Psychiatry - Paediatric & Law Flashcards
Describe the key clinical features of ADHD.
- triad: inattention, hyperactivity, impulsivity
- difficulty in relationships, reckless / dangerous behaviour, poor problem solving
- increased psych co-morbidity and substance misuse
Name the key risk factors for ADHD [3].
Triad: genetic disposition, perinatal precipitants, psychosocial adversity
- genetic: dopamine and serotonin transporter linked
- perinatal: tobacco / alcohol use in pregnancy, FAS, prematurity, hypoxia, long labour, foetal distress, low forceps, eclampsia
Describe the neurobiological changes seen in ADHD [2].
- decreased function in frontal lobe (reasoning, planning, impulse, judgement, initiation of action, social/sexual behaviour)
- increased dopamine removal, decreased NA (stress, attention), decreased 5-HT (mood, social behaviour, sleep, memory)
Describe the assessment and management of ADHD.
- school observation, questionaires, developmental history
- historical concerns from family
- gets in the way of life (e.g., work, education, driving, relationships)
- parent training, social skills training, sleep, diet supplements
- classroom behaviour management
- 1st line: methylphenidate, dexamfetamine (blocks DA reuptake)
- 2nd line: SSRIs, alpha agonists, antidepressants
Name the conditions under the umbrella of ‘autism spectrum disorders’.
asperger’s, rett’s, childhood autism, pervasive developmental disorder, PDD NOS
Describe the pathology and neurochemistry of ASD.
- higher male: 5:1
- in females, reduced SHBG means increased free testosterone
- may be caused by rubella, tuberous sclerosis, fragile X, encephalitis, untreated PKU, umbilical cord complication, foetal distress, brain injury / trauma, multiple birth, SGA etc.
- increased function of amygdala: anxiety, social and communication skills
- glutamate (neuronal damage), GABA (cell migration, neuron differentation, maturation), serotonin (neuron development)
Name the key clinical features of ASDs.
Triad: social communication, social imagination, social interaction (+ repetitive behaviours)
- communication: difficulty in grasping underlying meanings, narrow interests, difficulty sharing thoughts/feelings
- imagination: difficulties thinking flexibly, takes things literally
- interaction: difficulty picking up nonverbal cues, lacks empathy (when just trying to figure out social situations)
- repetitive behaviours: inflexible adherence to routine, abnormally intense interests
Describe the management options for ASDs.
- non-pharmacological: psychoeducation, SALT, behaviour analysis, social skills training
- pharmacological: rispiradone (severe aggression), AEDs, stimulants, antipsychotics, mood stabilisers, SSRI/SNRIs, melatonin
Define ‘intellectual activity’, and give the categories based on IQ.
- a condition of arrested / incomplete development of the mind, characterised by impairment of skills, level of intelligence, and cognitive / language / motor / social ability
- borderline 70-84
- mild 50-69
- moderate 35-49
- severe 20-34
- profound <20
Describe the assessment of intellectual disorders and the Flynn effect [6].
- conversation with parents/carers then a psychometric assessment
- may be immediately evident
- history of special schooling
- behavioural communication
- observation of behaviour in limited communication
- Flynn effect: average rate of IQ increase about 3 points/decade
Describe the management of intellectual disorders and the O’Brien principle.
- O’Brien: learning disabled people continue to grow/develop given an appropriate environment
- manage co-morbidities (epilepsy, mental illness, hypothyroidism, DM etc.)
- provide a therapeutic environment, psychoeducation, social needs, communication (hearing aids, glasses etc.)
Define and describe consent and capacity.
- consent: permission for something to happen, or agreement to do something
- capacity: ability to make a decision. a patient must
- understand/retain relevant information
- use and weigh information to make a decision
- communicative that decision
Describe the criteria required to conduct a procedure without capacity or consent.
- it must benefit the patient
- such benefit cannot be reasonably be achieved without the intervention
- take account of past and present wishes
- consult with other reasonable persons
- encourage use of residual capacity.
Describe the adults with incapacity act, and when it would be used.
if an adult cannot action, make, communicate, retain, or understand a decision in relation to mental disorder or inability to communicate by physical disability
not necessarily refusing the procedure, but not able to fully make / communicate their decision
Define the following terms:
- power of attorney
- guardianship
- advance statement
- named person
- power of attorney: gives someone else power to act as continuing financial and/or welfare attorney, in case capacity is later lost
- guardianship: a person makes specific decisions for another person over time
- advance statement: a written statement signed, witnessed, nd dated when the patient is well, describing how the patient would want (/not) to be treated
- named person: supports patient and their interests; same rights to be notified, attend, represent etc.
