Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Mental Health > Child Psychiatry > Flashcards

Child Psychiatry Flashcards

(85 cards)

Start Studying
1
Q

What is autism?

A

A pervasive developmental disorder
Characterised by a triad of impairment in social interaction, impairment in communication, and restricted, stereotype interests and behaviours.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the prenatal aetiology of autism?

A

Genetics e.g. chromosome 7
Older parental age
Drugs e.g. sodium valproate
Prenatal viral infections e.g. rubella

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the antenatal aetiology of autism?

A

Obstetric complications e.g. hypoxia during childbirth
Decrease GA at birth
Low birthweight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the postnatal aetiology of autism?

A

Toxins such as lead and mercury
Pesticide exposure

No proven link between the MMR vaccine and autism!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the risk factors for autism?

A 
Male 4x more likely to be affected
Genetics/family history
Advanced parental age
Parental psychiatric disorders e.g. schizophrenia
Prematurity - before 35 weeks
Maternal medication e.g. SV
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the features of autism?

A

ABC
Asocial - few social gestures, lack of eye contact, social smile, response to name, interest in others.

Behaviour restricted - rocking, twisting, upset at any change of daily routine, same foods, play same games, fascination with sensory aspects

Communication impaired - distorted or delayed speech, echolalia - repetition of words

Onset of autism before age of 3 years. Atypical autism after 3.

intellectual disability can occur, temper tantrums, impulsivity, cognitive impairment.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What other conditions are associated with autism?

A 
Epileptic seizures - 20%
Visual impairment
Hearing impairment
Infections
Pica - eating inedible objects
Constipation
Sleep disorders
Underlying medical conditions e.g. PKU, fragile X, CMV, congenital rubella
Psychiatric disorders - depression, bipolar, psychosis, OCD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What questions can be asked in a history of autism?

A

Child ever engage in pretend play alone or with others

Does the child struggle to interact or make friends

Have you noticed them making any abnormal movements e.g. flapping hands, walking on tiptoes

Do they struggle to communicate, is speech monotonous or repetitive

Do you have any concerns about your child’s development

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the ICD10 criteria for the diagnosis of autism?

A

A. Presence of abnormal or impaired development before the age of 3

B. Qualitative abnormalities in social interaction

C. Qualitative abnormalities in communication

D. Restrictive, repetitive and stereotyped patterns of behaviour, interests and activities.

E. The clinical picture is not attributable to other varieties of pervasive development disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is seen on MSE in autism?

A

Appearance and Behaviour
Ritualised, clapping, rocking, poor eye contact, lack of facial expression

Speech
Delayed, difficulty initiating and maintaining conversation, repetitive language, unusual rate, rhythm and tone

Mood
Normal or erratic mood changes

Thought
Obsessions and compulsions
Intense preoccupation with special interests

Perception
Sensitive to noise, touch, smell

Cognition
Impaired attention
May concentrate on special interests

Insight
May be poor
May be distressed if aware the don’t fit in

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the investigations for autism?

A 
Full developmental history
FH, pregnancy, birth, PMH
Developmental milestones
Daily living skills
Assessment of communication, interaction and behaviour

Hearing tests if required
Screening tools inc CHAT Checklist for Autism in Toddlers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the differentials for autism?

A 
Asperger's
Rett's
Childhood disintegrative disorder
Learning disability
Deafness
Childhood schizophrenia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is Asperger’s?

A

Similar to autism
Abnormalities in social interaction
Restricted stereotyped repetitive interests and behaviours
No impairment in language, cognition or intelligence
IQ normal
More prevalent in boys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is Rett’s syndrome?

A 
Severe progressive disorder
Starts early in life
Results in language impairment, repetitive stereotyped hand movements, loss of fine motor skills
irregular breathing and seizures
Almost exclusively seen in girls
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is Heller’s syndrome?

A

Childhood disintegrative disorder
Two years of normal development followed by loss of previously learned skills
Associated with repetitive, stereotyped interests and behaviours
Cognitive deterioration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the general management of autism?

A

Diagnosis be specialist
Local autism MDT teams and a key worker to manage
Speech and language, OT, educational psychologists
CBT
Interventions for life skills to support daily living, coping strategies, enable access to education and community facilities e.g. for sport
Address needs of physical, mental health and behaviour
Families offered support
Special schools
Melatonin for sleep disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the interventions for the core features of autism?

A

Social-communication intervention - play based strategies.

Do not use pharmacological agents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the interventions for challenging behaviour in autism?

