Child and adolescent mental health Flashcards Preview

Psychiatry > Child and adolescent mental health > Flashcards

Flashcards in Child and adolescent mental health Deck (29):
1

Relative frequency of types of abuse

Neglect > physical > sexual > emotional

2

At-risk groups for abuse

14-17 yo

Learning disability/ASD/other special needs

Foster children

Babies <1yo with bruising

3

Forms of physical abuse

Induced illness (only witnessed by parent)

Bruises/fractures/ano-genital signs

 

4

Clinical presentations that should raise safeguarding concerns

Unexplained poor school attendance

Fabricated illness

Pregnancy

Poisoning

Apprent life-threatening events (esp if repeatedly)

5

Risk factors for childhood mental illness

Maternal: Separation, mental illness

Home environment: Abuse, domestic abuse, financial/parental instability

Other: Parental loss (<11), poor social network, lack of hobbies/community

6

Brain changes during adolescence

Grey matter increases in size then pruning --> high plasticity + high risk of developing addictive behaviours

Increase in senses precedes increase in executive f(x) --> more risk-taking behaviour

Empathic responding not mature until adulthood

7

Differential for low mood in childhood

  • Physical illness (e.g. post-viral depression)
  • Medication (e.g. OCP)
  • Adjustment disorder:
    • School, friendship, relationship, family issues
    • Bereavement
  • Psychiatric illness
  • Neurodevelopmental disorder (esp ASD)

8

Associations of early depressive episodes in future life

Future depressive episodes

Greater psych + medical comorbidity

Impaired social/occupational f(x)

9

Risk factors for delibarate self-harm in adolescence

Self-harm by friends/family

Low self-esteem

Drug use

Depression, anxiety, impulsivity (esp in females)

10

First-line treatment for depression/anxiety in young people

Specific psychological therapy

Family therapy

Interpersonal therapy

CBT

11

Medication use for depression in children

Limited evidence base, only fluoxetine licensed

Need frequent monitoring ?suicidal risk in first 4w

12

Considerations for anxiety presentations in YP

Acute or chronic?

Triggers?

Severity + impact on f(x)

Family response (Esp encouragement of safety behaviours)

Comorbidity - ED, depression, low mood

13

Clinical features of AN in YP

Weight loss >15% OR failure to gain weight (<5th centile)

Fear of weight gain + attempts to lose weight

Body image distortion

Low mood, poor concentration, withdrawal

Hormonal disturbance (esp amennorhoea)

14

Clinical features of conduct disorder

Persistent/repetitve violent, antisocial, and/or aggressive behaviour that violates age-appropriate societal norms

>=3 behaviours with one for >=6mo

15

Examples of behaviours seen in conduct disorder

Violence/cruelty to animals/others

Property damage

Fire-setting

Forced sexual activity

Truancy

Bullying, deceit

16

Risk factors for conduct disorder

Bio: Neurodevelopmental issues, epilepsy, brain damage, ?genetic component

Psycho: Substance misuse, learning difficulties, depression/anxiety/ASD, child maltreatment or attachment issues

Social: Parental criminality, parental psych disorder, domestic abuse, social disadvantage

17

Aetiology of anxiety in children

Bio: Hyperthyroidism, cardiomyopathy, arrhythmia, genetic predisposition

Psycho: Stressful/traumatic life experiences, insecure attachment, timidness/shyness (predisposed personality)

Social: High social adversity, critical parenting

18

Presentation of anxiety in children

Mainly somatic symptoms (somatization)

Separation difficulty

School refusal

Social withdrawal

Aggression

Sleep disturbance

Inattention, over-activity

19

Management of anxiety in children

Psychoeducation: Of parents and child

CBT: Esp family-based with younger children

Relaxation techniques

20

Comorbidity in social anxiety disorder

30-60% anxiety

20% depression

Substance abuse

21

Gender ratio for depression in children

No difference pre-pubertal

More F post-pubertal

22

Risk factors for childhood depression

Bio: Female, endocrine issues, post-pubertal

Psycho: personal/parental Hx of depression, high neuroticism trait, ruminative style of thinking

Social: Poverty, permanent change in interpersonal relationships, parental loss, bullying, isolation

23

Recovery from childhood depression

10% at 3mths

50% at 1yr

80% at 2yrs

24

Recurrence for childhood depression

30% recurrence within next 5 years

20% progress to diagnosis of bipolar

25

Presentation of childhood depression

Atypical features: Weight gain, hypersomnia, sleep disturbance but not EMW

Mood: Irritable, feeling everything is unfair, withdrawal from school

Somatization: Abdominal pain, headache, fatigue

26

Clinical features of ODD

Oppositional defiance disorder

Recurrent disobediant and defiant behaviour (hostility towards authority figures)

Generally boys <10

Arguments, provocation of others, noncompliance with rules

Not extreme aggression (c.f. CD)

27

Poor prognostic factors for ODD/CD

Male

Co-morbid ADHD

Low IQ

Parental criminality, alcoholism

Poor socioeconomic and educational status

Early onset

28

Management of ODD/CD

Psychoeducation: Child + family

Parent management training: Group-based treatments (e.g. Positive parenting programme)

Treat comorbidity: e.g. ADHD, learning difficulty

Child interventions: Anger management, social skills

Education: Liaise with school

29

Differential/comorbidity for ODD/CD

ADHD/ASD

Adjustment (should resolve by 6 mo)

Depression/anxiety

Substance misuse

LD