Psychiatry through the lifecourse Flashcards
What factors are usually explored with children and adolescent mental health services (CAMHS)?
- systemic approach taken
4 Ps formulation:
Predisposing factors (genetics)
Precipitating factors (triggers?)
Perpetuating factors (exacerbations)
Protective factors
What are the different stages of development?
- Acoording to “Erikson’s Stages of Psychosocial Developement”
- AGE/PSYCHOSOCIAL TASK/ VIRTUE DEVELOPED
- 18 months/ trust vs mistrust/ Hope
- 18 months- 3yr/ autonomy vs shame/ Will
- 3-5 yr/ Initiative vs guilt/ purpose
- 5-13 yr/ Industry vs inferiority/ Competency
- 13-21 yr/ identity vs confusion/ Fidelity
- 21-39 yr/ Intimacy vs isolation/ Love
- 40-65 yr/ Generativity vs Stagnation/ Care
- 65 and older/ Integrity vs despair/ Wisdom
What causes the neural imbalances seen in adolescence (e.g. impulsivity)?
The prefrontal cortex matures later than the cortical areas associated with sensory and motor tasks
Adolescence is a period of neural imbalance caused by early maturation of subcortical brain areas and delayed maturation of prefrontal control areas
What is the peak age of onset for ADHD, Autism spectrum disorder and eating disorders?
ASD – 9
ADHD - 12
Eating disorders - 17
What are the core features for the diagnosis of ADHD? What guidelines are used?
DSM-5 criteria:
Persistent pattern ofinattentionand/orhyperactivity–impulsivity
Present for at least 6 months
Inappropriate for their developmental level
Interferes with functioning or development
Several symptoms present before age 12
Several symptoms present in two or more settings
The symptoms are not better explained by another mental disorder
What are the risk factors for ADHD?
Genetic Risk Factors:
- No isolated gene for ADHD, there are likely multiple genes conferring vulnerability for developing it
- Twin studies have shown a significant heritability for ADHD - as high as 76%
- First degree relatives of children with ADHD have an ADHD diagnostic probability 4-5x higher than the general population
- Boys are more vulnerable than girls (2:1 – 3:1)
Environmental Risk Factors:
- Premature birth
- Low birth weight
- Prenatal smoking exposure
Describe the prognosis of ADHD
70% of children who have this disorder will have the disorder as teenagers, and about 40%-60% will still have it as adults
What is dementia?
Degenerative disease of the brain:
Irreversible and progressive changes
Cognitive and behavioural impairment
Sufficiently severe to interfere significantly with social and occupational function
An umbrella term that has many underlying causes
What are the causes of dementia?
Reversible causes (not exhaustive)
Normal pressure hydrocephalus
Intracranial tumours
Subdural haematoma
Depression
B1, B6, B12 deficiency
Folate deficiency
Hypothyroidism
Neurosyphilis
Delirium
Always think to exclude – Surgical, metabolic, infective and psychiatric reversible causes for cognitive impairment
What happens to the brain with “normal pressure hydrocephalus”?
DILATED VENTRICLES:
Clinically presents with the Hakim-Adams triad;
Cognitive impairment/confusion
Urinary frequency/incontinence
Gait disturbance (magnetic/stuck to the floor gait)
What are the clinical features of mild dementia?
May live independently but some supervision/support often needed
Can still take part in community activities and can appear unimpaired to those who do not know them
Judgement and problem solving typically impaired
Social judgement may be preserved
Difficulty making complex plans/decisions and handling finances
What are the clinical features of moderate dementia?
Moderate Dementia
Require supports to function outside the home and only simple household tasks are maintained
Difficulties with basic activities of daily living (ADL’s), such as dressing and personal hygiene
Significant memory loss
Judgment and problem solving are typically significantly impaired, and social judgment is often compromised
May have difficulty communicating with individuals outside the home without caregiver assistance
Socializing is increasingly difficult as the individual may behave inappropriately (e.g., in disinhibited or aggressive ways), with associated behaviour changes (e.g., calling out, clinging, wandering, disturbed sleep, or hallucinations).
Difficulties are often obvious to most individuals who have contact with the individual.
What are the clinical features of severe dementia?
Severe memory impairment
Often total disorientation for time and place.
Often completely unable to make judgments or solve problems.
May have difficulty understanding what is happening around them.
Fully dependent on others for basic personal care in activities such as for bathing, toileting and feeding.
Urinary and faecal incontinence may emerge at this stage
What are the Behavioural and Psychological Symptoms in Dementia (BPSD)?
Common in Dementia
Includes apathy, mood disturbances, hallucinations, delusions, irritability, agitation, aggression and sleep changes
Typically, these symptoms are more frequent and impairing in moderate and severe forms of Dementia
What test is done for dementia?
Mini mental state examination (MMSE)
