Child & Adolescent Psychiatry

Question 1

What factors must be considered when formulating a management plan for psychiatric patients?

Answer 1

• Biological
• Psychological
• Social
• Predisposing, precipitating, maintaining and protective factors
• Risk assessment (harm to self/others)
• Consider patients:

1) Consent

2) Capacity

3) Legislation

Question 2

What are the biological factors that can influence psychiatric patients?

Answer 2

• Genetic predispositions
• Neuordevelopmental insults
• Illness

Question 3

What are the psychological factors that can influence a psychiatric patient?

Answer 3

• Temperament
• Attachment style
• Impulsivity
• Low-self esteem
• Belief systems

Question 4

What are the social factors that can affect a psychiatric patient?

Answer 4

1 - Family relationships

2 - Peer relationships

3 - Hobbies/interests

4 - School

5 - Criminality

Question 5

What is the definition of a conduct disorder?

Answer 5

Characterised by repetitive and persistent patterns of antisocial, aggressive or defiant behaviours which violate age-appropriate societal norms

Question 6

What are some of the long-term outcomes for patients with conduct disorders?

Answer 6

1 - Early, sudden death

2 - Social exclusion

3 - Poor school achievement

4 - Long-term unemployment

5 - Criminal activity

6 - Adult mental health problems

Question 7

What are some of the approaches to management of conduct disorders?

Answer 7

1 - Parent training programme

2 - Modification of school environment (behavioural support)

3 - Functional family therapy

4 - Multi-systemic therapy

Question 8

What are core features of hyperkinetic disorders, such as ADHD?

Answer 8

• Developmentally abnormal inattention
• Hyperactivity
• Impulsivity

Question 9

What are the most common co-morbid conditions that go along with ADHD?

Answer 9

1 - Learning disability

2 - Autism spectrum disorder

3 - Conduct disorders

4 - Tics

5 - Motor coordination problems

6 - Anxiety & depression

Question 10

How is ADHD managed?

Answer 10

1 - Psychoeducation

2 - Medication - stimulants, atomoxetine, guanfacine

3 - Behavioural interventions

4 - Parent training

Question 11

What are the medications used to manage ADHD?

Answer 11

Stimulants (Ritalin)

Atomoxetine

Guanfacine

Question 12

What is the brand name for methyphenidate?

Answer 12

Ritalin

Question 13

What drug is methyphenidate closely related to?

Answer 13

Amphetamine

Question 14

What are the side effects of methyphenidate?

Answer 14

Appetite loss

Weight loss

Sleep disturbance

Mild change in BP

Question 15

How does methyphenidate work?

Answer 15

• Prevents dopamine re-uptake therefore increasing circulating dopamine levels
• Prevents re-uptake of Noradrenaline therefore increasing circulating noradrenaline levels

Question 16

What is the 1st line treatment for ADHD?

Answer 16

Methylphenidate

Question 17

What is the 2nd line treatment for ADHD?

Answer 17

Atomoxetine

Question 18

What are the similarities and differences of methylphenidate and atomoxetine?

Answer 18

Simlarities - works on NAD system

Differences - Atomoxetine is non-stimulant

Question 19

Consider the following case and then list the biopsychosocial factors affecting this patient:

• 16 y.o. male
• Commited serious assault
• History of antisocial behaviour, impulsivity, poor conc. and hyperactivity
• Poor academically, father left age 4 with anger problems and has no contact
• Cousin diagnosed with AHDH
• Mum suffered with depression and smoked during pregnancy to deal with stress caused by husband

Answer 19

Biological:

• Genetic predisposition to ADHD
• Possible neurodevelopmental issues caused by antenatal stress and cigarette use
• Postnatal depression/stress

Psychological:

• Insecure attachment style with mum
• Anger at fathers rejection
• Impulsivity & low slef-esteem

Social:

• Mix of conflict and caring in relationship with mum

Question 20

What is self-harm and why do people do it?

Answer 20

Self-harm:

• A coping mechanism whereby an individual harms their physical self to deal with emotional pain or to break feelings of numbness by arousing sensation

Question 21

What are examples of self-harm?

Answer 21

Self-poisoning

Cutting

Burning

Question 22

What other problems can self-harm be an indicator for?

Answer 22

Psychiatric disorders

Psychosocial problems

Question 23

What factors increase risk of suicide?

Answer 23

• Persistent suicidal ideas
• Previous suicidal behaviour
• High lethality of method used
• High suicidal intent and motivation
• Ongoing precipitating stresses
• Mental disorder
• Poor physical health

Question 24

How is a suicidal young person managed?

Answer 24

• Safety of the young person is the priority!
• Take it seriously
• Admit to medical ward after serious attempts for medical treatment and psychosocial assessment
• Mental health & risk assessment
• Confidentiality