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MRCPsych Part B > Child & Adolescent Psychiatry > Flashcards

Child & Adolescent Psychiatry Flashcards

1
Q

Who outlined the mediators of the effect of parental psychiatric disorders on a child?

A

Rutter

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2
Q

What factors can mediate the effect of parental MI on a child?

A

Direct impact of exposure
Indirect impact due to altered interpersonal behaviour and parenting capacity
Social adversity, genetic or constitutional factors

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3
Q

Prenatal affects of maternal depression on the child

A

Poor nutrtition
Higher preterm birth
Low birth weight
Pre-eclampsia

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4
Q

Effect of maternal depression on the infant

A 
Anger and protective style of coping
Withdrawal
Passivity
Reduced attention
Lower IQ
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5
Q

Effect of maternal depression on the toddler

A

Passive noncompliance
Reduced expression of autonomy
Internalising and externalising problems
Reduced social interaction

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6
Q

Effect of maternal depression on school-aged children

A

Reduced adaptive functioning
Affective, anxiety and conduct disorders
ADHD-like presentation

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7
Q

Effect of maternal depression on adolescents

A

Affective disorders, anxiety disorders, phobias
Panic disorder
Conduct disorder
Substance and alcohol misuse

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8
Q

What is the most well known epidemiological study into the effect of childhood adversities and first onset of MI?

A

Survey into 21 countries in the WHO World Mental Health Survey Initiative Kessler et al. 2010

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9
Q

What is the most common childhood adversity?

A

Parental death

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10
Q

Prevalence of parental death

A

11-15%

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11
Q

Name some other childhood adversities

A

Physical abuse
Family violence
Parental MI

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12
Q

Rate of physical abuse in childhood

A

5.3-10.8%

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13
Q

Rate of family violence in childhood

A

4.2-7.8%

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14
Q

Rate of parental MI in childhood

A

5.3-6.7%

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15
Q

Which childhood adversities increase risk of adult psychiatric disorders?

A

Maladaptive family functioning

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16
Q

What psychiatric disorders are seen in those with a hx of sexual abuse?

A 
Depression
PTSD
Conduct disorders
Somatisation
Suicidal behaviour
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17
Q

F:M ratio of childhood sexual abuse

A

4:1

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18
Q

What % of childhood sexual abusers are male?

A

90%

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19
Q

What is the average age of children who are the victims of sexual abuse?

A

9-11

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20
Q

What is the most prevalent form of child maltreatment?

A

Neglect

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21
Q

How many childhood cases reported are due to neglect?

A

60%

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22
Q

How many childhood cases are reported for physical abuse?

A

20%

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23
Q

How many childhood cases reported are due to sexual abuse?

A

10%

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24
Q

Signs of physical abuse

A

Unexplained injuries, especially if recurrent
Improbable excuses for injuries
Refusal to discuss injuries
Untreated injuries or delay in presentation
Excessive physical punishment

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25
Q

Signs of possible physical neglect

A 
Constant hunger
Poor persona hygiene
Constant tiredness
Poor state of clothing
Frequent lateness or non-attendance at school
Untreated medical problems
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26
Q

Signs of possible non-organise failure to thrive

A

Significant lack of growth
Weight and hair loss
Poor skin or muscle tone and circulatory disorders

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27
Q

Signs of possible emotional abuse

A

Low self esteem, continuous self-deprecation
Sudden speech disorder
Self-mutilation
Rocking, head-banging or other neurotic behaviour

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28
Q

Behavioural signs of possible sexual abuse

A 
Lack of trust/over-familiarity with adults
Fear of a a particular individual
Social isolation
Sleep disturbances
Running away from home
Girls taking over mothering role
Unusual interest in genitals
Expressing affection in inappropriate ways
Developmental regression
Over-sexualised behaviour
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29
Q

Physical signs of possible sexual abuse

A 
Bruises/scratches in thighs/genital area
Itch/soreness/bleeding/discharge from rectum, vagina or penis
Pain or passing urine/recurrent UTI
Recurrent vaginal infection
Venereal disease
Stained underwear
Discomfort on walking/sitting
Pregnancy - particularly when reluctance to name father
Higher morning cortisol
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30
Q

Parental risk factors for childhood physical abuse

A 
Poverty
Psychosocial stress - especially financial
Young age
Low IQ
Criminal record
poor parenting skills
Experience of abuse as a child
Psychiatric problems
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31
Q

Risk factors in children of physical abuse

A 
Prematurity
Congenital malformation
Intellectual disability
Chronic illness
Difficult temparement
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32
Q

In which families is there an increase in child abuse?

