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Psych > W3 CAMHS > Flashcards

W3 CAMHS Flashcards

1
Q

What are the 5 domains of a child’s brain developing?

A

Critical period = develop language and vision, if deprived in this time cant pick it up in the future

Sensitive period = develop social skills, harder to pick up in future if deprived at this time

Plasticity = if suffer an early brain injury, can still develop normally because of plasticity. Our brain is very flexible

Synaptic pruning = our brain makes lots of potential outcomes, we undergo synaptic pruning so the pathways we often used and honed and refined whilst the ones we don’t use get smaller

Attachment = child and primary care giver relationship, crucial for normal development, 6-18 months key period

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2
Q

8 main domains of ACES

A
  1. Maltreatment (abuse, neglect)
  2. Violence and coercion (DV, gangs)
  3. Adjustment (migration, divorce)
  4. Prejudice (LGBT, racism)
  5. Household or family adversity (drugs)
  6. Inhumane treatment (torture)
  7. Adult responsibilities (young carer)
  8. Bereavement and survivorship (death, surviving illness)
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3
Q

What is the impact of experiencing 4 ACES

A
  • 2X Binge drink, poor diet
  • 3X smoke
  • 4x MH probs
  • 5x underage sex
  • 6x teen pregnancy
  • 7x violence
  • 11 x drugs
  • 11x prison

If ≥3 ACES —> Inc risk arthritis, asthma, COPD, heart attack, IHD

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4
Q

what phsyical health conditions are u more likley to have if have 4 ACES?

A

biggest rsik COPD
2. vision

also IHD, arthritis, asthma

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5
Q

peak time for mental disorder health burden

A

age 15-25

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6
Q

how do you categorise depression as mild/ moderate/ severe?

A

mild ≤ 4 symptoms

moderate 5-6

severe 7-10

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7
Q

management of mild depression

A

watch and wait (4 weeks)
psycho-eductaion - sleep hygiene
self help
supportive therapy - GP

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8
Q

treat moderate/severe depression

A

psychological

  • CBT
  • family therapy
  • IPT
  • psychodynamic

antidepresssant - NOT 1st line in kids

  • fluoxetine
  • from outset and/or if no improvement after 4-6 sessions of psychological tx
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9
Q

whats the most common psychndisorddr in childhood

A

anxiety

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10
Q

manage mild anxiety

A

psychological intervention

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11
Q

manage moderate/sevre anxiety

A

psychological intervention +/- meds

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12
Q

manage self harm

A

psychology input –> aim to develop better coping strategies to release tension

suggest alternatives to self harm - ice, red pen, elastic band

liase with school to dec bullying

  • not all kids who self harm are depressed
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13
Q

how can you diagnose schizophrenia in children?

A
  • symptoms > 1 month for most of the time
  • ≥ 1 clear 1st rank symptom
  • thought echo, insertion/withdrawal or broadcast
  • delusion of control, influence of passivity
  • running commetary auditory hallucinations
  • delsuions

AND 2 other features of schizophrenia

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14
Q

how does schizophrenia presentation differ in child vs adults?

A

kids

  • LC to have delusions
  • LC to have passivity phenomena and poverty of thought
  • manic episodes often have 1st rank sympotms
  • mania misdx as schiophrenia
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15
Q

what happens in the prodromal period of psychosis

A

lasts up to 12 months
subtle changes in behaviour/ experience/ mood
recognised by family 1st
social withdrawal and suspicion
alterations in expressed feeling
may have transient or attenuated psychotic experiences

NOT an absolute prediucotr of psychosis

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16
Q

how do you manage prodromal psychosis symptoms

A
  • if dont warranr dix of schizophrenia or psychosis

assess and treat co-morbidity
conisder CBT +/- family work
do NOT offer antipsychotics with aim of reducing risk of transition to schizophrenia

