Child and adolescent psychiatry Flashcards Preview

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Flashcards in Child and adolescent psychiatry Deck (38):
1

Psychiatric disorders of children and adolescents are divided into what 4 broad categories?

1) Mental retardation (learning disability)
2) Developmental disorders (specific and pervasive)
3) Acquired disorders with onset usually in childhood or adolescence
4) Acquired ‘adult’ disorders with onset in childhood or adolescence

2

Define "learning disability"

This condition describes the failure to develop a normal level of cognition rather than the loss of it, such as in dementia

3

What is cognition in relation to learning disabilities measured in?

Intelligence quotient (IQ)

4

What level of cognition is said to be subaverage?

IQ

5

As well as impaired cognition what should a patient have to be diagnosed with a learning diability?

Significant impairment in adaptive functioning (communication, self care, social skills, academia etc)

6

What are the classifications of learning disability according to ICD-10?

1) Mild
2) Moderate
3) Severe
4) Profound

7

What qualifies as a mild learning disability (LD)? (also state % of all LDs)

(85%) IQ 69-50
1) usually capable of unskilled or semi-skilled manual labour
and
2) may be able to live independently

8

What qualifies as a moderate learning disability (LD)? (also state % of all LDs)

(10%) IQ 49-35
1) language, self care and comprehension are limited and usually needs supervision
2) may be able to do some practical work with supervision

9

What qualifies as a severe learning disability (LD)? (also state % of all LDs)

(3-4%) IQ 34-20
1) needs substantial care, limited motor skills and speech.
2) capable of only very basic self care

10

What qualifies as a profound learning disability (LD)? (also state % of all LDs)

(1-2%) IQ

11

What is the prevalence of LDs in the general population? (and what is the M:F)

12% (M:F 1.5:1)

12

What are the two main types of developmental disorder?

1) Specific
2) Pervasive

13

What are the three traits of autism? (when do they manifest?)

(manifest in the first 3 years of life)
1) Impairment of social interaction – poor eye contact, facial expressions, failure to share and enjoy peer relationships
2) Impairment in communication – poor spoken language, extreme difficulty initiating and sustaining conversation, lack of imaginative play
3) Restricted, stereotyped interests and behaviours – intense preoccupation with interests such as dates, phone numbers, timetables etc, inflexible adherence to routines and rituals, repetitive motor movements such as clapping and an unusual interest in parts of hard or moving objects.

14

What % of autistic pts have mental retardation?

75%

15

What % of autistic pts develop epilepsy?

20-30%

16

What is the prevalence of autism?

0.05%

17

How does autism affect the sexes differently?

1) a male to female ratio of 3-5:1
2) but females are more seriously affected

18

What is the prognosis of autism?

1) Poor
2) Only 1-2% achieve full independence
3) 20-30% of patients achieving partial independence

19

What are the good prognostic factors for autistic children?

1) IQ above 70
2) Good language development by the age of 5-7
3) The home environment is supportive with good family education and support

20

What is the difference between autism and Asperger's syndrome?

there is no abnormalities in language acquisition and ability or in cognition development and intelligence in Asperger's

21

What broad term does Asperger's fall under?

Autistic spectrum

22

Describe the course of Rett's syndrome.

Normal development at birth up to around 5 months. This is followed by a progressive and destructive encephalopathy from 6 months to 2 years of age.

23

What is the gender ratio of Rett's syndrome?

Almost only ever seen in girls.

24

What are the symptoms of Rett's syndrome?

1) loss or lack of language development
2) loss of fine motor skills
3) incontinence
4) profound muscle wasting plus rigidity

25

Describe the course and symptoms of Child disintegrative disorder (Heller’s syndrome).

1) More common in boys
2) Characterised by around two years of normal development followed by a loss of previously acquired skills (language, social, adaptive, bowel and bladder control, and motor skills) before the age of 10
3) It is also associated with autism like impairment of social interaction and repetitive stereotyped interests and mannerisms.

26

Which two categories can acquired LD's be split into?

1) Those specifically developing in childhood
2) Those that are ‘adult’ psychiatric disorders that have a childhood onset

27

What age does ADHD/ hyperkinetic disorder usually begin before?

6-7 years old

28

What is are the important criteria required to make a diagnosis of ADHD?

1) symptoms are evident in more than one situation i.e. at school and at home
AND
2) symptoms are present for at least 6 months

29

What is prevelance of ADHD in school aged children in the UK?

1%

30

What is the M:F ratio of ADHD?

6:1

31

What is the 1st line pharmacological treatment for children with ADHD? (how effective are they?

CNS stimulants such as:
1) methylphenidate (Ritalin)
2) dexamphetamine
(highly effective in ¾ of children)

32

What % of children with ADHD have symptoms persisting into adulthood?

15%

33

What ages does conduct disorder usually affect children?

Boys by the age of 10-12
Girls by 14-16

34

What psychiatric issues may children with conduct disorder go on to develop?

1) antisocial personality disorder
2) substance related problems

35

What is opposition defiant disorder?

a pattern of defiant and hostile behaviour that does not violate the law or basic rights of others

36

What are emotional disorders? (what is the prognosis like?)

1) Disorders that revolve around anxiety and depression.
2) seldom persist into adult life 3) Tend to have a good prognosis.

37

What treatment is used in emotional disorders?

The treatment of these disorders is focused on behavioural and family therapy

38

Give 4 examples of emotional disorders and their usual age of onset.

1) Separation anxiety – normal in 6 months to 2 years
2) Phobic anxiety
3) Social anxiety – normal between 8 months and 1 year
4) Sibling rivalry – normal immediately after birth

These disorders are diagnosed when the response seems exaggerated.