A 
Multiple children
Poor housing
Welfare reliance
Single parents
Less parental education
Underemployment
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33
Q

At what age does physical abuse commonly begin?

A

adolescence

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34
Q

Relationship between self blame and powerlessness and sexual abuse?

A

Inverse relationship in children

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35
Q

Most common relationship in childhood sexual abuse?

A

Stepfather and stepdaughter

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36
Q

Risk factors of childhood sexual abuse?

A

Alcohol abuse
Overcrowding
Increased physical proximity
Rural isolation

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37
Q

Features of ADHD

A

Excessive and impairing levels of hyperactivity, inattention and impulsivity that are evident in more than one setting and cause serious impairment.

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38
Q

Exclusion criteria for ADHD

A

Those with pervasive development disorder, schizophrenia or another psychotic disorder

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39
Q

In what age group of children is hyperactivity more noticeable?

A

Pre-school

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40
Q

Change in criteria for ADHD in DSM V

A

Onset changed from before 7 to before 12

Comorbird diagnosis with ASD is now allowed

Sx threshold for adults is now 5 sx

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41
Q

What questionnaire is commonly used for ADHD?

A

Connor’s questionnaire to obtain information from schoolteachers

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42
Q

What is ADHD called in ICD 10?

A

Hyperkinetic disorder

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43
Q

Which diagnostic classification has stricter criteria for ADHD?

A

ICD 10

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44
Q

What is needed to confirm a diagnosis of ADHD?

A

Impairment from inattention/hyperactivity-impulsivity needs to be observable in at least 2 settings and interfere with developmentally appropriate functioning socially, academically or extracurricularly activities and persist for at least 6 months

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45
Q

Prevalence of ADHD using ICD 10

A

1-2%

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46
Q

M:F ratio of ADHD?

A

3:1

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47
Q

In which group of children is ADHD more common?

A

Boys
Areas of social deprivation
Children living in institutions

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48
Q

Heritability of ADHD

A

80%

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49
Q

ADHD in siblings

A

Siblings have 2-3x increased risk

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50
Q

Concordance % of ADHD in twins?

A

79% MZ

32% DZ

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51
Q

Which genes are implicated in ADHD?

A 
5
6
11
DAT1 and dopamine D4 gene
SNAP-25 gene
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52
Q

What areas of the brain are affected in ADHD?

A

Prefrontal cortex
Striatum
Cerebellum

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53
Q

What does PET show in ADHD?

A

Lower cerebral blood flow and metabolic rates in frontal lobe areas

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54
Q

What does PET show in girls with ADHD?

A

Globally glucose metabolism than both controls and males with ADHD

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55
Q

Which neurotransmitters are involved in ADHD?

A

DA and NA dysregulation in prefrontal cortex

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56
Q

Environmental factors of ADHD

A

Prenatal and perinatal obstetric complications
Low birth weight and prematurity
Prenatal exposure to EtOH, nictine and benzos
Poor attachment and severe early deprivation
Institutional rearing

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57
Q

How many patients with ADHD have a HI?

A

25%

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58
Q

Protective factors for ADHD

A

Relationships within family and at school

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59
Q

How many children with ADHD have a comorbird disorder?

A

50-80%

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60
Q

How many children with ADHD have oppositional defiant disorder?

A

40%

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61
Q

How many children with ADHD have anxiety disorder?

A

34%

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62
Q

How many children with ADHD have conduct disorder?

A

14%

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63
Q

How many children with ADHD have tic disorder?

A

11%

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64
Q

How many children with ADHD have mood disorder?

A

6%

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65
Q

How many patients with ADHD continue to meet diagnostic criteria at age of 25?

A

15%

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66
Q

How many people with ADHD will suffer some impairment from residual sx?

