Psychiatric disorders childhood

Question 1

What age does anxiety usually present

Answer 1

teenage years - period of change, maturing, pressure

Question 2

How does GAD present in children

Answer 2

• Free floating anxiety - about lots of things
• Fear of death or loss of parents
• Somatic manifestations - nausea, abdo pain, sickness, headaches, palps, tension
• Panic attacks - sudden onset, extreme fear

Question 3

What is seperation anxiety, how does it present?

Answer 3

• Anxiety manifest upon seperation (or threat) from attachement figures - usually mother
• Somatic manifestations
• Nightmares with seperation themes
• Refuse to go to school

Question 5

Management of anxiety disorders in children

Answer 5

• Behavioural therapy - systemic desensitisation, response prevention
• Psychotherapies - brief psychodynamic, family and cognitive therapy, grief therapy
• SSRI - fluoxetine

Question 6

Depression in children - key difference

Answer 6

• Low mood may not be pervasive - can be up and down
• In boys can be masked by anger
• Main concern is risk of self harm

Question 7

Biological symptoms of depressive disorder in children

Answer 7

• Not usually sleep/appetite
• Usually concentration and motivation affected worse

Question 8

Depressive disorders children core symptoms

Answer 8

• Low mood persistent but not necessarilty pervasive
• Anhedonia

Question 9

Management depressive disorders children

Answer 9

• CBT
• SSRI
• Manage underlying comorbids

Question 10

Behavioural problem in children - why

Answer 10

• Not sure if MH problem
• Cause can be complex - parenting often cited as issue but may not be simple
• Majority of children grow out, some persist

Question 11

Behavioural problems (oppositional disorder) features

Answer 11

• Uncooperative
• Unwilling to comply with requests
• Frequent temper tantrums
• Wilful, defiant, may be aggressive - other children in family safe?
• Unless managed can escalate - conduct disorder

Question 12

Conduct disorder types

Answer 12

• Socialised - less serious, phasic
• Unsocialised - more serious, leads to criminality, later diagnosis of antisocial personality disorder

Question 13

Features of conduct disorder

Answer 13

• Lying
• Stealing
• Truanting
• Violence to people and animals

Question 14

RF for conduct disorder

Answer 14

• Lack clear boundaries, inconsistent parenting
• Rejection
• Family conflict especially when witnessing violence/agression (normalised)
• Child abuse
• Temperament
• Co-morbid learning or developmental diffiuclties

Also ask about what they are accessing online and if parents aware

Question 15

Management of conduct disorder

Answer 15

• Consistent care and parenting - Triple P parenting program (positive parenting program)
• Behavioural therapy - handle stress, anger management
• School based interventions
• Community interventions - wellbeing service

Question 16

ADHD epidemiology

Answer 16

• 3-5% children
• Underdiagnosed
• Symptoms persist into adulthood in 2/3

Question 17

Diagnosing ADHD - how?

Answer 17

• History and observation in different settings
• Also use QB test - computerised, sensor on head and observer - objective score
• Questionaires for parents too

Question 18

Adult vs child ADHD

Answer 18

• Adults - emotional volatility/anxiety
• Children don’t have this as much

Question 19

What can ADHD co-exist with?

Answer 19

• Often other neurodevelopmental difficulties
• Eg dyslexia or autism

Question 20

Key features of ADHD

Answer 20

• Poor attention and concentration
• Physical overactvity
• Impulsivity
• Needs to occur in more than 1 environment
• Diagnosis after 6yrs but symptoms present before

Question 21

Management of ADHD

Answer 21

• Mild to moderate - consider parenting and school interventions first
• Severe - medication
• Treat co-morbid anxiety, behavioural problems, substance use (self medicate)

Question 22

Medication used for ADHD treatment

Answer 22

• Methylphenidate: short or long-acting stimulant
• Lisdexamphetamine
• Atomoxetine
• Guanfacine

Question 23

Autisim spectrum disorder epidemiology

Answer 23

• 1% - probably more
• Increasingly diagnosed
• Diagnosis made on history and observation - ADOS (done by someone they do not know)

Question 24

ASD associated co-morbids

Answer 24

• Anxiety
• ADHD
• Sleep problems
• OD
• LD

Question 25

Autism spectrum disorders features

Answer 25

* Socio/communication difficulties - verbal or non-verbal difficulties * Sensory processing difficulties * Effects on thinking - lack flexibilty, social imagination, theory of mind, generalisation * Occur in more than 1 environment * Symptoms present before 3 years old

Question 27

Management of ASD

Answer 27

* No definitive treatment * Psychoeducation * Stress reduction * Environmental changes * Treat co-morbidities

Question 28

At what age will PIER team take referrals? - early intervention psychosis

Answer 28

Aged 14 onwards - do joint work with CAMHS - advise

Question 29

Eating disorders in children - key features

Answer 29

* Rare in pre-adolescent period * Increasing prevelance in adolescence * Similar symptoms to adults * Delayed puberty and growth - significant issues * Prognosis worse if younger or male

Question 30

Psychotic illness in children - key features

Answer 30

* Hallucinations * Delusions * Thought disorder * Consider substance misuse * Rare before puberty