A

Treat co-existing physical disorders e.g. epilepsy, constipation, mental health problems, behavioural problems

Modification of environmental factors e.g. lighting, noise, social circumstances

Antipsychotics e.g. risperidone considered when psychosocial interventions insufficient or features are severe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the bio-psychosocial management of autism?

A

Biological
Treat co-existing disorders
Antipsychotics for behaviour
Melatonin

Psychological
Psychoeducation for families
Assessment of behaviour etc
CBT

Social
Modification of environmental factors
Social-communication intervention
Self-help groups
Special schooling
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is ADHD characterised by?

A

Inattention, Hyperactivity and Impulsivity
+
Early onset, persistent, present in >1 situation
+
More frequent and severe than comparable individuals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How common is ADHD?

A

2.4% prevalence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What can cause ADHD?

A

Genetic - DRD4/5 gene
Neurochemical - dopaminergic pathway changes
Neurodevelopmental - pre-frontal cortex abnormalities
Social - Drug/alcohol in parents, social deprivation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How is ADHD diagnosed?

A

Assessment by CAMHS to observe child, talk to parents and teachers and looking at school reports

DIVA test is used to judge symptoms

To be diagnosed, symptoms must interfere with performance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What inattentive signs are typical of ADHD?

A 
Distracted so doesnt finish tasks
Avoid tasks that req. concentration for a long time
Doesnt listen
Lose and forget belongings
Trouble organising tasks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What hyperactivity/impulsive signs are typical of ADHD?
``` Fidget and restless Doesn't engage in quiet activities Temper tantrums and aggression Doesnt wait their turn Talk lots, interrupt others, blurt out answers at school ```
26
What is hyperkinetic disorder?
ADHD Attention deficit hyperactivity disorder Early onset, persistent pattern of inattention, hyperactivity and impulsivity.
27
What is the aetiology of ADHD?
Genetic predisposition Neurochemical - reports of link between hyperkinetic disorder and genes coding for dopaminergic pathways Neurodevelopment abnormalities in the pre-frontal cortex Social deprivation, family conflict, parental cannabis and alcohol exposure
28
What are the risk factors for hyperkinetic disorder?
Male - 3x more likely Family history Environmental risk factors such as social deprivation, cannabis and alcohol
29
What are the three core features of hyperkinetic disorder?
Inattention - not listening, distractable, reluctant to engage, forgetting or regularly losing belongings Hyperactivity - restless, reckless, running and jumping around inappropriate places, cannot engage in quiet activities, excessive talking Impulsivity - difficulty waiting turn, interrupting others, blurt out answers, disobedient, temper tantrums
30
What is the ICD-10 criteria for hyperkinetic disorder?
Abnormality of attention, activity and impulsivity at home. Also at school or nursery Directly observed abnormality of attention or activity Does not meet criteria for a pervasive developmental disorder, mania, depressive or anxiety disorder. Onset before 7 Duration >6 months IQ above 50
31
What can be asked in the history of hyperkinetic disorder?
Inattention - reluctant to engage, leaves activities unfinished, loses stuff, does not listen when spoken to Hyperactivity - constantly fidgeting, jumping, running, cannot sit still Impulsivity - cannot wait turn, blurts out answers
32
What is important in an assessment of hyperkinetic disorder?
Observe child - overawed by clinical context, may interrupt parents Speak to child - do they make eye contact, offer them a toy are they easily distracted Speak to parents
33
What is observed on an MSE in hyperkinetic disorder?
Appearance and Behaviour - fidgety, unable to sit still, running, jumping, climbing Speech - loud, at inappropriate times, makes inexcessive noise Mood - normal, may be low if co-morbid depressive disorder No disorders or hallucinations Poor attention levels, lac of concentration Poor insight
34
What are the investigations for hyperkinetic disorder?
Blood tests including TFTs to rule out thyroid disease Hearing tests - examine middle and inner ear Rating scales
35
What are the differentials for hyperkinetic disorder?
``` Learning disabiltiy, dyslexia Oppositional defiant disorder Conduct disorder Autism Sleep disorders Mood disorders Anxiety disorder Hearing impairment ```
36
What is conduct disorder?
A repetitive and severe pattern of antisocial behaviour including aggression, destruction of property, deceitfulness and major violations of age-appropriate expectations.
37
What are the risk factors for conduct disorder?
Male Abuse as a child Poor SE status Parental psychiatric disorders
38
What is oppositional defiant disorder?
Defiant and disruptive behaviour against authoritative figures, but less severe than conduct disorder. Violations of law and physical abuse is less common.
