Paediatrics CAMHS Flashcards
How does depression present in childhood?
Low mood
Anhedonia
Low energy
Anxiety and worry
Clinginess
Irritability
Avoiding school
Hopelessness about the future
Poor sleep, particularly early morning waking
Poor appetite or over eating
Poor concentration
Physical symptoms e.g. abdo pain
What psychosocial factors contribute to depression in childhood?
Potential triggers (e.g. loss of a family member)
Home environment
Family relationships
Relationships with friends
Sexual relationships
School situations and pressures
Bullying
Drugs and alcohol
History of self harm
Thoughts of self harm or suicide
FH
Parental depression
Parental drug and alcohol use
History of abuse or neglect
How is mild depression managed in childhood?
Mild depression (associated with single negative event) can be managed by watchful waiting, avoiding alcohol and cannabis) with follow up in 2 weeks
Referral to CAMHS for children with moderate to severe depression
How does CAMHS manage moderate to severe depression?
Full assessment to establish diagnosis
Psychological therapy with CBT, non-directive supportive therapy, interpersonal therapy and family therapy
Fluoxetine (first line in children 10mg to 20mg)
Sertraline and citalopram are second line antidepressants
Continue medical for 6 months after remission
Intensive psychological therapy if no response to medical treatment
How is response to treatment assessed in secondary care?
Mood and feelings questionnaire
When may admission be required for mental health issues in adolescents?
Risk of self harm, suicide or self-neglect or where there may be an immediate safeguarding issue
What is GAD?
Mental health condition causing excessive and disproportional anxiety and worry which negatively impacts the persons every day life
What is the GAD-7 questionnaire?
A questionnaire to help establish the severity of the diagnosis
How to assess a patient presenting with anxiety?
Assess for environmental triggers and contributors, e.g. family, relationships, friendships, bullies, school pressures, alcohol and drug use
What is the management of mild and moderate to severe anxiety?
Mild = watchful waiting and diet, exercise, avoiding alcohol
Moderate = counselling, CBT, medical (SSRI e.g. sertraline)
What are Obsessions and what are Compulsions?
Obsessions = unwanted / uncontrolled thoughts and intrusive images the person finds difficult to ignore e.g. overwhelming fear of contamination with dirt
Compulsions = repetitive actions the person feels that they must do, generating anxiety if they are not done e.g. checking all electrical equipment is turned off to settle the anxiety of obsessing about the house burning down
Describe the ‘cycle’ in OCD?
Obsession leads to anxiety, leads to compulsive behaviour, leading to temporary improvement in anxiety, obsession reappears, cycle continues and becomes more engrained
What is OCD associated with?
- Anxiety
- Depression
- Eating disorders
- Autistic spectrum disorder
- Phobias
How is OCD managed?
Education / self help resources
Referral to CAMHS
Patient and carer education
CBT
SSRIs (under the guidance of CAMHS specialist)
Who does “autism spectrum disorder” apply to?
People affected by a deficit in social interaction, communication and flexible behaviour (grouping Asperger’s and autistic disorder together)
How is Asperger syndrome characterised?
Normal intelligence and function in everyday life but difficulty with reading emotions and responding to others
How does ‘social interaction’ change in autism?
Lack of eye contact
Delay in smiling
Avoid physical contact
Unable to read non-verbal cues
Difficulty establishing friendships
Not displaying a desire to share attention (i.e. not playing with others)
How does ‘communication’ change in autism?
Delay, absence or regression in language development
Lack of appropriate non-verbal communication e.g. smiling, eye contact, responding to others and sharing interest
Difficultly with imaginative behaviour
Repetitive use of words or phrases
How does ‘behaviour’ change in autism?
General interest in objects, numbers or patterns than people
Self-stimulating movements which are used to comfort themselves e.g. hand flapping or rocking
Intensive and deep interest which are persistent and rigid
Repetitive behaviours and fixed routines
Anxiety and distress with experiences outside their normal routine
Extremely restricted food preferences
How is autism diagnosed?
Detailed history and assessment of the child’s behaviour and communication (diagnosis can be made before 3 years old)
Who is involved in the management of autism?
Child psychology and child and adolescent psychiatry (CAMHS)
Speech and language specialists
Dietician
Paediatrician
Social worker
Charities e.g. national autistic society
What does ADHD stand for?
Attention deficit hyperactivity disorder
What are the features of ADHD?
Very short attention span
Quickly moving from one activity to another
Quickly losing interest in a task and not being able to persist
Constantly moving or fidgeting
Impulsive behaviour
Disruptive or rule breaking
Consistent across various settings (if its just at school = environmental problem)
What is the management of ADHD?
Detailed assessment
Parental and child education
Healthy diet and exercise (food diary for links between food and behaviour)
Elimination of these triggers should be done with the assistance of a dietician
Medication - central nervous system stimulants - methylphenidate (“Ritalin”), dexamfetamine, atomoxetine
How does anorexia nervosa present?
Person feels they are overweight despite evidence of normal / low body weight
Obsessively restricting calorie intake
Exercising excessively
Diet pills / laxatives
What are the features of anorexia nervosa?
Excessive weight loss
Amenorrhoea
Lanugo hair (fine soft hair across most of the body)
Hypokalaemia
Hypotension
Hypothermia
Changes in mood, anxiety and depression
Solitude
Cardiac complications - arrhythmia, cardiac atrophy and sudden cardiac death