17
Q

management of psychosis

A

offer oral antipsychotic if have psychosis with psychological tx

18
Q

side effects of tx of psychosis and how to amnage

A
  • antipsychotics (oral)
  • young people more sensitive to SEs
  • metabolic (weight gain, DM)
  • extrapyramidal
  • CV (QT interval)
  • Hormonal (prolactin)
  • -> monitor
  • weight and height
  • waist and hip circumference
  • pulse and BP
  • ECG if indicated or FH risk
  • fasting glucose and lipids, HbA1c
19
Q

what are the 3 acts for capacity and consent in adolescent psychiatry

A
  1. Children Act
  2. Mental health act
  3. Mental capacity act
20
Q

explain legislation for capacity and consent in teens

A
  1. Children Act - <18 YO, defines parental responsibility - parents can give consent on behalf of those under 16
  2. Mental health act - any age, same as adults
  3. Mental capacity act - ONLY for those >16 YO –> 4 principles (understand, retain, use, communicate)
    - BUT…
    16/17 can NOT make advance directives

difficult if a 16 YO refuses tx but parent wants to consent

21
Q

how can kids give consent

A

if >16, mental capacity act can be used = 4 principles (understand, retain, use, communicate)

if <16 can still give consent if they are competent to do so = GILLICK competence
= if mature enough to understand the nature of the advice/ infogiven
understand the implications of any decision made

–> use the same principles as assessing capacity under MCA

22
Q

how do you use weight to work out if a patient is anorexic?

A

weight for height

normal weight for height = 100 %

if <85% think anorexia
if <70% severe malnutrition

23
Q

define an eating disorder

A
  • persistent disorder of eating behaviour or behaviour intended to control weight
  • which signif impairs physical health or psychosoical functioning
  • driven by the fear of fatness or weight gain
24
Q

4 classifications of ED

A

anorexia nervosa

bulemia nervosa

binge eating disorder

OFSED other specified feeding or eating disorder

25
Q

what hair sign is seen in anorexia

A

lanugo hair = fine, soft white hair primarily on arms and chest (and face) - down hair

medium sign, 3-4 months into illness

grows to keep body warm

26
Q

what are 2 signs of bulemia

A

Russell’s sign = callouses on back of hands
slow to heal bc of acid getting into cuts

erosion of enamel of teeth, halitosis

27
Q

what are features on blood tests in anorexia

A

test - feature - high risk

FBC - anaemia, thrombocytopenia –> neutropenia

U&Es - disturbance, dehydration –> hyponatraemia, hypokalaemia

Ca, Mg, Phos - low –> hypophosphataemia

Glucose - low –> hypoglycaemia

TFTs - exclude hyperthyroidism

vit B+D - low

ECG - prolonged QTc, bradycardia –> cardiac arrhythmia, QTc >450 ms

28
Q

what is the risk in treatment of anorexia

A

refeeding syndrome

29
Q

descirbe refeeding syndorme

A
  1. body in catabolism/ malnutrition –> low insulin, high glucagon
  2. –> glycogenolysis, protein catabolism, gluconeogensis, vit and mineral depletion
  3. purposefully refeed –> carb as maiin source –> INC INSULIN sec
  4. –> ANABOLISM = protein synthesis, inc glucose uptake, inc thiamine use, intrracellular shit of phos/Mg/K, Na retention to inc ECV
  5. use phosphate in ATP…massive shift of whatever left in blood into clls
    phos drops really low –> cardiac arrhythmia and arrest

= hypophosphataemia + hypomagnesia + hypokalaemia!!!
= + thiamine deficient + salt and water retention!!!

30
Q

treatment of anorexia

A

1st line - AN focused family therapy
2nd - ED-CBT
adolescent focused tx

31
Q

treat bulimia

A

1st - family therapy BN
2nd ED-CBT
CBT guided self help
(can use SSRI sometimes, no medical tx)

32
Q

what is most commonly seen in AN

low cholesterol
raised serum creatine
hyperkalaemia
hyperphosphataemia
low GGT
A

raised serum creatine

–> hypercholsterolaemia, raised serum creatine, hypokalaemia, hypophosphataemia and high GGT

33
Q

which of the following is false in teen psychosis

prodromal for up to 12 months
delusions less common
passivity phenomena andpoverty of thought less pronounced
can be diagnosed after 2 weeks of sympotms
manic episodes often have 1st rank sx

A

can be diagnosed after 1 month of sympotms

Psych (5 decks)

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