39
When should those presenting with ADHD symptoms be referred?
If problems are having adverse impact on development; Watchful waiting up to 10 weeks Referral to group based focused support and don't wait for formal diagnosis If persist, specialist referral In adults should refer if evidence began in childhood, persisted throughout life, not explained by other psychiatric diagnoses
40
What are the general principles of management of ADHD?
Written information about self help, support groups e.g. Mind, AADDUK Discussion from professional - positives of diagnosis, effects, education, effect on driving, goals, treatment plan and pregerence Parent-training and education programmes, in school goers - psychoeducation and CBT
41
What pharmacological management can be offered for ADHD?
Not recommended for pre-school, in school age is reserved if persisting significant impairment Methylphenidate (Ritalin) offered first line, or lisdexamfetamine, dexamfetamine. CNS stimulants contribute to impulse control
42
What is a learning disability?
State of arrested or incomplete development of the mind. | Characterised by impairment of skills manifested during the developmental period.
43
What triad must exist to constitute a learning disability?
Low intellectual performance, IQ below 70 Onset at birth or during early childhood Wide range of functional impairment including social handicap due to reduced ability to acquire adaptive skills
44
What can some of the causes of a learning distability be due to?
Genetic - Down's, fragile X, prader-willi, hydrocephaly Antenatal - CMV, infection, nutritional deficiency, physical damage, pre-eclampsia Perinatal - birth asphyxia, intraventricular haemorrhage, neonatal sepsis Environmental - malnutrition, non accidental injury, neglect Psychiatric - autism, Rett's
45
What are the clinical features of a mild LD?
Identified at later age at school Adequate language abilities, social skills and self-care May be difficulties in academic work
46
What are the clinical features of moderate lD?
Able to communicate but language is limited | May need supervision for self-care but able to do simple work
47
What are the clinical features of a severe LD?
Marked degree of motor impairment, little or no speech in early childhood May eventually use simple communication May have associated physical disorders
48
What are the clinical features of profound LD?
Severe motor impairment and severe difficulties in communication Little or no self care Freq have physical disorders and require residential care
49
Presentation of GAD in children
Anxiety Fears of death of themselves or others Somatic manidestations - Nausea, abdopain, sickness, headaches, sweating, palpitations, tension Panic attacks - sudden, extreme fear, physical symptoms, faintness
50
Presentation of separation anxiety
Fear of or anxiety with separation from attachment figure Somatic manifestation Nightmares School refusal.
51
Management of anxiety disorders in children
Behaviour - systemic desensitisation, flooding (expose to painful memory (fast systematic densensitization), response prevention Psychotherapy - brief dynamic, family and cognitive therapy Anxiolytics (last resort include beta blockers and diazepam)
52
Management for Depression in children
CBT, Fluoxitine
53
List 3 child factors that promote resilience
``` Easy temperament and good nature Female (prior to adolescence) Male (during adolescence) Higher IQ Good social skills Empathetic Humour Self-aware of strengths and limitations ```
54
List 3 family factors that promote resilience
Warm and supportive parents Good parent-child relationship Parental harmony Valued social role
55
List 3 environmental factors that promote resilience
``` Supportive extended family Successful school experience Valued social role Extracurricular activities Member of faith/religious community ```
56
What is the importance of resilience in regards to child mental health?
Enhances formulation Recognises resources the child/family can use May prevent or inhibit development of mental disorders
57
How can child attachments be categorised?
``` Secure Insecure (avoidant) Insecure (anxious) Insecure (ambivalent) Disorganised ```
58
What is the ICD-10 criteria for conduct disorder?
1+ features at a marked level for over 6 months
59
What routine interventions exist for conduct disorder?
Group parent training programmes - for 3-11years Functional family therapy Multi systemic therapy - family-based, including school and community Child-focused programmes
60
When are pharmacological interventions to be considered in conduct disorder?
Risperidone is considered for short-term management of severely aggressive behaviour in conduct disorder with explore anger and severe emotional dysregulation.
61
What are the side effects of Risperidone?
Metabolic: weight gain, diabetes EPSE: akathisia, dyskinesia, dystonia CV: QTc prolongation Hormonal: increased PRL
62
What are pervasive developmental disorders?
Group of disorders characterised by delays in the development of multiple basic functions including socialisation and communication. Examples include autism, Asperger's, Rett syndrome Autistic spectrum
63
What is specific developmental disorders?
