?
- SCOFF Questionnaire (General practise) o Do you make yourself Sick because you’re uncomfortably full? o Do you worry you’ve lost Control over how much you eat? o Have you recently lost more than One stone in a 3-month period? o Do you believe yourself to be Fat when others say you are too thin? o Would you say that Food dominates your life? o Score of 2 or more suggests likely AN or BN
57
Investigations in eating disorders?
o Height/Weight/BMI (mBMI; \<95% is underweight, \>120% is overweight) o BP lying/standing, HR, temp o Bloods
58
General advice in eating disorders?
o Challenge not collusion o Food is medicine o Restore weight before psychological
59
What nutritional management is important in eating disorders?
o Weight gain – 0.5kg/week in community (Anorexia Nervosa) o May need NG tubes o Multivitamin supplementation
60
what psychological management important in eating disorderS?
o CBT, Motivational enhancement therapy (MET) o Family therapy o Cognitive remediation therapy – groups that run to help affected people
61
What is the prognosis of eating disorders in children?
o 50% recover o 30% improve o 20% chronic illness

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