Block 33 Week 5 Flashcards
(281 cards)
1
Q
common law principles which may be used to provide emergency care and treatment to patients that lack capacity:
A
- necessity
- duty of care
2
Q
common law allows?
A
- allows anyone to take reasonable and proportionate action to prevent immediate significant harm to others
- applies whether or not he has capacity
3
Q
principles of common law?
A
- in an emergency, when it’s not possible to find out a patient’s wishes, you can treat them without their consent
- provided the treatment is necessary to save their life or prevent a serious deterioration of their condition
- must be the least restrictive of the patient’s future choices
4
Q
under common law, it’s acceptable to act in a patient’s best interests if:
A
- the care and treatment is urgent and there is not time to consider the use of alternative legislation (e.g. the patient is unconsious and requires immediate treatment)
- care and treatment is necessary to save their life or prevent serious deterioration
5
Q
section II?
A
- Admission for assessment
- 2 doctors need to make the recommendation
- lasts for a maximum of 28 days
6
Q
at any time during a section 2, a patient can be put on
A
a section 3
7
Q
section 3?
A
- Admission for treatment
- long term civil section
- An AMHP makes an application for admission, based on the recommendations of two medical practitioners.
8
Q
duration of a section III?
A
- The initial period for which detention is authorised is six months, but it can be renewed by the RC for a further six months, then for further periods of 12 months.
9
Q
Section IV?
A
- used when it is of urgent necessity for the patient to be admitted and detained under section 2
- It is similar to s2, but differences include that only one medical recommendation is required, and it lasts up to 72 hours
10
Q
Section V?
A
- holding powers
- A nurse of the specified class may detain certain inpatients for up to 6 hours, and a doctor may detain inpatients for up to 72 hours.
11
Q
SECTION 136?
A
- police
- allows them to take and keep a patient at a place of safety
- can do this without a warrant if:
- you appear to have amental disorder, AND
- you are in any place other than a house, flat or room where a person is living, or garden or garage that only one household has access to, AND
- you are “in need ofimmediate care or control” (meaning the police think it is necessary to keep you or others safe).
12
Q
how long can police keep a person under section 136?
A
- police can keep the patient in a place of safety for up to 24 hrs which can be extended for another 12 hours if it was not possible to assess you in that time.
13
Q
community treatment orders?
A
- CTO is an order made by yourresponsible clinicianto give you supervised treatment in the community.
- This means you can be treated in the community for your mental health problem, instead of staying in hospital.
- But your responsible clinician canreturn you to hospitaland give you immediate treatment if necessary
- comes with certain conditions like living in a certain place or going to appointments
14
Q
how long does a CTO last?
A
- last 6 months from date of order
- You can only be put on a CTO if you are in hospitalunder certain sections,and ifcertain criteria are met.
15
Q
when can a CTO be made?
A
- section 3
- section 37 hospital order
- Unrestricted transfer direction under section 47 (Notional section 37)
16
Q
Who can’t be put on a CTO:
A
- You are under sections 2, 4 or 5
- You have already been discharged from your section.
17
Q
Criteria for a CTO?
A
- You are suffering from amental disorderfor which you need to receive medical treatment.
- You need to receive this medical treatment for your health or safety, or for the protection of others.
- You can receive this treatment without needing to be detained in hospital.
- Your responsible clinician needs to be able to recall you to hospital if necessary.
- Appropriate medical treatmentis available for you in the community
18
Q
what are the human rights?
A
- right to life
- right not to be tortured or treated in a inhuman or degrading way
- right to liberty
- right to respect for private and family life. home and correspondence
- right not to be discriminated against
- Right to freedom of thought, conscience and religion
- Right to peaceful enjoyment of possessions
19
Q
right to life?
A
- If people with mental health/capacity issues have their physical health needs ignored which could risk their life
20
Q
right to be free from inhuman or degrading treatment?
A
- neglect or lack of care leading to serious harm or suffering
- a person presenting a risk of serious self-harm or harming others including staff and others using the service
- failing to provide treatment to reduce serious harm experienced by the person
21
Q
right to liberty?
A
- decisions preventing a person from leaving a place (such as a care home or hospital) and ensuring the correct processes are followed
- when a person requires constant supervision or monitoring and ensuring they have access to the relevant safeguards
22
Q
restricting the right to liberty?
A
- this right can be restricted but only in specific circumstances e.g.
- detaining a person under the MA
- depriving a person of their liberty under theMental Capacity Act either where
23
Q
the right to not be tortured?
A
- not to be treated in a way that causes intense physical or mental suffering
- This could include police violence, poor prison conditions, or neglect or abuse in a care home
24
Q
when does neuroleptic malignant syndrome occur?
A
commonly occurs due to initiation of anti-dopaminergic medication or withdrawal of dopamine agonists. S
25
which AP carry high risk of weight gain?
Olanzapine and Clozapine
26
symptoms of NMS?
fever, sweating, muscle rigidity and confusio
27
Tx of NMS?
