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*Psychiatry > Symposium 4 - Child and Adolescent Psychiatry I > Flashcards

Symposium 4 - Child and Adolescent Psychiatry I Flashcards

1
Q

What is Developmental Psychopathology?

A

Processes that go wrong during development resulting with problem thinking/behaviour
Role of genes, biological processes and life experiences

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2
Q

What are the genetic factors of mental illness?

A

ADHD + Autism are highly genetic

Depression and anxiety substantially genetic

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3
Q

What intra-uterine and perinatal factors can affect a child’s mental health?

A 
Maternal health
Substance misuse
Toxins 
Drugs (antipsychotics)
Epigenetics 
Endocrine environment (androgens)
Prematurity
Twinning
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4
Q

What are the affects of Fetal alcohol syndrome?

A

Growth retardation - body, eyes, head, cerebellum

Neuro-developmental effects - Sensorimotor, cognitive development, executive function

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5
Q

How does White matter connectivity affect mental health?

A

Low connectivity associated with cognitive instability (ADHD) - poor concentration, distractibility

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6
Q

What physical neurological changes are seen in Fetal Alcohol syndrome?

A

White matter connectivity

Gray matter gyrification

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7
Q

What are the mental health outcomes for children with fetal alcohol syndrome?

A

Variable
Learning difficulties
ADHD or ADD or Hyp-Imp subtypes
Anxiety disorders

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8
Q

What are Hyp-Imp subtypes?

A

Difficulties remaining still when self control is needed

Act in response to immediate stimuli without consideration

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9
Q

What is ADD?

A

Distractibility

Sustaining attention to tasks without immediate rewards is hard

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10
Q

What childhood environmental factors can affect mental health?

A 
Carer - child relationship
Parenting skill/mental disorder 
Marital harmony
Nutrition, poverty
Abuse
Neglect
Discipline
Day care
Peer relationships
Life events
Early life stress
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11
Q

What is Attachment?

A

Proximity-seeking behaviour
Secure or insecure
Bonding good for mental health

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12
Q

How does early life stress impact the brain?

A

Influences function of limbic circuit + amygdala
Determines subsequent patterns
Early life stress influences mood and patterns of response to threat

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13
Q

How does early adversity affect dopamine?

A

Early adversity decreases Dopamine response
Decreasing reward sensitivity
Increasing behaviour required to elicit reward
Increased tolerance leading to increased behaviour

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14
Q

The reward deficiency model affects what?

A 
Addiction - leads to:
 - Obesity
 - Drug + alcohol
 - Gambling
 - Porn
Increased delay-aversion
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15
Q

Outline delay aversion?

A

Theory to explain ADHD - inability to wait and maintain attention in the absence of immediate reward

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16
Q

How does school refusal differ from truancy?

A

Fear of leaving home/going to school vs unwillingness

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17
Q

What paediatric mental health problems are associated with being out of school?

A 
Anxiety
Conduct disorder
Autism
Depression
OCD
18
Q

What are the effects of mental health issues on school attendance?

A 
Learning difficulties 
Emotion issues
Anxiety
Lack of energy 
Sensory issues 
Preoccupation
19
Q

What are the main anxiety disorders?

A

Separation anxiety - at doorstep

Social phobia - at school gate

20
Q

What are the features of anxiety disorders?

A

Anxious thoughts and feelings
Autonomic symptoms
Avoidant behaviour

21
Q

What are the motivational factors affecting school attendance?

A 
Bullying
Learning difficulties
Lack of friends 
Lack of attention
Maternal depression
22
Q

What is the neurophysiology of anxiety disorders?

A

Amygdala activity suppressed by right ventrolateral amygdala when labelling emotions
Reducing connectivity

23
Q

What is the treatment for anxiety disorders in children?

A

Behavioural - CBT
SSRIs i.e. Fluoxetine
Contain anxiety and return to school ASAP

24
Q

What is an emotional contagion?

A

Fearful child leads to the same in the parent then the doctor

25
Q

What is the principle of CBT?

A

Thoughts lead to feelings
Feelings lead to behaviour (which effects the environment)
Leads to worse thoughts

26
Q

What are the long term benefits of CBT?

A

Challenge - Success - Self confidence - Resilience

27
Q

What are the long term effects of no behavioural treatment?

A

Challenge - Avoidance - Low self confidence - Vulnerability

28
Q

What other behavioural therapies are used in children?

A

Psychoeducation
Goal-setting
Motivating
Externalising

29
Q

What is the prevalence of ASD?

A

1%
M:F
3:1

30
Q

What is the physiology of ASD?

A

Synaptic protein dysfunction
GABA, glutaminergic
Brain development

31
Q

What are the distinctive features of ASD?

A 
Social: 
 - Reciprocal conversation
 - Expressing emotional conver
 - Non-verbal communication
Repetitive behaviour:
 - Mannerisms, obsessions
 - Inflexible behaviour
32
Q

What non-verbal cues are associated with ASD?

A

Declarative pointing
Modulated eye contact
Facial expression

33
Q

What are the features of lower IQ ASD?

A

Decreased Joint attention, Emotional response, movements

34
Q

What are the features of higher IQ ASD?

A

Increased conversation, empathy, Interests

35
Q

What clinical issues are associated with ASD?

A 
Learning disabilities
Hyperactivity
School avoidance
Aggression, temper
Self injury and suicide
OCD
Anxiety
36
Q

What are the causes of ASD?

A

Co-morbid with: Rubella, Callosal agenesis, Down’s, Fragile X, Tuberous sclerosis

37
Q

How is ASD managed?

A

Establish needs, the can’t and the won’t
Decrease the demands
Early recognition and acknowledgement

38
Q

What are the features of Oppositional defiant disorder?

A 
Refusal to obey adults 
Argues with adults
Loses temper
Deliberately annoys people
Touchy or easily annoyed 
Spiteful or vindictive
39
Q

How does ODD differ from ADHD?

A

ODD - temperament, learned behaviour, more likely due to impaired parenting and adversity
ADHD - resistant to management, genetic, poor cognitive control and impulsion

40
Q

How are Hard to Manage children managed?

A

Multi-Systemic Therapy

Parent training

41
Q

What outcome risks are associated with H2M children?

A

Antisocial behaviour
Substance misuse
Long-term mental health issues

42
Q

Outline parent training in H2M children?

A

Structured
Based on Social learning theory
Focus on positive reinforcement of desired behaviour and developing relationships

*Psychiatry (18 decks)

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