CAMHS Flashcards
(58 cards)
1
Q
Factors affecting when a child may present to CAMHS
A
Age Frequency Severity Individual characteristics or temperament Impact on others Family/social circumstance
2
Q
Biological factors affecting children’s mental health
A
Temperament Genetic Neurodevelopmental Biochemical Appearance
3
Q
Developmental factors affecting children’s mental health
A
Attachment - most occurs between 18 months to 3 years
Learning
Cognitive
Emotional
4
Q
Social/environmental factors affecting children’s mental health
A
Acute stressors - abuse - domestic violence - bullying - loss of parent - relationship breakups Chronic adversity - socio-economic - parental mental illness - parental loss - family conflict - violence - parenting - abuse - exposure to community violence
5
Q
Significant influences children’s mental health
A
Parents and family - type of parenting - what constitutes good parenting - family structure School - academic success/failure - friendships - bullying Culture
6
Q
Protective factors for children
A
Temperament Coping strategies Problem-solving Self-esteem Stability Secure relationships Friendships Achievement
7
Q
Aetiology of children’s mental health problems
A
Multifactorial Cumulative effect Risk - vulnerability and predisposing factors Precipitating and perpetuating factors Inter-related
8
Q
Factors affecting consultations with children
A
Environmental - privacy - suitability - overstimulating, access to toys, age appropriate - intimidating - correct for what is being assessed Child factors - feeling safe/secure - willingness to engage - family or carers present - cognitive ability - communication/language problems - emotional development Clinician factors - setting enough time - age appropriate language - avoid patronising/condescending
9
Q
Common disorders of childhood and adolescence
A
GAD Separation anxiety disorders Phobic disorders OCD PTSD Depression
10
Q
Features of GAD in children
A
Free floating anxiety Fears of death or loss Somatic manifestations - nausea, abdo pain, sickness, headaches, sweating, palpitations, tension Panic attacks
11
Q
Features of separation anxiety
A
Anxiety that manifests upon separation from attachment figures
- somatic
- nightmares with separation themes
- school refusal
12
Q
Features of OCD in children
A
Persistently re-experiencing trauma Avoidance of associated stimuli or numbing of responsiveness Increased arousal - sleep disturbance - irritability - poor concentration
13
Q
Treatment of anxiety disorders
A
Behaviour therapy - systemic desensitisation - flooding - response prevention Psychotherapies - brief psychodynamic - family - CBT Anxiolytics - fluoxetine - SSRI
14
Q
Features of depressive disorders in children
A
Low mood which persistent but not necessarily pervasive Anhedonia/lower levels of enjoyment Biological symptoms not consistent - appetite/sleep not affected - concentration/motivation worse Can occur with anxiety symptoms
15
Q
Treatment of depressive disorders
A
CBT
Antidepressants - SSRIs
Manage underlying or comorbid problems
16
Q
Features of oppositional disorder
A
Uncooperative Unwilling to comply with requests Frequent temper tantrums Wilful, defiant may also be aggressive Tends to escalate unless managed
17
Q
Features of conduct disorders
A
Socialised
- less serious
- tends to be phasic in nature
Unsocialised
- serious
- potentially leads to criminality and antisocial personality disorder
- features lying, stealing, truanting, violence to people and animals
18
Q
Risk factors of conduct disorders
A
Lack of clear boundaries and inconsistent parenting
Rejection
Family conflict - witnessing violence and aggression
Child abuse
Child temperament
Comorbid learning or developmental difficulties
19
Q
Treatment of conduct disorders
A
Consistent care and parenting
Behavioural therapy
School-based interventions
Community interventions
20
Q
Key features of Attention Deficit Hyperactivity Disorder in children
A
Poor attention and concentration
Physical overactivity
Impulsivity
Needs to occur in more than one environment
Diagnosis after 6 years of age - but symptoms often present before
21
Q
Treatment of ADHD in children
A
Mild and moderate - consider parenting and school intervention first
Severe = medication first line
- methylphenidate - short or long acting stimulant
- lisdexamphetamine
- atomoxetine
