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a Psychiatry > Lecture - Comparing child and adult psychiatry > Flashcards

Lecture - Comparing child and adult psychiatry Flashcards

1
Q

What % of children and adolescents have mental health problems?

A

10% of children

20% of adolescents

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2
Q

How common is schizophrenia in children? Does an ‘imaginary friend’ mean psychosis in children?

A

Many children have an imaginary friend so this is usually normal

Schizophrenia prevalence is <0.02% (compared to 1% in adults) so very uncommon

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3
Q

Are antidepressants more or less effective in children?

A

Antidepressants are less efficacious in children

The childhood brain is however more sensitive to cannabis-induced psychosis and medication side-effects (e.g. antipsychotics)

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4
Q

Is personality disorder diagnosed in children?

A

Usually no as personality is developing at least until the age of 18

But can rarely be diagnosed

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5
Q

What is treatment of psychiatric conditions in childhood centred around?

A

Psychological therapies are most helpful

Management must involve liaising with social institutions e.g. family, school, social services, other communities such as public/voluntary oranisations or religious groups.

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6
Q

What is the SSRI of choice in children?

A

Fluoxetine

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7
Q

How common is anxiety in children? What are children anxious about at different ages?

A
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8
Q

What is the management of anxiety in children?

A
  1. Psychoeducation (child, parents, family)
  2. CBT - brief and group both effective
    • Medication (2nd line) - SSRI like fluoxetine, sertraline (for OCD)
  3. Liaise with school e.g. for school phobia, attendance, ADHD etc

*school-based CBT prevention strategies is collecting positive evidence

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9
Q

What is the prognosis of anxiety in childhood?

A
  • Most do nott persist into adulthood
  • BUT most adulthood/adolescence anxiety started with diagnosed/undiagnosed childhood anxiety
  • 5x increased risk of adulthood anxiety in child anxiety disorder
  • Remission : separation anxiety > phobias > general anxiety > panic > OCD (worst remission)
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10
Q

How does depression in children usually present? How is it diagnosed?

A

Symptoms: (1) affective, (2) biological, (3) cognitive, (4) impairment

  • Irritability is common as well as the adult symptoms
  • Somatis symptoms
  • Social withdrawal/ school refusal/ change in academic performance
  • Has to last at least 2 weeks and be present most of the time
  • Peristent
  • Comorbid anxiety, conduct and hyperkinetic disorders are common

Diagnosis criteria used is the same as in adults.

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11
Q

How common is depression in children?

A
  • 40% of 14year olds are ‘miserable’ at some point so need to distinguish depression from sadness
  • Depressive disorder uncommon in prepubertal stage but ~5% of adolescents have depressive disorder
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12
Q

How do you formulate the aetiology of depression in childhood?

A
  1. Predisposing factors
  2. Precipitant factors
  3. Perpetuating factors
  4. Presentation
  5. Protective factors are also looked at here.
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13
Q

What genes are implicated in childhood depression?

A
  • BDNF gene polymophism associated with early-onset depression especially if environmental adversity
  • Shorter allele variant of 5-HT transporter gene predisposes to depression but only in maltreated children
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14
Q

What is the management of depression in children?

A
  • Psychoeducation
  • Advice on sleep, exercise, diet
  • Manage environmental stressors e.g. work with school to prevent bullying

Mild depression

  1. ‘Watchful waiting’ for 2 weeks by GP/cousellor/social worker
  2. If unresolved: 3 months psychological therapy - supportive, digital/group CBT, group NDST, group IPT

Moderate-severe depression

  1. Review CAMHS
  2. Then: 3 months CBT, interpersonal, family therapy, psychodynamic psychotherapy, brief psychological intervention *
  3. If unresolved: Switch psychological therapy or add fluoxetine combined

*but there is some disagreement and clinical judgement should also be used as to when medication can be added.

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15
Q

What is the only SSRI with favourable:risk benefit profile in children with depression?

