Symposium 4 - Child and Adolescent Psychiatry I Flashcards
What is Developmental Psychopathology?
Processes that go wrong during development resulting with problem thinking/behaviour
Role of genes, biological processes and life experiences
What are the genetic factors of mental illness?
ADHD + Autism are highly genetic
Depression and anxiety substantially genetic
What intra-uterine and perinatal factors can affect a child’s mental health?
Maternal health Substance misuse Toxins Drugs (antipsychotics) Epigenetics Endocrine environment (androgens) Prematurity Twinning
What are the affects of Fetal alcohol syndrome?
Growth retardation - body, eyes, head, cerebellum
Neuro-developmental effects - Sensorimotor, cognitive development, executive function
How does White matter connectivity affect mental health?
Low connectivity associated with cognitive instability (ADHD) - poor concentration, distractibility
What physical neurological changes are seen in Fetal Alcohol syndrome?
White matter connectivity
Gray matter gyrification
What are the mental health outcomes for children with fetal alcohol syndrome?
Variable
Learning difficulties
ADHD or ADD or Hyp-Imp subtypes
Anxiety disorders
What are Hyp-Imp subtypes?
Difficulties remaining still when self control is needed
Act in response to immediate stimuli without consideration
What is ADD?
Distractibility
Sustaining attention to tasks without immediate rewards is hard
What childhood environmental factors can affect mental health?
Carer - child relationship Parenting skill/mental disorder Marital harmony Nutrition, poverty Abuse Neglect Discipline Day care Peer relationships Life events Early life stress
What is Attachment?
Proximity-seeking behaviour
Secure or insecure
Bonding good for mental health
How does early life stress impact the brain?
Influences function of limbic circuit + amygdala
Determines subsequent patterns
Early life stress influences mood and patterns of response to threat
How does early adversity affect dopamine?
Early adversity decreases Dopamine response
Decreasing reward sensitivity
Increasing behaviour required to elicit reward
Increased tolerance leading to increased behaviour
The reward deficiency model affects what?
Addiction - leads to: - Obesity - Drug + alcohol - Gambling - Porn Increased delay-aversion
Outline delay aversion?
Theory to explain ADHD - inability to wait and maintain attention in the absence of immediate reward
How does school refusal differ from truancy?
Fear of leaving home/going to school vs unwillingness
What paediatric mental health problems are associated with being out of school?
Anxiety Conduct disorder Autism Depression OCD
What are the effects of mental health issues on school attendance?
Learning difficulties Emotion issues Anxiety Lack of energy Sensory issues Preoccupation
What are the main anxiety disorders?
Separation anxiety - at doorstep
Social phobia - at school gate
What are the features of anxiety disorders?
Anxious thoughts and feelings
Autonomic symptoms
Avoidant behaviour
What are the motivational factors affecting school attendance?
Bullying Learning difficulties Lack of friends Lack of attention Maternal depression
What is the neurophysiology of anxiety disorders?
Amygdala activity suppressed by right ventrolateral amygdala when labelling emotions
Reducing connectivity
What is the treatment for anxiety disorders in children?
Behavioural - CBT
SSRIs i.e. Fluoxetine
Contain anxiety and return to school ASAP
What is an emotional contagion?
Fearful child leads to the same in the parent then the doctor
What is the principle of CBT?
Thoughts lead to feelings
Feelings lead to behaviour (which effects the environment)
Leads to worse thoughts
What are the long term benefits of CBT?
Challenge - Success - Self confidence - Resilience
What are the long term effects of no behavioural treatment?
Challenge - Avoidance - Low self confidence - Vulnerability
What other behavioural therapies are used in children?
Psychoeducation
Goal-setting
Motivating
Externalising
What is the prevalence of ASD?
1%
M:F
3:1
What is the physiology of ASD?
Synaptic protein dysfunction
GABA, glutaminergic
Brain development
What are the distinctive features of ASD?
Social: - Reciprocal conversation - Expressing emotional conver - Non-verbal communication Repetitive behaviour: - Mannerisms, obsessions - Inflexible behaviour
What non-verbal cues are associated with ASD?
Declarative pointing
Modulated eye contact
Facial expression
What are the features of lower IQ ASD?
Decreased Joint attention, Emotional response, movements
What are the features of higher IQ ASD?
Increased conversation, empathy, Interests
What clinical issues are associated with ASD?
Learning disabilities Hyperactivity School avoidance Aggression, temper Self injury and suicide OCD Anxiety
What are the causes of ASD?
Co-morbid with: Rubella, Callosal agenesis, Down’s, Fragile X, Tuberous sclerosis
How is ASD managed?
Establish needs, the can’t and the won’t
Decrease the demands
Early recognition and acknowledgement
What are the features of Oppositional defiant disorder?
Refusal to obey adults Argues with adults Loses temper Deliberately annoys people Touchy or easily annoyed Spiteful or vindictive
How does ODD differ from ADHD?
ODD - temperament, learned behaviour, more likely due to impaired parenting and adversity
ADHD - resistant to management, genetic, poor cognitive control and impulsion
How are Hard to Manage children managed?
Multi-Systemic Therapy
Parent training
What outcome risks are associated with H2M children?
Antisocial behaviour
Substance misuse
Long-term mental health issues
Outline parent training in H2M children?
Structured
Based on Social learning theory
Focus on positive reinforcement of desired behaviour and developing relationships