- guanfacine
Treat co-morbidity anxiety, behavioural problems, substance use
22
Q
Key features of Autism Spectrum disorders in children
A
Socio/communication difficulties - verbal/non-verbal
Sensory processing problems difficulties
Effects on thinking - lack of flexibility, social imagination, theory of mind, generalisation
Needs to occur in more than one environment
Symptoms must be present before 3 years of age
23
Q
Treatment of autism spectrum disorders in children
A
No definitive treatment Approaches - psycho-education - stress reduction - environmental changes - treat co-morbidities
24
Q
Key features of eating disorders in children
A
Rare in pre-adolescent period Increasingly prevalence in adolescence Similar symptoms to adult presentation Delayed puberty and growth are significant issues Prognosis worse if younger or male
25
Define autism
Pervasive developmental disorder characterised by triad of
- impairment in social interaction
- impairment in communication
- restricted, stereotyped interests and behaviours
26
Aetiology of autism
```
Prenatal
- genetics - chromosome 7, fragile X syndrome, tuberous sclerosis
- parental age - over 40
- drugs - sodium valproate
- infection - rubella
Antenatal
- obstetric complications - hypoxia, small gestational age, low birth weight
Postnatal
- lead and mercury
- pesticide exposure
```
27
Risk factors for autism
```
Male
Genetics/family history
Advancing parental age
Parental psychiatric disorders
Prematurity
Maternal medicine use
```
28
Clinical features of autism
Asocial
- few social gestures
- lack of eye contact, social smile, response to name, interest in others, emotional expression
Behaviour restricted
- restricted repetitive and stereotyped behaviours - rocking and twisting
- upset to change in daily routine
- preference of same foods, clothes and games
- obsessively pursued interests
- fascination with sensory aspects of environment
Communication impaired
- distorted and delayed speech
- echolalia - repetition of words
29
Onset of autism
50% of parents have concern by 12-18 months
| Onset before age of 5
30
ICD-10 criteria for diagnosis of autism
Presence of abnormal or impaired development before the age of 3
Qualitative abnormalities in social interaction
Qualitative abnormalities in communication
Restrictive, repetitive and stereotyped patterns of behaviour, interests and activities
Clinical picture is not attributable to other varieties of pervasive developmental disorder
31
Features of Asperger's syndrome
Similar to autism with abnormalities in social interaction and restricted, stereotyped, repetitive interests and behaviours
No impairment in language, cognition or intelligence
32
Features of Rett's syndrome
Severe, progressive disorder starting in early life
Language impairment, repetitive stereotyped hand movements, loss of fine motor skills, irregular breathing and seizures
MECP2 gene
33
Features of childhood disintegrative disorder
Characterised by 2 years of normal development followed by loss of previously learned skills
34
Management of autism
Local autism teams - key workers
CBT - if verbal and cognitive ability
Interventions for life skills - daily living tasks, coping strategies
Ensure physical, mental health and behavioural issues addressed
Families and careers offered personal, social and emotional support
Consider special schooling
Melatonin for sleep disorders
35
Bio-psycho-social management of autism
```
Bio
- treat co-existing disorders
- antipsychotics of behaviour challenges
- melatonin
Psych
- psychoeducation
- full assessment
- CBT
Social
- modification of environmental factors
- social-communication intervention
- self-help groups
- special schooling
```
36
Define hyperkinetic disorder
Also known as ADHD - attention deficit hyperactivity disorder
Characterised by early onset, persistent pattern of inattention, hyperactivity and impulsivity that are more frequent and severe than in individuals at a comparable stage of development and present in more than one situation
37
Aetiology of ADHD
Genetic
Neurochemical - abnormality in dopaminergic pathways
Neurodevelopmental - abnormalities of the pre-frontal cortex
Social - association with social deprivation and family conflict as well as parental cannabis and alcohol exposure
38
Risk factors ADHD
```
Male
FH
Environmental factors
- social deprivation