A

Fluoxetine

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16
Q

When should you admit a child with depression?

A

High risk

Poor home supervision/support

Intensive assessment required

17
Q

Which scoring system is used in children with depression?

A

Mood and feelings questionnaire (MFQ) - questionnaire used to monitor and review mood in the last 2 weeks

18
Q

What is the prognosis with childhood depression?

A
  • Untreated cases - 1/3 remit in 2 months, 10% still depressed after 1 year
  • Approximately 1/3 relapse
  • If untreated: increased risk of suicide attemps, bipolar disorder
19
Q

How is bipolar disorder diagnosed in children?

A

Requires a clear manic episode with euphoria over several days

20
Q

What is the epidemiology of bipolar disorder diagnosis?

A

Increasingly diagnosed in USA but not the same in the UK

21
Q

What can bipolar disorder symptoms overlap with?

A

Overlap of symptoms with other conditions:

  1. Irritability (prominent in children) &/or behavioural problems:
    • Can be normal in adolescence
    • Also associated with Depression, ADHD, Drugs, Conduct disorder…
  2. Impulsivity / Disinhibition
    • Can be normal in childhood
    • Also associated with ADHD, drugs…
  3. Grandiosity / Paranoia
    • Ego-centrism is part of normal development in younger children
22
Q

Why can diagnosing psychosis in children be challenging?

A

May not have the words to describe the symptoms

23
Q

How does childhood psychosis differ from childhood psychosis?

A
  1. Delusions not usually as systematic or complex vs. adults.
  2. Delusional content may reflect concerns specific to child’s developmental stage eg. monsters.
  3. Can be difficult to differentiate between types of psychosis (eg. schizophrenia, affective…) and may have difficulty describing
24
Q

What are the differentials for psychosis in childhood?

A

Symptoms of another disorder:

  1. Social isolation & communication difficulties in autism
  2. Perceptual abnormalities in neurological or emotional disorders

Age-appropriate experiences & behaviours:

  1. Sleep-related perceptual phenomena
  2. Imaginary friends / fantasy figures
  3. Child’s understanding and expression of religious/cultural beliefs & concepts
25
Q

Why is early intervention in psychosis (EIP) crucial?

A
  • Earlier the onset of psychosis, the worse the prognosis
  • Longer psychosis is left untreated, the harder it is to treat
  • Good early experience of services may help later engagement
26
Q

What are the aims of EIP?

A
  1. Detect and treat previously hidden pscyhosis in community
  2. Monitor those with prodromal symptoms (or ‘high risk mental state’) - but evidence for anti-psychotics is inconclusive
  3. Improve outcomes by facilitating recovery
27
Q

What are the challenges with psychosis in childhood?

A
  • Prodromal symptoms may be difficult to detect/differentiate - poor social skills, cognitive deficits, perceptual abnormalities
  • Younger people are more sensitive to anti-psychotic side effects
28
Q

Who delivers EIP in children?

A
  • CAMHS (up to 18 years only)
  • Specialist EIP services (usually up to age of 25 years)
29
Q

Does cannabis cause psychotic illness? What are the complications of cannabis use in adolescence?

A

Yes - cannabis can cause acute drug-induced psychosis; the risk of developing this is higher in younger people than adults.

Complications: dose-dependent relationship between cannabis use and…

  • …psychotic symptoms (in 15-16yo)
  • …schizophrenia (in adulthood)
30
Q

What are the compications of substance misuse in adolescents?

A

8% of deaths in 15-19 years old due to substance misuse

10% of 15-15 year olds report problems linked with substance misuse and the age of use is decreasing (30% of this age group have regular alcohol use)

10% of substance users at 18 years are dependent

31
Q

Can substance misuse in children be treated?

A

Yes a RCT showed that motivational intervention halved frequency of:

  • alcohol bingeing at 1 year follow-up in adolescents with alcohol misuse.
  • cocaine and ecstasy use among regular teenage users.

a Psychiatry (50 decks)

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