Paediatric neuropsychiatry - emotional, psychotic & conduct disorders

Question 1

Conduct disorder

Answer 1

“Persistent failure to control behaviour appropriately within socially defined rule” –> Aggressiveness, Destruction of property, Thefts, Truanting etc

Question 2

Oppositional-defiant disorder

Answer 2

A subtype of conduct disorder – more likely in younger children & girls
Shorter duration of symptoms – 6 months
Doesn’t require delinquent acts in conduct disorder

Question 3

Prevalence of conduct disorder

Answer 3

Higher in deprived areas - M:F, 3/1, 7%/4%

Commonest child psychiatric problem

Question 4

Associated with conduct disorder (6)

Answer 4

Hyperactivity Educational failure
Low mood Poor interpersonal relationship
Low IQ and specific reading disorder

Question 5

Risk factors for conduct disorder (6)

Answer 5

Early onset, lifetime persistent disorder.
Teenage parents, harsh inconsistent discipline, Family conflict, maternal mental health problems, changes in primary carer, Neurocognitive risk factors

Question 6

Treatments for conduct disorder

Answer 6

CBT or behavioural therapy, family therapy, involve school and social services.
Group based parent training & education programmes

Question 7

Prognosis of conduct disorder

Answer 7

40% of conduct disorder became delinquent adults
90% of delinquent young adults had conduct disorder
Males tended to keep same symptoms, females more commonly developed different symptoms or PD (homo- or heterotypic continuity)

Question 8

Factors which improve outcome of CD

Answer 8

female, high IQ, resilient temperament, good parenting/close relationship with key adult, commitment to social values, increased economic equality

Question 9

Factors which worsen outcome of CD

Answer 9

Onset before 10yrs, aggression at early age, asocial aggression, Low IQ and poor educational attainment, Low SE status, hyperactivity, familial criminality

Question 10

Anxiety disorders in children

Answer 10

4-8% of young people – 2nd commonest child psychiatric disorders – stressful events and parent-to-child learning
More common in girls (they are more likely to talk about it)

Question 11

Symptoms of anxiety disorders in children (4)

Answer 11

overly concerned about competence and needing reassurance, fear of dark etc, fear of abandonment/harm to attachment figure (more in younger children), somatic complaints

Question 12

Types of Anxiety disorders in children (5)

Answer 12

specific phobias, separation anxiety, general anxiety, social anxiety, panic disorder

Question 13

Treatment of anxiety in children

Answer 13

Work with family and school
Psychological — CBT, relaxation therapy, psychodynamic psychotherapy
Drugs – SSRIs (fluoxetine)

Question 14

Depression in children

Answer 14

common - 10% of 10yos and 40% of 14yos are miserable
Symptoms as with adults after age 8 – less sleep and appetite disturbance, and less cognitively complex
More somatic symptoms

Question 15

Causes of depression in children (3,3,3,4)

Answer 15

Predisposing – bullying, romantic/school problems, abuse
Precipitating – exam failure, fights with family or partner
Perpetuating – learning problems, hostile peers or family
Protective – high IQ, supportive family, hope, realistic plans

Question 16

Prevalence of Depression in children

Answer 16

0.2-1% of 10yrs, 1-5% of 14yrs,

genders equal up to puberty where girls are more at risk

Question 17

Treatment of depression in children (5)

Answer 17

CBT, interpersonal therapy, family therapy, risk management

Fluoxetine with psychological therapy

Question 18

Stress disorders in children (3)

Answer 18

PTSD – Acute stress disorder (PTSD symptoms from 2d-1month)
Adjustment disorders - mixed anxiety/depression which is an excessive response to an event starting within 1/12 & ending 6/12

Question 19

PTSD in children

Answer 19

Reorder events and may believe trauma was predicted by signs, and are then hyper-vigilant of this signs. Repeat in play instead of flashbacks –> victims of sexual abuse are more likely to be sexually disinhibited. Adolescents are more likely to be violent or aggressive

Question 20

Attachment style

Answer 20

secure
Anxious - ambivalent
Anxious - avoidant
Disorganised types (all others are ‘organised)

Question 21

Psychosis in children

Answer 21

Rare in childhood with incidence spiking in early adulthood - first episodes may be in adolescence
4% of schizophrenia present before the age of 18

Question 22

Clinical features of schizophrenia in children

Answer 22

poor pre-morbid functioning and IQ
Insidious onset with a strong family history
Predominantly negative symptoms with a severe, unremitting course - prodrome>social withdrawal and frank psychosis

Question 23

Management of childhood schizophrenia

Answer 23

Early detection and treatment is better
Drugs are the same but lower doses - must be careful to not alienate them and control side effects closely
Transient, non-affective early onset psychosis has the best prognosis