Treatment is through stopping anti-dopaminergic medications and sometimes starting dopamine agonists such as bromocriptine.
28
benzodiazepine used to treat acute alcohol withdrawal and anxiety.?
Chlordiazepoxide
29
Risperidone causes?
hyperprolactinaemia
30
pancreatic pseudocyst vs cyst?
A pseudocyst is surrounded in granulation tissue, as opposed to a true cyst which is surrounded with epithelial tissue
31
how does a pancreatic abcess present?
systemic signs of infection such as fever, rigors, and possibly a palpable tender mass
32
which area of the bowel is most likely to be affected by ischaemic colitis?
splenic flexure
33
structural vs motility disorder of the oeseophagus?
Difficulty swallowing solids only is probably a structural disorder.
Difficulty swallowing both liquids and solids is probably a motility disorder
34
dysphagia to only solids?
Dysphagia to solids only points towards a structural disorder of the oesophagus like cancer, strictures or webs/rings.
35
dysphagia to both solids and liquids?
Dysphagia to both liquids and solids points towards an oesophageal motility disorder like achalasia, scleroderma or nutcracker's oesophagus.
36
progressive history of dysphagia?
A progressive history of dysphagia points towards cancer, with foods that were initially manageable becoming increasingly difficult to swallow over time.
37
volvulus?
- Volvulus also more commonly causes a large bowel obstruction rather than a small bowel obstruction.
- In the case of a sigmoid volvulus, the ‘coffee bean’ sign on abdominal x-ray is more characteristic.
38
surface landmark for the femoral artery?
The surface landmark for the femoral artery is midway between the ASIS (anterior superior iliac spine) and pubic symphysis. This is also known as the mid-inguinal point.
39
role of CCK?
- role in the stimulation of pancreatic enzyme secretion and gallbladder contraction,
- as well as in the regulation of gastric emptying and the induction of satiety.
40
Somatostatin is produced by?
D cells within both the pancreas and stomach.
41
role of somatostatin?
- inhibits acid, pepsin, gastrin, pancreatic enzymes, insulin, and glucagon,
- while concurrently promoting mucous production.
42
factors inc stomach acid production?
* Vagal nerve stimulation
* Gastrin release
* Histamine release (indirectly following gastrin release) from enterchromaffin like cells
43
Factors decreasing production of stomach acid:
* Somatostatin (inhibits histamine release)
* Cholecystokinin
* Secretin
44
triad of ascending cholangitis?
triad of fever, pain and jaundice, Charcot's triad.
45
Courvoisier's sign?
a palpable gallbladder in the presence of painless jaundice is unlikely to be gallstones
46
Acute mesenteric ischaemia?
- Acute mesenteric ischaemia is indicated by the sudden onset generalised abdominal pain, and is typically described in exams as 'out of proportion to examination findings'. Diarrhoea is a symptom associated with acute mesenteric ischaemia.
- AF is a strong RF
47
type of cells seen on biopsy in a gastric adenocarcinoma?
signet cells
48
Mnemonic for the Descending abdominal aorta branches from diaphragm to iliacs:
'Prostitutes Cause Sagging Swollen Red Testicles [in men] Living In Sin':
Phrenic [inferior]
Celiac
Superior mesenteric
Suprarenal [middle]
Renal
Testicular ['in men' only]
Lumbars
Inferior mesenteric
Sacral
49
drug to avoid in bowel obst?
metoclopramide
50
gold standard for diagnosing coeliac?
Endoscopic intestinal biopsy is the gold standard for diagnosis of coeliac disease and should be performed in all patients if the diagnosis is suspected following serology - IgA-ttg
51
which drug class can cause gynaecomastia?
H2 receptor antagonists such as ranitidine can cause drug-induced gynaecomastia
52
drug that can cause acute panc?
Azathioprine is a cause of acute pancreatitis
53
classic symtoms of anemia?
Headaches, shortness of breath and palpitations are classical symptoms of anaemia. The most common nutritional causes of anaemia are B12, Folate and Iron.
54
meckles diverticulum?
Meckel's diverticulum results in ectopic ileal, gastric or pancreatic mucosa
55
celiac microscopic changes seen?
- villous atrophy
- crypt hyperplasia
56
complication of celiac?
hyposplenism
57
assesment of the child with MH disorder - history of presenting concerns?
- precise nature
- onset - connection to events
- duration & exacerbating/ relieving factors
- pervasiveness (home, school, other)
- Parents’ beliefs about causation.
- Strategies used--success or otherwise.
- Effect on other family members
58
psychiatric symptoms to look for in a child MH assessment?
* Anxiety--- panic, fears, phobias
* Mood changes--sleep,appetite,self-harm.
* Obsessional traits,thoughts,rituals.
* Habit disorders---wetting,soiling.
* Oppositional/conduct problems.
* Motor activity,attention span,impulsivity.
* Psychotic symptoms.