Classification of disorders characterised by delayed development in one specific area. Specific speech articulation Receptive language disorder Expressive language disorder Specific reading or spelling disorder
64
What occurs in methylphenidate toxicity?
Those similar to acute amphetamine intoxication Euphoria, delirium, confusion, toxic psychosis Hallucinations
65
Name 3 side effects of atomoxetine
``` Anorexia Dry mouth NaV Headache Fatigue ```
66
What is the indication for atomoxetine?
ADHD
67
What skills may be impaired in someone with a learning disability?
Cognition Language Motor skills Social skills
68
Differentiate between impairment, disability, and handicap
Impairment: Any loss/abnormality of psychological, physiological or anatomical structure or function. Disability: Any restriction/lack of ability to perform an action in a normal manner or range. Handicap: A disadvantage for a given individual, resulting from impairment or disability that limits/prevents the normal fulfilment of a role.
69
List three physical associated problems of learning disabilities
``` Motor and mobility problems Speech, hearing and visual impairment Epilepsy Urinary and faecal incontinence Increased risk of obesity and fractures Poor oral health Poor diet, constipation, GORD Sleep disorders Premature death ```
70
Name 3 common comorbid psychiatric disorders seen in people with learning disabilities
``` Schizophrenia Anxiety disorders Depressive disorders Bipolar affective disorder Personality disorders Early-onset dementia Autism ADHD ```
71
How does schizophrenia present differently in people with learning disabilities?
Prevalence is 3x greater Earlier age of onset (23yr) More commonly associated with epilepsy, negative symptoms, and impaired episodic memory
72
What additional symptoms may present in schizophrenia of severe learning disability?
Unexplained aggression Bizarre behaviour Mood lability Increased mannerisms and stereotypes
73
How does bipolar affective disorder present differently in people with Learning disabilities?
Prevalence is greater (2-12%) | More difficult to diagnose if severe LD also present
74
How does depressive disorder present differently in people with Learning disabilities?
Commonly missed More marked biological features, with diurnal variation Suicidal ideation is less frequent in severe LD
75
List five associated behavioural problems alongside learning disabilities
Difficulty accessing care and support Poor self-care: hygiene, diet, exercise, physical and mental health Lack of supportive social network Lack of regular employment and income Boredom Harmless behaviour interpreted as aggression Temper tantrums Criminal activity due to challenging behaviour or misunderstanding Challenging behaviour Communication difficulties, ASD, sensory impairment
76
What types of behavioural disorders are seen in the LD population?
``` Aggression and antisocial Social withdrawal Stereotypic behaviours Hyperactive disruptive behaviours Repetitive communication disturbance Anxiety/fearfulness ```
77
Name 3 interventions can be used in behavioural disorders
Educational and social intervention Facilitating communicate needs - e.g. hearing aid Behavioural intervention - reinforcement Psychotherapy Pharmacological treatment for comorbidities Physical intervention - protect individual and others
78
Outline the co-occurrence of epilepsy and LD
Epilepsy is more in patients with LD of various causes. May be due to shared aetiologies. Frequent epileptic seizures may lead to (or worsen) permanent loss of intellectual functioning. Therefore, early diagnosis and treatment is essential to prevent fatal progression.
79
What problem arises in the management of epilepsy if severe LD is present?
A person with a severe learning disability is more likely to have side-effects than someone with a milder learning disability.
80
Describe the cautions of using pharmacological treatment in people with LD
Presence of any comorbid physical disorders (e.g. epilepsy, constipation, cerebral palsy) increase the likelihood of side effects. Atypical responses are more common ➔ advise lower doses and gradual increases in medication. Evidence base is lacking in LD population
81
What are the indications for antipsychotics in people with LD?
Comorbid psychiatric disorders (e.g. schizophrenia) | Acute behavioural disturbances
82
What are the indications for antidepressants in people with LD?
Depression OCD Anxiety disorders Violence, self-injury, and non-specific distress
83
What are the indications for Lithium in people with LD?
Bipolar affective disorder Augmentation of antidepressant therapy Some effect in reducing aggressive outbursts
84
How should cognitive therapies and CBT be delivered to the LD population?
Borderline/mild/moderate LD: Cognitive approaches may be adapted to level of intellectual impairment.
85
What is the aim of behavioural treatments in learning disabilities?
Teach basic skills: feeding, dressing Establish normal behaviour patterns: sleep Teach more complex skills: social skills, relaxation Alter maladaptive pattens of behaviour: phobias, disinhibition etc.

Mental Health (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions