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Paediatrics > Mental Health > Flashcards

Mental Health Flashcards

1
Q

Whenever reviewing someone who has presented with weight loss, what is it important to do?

A

Carry out a full history.

Weight loss could in be caused by many different things and so it is important to take a full history

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2
Q

What conditions can cause rapid weight loss other than Anorexia Nervosa?

A

Coeliac disease

Type 1 diabetes mellitus

Hyperthyroidism

Malignancy

Inflammatory bowel disease

Oesphageal problems eg achalasia

Severe depression/OCD/autism

Juvenile arthritis

Addisons

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3
Q

What is lanugo hair?

A

This is hair that develops when the body experiences rapid weight loss. It is a way of keeping the body warm following the rapid loss of fat insultation.

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4
Q

What is the short term management for a patient with Anorexia Nervosa?

A

Measure weight for height ratio (bit different to BMI)

  • if this is less than 75%, start Thiamine, Vitamin B complex and Multivitamins

Diet plans (to help gain weight), monitor bloods, repeat ECGS

Only discharge when stable

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5
Q

Who is part of the MDT for children with Anorexia Nervosa and what does each do?

A

Psychiatrist - to help diagnose the underlying mental illness

Prescribe medications to treat underlying mental illness or comorbidities

Paediatrician - Also to monitor health, using different scans and tests

Dietician - help with weight gain journey

Therapists - to help with thought processes

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6
Q

What are the two most common eating disorders in adolescents?

A

Anorexia Nervosa and Bulimia

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7
Q

What is the Weight-for-Height Ratio?

A

A method of calculating whether a childs weight is appropriate for their height. This is used instead of BMI in younger people.

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8
Q

What are the clinical features of Anorexia Nervosa?

A

Wearing oversized clothing OR wearing fitted clothing to exaggerate appearances

Lanugo hair

Rough or scaly skin

Bradycardia and hypothermia

Decreased BMI - underweight

Acrocyanosis of the hands and the teeth

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9
Q

What are the risk factors of Anorexia Nervosa?

A

Familial

Personality traits

Previously overweight

Affective disorders

Psychiatric disease

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10
Q

What can help with the diagnosis of Anorexia Nervosa?

A

The patient could demonstrate any of the below diagnostic criteria:

  1. Intense fear of gaining weight despite being incredibly underweight.
  2. Denial of the seriousness of the low body weight—a disturbance in the way in which one’s body weight or shape is experienced
  3. Amenorrhoea in postmenarche females
  4. Refusal to maintain body weight at or above a minimally normal weight for age and height - this means they want to be thinner or smaller than the smallest expected amount for the height and weight of their age.
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11
Q

What is Thiamine used for?

A

B1 deficiency in children with Anorexia Nervosa

(Unrelated!! but also those with Wernicke’s Encephalopathy in Alcohol Withdrawal)

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12
Q

What questions should you consider in a child who is presenting with Behavioural Issues?

A

Ask about members of the family and if the px gets on with the others?

What is giving the impression that the px has behavioural problems?

TED and SOCRATES - e.g. onset of the problems, describe the problems, what makes it worse or better, when is it seen most, how much is it affecting every everyone?

Stresses around the start of the problems or current stresses?

ICE - from guardians and px themselves

Development and Progression

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13
Q

What is the clinical diagnosis of Autism Spectrum Disorder?

A

It is impaired social interaction and communication, seen with stereotyped behaviours, interests and activities.

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14
Q

How many times more likely are males to get Autism in comparison to females?

A

4 times more likely

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15
Q

Which 4 mental conditions all come under the general umbrella of Autism Spectrum Disorder?

A

Autism

Aspergers Syndrome

Childhood Disintegrative Disorder

Pervasive Developmental Disorder

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16
Q

At what age is Autism Spectrum Disorder expected to be seen in children?

A

<5 years old

17
Q

What is the main aetiological factor of Autism Spectrum Disorder (ASD)?

A

Genetics

18
Q

What are the clinical features of Autism Spectrum Disorder?

A

Markedly impaired social interaction and social communication

Delays in responding to social cues like smiling and speaking

Continuous repetitive behaviours, interests and activities

Meltdowns

ADHD - in some cases

Some have learnign disabilities; others are genuises

19
Q

How is Autism Spectrum Disorder investigated?

A

ASD screening programmes

  • CARS, CAST and MChAT
20
Q

How is Autism Spectrum Disorder treated/managed?

A

Improving their ability to function independently

Using pharmacology to treat the mental conditions that surface as a result of the disease

Non-pharmacological treatment - education and early behavioural interventions

21
Q

What is Attention Deficit Hyperactivity Disorder (ADHD)?

A

Chronic neurobehavioral disorder characterised by inattention, hyperactivity, impulsivity, or a combination of these symptoms.

22
Q

At what age is ADHD usually identified?

A

Between 3 - 7 years old

23
Q

Which three clinical features are characteristic of ADHD?

A

Inattention

Hyperactivity

Impulsiveness

24
Q

How is ADHD diagnosed?

A

It is usually diagnosed based on clinical history taking and reports from the childs parents, guardians and teachers.

25
Q

What is the Connor’s Rating Scale?

A

A questionnaire assessing academic, behavioural & social issues in young people (6-18 years old

26
Q

What are some differentials for inattention and hyperactivity?

A

Hyperthyroidism

Sleep disorders

Seizure disorder

Substances Use

Genetic Disorders - Digeorge syndrome and Neurofibromatosis

27
Q

How long is the “wait and watch” phase after a positive diagnosis of ADHD in a child?

A

10 weeks

28
Q

Are medications used to treat children with ADHD?

A

It is not advised to use medication in children unless it is the last resort and the child is older than 5 years old

29
Q

What are the pharamcological treatments of ADHD?

(when meds are actually used)

A

Methylphenidate and Amphetamines

Methylphenidate is also known as Ritalin

30
Q

What is the MAIN side effect to look out for in medications for ADHD?

A

Cardiotoxicity - make sure to get an ECG before starting the medications. Refer the px to Cardiology if there is a past medical hx or family hx of heart disease

31
Q

What are the important things to look out for in a Mental State Exam?

A

Appearance - clothing, weight, scars, objects

Behaviour - engagement and rapport, eye contact, facial expressions

Speech - rate, quanity, tone etc

Mood and Affect

Thoughts

Perceptions and Cognitions

Insight and Judgement

32
Q

How do you assess suicidal thoughts in a person?

A

Ask directly about suicidal thoughts

have they attempted?

If they have, what prevented them from going through with it

If they haven’t, whats stopping them from wanting to?

How often do they have suicidal thoughts?

33
Q

What is Conduct Disorder?

A

A repetitive and persistent pattern of dissocial, aggressive or defiant behaviour.

34
Q

What is Somatisation?

A

The manifestation of psychological distress by the presentation of physical symptoms.

Paediatrics (10 decks)

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