(psych) psychiatry through the lifecourse Flashcards
in terms of child and adolescent health, what are the 4 Ps?
predisposing, precipitating, perpetuating and protective factors
by what age do most mental health conditions start?
approx 14 years (but often most cases are undetected and untreated)
what must be considered when a child’s mental health is being assessed?
important to consider developmental age
how is a child’s developmental age assessed?
using Erikson’s stages of psychosocial development
what are Erikson’s stages of psychosocial development?
the theory that personality develops in eight stages through a predetermined order, from infancy to adulthood
the idea that we encounter various crises and by resolving them, we contribute to our psychosocial development
how does the brain develop through childhood and adolesence?
cortex reaches its maximal volume soon after birth
but structural maturation continues through adolesence as grey and white matter have different maturation times
why does maturation continue after the maximum volume is reached by the cortex?
while maximal volume is reached, the structures are not sufficiently developed
structural maturation takes place through adolesence as grey and white matter have different maturation rates
how does grey matter mature?
maximum density of gray matter is reached first in the primary sensorimotor cortex and last in higher association areas such as the prefrontal cortex
how does white matter mature?
volume of white matter increases continually from childhood into early adulthood
how does the prefrontal cortex develop compared to the subcortical areas?
the prefrontal cortex matures later (maxium density reached later) than the cortical areas associated with sensory and motor task
why is adolescence a period of neural imbalance?
due to the early maturation of the sensorimotor cortical areas and the delayed maturation of the prefrontal control areas
how does the neural imbalance affect behaviour during adolesence?
during highly emotional situations, the developed sensorimotor cortical regions (limbic and reward systems) will affect behaviour more than the relatively immature prefrontal control system
what is the age of onset for attention deficit hyperactivity disorder (ADHD)?
approx 9.5 years
what is the age of onset for autism spectrum disorder?
approx 5.5 years
what is the age of onset for autism spectrum disorder (ASD)?
approx 5.5 years
what is the age of onset for depression?
approx 19.5
what is the age of onset for anxiety?
approx 5.5
what is the age of onset for obsessive compulsive disorder?
approx 14.5
what is the age of onset for substance misuse?
approx 19.5
a 10 year old girl, doesn’t want to sleep in the room alone, gets raised heart rate, sweating and difficulty breathing in crowded places, and does not like doing presentations in class
what is her diagnosis?
anxiety
due to raised heart rate, tachypnoea in crowded situations
a 10-year-old boy, several attendances to GP and Emergency Department with recurrent abdominal pain, no physical cause found so far
what is his diagnosis?
somatisation disorder
pain but no cause found, could be due to psychological concerns
a 15-year-old young woman with tiredness, sleeping 12 hours/day, irritability, and reduced enjoyment from her hobbies
what is her diagnosis?
depression
due to anhedonia and irritability
a 4-year-old boy whose language is behind peers in class, doesn’t interact much with others, prefers watching buses/trains to playing in the playground
what is his diagnosis?
autism spectrum disorder
lack of interaction w peers and behind in class
an 8-year-old boy who has been fidgeting in lessons, speaking out of turn, and struggling to stay focused on homework tasks
what is his diagnosis?
attention deficit hyperactivity disorder (ADHD)
due to fidgeting and struggle to focus
an 8-year-old boy who has been fidgeting in lessons, speaking out of turn, and struggling to stay focused on homework tasks
what is his diagnosis?
attention deficit hyperactivity disorder (ADHD)
due to fidgeting and struggle to focus
a 9-year-old boy has been using increasing amounts of alcohol hand gel, wearing rubber gloves when going outdoors, and lining up the toys in his room before going to sleep
what is his diagnosis?
obsessive compulsive disorder
due to increased hygiene and need for conformity
a 10-year-old boy with involuntary movements in the face, neck, and arms as well as making sounds that are not context-appropriate
what is his diagnosis?
