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Flashcards in CAMHS Deck (15)
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1

Genetic risk ADHD

Population risk - 5% children, 2.5% adults
Siblings - 2-3x baseline risk

2

Prevalence of nocturnal eneuresis

15% of 5 year olds
7% of 7 year olds
5% of 10 year olds
2% of 15 year olds

3

CAMHS ADHD (history)

- Clarify HPC (onset, duration, location)
- Hyperactivity (sit still, climbing)
- Inattention (teacher reports, concentration at home, not finishing tasks, forgetful, losing things)
- Impulsiveness (shouting out, interrupting, risky situations)
- Comorbidities (FHx, tics, language, social development, Police, mood)

4

CAMHS ADHD (management)

- Explain diagnosis
- Clarify symptoms
- Explain medication (mechanism, side-effects, monitoring)
- Alternative treatments (environmental change, OT, parenting and teaching strategies)

5

Sibling risk of ADHD

- Twice the risk (baseline risk is 3-5%, so sibling risk is 6-10%)

6

Methylphenidate - side-effects and monitoring

- Baseline ECG, HR, BP, height and weight
- 3 monthly HR/BP, 6 monthly weight/height
- Common: appetite suppression, GI upset, insomnia, headache, tics, BP
- Severe: liver impairment, sudden cardiac death, leucopenia.

7

Conduct disorder (history)

- Clarify HPC (onset, duration)
- Behaviour towards adults (arguments, defy rules, deceitful)
- Behaviour towards others (blame others, fights, cruelty to people/animals)
- Behaviour towards property (destructive, theft, run away, other crimes)
- Risk factors (FHx - psych, forensic, substances; developmental problems; abuse)
- Comorbidity (mood, enjoyment, anxiety, sleep, appetite, ADHD, learning, drug use)

8

CAMHS ASD (history)

- Clarify HPC (onset, duration)
- Explore social interaction (eye contact, affection, friendships, imaginary play)
- Explore social communication (language development, repetitive speech, echolalia, accents, facial expression)
- Restricted/stereotyped behaviour (special interests, routines/rituals, repetitive movements, sensory sensitivity)
- Comorbidities (mood, sleep, appetite, anxiety, ADHD, epilepsy, LD)
- Risk (aggression, self-injury)
- Developmental history (pregnancy, milestones) and FHx

9

CAMHS psychosis (history)

- Clarify HPC (onset, duration)
- Delusional beliefs
- Explore auditory hallucinations (quality, content, number, 2nd/3rd person, commentary, commands, insight)
- Hallucinations in other modalities
- Thought interference and passivity phenomena
- Mood (mood, sleep, appetite, enjoyment)
- PPHx, PMHx, substance use
- Risk (self and others)

10

CAMHS psychosis (d/w consultant)

- Summarise case and formulation
- Differential diagnosis
- Management (drug screen, bloods, medication)
- Alternative treatments (education, CPN, CBT)
- Address concerns
- 35% conversion to SCZ

11

CAMHS sexual abuse (d/w consultant)

- Summarise case and formulation
- Explain need to break confidentiality
- Acute management of presenting issue
- Urgent discussion with either social work or CP cons (who will alert other core agencies and arrange full history/forensic examination etc)
- Other children at risk
- Longer term management (full investigation, counselling, accommodation)

12

CAMHS bullying and overdose (history)

- Explore current suicide attempt (chronology, final acts, intent, current feelings)
- Underlying stressors
- Explore bullying (name-calling, violence, rumours, disclosure)
- Psychiatric comorbidities (mood, enjoyment, sleep, appetite, nightmares/flashbacks, school avoidance)
- Risk (drugs, alcohol, self-harm, ongoing suicidality)

13

CAMHS enuresis (history)

- Clarify HPC (onset, duration)
- Explore enuresis (daytime dryness, bowel problems, parental response)
- Identify stressors (home, school)
- Psychiatric comorbidities (mood, enjoyment, sleep, appetite, nightmares/flashbacks, school avoidance)
- Developmental history (pregnancy/delivery, delay, potty training)
- Medical causes (UTI, PMHx, medications)

14

CAMHS selective mutism (explanation)

- Clarify likely diagnosis and DDx (anxiety, shyness)
- Identify stressors (home, school)
- Developmental history (pregnancy/delivery, delay, PMHx)
- Investigations (physical examination, ed psych Ax, SLT)
- Treatment (Behavioural therapy, SLT, family therapy, art/play therapy)
- Gain consent to share information with school

15

CAMHS self-harm (discussion with student)

- Summarise case
- Explain difference between self-harm and suicide
- Reasons for self-harm
- Explain suicide risk assessment
- Exclude underlying mental disorder (depression, PD)
- Explain management plan (consider admission, safety plan, medication, CBT)