A

50%

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67
Q

What are children with hyperkinetic disorder at risk of?

A

5x risk of antisocial behaviour, substance abuse and other psychiatric disorders

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68
Q

How many children with ADHD go on to develop substance misuse problems?

A

15-20%

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69
Q

Which type of ADHD go on to exhibit fewer impulsive-hyperactiver sx as they get older?

A

ADHD, combined type

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70
Q

What factors are linked with poor prognosis for ADHD?

A

Early stressful life experiences such as poverty, overcrowding, expressed emotions and parental psychopathology
Severe sx
Predominantly hyperactive-impulsive in nature
Association with conduct, language or LD

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71
Q

First line treatment of ADHD

A 
Educational interventions
Family training programme based on social learning theory and behavioural interventions
Individual/family therapy
CBT - especially behavioural
Social skills training
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72
Q

What is the biggest study looking into treatment for ADHD?

A

Multimodal treatment study of children with ADHD (MAT)

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73
Q

Describe the structure of MAT

A

RCT involving 579 children with ADHD

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74
Q

Results of MAT

A

Confirmed effectiveness of medication management in children + adolescents
Intensive behavioural therapy involving child, family & teachers added little benefit
Psychological interventions were important for families who did not wish to use medication

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75
Q

How do stimulants work in management of ADHD?

A

Release NA, dopamine and seretonin, increasing extracellular dopamine and inhibiting impulses, helping persistence in motor and cognitive functions.

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76
Q

What drugs are licensed for ADHD?

A

Methylphenidate
Atomoxetine
Alpha 2 agonists
Antipsychotics

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77
Q

Onset of Methylphenidate?

A

1-3 hours

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78
Q

Half life of Methylphenidate?

A

2-3 hours

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79
Q

Dose range of Methylphenidate

A

5-60mg/day

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80
Q

Which drug is n longer licensed for ADHD and why?

A

Pimoline

Causes liver failure

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81
Q

How does Atomoxetine work?

A

NARI

Increases noradrenaline in the synaptic cleft

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82
Q

What note did MHRA add to Atomoxetine in Dec 2012?

A

Can cause increase in BP and HR and therefore should be monitored

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83
Q

Monitoring for Methylphenidate

A

Height, weight, BP and HR initially 3 monthly, then 6 monthly

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84
Q

What does MHRA advise patients on Atomoxetine should be monitored for?

A

BP, HR
Signs of depression, suicidal thoughts and behaviour
Height & weight
3 monthly, then 6 monthly

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85
Q

Which drug has the largest and most rapid effect on ADHD?

A

Methylphenidate

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86
Q

How does Methylphenidate work?

A

Indirect sympathomimetic by increasing DA and release

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87
Q

What sx can Methylphenidate help with?

A

Comorbid aggression and oppositional defiant disorder

Hyperactivity

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88
Q

Adverse effects of Methylphenidate

A 
Weight loss
Sleep disturbance
Cramps/headaches
Mild BP and HR increase
Emotional blunting
Evening crash
Depression
Tics
Hallucinations
Mild growth slowing for 2 yearss
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89
Q

Initial dose of Methylphenidate

A

5-10mg OD

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90
Q

How is Methylphenidate dose increased

A

5-10mg per week

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91
Q

Which SE are not found with Atomoxetine?

A

Insomnia

Tics

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92
Q

Which comorbid disorder can Atomoxetine help with in ADHD?

A

Depression

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93
Q

Adverse effects of Atomoxetine

A

Weight loss
GI sx
Fatigue, dizziness
Mild growth slowing

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94
Q

Which antidepressants can be used for ADHD

A

TCAs

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95
Q

Adverse effects of TCAs

A 
Sedation
BP changes
Dizziness on standing
Dry mouth
Cardiac conduction block: need ECG monitoring
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96
Q

What sx do alpha 2 agonists treat in ADHD?

A

Hyperactivity-Impulsiveness
Tic disorders
Aggression

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97
Q

Which patients are alpha 2 agonists good for in ADHD?

A

Overaroused

Comorbid anxiety

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98
Q

Adverse effects of alpha 2 agonists for ADHD

A 
Response delayed
Sedation
Postural hypotension
Dry mouth
Hypertensive rebound if dose missed
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99
Q

When are antipsychotics helpful for ADHD?

A

If stimulants or atomoxetine does not help
Comorbird anxiety or aggression
Tic disorder
Bipolar disorder

100
Q

Adverse effects of antipsychotics

A 
Sedation
EPSEs
Endocrine effects
TD
Akathisia
Weight gain
Riskiest drug - last resort for ADHD
101
Q

What are the disorders of childhood conduct?

A

Conduct disorder

Oppositional defiant disorder

102
Q

What characterises conduct disorder?

A

Severe and persistent pattern of antisocial, aggressive or defiant behaviours that defy age-appropriate societal norms

103
Q

What is the difference between ODD and conduct disorder?

A

In ODD the behaviour does not defy age-appropriate societal norms to the extent as CD

104
Q

How are CD and ODD classified in the ICD 10?

A

ODD is a subtype of CD

105
Q

How are CD and ODD classified in DSM V?

A

DSM V excludes ODD if CD is present

106
Q

Diagnostic criteria for CD under ICD 1

A

At least one behaviour present for 6 months:
physical aggression or threats to harm people, cruelty to people or animals
Destruction of own property or others
Theft or acts of deceit
Frequent and serious violent of age-appropriate rules

107
Q

DSM V criteria for CD

A

At least 3 of 15 behaviours should begin before 13 years for a period of 12 months.

108
Q

What has DSM V added to diagnostic criteria of CD?

A

Limited prosocial emotions specifier for children who do not meet full criteria but present with limited prosocial emotions.

109
Q

In which group of children is CD increased?

A

Children of parents with antisocial PD and alcohol dependence

110
Q

Prevalence of CD in the UK

A

5-7%

111
Q

M:F ratio of CD

A

4:1

112
Q

Significant risk factors for CD according to the Ontario Child Health Survey (1987)

A

Family dysfunction
Parental MI
Low income

113
Q

Risk factors for CD according to Rutter (1978)

A 
Low socioeconomic status
Criminality of father
Overcrowding
Maternal neurosis
Institutional care
Chronic maternal discord
114
Q

Biological risk factors for CD

A

More common in families
Temperament of ‘callous-unemotional’
Brain injury
Low IQ

115
Q

Neuroimaging in CD

A

Prefrontal regions may have reduced volumes

116
Q

Neurochemical findings in CD

A

Low CSF seretonin and deficient serotonergic activity seen in those with early onset and more aggressive behaviour.
Autonomic under-arousal.

117
Q

Psychosocial risk factors of CD

A 
Maternal smoking during pregnancy
Parental criminality and substance abuse
Harsh and inconsistent parenting
Lack of warm parental relationship
Domestic violence and child abuse
Large family size
Low family income
Early loss and deprivation
School failure
Social isolation
118
Q

What does CD increase risk of in the future?

A 
Criminality and antisocial PD
Difficulties in education, work and finances
Homelessness and abuse
Drug and alcohol dependence
Poor physical health
MI and suicidal behaviour
119
Q

How many children with CD go on to have severe antisocial problems in adulthood?

A

<50%

120
Q

Protective factors of CD

A 
Female
High IQ
Resilient temperament
Good parenting
Warm relationship with key adult
Commitment to social values
Increased economic equality
121
Q

Poor prognostic factors of CD

A 
Onset <10 years
Increased aggression at earlier age
Aggression carried out in isolation rather than groups
Low IQ
Low socioeconomic status
Poor school achievement
Attentional problems and hyperactivity in childhood
Poor parenting
Family criminality
122
Q

Treatment of CD

A

Psychological therapies

Parent management training

123
Q

NICE recommendations for treatment of CD and ODD <12 years

A

Group based parent training programmes

124
Q

What does CBT for CD include?

A

Social skills training

Anger management

125
Q

Targets of CBT for CD?

A

Aggressive behaviour
Social interactions
Self-evaluation
Emotional dysregulation

126
Q

Best therapies for CD?

A

Functional family therapy

Multisystemic therapy

127
Q

Target age for functional family therapy?

A

11-18

128
Q

Structure of functional family therapy?

A

8-12 1 hour sessions in family home to overcome attendance problems

129
Q

Phases of treatment of functional family therapy

A

Engagement
Motivation
Behavioural Change
Generalisation

130
Q

Aim of functional family therapy

A

Keep family in treatment and only then move on to finding what they want
Therapist must understand parents goals first

131
Q

What does functional family therapy aim to address?

A

Family processes such as improving communication between parent and child, reducing interparental inconsistency, supervision and monitoring and rules and sanctions.

132
Q

Does functional family therapy reduce rates of reoffending?

A

Yes - by 50%

133
Q

Structure of multisystemic therapy

A

Team available 24 hours

Treatment given over 3 months

134
Q

What happens in multisystemic therapy?

A

Patient and families needs assessed in the home and in context of school
Intervention used to address difficulties and promote strengths
Regular written feedback from parents and patient

135
Q

Responsibility of therapist in multisystemic therapy

A

Ensuring appointments are kept and for making change happen

136
Q

What characterises ODD?

A

Enduring pattern of negative, hostile, disobedient and defiant behaviour w/o serious violation of societal norms or rights of others.

137
Q

Duration criteria for ODD

A

Sx must be persistent and evident for 6 months

138
Q

Sx of ODD

A

Temper outbursts
Active refusal to comply
Tendency to blame others
Spiteful behaviours

139
Q

Age of onset between ODD and CD

A

Earlier in ODD

140
Q

When does ODD tend to begin?

A

8 years of age

141
Q

Prevalence of ODD

A

2-5%

142
Q

Males vs females in diagnosis of ODD?

A

Before puberty more in boys

After puberty equal in boys and girls

143
Q

How many children with ODD show no sx in adulthood?

A

25%

144
Q

Aetiology of ODD

A

Temperamental factors - sick/traumatised child

Power struggle between child and parent

145
Q

Which psychiatric problem is an early predictor of ODD and CD in later life?

A

ADHD

146
Q

Poor prognostic factors of ODD

A

Early onset of sx
Longer duration of sx
Co-morbid anxiety, impulse control and substance misuse
Development of CD

147
Q

Primary treatment of ODD

A

Family intervention using both direct training of parents in child management skills and assessment of family interactions

148
Q

What do behaviour therapists focus on with parents of children with ODD?

A

How to alter their behaviour to discourage childs oppositional behaviour and encourage appropriate behaviour

149
Q

Prevalence of depression in pre-puberty

A

1%

150
Q

Sex difference in depression pre-puberty

A

None

151
Q

Prevalence of depression post-puberty

A

3%

152
Q

Sex difference in depression post-puberty

A

More common in females

153
Q

How many young people with depression continue to remain depressed after one year?

A

50%

154
Q

How many people with adolescent depression will have a recurrence in 5 years?

A

30%

155
Q

Why is clinical picture of depression more often seen in adolescence?

A

Cognitive changes such as formal operational thought allow hopelessness to be experienced

156
Q

When should depression in children only be diagnosed?

A

If there is impairment of social role functioning or sx lead to significant suffering or psychopathy e.g. suicidality

157
Q

Sx of depression in young children

A 
Poor feeding
Failure to thrive
Tantrums/irritability
Separation anxiety
Hyperactivity
Regressed behaviour
158
Q

Sx of depression in older children

A 
Somatisation (headache) or hypochondriacal ideas
School refusal
Poor academic achievement
Decline in school work
Sleep disturbance
Antisocial behaviour
159
Q

Sx of depression in adolescents

A 
Anhedonia
Social withdrawal
Low self-esteem
Biological sx
Suicidal acts
Behavioural problems
Substance misuse
160
Q

What is dysthymic disorder?

A

Chronic condition with fewer sx than depression but lasts a minimum on of one year

161
Q

How many children with depression have longstanding psychosocial difficulties?

A

95%

162
Q

Risk factors for depression in children

A 
FHx of depression
Early loss of parent
Parental separation
Stressful life events
Hx of abuse
163
Q

Maintaining factors of depression in children

A 
Persistence of subthreshold sx
Scarring
Personality, temperament, cognitive abilities
Persisting advesity
Comorbidity
164
Q

What is scarring?

A

First episode of depression sensitizes people to further episodes

165
Q

How many children with depression have a comorbidity?