59
personal history and development in a child?
* pregnancy and birth
* developmental milestones
* temperament and personality
* school history
60
Fhx in a child MH assessment?
* Child’s social context.
* Current family relationships.
* Extended Family relationships.
* Parents’ personal history.
* History of inherited illness.
* Specific H/O mental & developmental disorders
61
Forensic & Drug/Alcohol History in a child MH history?
* contact w police
* Experimentation/use of illicit substances e.g.: alcohol,amphetamines, ecstacy,solvents,cannabis.
62
social care history in a child MH assessment?
* reasons for entering care e.g. abuse
* voluntary or statutory
* foster parents or LA home?
63
MSE In a child?
* full MSE for older adolescents
* for children, assessment of Mental State is mostly based on observation at interview.
64
what is secure attachment?
Support mental processes that enable the child to regulate emotions, reduce fear, attune to others, have self-understanding and insight, empathy for others and appropriate moral reasoning
65
insecure attachment?
If a child cannot rely on an adult to respond to their needs in times of stress, they are unable to learn how to soothe themselves, manage their emotions and engage in reciprocal relationships.
66
when is attachment behaviour most prominent?
6 and 36 months
67
differential smiling at ? months
6 months
68
stranger anxiety at ? months
9 months
69
factors promoting attachment ?
* maternal sensitiity
* warmth
* emotional responsiveness
* involvement
* reciptocity
70
what is secure attachment (3)
◦Secure base effect, distressed on separation, greets positively on return
71
insecure attachment (4)?
◦ Difficult to settle/angry/ ignores on reunion
◦ Explores with no anxiety,
◦ Little distress on separation, ignore on reunion
◦ Fear of or for the care giver
72
insecure attachment is often associated w?
poor parenting/ abuse
73
Assessment of attachment?
* Behaviours on separation and reunion
* Patterns of comfort seeking when hurt/ upset
* Reliance on caregivers when help needed
* Affection shown to caregivers
* Exploratory behaviour in different settings
* Co-operativeness
* Controlling behaviour (seeking to control caregiver)
74
Factors presenting risk to the quality of attachment between child and parent:
* Poverty
* Parental mental health difficulties
* Exposure to neglect, domestic violence or other forms of abuse
* Alcohol/drug taking during pregnancy
* Multiple home and school placements
* Premature birth
* Abandonment
* Family bereavement
75
secure attachments constitute ?
65%
76
child's behaviour in secure attachment?
* explores room
* actively distressed if mother leabes
* positive reunion and accepts comfort eaily
* more confident and with positive self esteem
77
mother's behaviour in secure attachment?
* seen as available
* dependable and warm
* responsive to child's cues, quick
78
anxious attachment constitutes ?
10-15%
79
child's behaviour in avoidant attachment?
* not distressed by mother leaving
* avoids mother on return, focusing on environment
* has learnt to suppress behaviours normally used to alert mothers
80
mother's behaviour in avoidant attachment?
* rejecting angry hostile if child makes demands in stresful situation
81
ambivalent/ resistant attachment constitutes?
8-10%
82
what is the child's behaviour like in ambivalent/ resistant attachment?
* very distressed when mother leaves
* ambivalence on return both seeking comfort and then rejecting/ resisting on reunion
83
mother's behaviour in ambivalent attachment?
* inconsistent care giving
* unresp and insentive to childs needs and demands
84
disorganised attachment constitutes ?
15-19%
85
disorganised attachment behaviours?
* contradictory behaviours strong proximity seeking and strong avoidance
* distress, anger, freezing and stereotypes
86
mother's behaviour in disorganised attachment?
* frightened or frightening
* abusive
87
management of attachment difficulties?
* psychoeducation
* formulation of difficulties
* liason w other agencies
* systemic work w whole family
88
conduct disorders?
* > 6m duration
* Umbrella term, range of behavioural difficulties inc. CD and ODD
* At the most severe end will involve antisocial and criminal acts
89
higher rates of conduct disorders in?
adhd and autism
90
opositional defiant disorder?
younger children; defiant, disobedient, disruptive but not aggressive or antisocial behaviour
91
management of behav and conduct disorders?
* prevention
* psychoeducation
* family therapy
* parenting support via social care
* Parenting interventions have evidence for 11 and under; child-focused groups recommended for older children but often not available
92
emotional disorders?
* includes anxiety disorders
* depressive disorders
* mania
* bipolar
93
higher ates of emotional disorders in?
girls
94
anxiety disorders are more common than?
depressive disorders in the younger population
95
anxiety?
* runs in families
* trauma and adverse life events
96
Yerkes-Dodson curve
97
precipitating factors for emotional disorders?
* bullying
* school transitions
* exams
* house moves
* physical illness
* parental separation
* frienship problems
* new step parents
* domestic discord
* bereavement
98
CBT model of anxiety
99
systemic aspects/ perpetuating factors in emotional disorders?
