Mental Health

Question 1

What is the common presentation of a child with Autism? What are the diagnostic features?

Answer 1

• biopsychosocial model - externalising and internalising disorders (anxiety/withdrawn/other stuff going on in life)
• persisting impairments in social communication, repetitive, stereotyped patterns of behaviours/interests.

1. language delay/regression
   
   • <1 year old - delayed language development
   • 24months - single words
   • 3 years - no phrase speech
   • early speech - adult-like speech
2. Communication impairment
   
   • verbal/non-verbal
   • facial expressions, demeanour
3. Social impairment
   
   • social interest
   • response
   • imaginative play
   • may be socially motivated but less sophisticated
4. Repeptitive/Rigid/Stereotyped interests
   
   • abnormal interest or focus
   • inflexible adherence to specific routines
   • stereotyped behaviours
5. Others:
   
   • feeding trouble
   • placid or irritable
   • macrocephaly
   • stimming (self-stimulating) to overcome distress
6. Associated with
   
   • itellectual disability 50%
   • Epilepsy
   • ADHD, Aggression, disruptive behaviour

Question 2

What are some RFs for Autism?

Answer 2

• Male (4:1)
• FHx

Question 3

What investigations are used to assess Autism?

Answer 3

• Clinical specialist assesses multiple domains:
  
  • hearing test
  • visual testing
  • psychological testing - IQ (median 100, beyond 2 SD is super or not very, with arbitrary cut off), WAIS 4 test - Burks Dobson curve.
  • chromosomal analysis
  • rule out psychotic disorders, social problems, depression, abuse
• in terms of treatment its multidisciplinary:
  
  • early intervention (behaviour modification, speech therapy, special ed, social skills)
  • medication - co-morbid psychopathology

Specify if:

• Intellectual impairment
• Language impairment
• Ass. w. known medical / genetic condition / environmental factor
• Ass w. another neurodev / behavioural disorder
• Catatonia

Question 4

What is the DSM 5 criteria for ADHD?

Answer 4

1. persistent pattern of inattention +/- hyperactivity and impulsivity with 1 or both of:
   
   1. inattention
      
      • no attention to details
      • difficult sustaining attention
      • difficulty organising tasks
      • easily distracted
      • reluctant to engage in tasks requiring sustained mental effort
   2. hyperactivity + impulsivity
      
      • figits
      • leaves seat
      • runs about + climbs
      • doesn’t play
      • talks excessively

two types - inattentive types are often missed.

1. severeal symptoms present in >2 settings
2. presents at age <12
3. functional impact
4. not during another mental disorder

Question 5

What are some differentials for Autism?

Answer 5

• ADHD
• ODD (oppositional defiant disorder)
  
  • Conduct disorder a violent subset of this
    
    • violating social norms and don’t care, no empathy
  • disobedient to authority figures (DSM-5)
    
    • persistent deficits in social communication
    • restricted repetitive patterns of behaviour
    • early development
    • cause significant distress
  • other peoples fault, don’t take responsibility
  • mostly psychological strategies, meds not indicated.
    
    • cycle of change and motivational interviewing
    • CBT
    • social skills
    • family interventions
• patient with both ADHD and ODD how do you treat them? explain how the medication works? ADHD symptoms and not the ODD symptoms.

Question 6

Treatment for ADHD?

Answer 6

1. stimulant medication - single most effective treatment
   
   • (dexamphetamine (SA/LA forms)
   • methylphenidate (SA/LA forms)
   • other meds:
     
     • atomoxetine
     • clonidine/imipramine/risperidone
2. psychosocial - psychologist with EBP (evidence based practice) expertise

Education, positive parenting, focused counselling.

• time management strategies
• CYCLE OF CHANGE
• clear instructions
• implement environmental manipulations
• limit amounts of group work
• working memory strategies
  
  • be aware of overload

If they have multiple conditions you have to treat them all individually. MD team:

• GP
• Paediatrician
• Psychiatrist
• Inpatient

Question 7

3 expecptions to confidentiality?

Answer 7

1. planning on killing someone
2. planning on hurting yourself
3. being abused

if these things have happened we will work through what we are going to do together

Question 8

HEADSS Framework?

Answer 8

• Home
• Education/Employment/Eating/Exercise
• Activities and Peer relations
• Drugs/cigarettes/alcohol
• Sexuality
• Suicide/Depression
• Safety (media)
• Spirituality