A

50-80%

166
Q

How many children with depression also have anxiety?

A

50-80%

167
Q

How many children with depression have CD?

A

25%

168
Q

How many children with depression have OCD?

A

15%

169
Q

How many children with depression have an ED?

A

5%

170
Q

Treatment for mild depression in children

A

Watchful waiting for 4 weeks

Then supportive therapy, self help or group CBT

171
Q

Treatment for moderate to severe depression in children

A

CAMHS review

3 months of individual CBT, IPT or shorter term family therapy

172
Q

Evidence for CBT vs other therapies for childhood depression

A

CBT reduces duration of illness compared to other therapies

173
Q

NICE guidance for moderate to severe depression

A

Consider psychotherapy before medication

174
Q

When should combination treatment be considered in childhood depression?

A

In all cases of moderate to severe depression

175
Q

First line medication for childhood depression

A

Fluoxetine

176
Q

Second line medication for childhood depression

A

Sertraline

Citalopram

177
Q

Which medication has FDA and MHRA approval for childhood depression?

A

Fluoxetine only

178
Q

What needs to be monitored when using Fluoxetine in children at initiation and dose changes?

A

Agitation
Irritability
Unusual changes in behaviour
Emergence of suicidality

179
Q

Which study compared medication with therapy for childhood depression?

A

Treatment of Adolescents with Depression Study (TADS)

180
Q

Structure of TADS

A

439 children given either CBT, fluoxetine, a combination or placebo

181
Q

Results of TADS

A

CBT not superior to placebo
Combination and Fluoxetine alone were superior to both CBT and placebo
Combination showed faster recovery
Fluoxetine had more favourable outcomes for severe depression
Combined treatment superior to fluoxetine alone for remission

182
Q

ECT in children?

A

Not recommended in 5-11 year olds

183
Q

How common is suicide as cause of death in adolescents?

A

Third; following accidents and homicides

184
Q

How many adolescent deaths are due to suicide?

A

12%

185
Q

Suicidal ideation in adolescents?

A

14% in boys

25% in girls

186
Q

Most common cause of suicide in boys

A

Hanging

187
Q

Most common cause of suicide in girls

A

OD

Jumping from heights

188
Q

How many adolescents who attempt suicide repeat within a year?

A

10%

189
Q

How many adolescents who complete suicide will have made a previous attempt?

A

40%

190
Q

Incidence of completed suicide in children

A

Declining until recently

191
Q

Incidence of non fatal DSH in children

A

Rising

192
Q

Social class of those who complete suicide

A

Upper and Lower

193
Q

Social class of those who DSH

A

Lower

194
Q

Childhood of those who complete suicide

A

Death of parent

195
Q

Childhood of those who DSH

A

Broken home

196
Q

Precipitants of children who complete suicide

A

Guilt

Hopelessness

197
Q

Precipitants of DSH in children

A

Situational crises

198
Q

FHx of children who complete suicide

A

2-4 times more likely to have a first degree relative who committed suicide

199
Q

Sx of mania in children

A 
Increased energy
Distractibility
Pressured speech
Grandiosity
Racing thoughts
Euphoria
Decreased sleep
Flight of ideas
Poor judgement
200
Q

How do children with mania typically present?

A

Atypical or mixed features characterised by irritability, labile mood and behavioural problems

201
Q

Prevalence of bipolar disorder in adolesence

A

1%

202
Q

M:F of bipolar in childhood

A

M>F

203
Q

M:F of bipolar in adolescence

A

M=F

204
Q

How many adults with bipolar had onset of mood sx before the age of 20?

A

60%

205
Q

How many children with bipolar have ADHD?

A

70%

206
Q

How many children with bipolar have ODD?

A

40%

207
Q

How many children with bipolar have anxiety?

A

30%

208
Q

How many children with bipolar have substance misuse?

A

40%

209
Q

How many children with bipolar have Tourette’s?

A

8%

210
Q

How many children with Bipolar have bulimia?

A

3%

211
Q

Outcome of early onset bipolar?

A

50% show long-term decline in function

212
Q

How many adolescents wit depression go on to experience a manic episode by adulthood?

