10.2. Child and Adolescent Psychiatry - Assessment / Management of Common Presentations

Question 1

What Factors have to be Considered when Formulating Management in Child / Adolescent Psychiatry?

Answer 1

1. Biological Aspects
2. Psychological Aspects
3. Social Aspects
4. Identify Predisposing / Precipitating / Maintaining / Protective Factors

Question 2

What Biopsychosocial Factors need to be considered when Formulating Management in Child / Adolescent Psychiatry?

Answer 2

1. Biological - Genetic Predisposision / Neuro-developmental Insults / Illness …
2. Psychological - Temperament / Attachment Style / Psychological Attributes (Impulsivity / Perfectionism …)
3. Social - Family Relationships / Peer Relationships / Hobbies / Religious Faith / Neighbourhood / School…

Question 3

What are Characteristics of Conduct Disorders?

Answer 3

Repetitive and Persistent Patterns of Antisocial / Aggressive / Defiant Behaviours, which Violate Age-Appropriate Societal Norms

Question 4

What is the Course of Conduct Disorders?

Answer 4

It is a Persistent Disorder with Increase Risk of:

1. Early Death - Often by Sudden / Violent Means
2. Social Exclusion
3. Poor School Achievement
4. Long-Term Unemployment
5. Criminal Activity
6. Adult Mental Health Problems
7. Poor Interpersonal Relationships - including their kids

Question 5

What is the Management of Conduct Disorders?

Answer 5

Will be based on Biopsychosocial Assessment:

1. Parent Training Programme
2. Modify School Environment - Behavioural Support
3. Functional Family Therapy
4. Multi-Systemic Therapy
5. Child Interventions - Social Skills / Problem Solving / Anger Management / Confidence Building
6. Treat Comorbidity
7. Address Child Protection Concerns

Question 6

What are the Characteristics of Hyperkinetic Disorders?

Answer 6

Core Features of:
1. Developmentally Abnormal Inattention
2. Hyperactivity
3. Impulsivity
Present Across Time and Situations

Question 7

What are the Symptoms of Hyperkinetic Disorders?

Answer 7

1. Learning Disability
2. Autism Spectrum Disorders
3. Conduct Disorder
4. Tics
5. Motor-Coordination Problems
6. Substance Misuse
7. Anxiety / Depression
   Note - Majority are Symptomatic into Adulthood

Question 8

What is the Management of Hyperkinetic Disorders?

Answer 8

1. Psychoeducation
2. Medications - Atomoxetine / Guanfacine / Stimulants (Methylphenidate)
3. Behavioural Interventions
4. Parent Training - PinC / School Interventions
5. Treat Comorbidity
6. Volunteer Organisations / Benefits

Question 9

What Factors increase the Risk of Suicide in Child / Adolescent Psychiatry?

Answer 9

1. Persistent Suicidal Ideas / High Intent / High Motivation
2. Past Suicidal Behaviours / High Lethality of Method
3. Ongiong Precipitating Stresses
4. Mental Disorder / Poor Physical Health
5. Parental Psychopathology / Suicidal Behaviour
6. Physical / Sexual / Emotional Abuse
7. Disconnection from Support Systems

Question 10

What is the Management of Self-Harm in Child / Adolescent Psychiatry?

Answer 10

1. Usually Admit to Age-Appropriate Medical Ward
2. Mental Health Risk Assessment - Specifically Trained Staff
3. Further Referral to Agencies as Appropriate