- family conflict
- parental cannabis
- alcohol exposure
```
39
Core features of ADHD
Inattention
Hyperactivity
Impulsivity
40
ICD-10 criteria for ADHD
Demonstrate abnormality of attention, activity and impulsivity at home
Demonstrate abnormality of attention and activity at school or nursery
Directly observed abnormality of attention or activity
Does not meet criteria for pervasive, developmental disorder, mania, depressive or anxiety disorder
Onset before 7 years
Duration at least 6 months
IQ above 50
41
Differential diagnosis of ADHD
```
Learning disability
Dyslexia
Oppositional defiant disorder
Conduct disorder
Autism
Sleep disorders
Mood disorders
Anxiety disorder
Hearing impairment
```
42
Management of ADHD
Pre-school
- parent-training and education programmes
- reinforce positive behaviour and manage disruptive behaviour
- drug treatment not recommended
School goers
- psychoeducation and CBT and social skills training
- drug treatment first line if severe - CNS stimulant methylphenidate
43
Side effects of CNS stimulants
Headache
Insomnia
Loss of appetite
Weight loss
44
Define learning disability
State of arrested or incomplete development of the mind
- characterised by impairment of skills manifested during the developmental period, and skills that contribute to the overall level of intelligence
45
ICD-10 criteria for learning disabilities
```
Mild = IQ - 50-70
- mental age 9-12
Moderate = IQ 35-49
- mental age 6-9
Severe = IQ 20-34
- mental age 3-6
Profound = IQ < 20
- mental age < 3 years
```
46
Features of learning diability
Low intellectual performance
Onset at birth or early childhood
Wide range of functional impairment
47
Aetiology of learning diability
```
Genetic
- Down's syndrome, fragile X syndrome, Angelman
Antenatal
- congenital infection - rubella, CMV, toxoplasmosis
- nutritional deficiency
- intoxication
- endocrine disorders - hypothyroidism, hypoparathyroidism
- physical damage
Perinatal
- birth asphyxia
- intraventricular haemorrhage
- neonatal sepsis
Neonatal
- hypoglycaemia
- meningitis
- neonatal infection
Postnatal
- infection
- anoxia
- metabolic
- cerebral palsy
Environmental
- neglect/non-accidental injury
- malnutrition
- socioeconomically deprived
Psychiatric
- Autism
- Rett's syndrome
```
48
Clinical features of learning diabilities
Motor disabilities
Epilepsy
Impaired hearing / vision
Incontinence
49
Features of Down's syndrome
Trisomy 21
| Characterised by LD, dysmorphic facial features and multiple structural abnormalities
50
Physical features of Down's syndrome
```
Palpebral fissure
Round face
Occipital and nasal flattening
Brushfield spots - pigmented spots on iris
Brachycephaly
Low-set small ears
Epicanthic folds
Mouth open and protruding tongue
Stabismus (squint)
Sandal gap deformity
Single palmar crease
```
51
Medical problems associated with Down's syndrome
Heart defects - ventricular and atrial septal defects
Hearing loss
Visual disturbance - cataracts, strabismus, keratonconus
GI problems - oesophageal/duodenal atresia, Hirschsprung's, coeliac
Hypothyroidism
Haematological malignancies -
Increased incidence of Alzhimer's
52
Features of fragile X syndrome
Sex-linked disorder with developmental, physical and behavioural problems
53
Physical features of fragile X syndrome
```
Large, protruding ears
Long face
High arched palate
Flat feet
Soft skin
Lax joints
```
54
Medical problems associated with fragile X syndrome
Mitral valve prolapse
55
Features of Prader-Willi syndrome
Due to deletion of chromosome 15
Characterised by hypotonia and developmental delay as an infant and obesity, hypogonadism and behavioural problems in later years
56
Features of Cri du chat
Caused by partial deletion of chromosome 5
| Those affected have a high-pitched cry like a cat
57
Common psychiatric co-morbidities in LD
```
Alzheimer's disease
Schizophrenia
Anxiety
Hyperkinetic disorder
Eating disorders
Personality disorders
```
58
Management of learning disorders
Multidisciplinary approach - psychiatrist, speech and language therapies, specialist nurses, psychologist, occupational therapist, social worker and teachers
GP for physical health problems
Antipsychotics for challenging behaviour
Behavioural techniques - applied behavioural analysis, positive behaviour supports, CBT
Family education
Prevention - through genetic counselling and antenatal diagnosis
