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Psychiatry > Child and adolescent psychiatry > Flashcards

Child and adolescent psychiatry Flashcards

1
Q

When do we get involved with children’s mental health?

A

1 - some kind of probably mental illness

2 - functional impairment or risk

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2
Q

What risks are we worried about in younger people?

A 
Suicide
Self harm
Alcohol abuse
Drug abuse
Abuse toward the person
Groomed
Running away
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3
Q

What function do we look at?

A

Grades

Friends

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4
Q

What is a hallucination?

A

Perception of a stimulus in absence of a stimulus

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5
Q

Does children hearing voices mean psychosis?

A

Not necessarily - imaginary friend, etc

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6
Q

What neurological conditions can cause hearing voices?

A

Complex temporal seizures

Brain tumours

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7
Q

What non neurological conditions can cause low mood and depressive symptoms?

A

Anaemia

Endocrine disorders - hypothyroid

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8
Q

What should be asked about in personal history?

A 
Ask about school they go to
Moving houses
How they get on with friends and family
Life events - death of parent, parental separation, breakups, major physical illness
Bullying
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9
Q

What should you ask about the patient’s future?

A

Ask about their goals and family’s goals
Check what their expectations of progress are
Formulate a plan

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10
Q

What are the 4 p factors?

A

Predisposing factors
Precipitating factors
Perpetuating factors
Protective factors

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11
Q

Is mental state examination past or present?

A

Present

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12
Q

What is developmental psychopathology?

A

Science underpinning psychiatry

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13
Q

How can we find genetic factors in psychopathology?

A

Twin studies, adoption studies

Calculate %of variance due to environment and % due to genetics

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14
Q

What psychiatric conditions are highly genetic?

A

Autism

ADHD

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15
Q

What factors come into play in psychiatry?

A

Environmental and genetic factors together

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16
Q

What intra-uterine/perinatal factors can contribute to psychiatric health?

A 
Maternal health - antibodies, obesity, diabetes
Substance misuse - alcohol, marijuana
Toxins - lead, mercury
Drugs - psychotropics/antiepileptics
Epigenetics - folate controlled methylation
Endorine environment
Immune environment
Premature birth
Twinning
Impressive levels of resilience
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17
Q

What are features of fetal alcohol syndrome?

A

Growth retardation - head, brain, eyes, body
Facial features
Neurodevelopmental defects - sensorimotor, cognitive, executive function, language

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18
Q

What are facial features in fetal alcohol syndrome?

A

Short palpable fissure length in orbit
Thin upper lip
Smooth philthrum

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19
Q

What is white matter connectivity?

A

Functions that require interplay between brain areas

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20
Q

What is low white matter connectivity linked to?

A

ADHD, poor concentration, distractability

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21
Q

What are outcomes of fetal alcohol syndrome?

A

Learning difficulties
Conduct disorders
Combined ADHD and ADD
Anxiety disorders

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22
Q

What are environmental factors during childhood that can affect psychiatry?

A 
Carer - child relationship
Parenting skill and parental mental disorder
Marital harmony, family function
Nutrition, poverty, deprivation
Abuse, neglect
Discipline
Day-care and schooling
Peer relationships
Life events
Physical disability
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23
Q

How does the brain respond to stress?

A

Development and function of limbic circuit and amygdala

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24
Q

What happens if children experience early adversity?

A 
The brain is trained to adapt to a hostile environment
Increases perceived aggression
Increased limbic response
Preparation of aggressive response
Aggression
25
Q

How does head injury affect behaviour?

A

Behavioural regulation is diminished

26
Q

What is executive control?

A

Taking control over automatic and learned behaviours

27
Q

What is required for executive control?

A

Self-awareness and capacity to self-monitor

28
Q

What is delay aversion?

A

An inability to wait and maintain attention in the absence of immediate reward

29
Q

What is expressed emotion?

A

Increased worry and stress from carer increase risk of relapse of conditions in child

30
Q

What is the difference between school refusal and truancy?

A

School refusal is a fear of leaving home or going to school, truancy is unwilling to go

31
Q

What mental health problems are associated with being out of school?

A 
Anxiety
Conduct disorder
Autism
Depression
OCD
32
Q

What are effects of mental health problems on school attendance and performance?

A 
Learning difficulties due to poor attention
Co-morbid or specific learning problems
Difficulty controlling emotion
Anxiety
Lack of energy
Difficulties joining in
Sensory problems
Preoccupation
Associations between mental health and learning difficulties ie dyslexia
33
Q

What are motivational factors for school attendance?

A 
Learning difficulties
Lack of friends
Bullying
Lack of parental attention or concern
Being encouraged to stay at home - maternal depression
34
Q

What physiologically causes anxiety disorders?

A

Amygdala is suppressed by right ventrolateral amygdala

35
Q

How can anxiety disorders be treated?

A 
Behavioural - learning alternative patterns of behaviour
Desensitisation
Overcoming fear
Managing feelings
SSRI
36
Q

What is feeding fear and escalation?

A

A child has a physical anxiety symptom and is allowed by parents and/or doctor to avoid the cause, the child becomes more comfortable through avoiding it and anxiety becomes worse

37
Q

What are long term effects of behavioural treatment?

A

The patient successfully overcomes a challenge, which increases self confidence, leading to increased resilience allowing the patient to challenge themself further

38
Q

What are long term effects of no behavioural treatment?

A

Challenge leads to avoidance
Avoidance leads to lower self confidence
Lower self confidence leads to vulnerability
Vulnerability leads to the challenge being worse

39
Q

How do we do CBT with children?

A

Children are less likely to have cognitive awareness
Parents are collaborators in the team
Step-wise approach
Overcome barriers to change

40
Q

How can we overcome barriers in CBT in children?

A

Psychoeducation - explain the problem so it makes sense to everyone
Goal setting - setting reasonable objectives
Motivating
Externalising - taking blame, guilt, and anger out of the equation

41
Q

How is autism spectrum disorder defined?

A

A syndrome of distinctive behavioural abnormalities

42
Q

How long does autism last?

A

Life

43
Q

Are men or women more susceptible to autism?

A

Men

44
Q

What is pathophysiology of autism?

A

Synaptic protein abnormalities

45
Q

What changes within the brain going along the autism spectrum?

A

Effects on synaptic function, neural migration, and brain development

46
Q

What are distinctive social features of autism?

A

Reciprocal conversation
Expressing emotional concern
Non-verbal communication

47
Q

What non-verbal communication features are in autism?

A

Declarative pointing
Modulated eye contact
Other gestures
Facial expression

48
Q

What repetitive behaviours are seen in autism?

A

Mannerisms and stereotypes
Obsessions
Preoccupations
Rigid and inflexible patterns of behaviour - routines, rituals

49
Q

What are 3 domains of autism?

A

Reciprocity
Language
Obsessions

50
Q

What is the difference between people lower on the autism spectrum compared to higher?

A

Can see more than one perspective
Can give something divided attention
Flexible learning
Social understanding

51
Q

What are clinical problems in autism?

A 
Learning disability 
Disturbed sleep and eating
Hyperactivity
High levels of anxiety and depression
OCD
School avoidance
Aggression
Temper tantrums
Self injury
Suicidal behaviour
52
Q

What is the main cause of autism?

A

Genetic

53
Q

What genetic disorders are co-morbid with autism?

A 
Rubella
Callosal agenesis
Down's
Fragile X
Tuberous sclerosis
54
Q

How is autism managed?

A 
Recognition and acknowledgement
Establishing needs
Appreciating can't and won't
Broken leg metaphor
Decrease demands - reduce stress and improve coping
Medication
55
Q

What are features of oppositional defiant disorder?

A 
Refusal to obey adults request
Often argues with adults
Often loses temper
Deliberately annoys people
Touchy or easily annoyed by others
Spiteful or vindictive
56
Q

What is the main difference between oppositional defiant disorder and ADHD?

A

ODD is mainly learned/ environmental, ADHD is heavily genetic

57
Q

What are outcome risks for hard to manage children?

A

Antisocial behaviour
Substance misuse
Long-term mental health problems

58
Q

How do we train parents?

A

Inform by social learning theory

Focus on positive reinforcement of desired behaviour and developing positive parent-child relationships

Psychiatry (18 decks)

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