A

20%

213
Q

What features of a depressive episode in adolescence predict development of mania

A

Rapid onset of episode with psychomotor features
Depressive episode with psychosis
FHx of mania
History of mania/hypomania following antidepressant treatment

214
Q

Suicide risk of children with bipolar

A

10%

215
Q

NICE recommendation for treatment of bipolar in children

A

Same medication as for adults but at lower doses

216
Q

First line treatment for acute mania in children

A

Atypical antipsychotics: Olanzapine, Risperidone

Followed by Valproate/Lithium

217
Q

Why are higher doses of lithium needed in children?

A

Children have higher renal filtration rate and higher proportion of body water

218
Q

Which SEs of lithium are more common in children?

A

Tremors
Drowsiness
Ataxia
Confusion

219
Q

What defines childhood onset schizophrenia?

A

Onset of psychotic sx by 18 years of age

220
Q

Which children are at risk of childhood onset schizophrenia?

A

Increased heritability aetiology

221
Q

What defines very early onset schizophrenia?

A

Psychosis before 13 years of age

222
Q

Prevalence of schizophrenia in adolescence

A

1-2 per 1,000

223
Q

M:F ratio of <13

A

2:1

224
Q

What characterises childhood schizophrenia?

A

More negative sx
Disorganised behaviour
Greater disorganisation both of thought and sense of self
Fewer systematized or persecutory delusions
More chronic course

225
Q

Common features of children with childhood onset schizophrenia before development of the disorder

A

Delays in language, reading, bladder control and social functioning

226
Q

Neuropsychological deficits found in children who go on to have childhood onset schizophrenia

A

Attention
Working memory
Premorbid IQ

227
Q

Characteristics of children who develop childhood onset schizophrenia

A

Socially rejected, clingy
Limited social skills
Hx of delayed motor and verbal milestones
Poorly in school

228
Q

What type of hallucinations can present in childhood onset schizophrenia?

A

Visual

229
Q

How many children with childhood onset schizophrenia have delusions?

A

> 50%

230
Q

What do delusions in childhood onset schizophrenia increase with?

A

Age

231
Q

Which clinical sx of childhood onset schizophrenia are associated with poor premorbid function?

A

Illogical thinking
Poverty of thought
Formal thought disorder

232
Q

Heritability of schizophrenia

A

82%

233
Q

Risk of schizophrenia amongst first degree relatives with and without the disease

A

With the disease: 5-10%

Without the disease: 0.2-0.6%

234
Q

Neuroimaging findings in childhood onset schizophrenia

A

Enlarged lateral ventricles
Grey matter loss starting in parietal region and proceeding frontally to dorsolateral prefrontal cortex and temporal cortices including superior temporal gyri

235
Q

What is correlated with relapse rates in childhood onset schizophrenia?

A

High expressed emotion

236
Q

What predicts development of schizophrenia in high risk individuals?

A

Early attentional deficits
Deficits in social functioning
Deficits in organisational ability
Lower intellectual ability

237
Q

Course and outcome of childhood onset schizophrenia

A

Responds less to medication

Poor prognosis

238
Q

Predictors of course and outcome of early onset schizophrenia

A

Childs level of functioning before disease
Age of onset
IQ
Duration of episode
Duration of untreated psychosis
Presence of negative sx
Response to pharmacological interventions
How much functioning the child regained after first episode
Support available from family

239
Q

Risk of premature death in childhood onset schizophrenia

A

8.5%

240
Q

Risk of suicide or accidental death from psychotic sx in childhood onset schizophrenia?

A

5%

241
Q

Treatment of childhood onset schizophrenia

A

Same as adults

242
Q

Which side effects are more common from antipsychotics in children?

A

Metabolic
EPSEs
Acute dystonia

243
Q

What do trials show re efficacy of antipsychotics in children

A

Olanzapine and Risperidone are effective

244
Q

Which antipsychotics should be avoided in children?

A

Depot

Sedating drugs

245
Q

Psychosocial interventions for childhood onset schizophrenia?

A 
Family work
Focus on psychoeducation
Social skills
Problem solving strategies
CBT
246
Q

Typical or atypical antipsychotics in children?

A

Atypical

MRCPsych Part B (64 decks)

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