Tic disorder/Tourette syndrome
due to involuntary movements and unexplained sounds
a 15-year-old young man with conduct disorder has been truanting from school and stealing his mother’s credit cards; he was found smelling of cannabis, and more recently has been smoking it in his bedroom
what is his diagnosis?
substance misuse
a 16-year-old young woman has been cutting herself with a razor when feeling distressed and recently has bought several packets of paracetamol
what is her diagnosis?
self-harm and possible suicide risk
a 14-year-old girl who has been spending a lot of time thinking about food, has cut out carbohydrates from her diet, has been skipping breakfast and using grandfather’s laxatives to lose weight
what is her diagnosis?
eating disorders
what are the core features of ADHD?
persistent pattern ofinattention,hyperactivity and impulsivity
inappropriate for their
developmental level
interferes with functioning or development
what is required to diagnose ADHD?
six or more symptoms of either inattention/hyperactivity-impulsivity for children up to age 16 years
OR five or more for adolescents age 17 years and older and adults
symptoms have been present for at least 6 months + to an extent that is disruptive and inappropriate for the person’s developmental level
what are the risk factors for ADHD?
genetic:
- no isolated gene for ADHD, several genes contribute to vulnerability for developing it
- significant heritabilIty at 76%
- first degree relatives of children w ADHD have a diagnostic probability approx x4-5 higher
environmental:
- premature birth
- low birth weight
- prenatal tobacco exposure
what are the genetic factors for ADHD?
- no isolated gene for ADHD, several genes contribute to vulnerability for developing it
- significant heritabilIty at 76%
- first degree relatives of children w ADHD have a diagnostic probability approx x4-5 higher
what are the environmental factors for ADHD?
premature birth
low birth weight
prenatal tobacco exposure
what is the prognosis for ADHD patients?
approx 70% of children who have this disorder will have the disorder as teenagers, and approx 40%-60% will still have it as adults
what is dementia?
degenerative disease of the brain with cognitive and behavioural impairment
that is sufficiently severe to interfere significantly with social and occupational function
what is the epidemiology of dementia?
worldwide, 47.5 million people have dementia +
expected to reach 75.5 million by 2030 and 135.5 million by 2050
in UK, dementia is leading cause of death in women and is second to heart disease for men
what is the most common cause of dementia?
Alzheimer’s disease (causes approx 70% of cases)
what are the early symptoms of dementia?
absent-mindedness
difficulty recalling names and words
difficulty learning new information
disorientation in unfamiliar surroundings
reduced social engagement
what are the early symptoms of dementia?
absent-mindedness
difficulty recalling names and words
difficulty learning new information
disorientation in unfamiliar surroundings
reduced social engagement
what are the progressive symptoms of dementia?
marked memory impairment
reduced vocabulary
loss of less complex speech patterns
mood swings and/or apathy
decline in ADLs & social skills
emergence of psychotic phenomena
what are the symptoms of advanced Alzheimer’s disease?
monosyllabic speech
psychotic symptoms
behavioural disturbance
loss of bladder and bowel control
reduced mobility
what are the psychiatric symptoms of dementia?
delusions (usually of a paranoid nature)
auditory and/or visual hallucinations (can be a simple misidentification + indicate rapid cognitive decline)
depression
what are the behavioural disturbances seen in dementia?
aggression, explosive temper
wandering
sexual disinhibition
incontinence
excessive eating
searching behaviour
what personality changes are seen in dementia?
an exaggeration of premorbid traits
coarsening of affect (visible reaction a person displays) and egocentricity
what can be used to test for dementia and Alzheimer’s?
an MMSE (mini-mental state examination)
what is an MMSE?
mini-mental state examination
set of 30 questions that doctors and other healthcare professionals commonly use to check for and monitor the progression of cognitive impairment
how can the scores of an MMSE be interpreted?
25-30 = normal 21-24 = mild impairment 10-20 = moderate impairment <10 = severe impairment
