W3 CAMHS Flashcards
What are the 5 domains of a child’s brain developing?
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
8 main domains of ACES
- Maltreatment (abuse, neglect)
- Violence and coercion (DV, gangs)
- Adjustment (migration, divorce)
- Prejudice (LGBT, racism)
- Household or family adversity (drugs)
- Inhumane treatment (torture)
- Adult responsibilities (young carer)
- Bereavement and survivorship (death, surviving illness)
What is the impact of experiencing 4 ACES
- 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
what phsyical health conditions are u more likley to have if have 4 ACES?
biggest rsik COPD
2. vision
also IHD, arthritis, asthma
peak time for mental disorder health burden
age 15-25
how do you categorise depression as mild/ moderate/ severe?
mild ≤ 4 symptoms
moderate 5-6
severe 7-10
management of mild depression
watch and wait (4 weeks)
psycho-eductaion - sleep hygiene
self help
supportive therapy - GP
treat moderate/severe depression
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
whats the most common psychndisorddr in childhood
anxiety
manage mild anxiety
psychological intervention
manage moderate/sevre anxiety
psychological intervention +/- meds
manage self harm
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
how can you diagnose schizophrenia in children?
- 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
how does schizophrenia presentation differ in child vs adults?
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
what happens in the prodromal period of psychosis
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
how do you manage prodromal psychosis symptoms
- 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
management of psychosis
offer oral antipsychotic if have psychosis with psychological tx
side effects of tx of psychosis and how to amnage
- 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
what are the 3 acts for capacity and consent in adolescent psychiatry
- Children Act
- Mental health act
- Mental capacity act
explain legislation for capacity and consent in teens
- Children Act - <18 YO, defines parental responsibility - parents can give consent on behalf of those under 16
- Mental health act - any age, same as adults
- 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
how can kids give consent
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
how do you use weight to work out if a patient is anorexic?
weight for height
normal weight for height = 100 %
if <85% think anorexia
if <70% severe malnutrition
define an eating disorder
- 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
4 classifications of ED
anorexia nervosa
bulemia nervosa
binge eating disorder
OFSED other specified feeding or eating disorder
