Child and Adolescent Psychiatry

Question 1

What are some of the biological factors that influence paediatric psychiatry?

Answer 1

Genetic predispositions
Neurodevelopmental insults
Illness

Question 2

What are some of the psychological factors that influence paediatric psychiatry?

Answer 2

Temperament
Attachment style
Psychological attributes (Impulsivity, low self esteem, perfectionism, belief systems)

Question 3

What are the social factors that influence paediatric psychiatry?

Answer 3

Family relationships 
Peer relationships 
Hobbies/interests 
Religious faith 
Neighbourhood 
School (rural/urban) 
Criminality 
Finances

Question 4

What is a conduct disorder?

Answer 4

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

Question 5

What are the possible complications of conduct disorders?

Answer 5

Increased risk of early death, often by sudden or violent means 
Increased risk of social exclusion 
Poor school achievement 
Long-term unemployment 
Criminal activity 
Adult mental health problems 
Poor interpersonal relationships

Question 6

What is the management pathway for conduct disorders?

Answer 6

Parent training programme (12 or younger)
Modification of school environment
Functional family therapy
Multi-Systemic therapy
Child interventions (social skills, problem-solving, anger management, confidence building)
Treat comorbidity
Address child protection concerns

Question 7

What are hyperkinetic disorders?

Answer 7

Characterised by core features of developmentally abnormal inattention, hyperactivity and impulsivity present across time and situation

Question 8

What are the management options for ADHD?

Answer 8

Psychoeducation 
Medication (stimulants, atomoxetine, guanfacine) 
Behavioural interventions 
Parent training 
School interventions 
Treat comorbidity

Question 9

What are the medications for ADHD?

Answer 9

Methylphenidate (1st line)

Atomoxetine (2nd line)

Question 10

What are the side effects of ADHD medication?

Answer 10

Apetite suppression
Weight loss
Sleep disrupted
BP increased

Question 11

What are the factors that increase the risk of suicide?

Answer 11

Persistent suicidal ideas
Previous suicidal behaviour
High lethality of method used
High suicidal intent and motivation
Ongoing precipitating stresses
Mental disorder
Poor physical health
Impulsivity, neuroticism, low self esteem, hopelessness
Parental psychopathology and suicidal behaviour
Physical and sexual abuse
Disconnection from support systems

Question 12

What are the management options for self harm and suicide?

Answer 12

Admit to age appropriate medical ward after serious attempt for medical treatment and psychosocial assessment
Mental health and risk assessment
Further referral to agencies as appropriate (CAMHS, child protection)

Question 13

What are the intra-uterine and perinatal factors that may influence paediatric mental health?

Answer 13

Maternal stress 
Substance misuse 
Toxins (lead, mercury, PCBs) 
Drugs (psychotropics, anti epileptics) 
Epigenetics (folate controlled methylation) 
Endocrien environment 
Immune environment 
Premature birth/ perinatal complications 
Twinning

Question 14

What are the psychosocial influences wit regards to head injury and behaviour?

Answer 14

Carer-child relationships 
Parenting skill 
Parental mental disorder 
Marital harmony 
Nutrition 
Discipline 
Schooling
Peer relationships 
Family functioning 
Abuse (physical, sexual, emotional) 
Life events (losses) 
Race

Question 15

What is reward based learning?

Answer 15

Behaviour leads to satisfying drive (friends, food, drink, sex)
Stimulates dopamine release in NA
Experience of pleasure
Conditioned association between behaviour and anticipated pleasurable response
Conditioned association between contextual cues and anticipated pleasurable response
Contextual cues leads to pleasurable response

Question 16

In what areas can the reward deficiency model be applied?

Answer 16

Obesity (food and sugar addiction)
Drugs and alcohol
Gambling
Porn

Question 17

How does the reward deficiency model of addiction work?

Answer 17

Early adversity, reduced DA function 
Decreased reward sensitivity 
Increased behaviour to elicit reward; increased reward required for satiety 
Increased tolerance 
Increased behaviour

Question 18

What are the features of hyperkinetic disorders?

Answer 18

Hyperactivity
Distractibility
Impulsivity
Present from an early age and across all settings
Strong genetic component
Aggravated by lower IQ and brain damage
Failure of development of cortico-striatal and cortico-limbic regulation

Question 19

What are the effects of hyperkinetic disorders?

Answer 19

Worse relationships with peers, teachers
Poor school performance
Increased abuse: physical, emotional, sexual
Novelty seeking, aberrent peer relationships, drug and alcohol misuse

Question 20

What mental health problems are associated with being out of school?

Answer 20

Anxiety 
Conduct disorder 
Autism 
Depression 
OCD

Question 21

What are the effects of mental health problems on education?

Answer 21

Learning difficulties due to poor attention 
Co morbid specific learning problems 
Difficulty controlling emotions 
Anxiety 
Lack of energy, motivation 
Difficulties joining in (struggle to make friends) 
Sensory problems (noise) 
Fear of germs and contamination

Question 22

What is the treatment for anxiety disorders in children?

Answer 22

SSRI

Behavioural (densensitisation, overcoming fear, managing feelings)

Question 23

What are the long term effects of successful behavioural treatment?

Answer 23

Resilience
Success
Self-confidence

Question 24

What are the long term effects of no behavioural treatment?

Answer 24

Vunerability
Low self-confidence
Avoidance

Question 25

What is autistic disorder?

Answer 25

Qualitative impairments in reciprocal social interaction Qualitative impairments in communication Restricted, repetitive and stereotyped patterns of behaviour, interests and activities

Question 26

What are the clinical features of autistic spectrum disorder?

Answer 26

Increased rigidity, sameness, fixed learning patterns and technical understanding Decreased self-other perspective taking, sharing/ divided attention, flexible learning and social understanding

Question 27

What are the qualitative impairments in reciprocal social interaction?

Answer 27

Failure to appreciate socio-emotional cues Failure to respond to other’s emotions No modulation of behaviour according to social situation Lack of facial expression and social smiling Failure to direct attention No seeking to share

Question 28

What are the qualitative impairments in communication?

Answer 28

Poor social use of language e.g. conversation inflexible of language use e.g. stereotypies and echolalia Lack of social-imitative and make believe play Reduced gesture, eye gaze and modulation of tone, rate or volume of speech

Question 29

What are the non-specific features of autistic spectrum disorder?

Answer 29

``` Learning disability – mild to severe Self-injury Aggression Temper tantrums Hyperactivity Disturbed sleep and eating habits Developmental Motor Coordination Disorder ```

Question 30

What restricted, repetitive and stereotyped patterns of behaviour, interests and activities is present in autistic spectrum disorder?

Answer 30

``` Unusual Preoccupations Circumscribed interests Verbal rituals Adherence to routines, rigid habits and resistance to change. Unusual sensory interests Motor stereotypies ```

Question 31

What co-morbid conditions are associated with autistic spectrum disorder?

Answer 31

``` Learning disability (delayed milestones, poor verbal IQ) Depression Social anxiety Obsessional-compulsive disorder Attention-Deficit-Hyperactivity-Disorder Conduct disorder ```

Question 32

When is a diagnosis of autistic spectrum disorder made?

Answer 32

Many symptoms are present Present since age 3 Symptoms are pervasive

Question 33

What are the causes of autistic spectrum disorder?

Answer 33

Mostly idiopathic genetic

Question 34

What are the key features of appositional defiant disorder?

Answer 34

``` Refusal to obey adults request Often argues with adults Often loses temper Deliberately annoys people Touchy or easily annoyed by others Spiteful or vindictive ```

Question 35

What are the management options for Hard to Manage (H2M) children?

Answer 35

Parent training programmes | Multi-Systemic therapy