* family members might accommodate to avoid upsetting the anxious child
* school non-attendance with avoidance could be reinforcing
* parental anxiety leading to modelled behaviour and further anxiety
100
severity of depression?
101
depression is the ? leading cause of death in 15-24 yr olds
3rd
102
depression - females outnumber males from
* same diagnostic criteria as for adults
* females outnumber males from middle adolescence
103
Mild depression Tx?
* Watchful waiting (up to 4 weeks)
* Non-directive supportive therapy/ group CBT
* guided self-help
104
moderate to severe depression Tx?
* Brief psychotherapy (~3 months) might be CBT, IPT or FT
* +/– Fluoxetine
105
depression unresponsive to treatment or recurrent?
* Multidisciplinary Team review
* Intensive psychotherapy (30 sessions)
* +/– Fluoxetine
106
complications of depression?
* drugs and alcohol
* conduct disorder
* running away
* promiscuity
* self harm
* school non attendance
* risk taking
107
prev of self harm in adolescence?
* prev of 5-15%
* peaks in adolescent years and early 20s
* higher rates in females
108
why do adolescents self harm?
109
RF for self harm?
* disputes - parents, peers, siblings
* difficulties w relationships
* school problems
* physical ill health
* prev history of abuse
* intercultural stresses
* depression
* bullying
* sexual problems
* alc and drug use
* awareness of self harm by friends/ family
110
factors associated w inc suicide risk?
* Conducted in isolation
* Timed so that intervention was unlikely
* Precautions to avoid discovery
* Preparation in anticipation of death e.g. giving things away
* Act considered for hours/days beforehand
* Suicide note
* Adolescent told others beforehand about thoughts of suicide
* Or, they did not alert others
111
strategies to keep self harming children safe?
* Strategies that help when upset/distressed.
* Talking with an understanding adult.
* Ringing a helpline.
* Going to see a GP/ CAMHS professional.
* Speak to parents or guardians about how they can help to keep that young person safe.
112
Common characteristics of adolescents who die by suicide
* Broken home (separation/ divorce/ death).
* Family psychiatric disorder or suicidal behaviour.
* Psychiatric disorder or behavioural disturbance.
* Substance misuse.
* Previous self-harm (~¼ to ½ of suicides have previously self-harmed)..
* Older male teenagers.
* Violent methods of self-harm.
113
Asperger's and autism: triad of
* abn of communication
* abn of social development
* restriction of behaviour or interests
114
NICE guidance for Aspergers and autism?
* problems in sustaining or obtaining employment or education
* difficulties in initiating or sustaining social relationships
* previous or current contact with mental health or learning disability service
* a history of a neurodevelopmental condition
* ADHD or mental disorder
115
ASD and AG - social communication
* difficulties in interpreting; emotions, gestures, literal interpretation, understanding reasons behind others actions
* Formal / stilted or pedantic language
* Poor listening skills / conversational reciprocity
116
other social communication issues w ASD
* May be over compliant
* Honest to the extent of bluntness / rudeness
* Difficulty in understanding tone of voice / facial expressions / intonation
* 2 way conversation difficult
* Can come across as argumentative / belligerent / stubborn
117
children w ASD/ AG may develop normally and then decline around the age of
2 (similar time to MMR vaccination)
118
language development in ASD?
* Delayed and deviant
* Peculiar use of words and sounds
* Repetitive – poor conversation / echolalia
119
ASD - social relationships?
* autistic aloneness - can appear aloof, indifferent
* May be unable to make warm emotional relationships with people
* May not like being touched / cuddle
* People may seem like inanimate objects
* Lacks demonstration of empathy
* Behaves inappropriately or oddly
* Poor theory of mind
120
ASD - may avoid?
* May avoid eye contact
* Difficulty sharing / interacting in groups / teams
* Naive interactions
121
ASD - imagination?
* Little imagination / creative play
* Can be creative – social imagination most affected area – predicting others intentions or behaviours / imagining outside their own routine
122
ASD - sameness?
do not like change in routine (can lead to anxiety or upset)
123
Baehaviours in ASD/ AG?
* like set rules and rituialistic behaviours
* Difficulty in anticipating the future
* Unable to foresee consequences of actions
* Obsessions / interests that dominate
* focus on minor details
* Mannerisms – purposeless repetitive movements / rocking / hand flapping / spinning (can improve balance and posture)
124
ASD/ AG - sensory difficulties?
* may be over or under sensitive to sounds/ bright lights
* diffulties navigating e.g. stairs
125
Prev of ASD/ AG?
* M >f
* 1% population
* IQ – uneven abilities – ¾ low
126
Aetiology of ASD/ AG - genetic?
* Genetic – up to10x more common in siblings
* 60x more common in twins
127
other aetiological factors in ASD/ AG?
* Organic brain disorder – increase in incidence of childbirth complications / epilepsy
* Lack theory of mind – developed by age 4
* empathy hypothesis
128
Co-morbidity w ASD/ AG?
* OCD
* Often misdiagnosed as having a psychotic disorder – (need careful assessment) esp during mood symptoms
* parkinsonian symptoms
* anxiety - managed w behavioural techniques
* depression - worse on leaving home/ going to college
* Increase in them being accused of harassment, increase in loneliness, sexual frustration, bullying
129
Assessment process for ASD?
* autism strategy 2010
* patient sees GP -> referral to secondary care or specialist service -> screen takes place and identification of co-morbid conditions
* -> Report sent back to GP with recommendation or not to seek funding from the CCG
130
What occurs during an autism assessment?
* Psychosocial
* Developmental history
* Observational assessment
* Cognitive assessment
* Associated medical conditions
* Social and educational development
* Communication
131
tests for autism?
* lAQ test (online) – AQ 10 score above six, consider full assessment. AAA (Adult Asperger Assessment = AQ AND EQ)
132
look for signs of ? and ? in autism
* Look for signs of depression and anxiety – bizarre speech content, increase in rituals, withdrawal, anger, sleep, hand flapping increasing, biological symptoms
* Often depression is not recognised – total withdrawal, refusal to go to work or college, suicidal ideation or suicide, alcoholism, aggression and paranoia.
133
Mx of autism?
* health passport
* Visual information (thought bubbles, images, worksheets)
* One instruction at a time
* Time to process information
134
Mx of autism - social skills groups?
* To include modelling, peer feedback, discussion and decision making, strategies for dealing with socially difficult situations
135
Mx of autism - activity program
* family education / teacher support / special schooling / daytime activities – structured leisure activity programme
136
Mx of autism - anger management?
* anger management programme: needs analysis for anger provoking situations
137
Mx - of autism - training?
* coping skills training
* relaxation training
* problem solving skills
138
other Tx for autism?
* Conventional drug treatments (but more susceptible to movement disorders including catatonia)
* Conventional psychological therapies
139
what is ADHD?
* neurodevelopmental disorder (impairments of the growth and development of the brain), associated with significant adulthood pathology
* Symptoms present in childhood and often persist
140
greatest RF for ADHD?
* parental history is the greatest RF
* 80% hereditability
141
Pre- and Perinatal RF for ADHD?
* Cigarette exposure
* alcohol exposure
* drug exposure
* ? caffiene
* low birth weight
* Premature delivery, foetal hypoxia / exposure to lead and zinc deficiency.
* Increase in Prada Willi / Anglemans / neurofibromatosis, fragile x / brain injury
142
other RF for ADHD?
* early psychosocial adversity - discordant family relationships
* SES
* parental IQ, ADHD, parental conduct disorder, low levels of NT dopamine and norephidrine
143
Brain structure in ADHD?
* PFC and anterior cingulate cortex - low activity
* lower brain activity during attentional tasks in the temporal and parietal regions
* and in the frontal regions during motor tasks on fMRI
144
Prev of ADHD in the UK?
* 1% to 2% in the UK
* boys> girls
145
2 things which are necessary for an ADHD diagnosis?
impaired attention and overactivity
146
impaired attention?
manifested by a lack of persistent task involve
147
overactivity?
characterised by restlessness, talkativeness, noisiness and fidgeting, particularly in situations requiring calm
148
ICD-10 - other diagnostic criteria for ADHD?
* Early onset – behavioural symptoms present prior to 6 years of age, and of long duration
* Impairment must be present in two or more settings (e.g. home, classroom, clinic)
* Diagnosis of anxiety disorders, mood affective disorders, pervasive developmental disorders and schizophrenia must be excluded.
149
Link between ASD and ADHD?
* both are neurodevelopmental disorders
* ASD can have u to 40-50% w ADHD
* commonly associated w LDs
150
effects in adulthood of ADHD?
* increased crime
* failed relationships
* 80+% have at least one co-morbid psychiatric condition - inc mH problems like antisocial behaviour, depression
* inc drug use
* link w obesity and binge eating - lack of control and reward
* driving accidents
151
Why someone might want a diagnosis for ADHD?
* family concern
* DD conduct disorder - attachment disorders
* medications
* get out of trouble w police/ excuse for behaiours
152
Structured diagnostic interview for ADHD?
DIVA
153
How someone might react to a diagnosis?
* elation
* anger - lost years
* confusion
* turmoil
* sadness
* anxiety
* stigma
* grief
154
Benefits of ADHD Tx?
* reduction in traffic accidents - 50% avoidable w treatment
* reduction in overall number of visits to doctor
* Reduced social adversity, improved relationships
* Reduction of drug / alcohol misuse / criminality
155
first line in ADHD Tx?
methylphenidate - dopamine releasing agent
156
what can be used if methylphenidate doesn't work for ADHD?
atomoxetine or dexamphetamine
157
atomoxetine?
24 hr effect / social anxiety / potential for drug misue– non stimulant
158
dexamphetamine?
(dopamine and noradrenaline releasing) – more effective
159
ADHD - residual impairment after meds?
* CBT if residual impairment or no resp to meds
160
what needs to be monitored on ADHD medications?
* Monitor physical health, heart rate, BP, weight, examine cardiovascular system
161
what needs to be monitored especially in the first 6 weeks after ADHD meds are started?
OP monitoring of agitation, depression, suicidal thinking, self harming
162
Management of ADHD in children?
* Tx - medication w behavioural interventions
* psychological: CBT, behavioural work, family therapy, education
* social skills training
* school interventions and teacher support
163
Pre-treatment screening for ADHD?
* Heart rate, blood pressure and examination of the cardiovascular system
* Weight
* ECG if there is a PMx or FHx of cardiac disease, a history of sudden death in young family members, or abnormal physical cardiovascular findings, undue breathlessness, exercise syncope
164
red flags in self harm?
- Current suicidal thoughts
* Previous suicide attempts
* Detailed plans of how to carry out self harm
* Suicide note
* Depression, anxiety, psychosis and other mental illness
* Feeling of hopelessness
* Poor social support
* Family history of self-harm or suicide
* Child in care
165
examination components in a self harming teen?
* assess for confusion
* assume capacity unless evidence to the contrary
* mental state - severe distress?
* Jaundice. Jaundice may indicate liver failure due to recent paracetamol overdose.
166
examination in a self harming ppt - pulse?
Tachycardia may indicate anxiety or impending shock in medication overdose.
167
examination in a self harming ppt - RR?
May be reduced in opioid overdose and raised in overdose of central stimulants
168
Examination in a self harming ppt - pupils?
miosis may indicate opiod overdose
169
normal social and emotional development?
* develop frienships and attachments to preferred adults
* learn how to express emotions verbally
* individualisation/ separation
170
CAHMS?
* service for young people up to 18yrs
* works w families and young people
171
CAHMS liases w other agencies like?
social services, education, voluntary sector, health
172
referral process to CAHMS?
* SPA - single point of access - call from GP or self referral
* triage system
* then referred to main CAHMS
173
Tier 1 in CAHMS?
primary care, early intervention: GP, HV
174
Tier 2 at CAHMS?
individual CAMHS therapists at LTs
175
Tier 3 at CAHMS?
specialist teams, community teams
176
Tier 4 at CAHMS?
tertiary services, inpatient service, dead service
177
What are some tier 3 teams?
* eating disorder teams
* family therapy
* ASD and ADHD
* CAHMS crisis team
* psychosis pathway w the EIT
178
CAHMS crisis team?
* works at hospital 24/7
* assesses young people who self harm who are admitted to hospital
* complete risk assessment and follow up intevention
* team meet to discuss cases, interventions but also offers home based treatment
179
MDT at CAHMS?
* MDT assessment, diagnpsis, risk assessment, formulatiom, treatment planning
180
benefits of MDT working?
* skill mix - EBD treatment
* shared responsibility and knowledge
* sharing of skills
* range of interpersonal approaches
* supervision and support
181
assessing young ppl in CAHMS?
* assess in prescence of parent/ carer
* includes time w young person alone as well as w family
182
Developmental history to take in young ppl?
* early life, pregnancy, physical, emotional and language development
* life stresses
* academic, social, peer relationships
* education and exam results
* imp family events
* illnesses
* forensics
* friendships
183
core features of ADHD?
* onset before age 7 with symptoms for > 6 months, but may be diagnosed much later
* hyperactivity
* impulsivity
* inattention
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ADHD - signs must have persisted for?
at least 6 months to a degree that is maladaptive and inconsisent with the developmental level of the child
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inattention ICD criteria
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overactivity ICD criteria
187
Impulsivity ICD criteria?
188
Conduct disorder and hyperactivity
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CAHMS ADHD assessment ?
* history - parent and child
* observation - school and clinic
* school liason - info on symptoms, academic ability, behaviour, peer relations
* rating scales (Connors)
* assess for co-morbidity - ODD, conduct disorders, anxiety, OCD
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onset of action of methylphenidate vs atomoxetine?
* methylphenidate - controlled stimulant drug - 4 hrs
* Atomoxetine - non stimulant drug, delayed onset of action (6-8 weeks)
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common side effects of ADHD meds?
* most common - appetite reduction
* nausea
* sleep disturbance
* headache
* increased anxiety
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less common ADHD meds side effects
* tics
* lower seizure threshold
* psychosis
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ADHD - advice for young person?
* advice on strategies - sleep, organisational skills, anger management
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ADHD - parents?
parent management advice e.g. Webster Stratton Parenting
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ADHD - school liason?
classroom strategies to limit impact of symptoms and support for any LDs
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prognosis of ADHD?
* about 50% continue to have difficulties in adulthood
* poor STM
* self medication - nicotine/ alcohol
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Epidemiology of Autism?
* affects 1 in 100
* males more commonly affected
* must be present before 72 months
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3 areas of autism?
communnication, social interaction, restricted interests and rituals
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communication?
* only 50% develop functional speech
* diffs holding convo
* abn tone, rate and rhythm
* literal understanding of lanuage
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autism: social interaction?
* poor gaze and gesture
* difficult peer relationships
* rarely seek physical contact
* behaviour not modulated by context
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theory of mind?
* if you have theory of mind you're able to work out what's going on in the mind of the person you're talking to
* mindblindess
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how mindblindness can show in the behaviour of children with ASD?
203
Restricted interest and rituals ?
* preoccupied w a specific field
* fixation/ attachments w objects
* rituals and routines
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psychosocial management of autism?
* family support and education
* info
* behavioural methods
* counselling
* practical help
* respite
* speech therapy
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6 weeks - gross motor milestones?
* good head control - raises head when on tummy
* stabilises head when raised to sitting position
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6 weeks - fine motor/ vision?
* tracks objects/ face
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6 weeks - speech/ language?
* stills, startles at loud noise
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6 weeks - social?
* social smile
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6 months - gross motor?
* sit without support, rounded back
* rolls tummy (prone) to back (surprise)
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6 months - fine motor/ vision?
* palmar grasp
* transfer hand to hand
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6 months - language/ speech?
* turns head to loud sounds
* understands bye
* babbles (monosyllabic)
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6 months - social?
* puts objects to mouth (stops at 1 yr)
* reaches for bottle/ breast
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3 months - gross motor?
head control
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3 months - fine motor?
reaches for objects, fixes and follows
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3 months - hearing and lanuage?
cries, laughs, vocalises (4 months)
216
social at 3 months?
laughing
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gross motor @ 9 months?
- sits alone
- crawls
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9 months - fine motor and vision?
pincer grip - 9 to 12 months
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9 months - language?
inappropriate sounds
220
9 months - social?
stranger anxiety
221
12 months - gross motor?
stands alone
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12 months - fine motor?
pincer grip
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12 months - speech?
- babbles, understands simple commands
* says Mamma/ Dadda
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12 months - social?
* social: socially responsive
* wave bye
225
18 months - gross motor?
walks alone
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18 months - fine motor?
uses spoon
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18 months - language?
uses words
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18 months - social?
stranger shyness, tantrums
229
2 years - GM?
* runs
* stairs (2 feet per step)
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2 years - fine motor?
circ scribbles and lines
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2 years - language?
2 word phrases
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2 years - social?
knows identity, parallel play
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3-4 yrs: gross motor?
* stand on one foot
* stairs (1 foot per step at 3)
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3-4 yrs - fine motor?
builds bridge w bricks
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3-4 yrs - hearing and language?
short sentences, knows colours
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3-4 yrs: social?
interactive play
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5 yrs: GM?
skips/ hops
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5 yrs: fine motor?
full drawings
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5 yrs: hearing and language?
fluent speech
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5 yrs: social?
dresses self
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how do children learn?
* children learn by observing, family members and caregivers are also the main influencers that determine how a child will socialize and learn—contributing to their overall physical, social and intellectual development.
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psychosocial wellbeing?
* Psychosocial well-being refers to a child’s emotional, social, and psychological state, including their ability to regulate emotions, develop healthy relationships, and adapt to different environments.
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cognitive development?
refers to a child's intellectual growth, their ability to think, reason and solve proble
244
family environment?
* family environment: Parenting styles, family dynamics, and the presence of support systems all influence a child’s upbringing.
245
nurting and supportive family provides child w?
* A nurturing and supportive family environment provides children with the security and stability they need to explore and develop their psychological skills and abilities.
246
what contributes to a child's wellbeing?
* Positive family dynamics, open communication, and access to support systems, whether through extended family or community resources, contribute to a child’s overall psychological well-being and development
* a positive famuly dynamic creates a safe space -> these relationships offer a sense of belonging, emotional stability
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what can constant conflicts cause in a child?
* conflicts, neglect, or unstable family dynamics can have adverse effects. Constant conflict or neglect can lead to developmental delays, emotional challenges such as anxiety and depression, and even behavioral issues.
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other factors which can influence a child's development?
* Many factors, such as low birth weight, child temperament, a recent move or their family being under stress, can affect a child’s development
* children's MH is affected by their development
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what do CAHMS offer - therapy?
* Talking therapies - 1 on 1
* group therapy
* family therapy
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what do CAHMS offer - other?
* creative therapy - using arts to explore feelings with a creative therapist
* medication - advising on drugs and prescribing them
* inpatient hospital care
* physical checks and medical reviews
* crisis support
251
CBT in cahms?
* helps them overcome negative thoughts, unhelpful behaviours, difficult emotions
* low self esteem, depression, anxiety, OCD, PTSD
252
Family therapy in CAHMS?
* helps families work together to improve relationships and support each other in finding solutions to problems resulting from mental health difficulties
253
support and services available to carers of children with autism spectrum disorders?
* physical help - such as assistance in the home, help with gardening, help with laundry
* other forms of support - such as trips/holidays, travel assistance, training, or short breaks (see below for more information about short breaks).
* a direct payment so you can purchase agreed services or items yourself
254
Short breaks for carers?
* respite
* break from caring responsibilities
* home-based respite care – eg a sitting service for a few hours a week or a personal assistant to stay overnight
255
family based short term respite care?
this is where a disabled person is linked with a family who they then go to stay with on a regular basis
256
other types of short breaks?
* after school clubs
* centre-based short term residential care
257
early bird for autism?
* for parents whose child has received a diagnosis of autism and is aged under 5
* The programme aims to support parents in the period between diagnosis and school placement, empowering and helping them facilitate their child's social communication and behaviour in their natural environment.
* It also helps parents to establish good practice in supporting their child at an early age.
258
early bird helps parents...
understand autism and develop ways of interaction and communication
259
early bird - parents will have weekly?
commitment of a two-and-a-half hour training session or home visit, and to ongoing work with their child at home.
260
early bird plus?
* 4-9
* The programme aims to promote a consistent approach across setting e.g. home and school, by encouraging parents/carers to attend the sessions with a professional who is working regularly with their child.
* aims to build parents confidence to problem solve
261
teen life?
* 6 session programme
* aged 10-16
262
the teen life programme?
* The Teen Life programme aims to empower parents and supporting professionals to understand more about how autism is experienced by autistic teenagers.
* Topics covered include understanding autism in teenagers, women and girls, self-esteem, spending time with other people, stress and anxiety, behaviour, puberty, independence skills, education strategies and planning for the future.
263
what does teen life aim to do?
* aims to bring parents together to share info, experiences and ideas in a structured way
* emphasises importance of autistic perspectives
264
national charities?
* national autistic society
* ambitious about autism
265
local support groups for autism?
* search using the national autistic society services directory
266
social media and forums for autism?
* online groups - e.g. national autistic society facebook group
* groups ran by autism charities
* forums - national autistic society community
267
local offer?
* people under 25 can ask their local council about their local offer - support they provide for young people with special educational needs.
* every council has one
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role of schools in MH?
* mental health support teams
* teaching about MH in school
* identifying mental ill health and providing targeted interventions
* prevention - positive school culture
* addressing social deprivation will address one of the root causes of mental illness
269
role of health visitors in MH?
* offer preventative health promotion
* referral to specialist MH services
* trained to support family relationships
* recognition of early cues and reduction in post natal depression
* specialist health visitors in perinatal and infant mental health
270
role of social services in MH?
* many social workers have therapeutic training and offer individuals or group therapy to children, young people and their families.
* risk management, community in-reach, safeguarding knowledge
* can refer a child to CAHMS
271
Role of educational psychologists?
* concerned w children's learning and development , support schools and the LA to improve the child's exp of learning
* They use their specialist skills in psychological and educational assessment techniques to help those having difficulties in learning, behaviour or social adjustment
272
what do EPs help to do?
* they help to understand the child's strengths and weaknesses and the quality of their learning envir
* encouraging equal access and opportunities to the curriculum for all children
* offering intervention strategies for individuals and organisational situations, for example in schools, classrooms
273
signs of physical abuse?
* bruises - particularly indicative of abuse if observed in infants and immobile children
* broken/ fractured bones
* burns/ scalds
* bite marks
* The effects of poisoning (e.g. vomiting, drowsiness, seizures)
* Breathing problems from drowning, suffocation, or poisoning
* head injuries
* Seeming frightened of parents, reluctant to return home after school
* Displays frozen watchfulness
* Constantly asking in words/actions what will happen next
* Shrinks away at the approach of adults
274
signs of online sexual abuse?
* seem distant, upset or angry after using the internet or texting
* spending a lot more/ lot les time online than usual
* be secretive over who they're talking to
275
signs of physical sexual abuse?
* bruises
* bleeding, discharge, pains or soreness in their genital or anal area.
* STIs
* pain/ sore throat
* Pregnancy.
* Difficulty in walking/sitting that are not usual for the child.
276
signs of emotional abuse?
* seem unconfident or lack self-assurance
* struggle to control their emotions
* have difficulty making or maintaining relationships
* act in a way that's inappropriate for their age
* extreme outbutsts
* seem isolated from their parents
* lack social skills
* few friends
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if a child is in immediate danger?
refer to children's social care/police
278
mneumonic for milestones
head, shoulders, knees and toes 3 6 9 12.
3 months - control of head
6 months - sitting up
9 months - crawling
12 months - walking
279
foods that can not be taken with MAOI?
When tyramine containing foods (e.g. cheese) are taken alongside monoamine oxidase inhibitors a hypertensive crisis can occur
280
First line for acute stress disorders?
Trauma-focused cognitive-behavioural therapy (CBT) should be used first-line for acute stress disorders
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