Paediatric neuropsychiatry - emotional, psychotic & conduct disorders Flashcards
Conduct disorder
“Persistent failure to control behaviour appropriately within socially defined rule” –> Aggressiveness, Destruction of property, Thefts, Truanting etc
Oppositional-defiant disorder
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
Prevalence of conduct disorder
Higher in deprived areas - M:F, 3/1, 7%/4%
Commonest child psychiatric problem
Associated with conduct disorder (6)
Hyperactivity Educational failure
Low mood Poor interpersonal relationship
Low IQ and specific reading disorder
Risk factors for conduct disorder (6)
Early onset, lifetime persistent disorder.
Teenage parents, harsh inconsistent discipline, Family conflict, maternal mental health problems, changes in primary carer, Neurocognitive risk factors
Treatments for conduct disorder
CBT or behavioural therapy, family therapy, involve school and social services.
Group based parent training & education programmes
Prognosis of conduct disorder
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)
Factors which improve outcome of CD
female, high IQ, resilient temperament, good parenting/close relationship with key adult, commitment to social values, increased economic equality
Factors which worsen outcome of CD
Onset before 10yrs, aggression at early age, asocial aggression, Low IQ and poor educational attainment, Low SE status, hyperactivity, familial criminality
Anxiety disorders in children
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)
Symptoms of anxiety disorders in children (4)
overly concerned about competence and needing reassurance, fear of dark etc, fear of abandonment/harm to attachment figure (more in younger children), somatic complaints
Types of Anxiety disorders in children (5)
specific phobias, separation anxiety, general anxiety, social anxiety, panic disorder
Treatment of anxiety in children
Work with family and school
Psychological — CBT, relaxation therapy, psychodynamic psychotherapy
Drugs – SSRIs (fluoxetine)
Depression in children
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
Causes of depression in children (3,3,3,4)
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
Prevalence of Depression in children
0.2-1% of 10yrs, 1-5% of 14yrs,
genders equal up to puberty where girls are more at risk
Treatment of depression in children (5)
CBT, interpersonal therapy, family therapy, risk management
Fluoxetine with psychological therapy
Stress disorders in children (3)
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
PTSD in children
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
Attachment style
secure
Anxious - ambivalent
Anxious - avoidant
Disorganised types (all others are ‘organised)
Psychosis in children
Rare in childhood with incidence spiking in early adulthood - first episodes may be in adolescence
4% of schizophrenia present before the age of 18
Clinical features of schizophrenia in children
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
Management of childhood schizophrenia
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
