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CAMHS Flashcards

(85 cards)

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1
Q

Which anxiety disorder will see in under 3s

A

Separation

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2
Q

Which anxiety disorder seen in 3-6 year olds

A

Phobias
Monsters

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3
Q

How does depression present in a child

A

Irritability as opposed to low mood
Somatic symptoms
Social withdrawal

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4
Q

Management of anxiety in a child

A

1st line- psychoeducation, Group CBT
Second line- fluoxetine or sertaline if OCD
Liaise with school if pertinent to presentation

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5
Q

What is SSRI for OCD in children

A

Sertaline

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6
Q

What required for diagnosis of BPAD in children in the UK

A

1 epidose of manic episode

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7
Q

What is encopresis

A

Voluntarily letting out stool into clothes

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8
Q

What are examples of behaviour disorders

A

Sleep disorder
Encopresis
Enuresis
Feeding disorder

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9
Q

Management principles of behaviour disorders

A
  1. Rule out physiological cause
  2. Behavioural therapy based around conditioning and positive behaviour rewards
    - eg if sleeping disorder look at sleep environment and hygiene, if encopresis look at using toilet after meals
  3. Last line medication like melatonin for sleep and desmopressin for enuresis
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10
Q

What is difference between school refusal and truancy

A

School refusal the parents are aware
Truancy the child skips school and the parents have no idea

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11
Q

Difference in age presentation of school refusal versus truancy

A

School refusal- 5-12
Truancy- teenagers

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12
Q

What can cause school refusal

A

Underlying mental disorder- anxiety and depression
Somatisation
Bullying

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13
Q

What is truancy related to

A

Conduct disorder

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14
Q

What can normally cause truancy

A

Academically unable
Large/disorganised families

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15
Q

What are key features of conduct disorders

A

Repetitive and persistent pattern of defiant behaviour for over 6 MONTHS
Beyond appropriate age norms

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16
Q

What are features of conduct disorder as opposed to opposional defiant disorder

A

ODD
- severe tantrums
- defiance and refusal to comply with rules

Conduct disorder
- truancy
- stealing
- physical fights

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17
Q

Behavioural management of conduct disorder and ODD

A

Identify triggers or pre-emptive factors and sort these out
Reward positive behaviour consitently and repetitively
Ignore negative behaviour and have clear boundaries with explicit consequences

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18
Q

What is triad for ADHD

A

Impulsivity
Inattention
Hyperactivity

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19
Q

Criteria for ADHD versus hyperkinetic disorder

A

ICD 10 did not formally identify ADHD as a condition instead hyperkinetic disorder
ICD-10 for hyperkinetic disorder
- symptoms over 6 months
- present under age of 6
- combination of inattention and hyperactivity present in at least 2 settings

DSM-V for ADHD
- present under 12
- for 6 months
- presence of 6 inattention symptoms and 6 hyperactivity
- NOT better explained by conduct disorder

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20
Q

Difference in ADHD in adults (17 and over) versus children (16 and under)

A

Children
- present under age of 12
- at least 6 months
- presence of 6 symptoms

Adult
- at least 6 months
- presence of 5 inattention symptoms and 5 hyperactivity

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21
Q

What is main neurological pathology behind ADHD

A

Prefrontal cortex hypoactivity

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22
Q

Imaging findings in ADHD

A

Frontal cortex atrophy
Reduced blood flow fMRI

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23
Q

Risk factors for ADHD

A

Foetal alcohol syndrome
Low birth weight
Prematurity

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24
Q

Management of ADHD

A

Refer to specialist to make diagnosis
First line is family education and training
Second line methyphenidate if symptoms still severe
Third line if does not work- lisdexamfetamine
Fourth line if does not work- dexamfetamine
Can also consider Atmoxetine
If medication unsuccessful use CBT
MLD

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25
Who is pharmacotherapy only given to in ADHD
Over 5s Those who family education does not work Functional impairment severe
26
Side effects of methylphenidate
Arrythmias Insomnia Anorexia Hypertension Tics
27
Side effects of amfetamines in ADHD
Arrythmias Insomnia Anorexia Hypertension
28
What needs to be monitored with methylphenidate and amfetamines
Baseline ECG and BP Monitor growth
29
Class of atmoxetine
SNRI
30
Side effects of atmoxetine
Suicidal thoughts Anorexia GI upset Difficulty starting work
31
Physical conditions associated with causing autsm
Frgaile X Tuberous sclerosis Downs syndrome
32
Management of autism
Psycho-education of family MDT- specialist schools, occupational therapy, SALT Behaviour management
33
What does IQ stand for
Intelligence quotient
34
Ranges for IQ
Normal - above 70 Mild- 50-69 Moderate- 35-49 Severe- 20-34 Profound is less than 20
35
Autistic features Hypotonia Microcephaly Seizures Abnormal gait
Rett syndrome
36
How does rett syndrome present
Autistic features Hypotonia Microcephaly Seizures Abnormal gait
37
Pathophysiology of RETT syndrome
X linked autosomal dominant- normally present in girls as boys die Is progressive neurological condition
38
If sleep difficulties in someone with learning difficulties what give to help sleep
Melatonin
39
Learning difficulty versus learning disability
Learning disability means would struggle to live independently
40
Management of different IQs in terms of social care
Mild- at school with supervidion All else special schools
41
What is systemic thinking when it comes to psychiatric conditions
Thinking about all of the factors which may contribute to development of the disease from an individual, family and environmental side of things- think of them in systematic way using the 4ps
42
What are 4 ps for systematic thinking
Predisposing Precipitating Perpetuating Protective
43
What is systemic versus systematic thinking
Systemic- thinking about the aetiology from an individual, family and environmental factor Systematic- thinking about these factors in a structured manner using the 4ps
44
What conditions does high criticism lead to
Depression Schizophrenia Conduct disorder
45
What anxiety disorder seen between 6-12
Performance anxiety
46
What anxiety disorder seen between 12-18
Social anxiety
47
Advice for all CAMHS patients with depression
Psychoeducation Advice on sleep, exercise etc Manage stressors- eg school
48
Mild depression management in children
Can offer 2 weeks watchful waiting or 3 months low intensity psychological therapy, digital CBT, group CBT
49
Moderate- severe depression management in children
Reviewed by CAMHS 3 months of higher intensity psychological therapy- family therapy, individual therapy, brief psychosocial intervention 2nd line- switch psychological therapy or add fluoxetine
50
When admit for CAMHS depression
High risk to self Poor home supervision Intensive assessment required
51
Prognosis of anxiety and depression in children
Anxiety- most cases will resolve by adulthood Depression- in 1 year 10% will still be depressed
52
How can mania present in children
Irritability- especially in children Impulsivity Grandiosity
53
Why is identifying psychosis hard in children
Have to differentiate from autism, learning difficulties and perceptual abnormalities There are age appropriate behaviours which could be considered as psychosis such as seeing monsters
54
Management of psychosis in an adolescent
Early inerevention psychosis delivered by CAMHS Very important as early management leads to far better outcomes in future
55
Management of substance misuse in adolescents
Refer to CAMHS Rule out underlying causes and identify triggers Motivational interview
56
Reasons for school refusal
Fears - bullying - phobia of school Somatisation
57
Management of school refusal
Treat underlying psych disorder Early graduated return to school Liaise with education welfare officer
58
Management of truancy
Effective boundary setting Supporting needs at school Liaise with education welfare officer
59
What are the habits disorders
Sleeping Eating Bowel and urinary incontinence
60
When are habit disorders seen
Pe-school
61
Management of ODD or conduct disorder
Treat underlying disorder Target risk factors Parenting programmes Mentoring
62
What underlying mental disorder most often seen in ODD
ADHD
63
What is extinction
A response to a behaviour fades over time
64
Which conditions in children have massive biological aetiology
ADHD Autism
65
What tests can you use to test prefrontal cortex in ADHD
Wisonsin card sorting Stroop - colours written out but colour of text different
66
Triad for autism
Poor social interactions - less interest in sharing/time with others - poor non verbal communication - no friends Communication difficulties - delay in language development - lack of back and forth chat Ritualistic - repeats same behaviour - likes routine
67
Co-morbid disorders seen in autism
Low IQ Phobias ADHD Epilepsy
68
How is intellectual impairment measured
Wechsler adult intelligence scale
69
What does wechsler adult intelligence scale assess
Verbal IQ- general knowledge, maths, vocab Performance IQ- visuospatial, picture
70
How is adaptive/social functioning assessed
Adaptive behaviour assessment system II (ABAS) in a clinical interview
71
How is learning diability assessed in children
Clinical interview School reports
72
Causes of severe learning disabilities
Brain damage Genetic abnormalities Hypothyroidism
73
Physical causes of learning disability
Poor diet and obese Poor eyesight and hearing
74
Management of learning disabilities
Psycho - Family therapy - CBT - creative therapies Social - skills training - community inclusion
75
How is autism diagnosed
Autism diagnostic inventory
76
How is irritability managed in autism pharmacologically
Risperidone and aripiprazole
77
How are obsessional behaviours treated pharmacologically in autism
SSRIs
78
How are stereotypical motor behaviours treated in autism
Dopamine antagonists
79
What are paediatric autoimmune psychiatric conditions associated with strep infection
Post strep infections can get OCD or tic disorder
80
How does childhood disintegrative disorder present
Initial period of normal social development then loss of skills and social withdrawal
81
What is difference between tourettes syndrome and tic disorder
Tourettes includes both vocal and motor tics Tic disorderhas only 1 of the 2
82
How long must a tic be there to be classified as tourettes
1 year
83
Management of tourettes
If mild - Self help- education about them and identifying triggers If debilitating - risperidone - exposure with response prevention
84
How does methylphenidate OD present
HTN Tachycardic High fever Restless Cant sleep
85
What do if develop tics on methylphenidate
Switch medication

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