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child psychosis Flashcards

1
Q

VEOP?

A

very early onset psychosis

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2
Q

VEOP?

A

very early onset psychosis

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3
Q

early onset psychosis?

A

13-18

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4
Q

who gets brief psychotic symptoms?

A
  1. 10-28% adult population

2. 8% children have transient hallucinations

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5
Q

brief psychotic symptoms and development of psychosis

A

not related

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6
Q

prevalence of psychosis in kids

A

13yrs 0.009%
18yrs 0.2%
general population 3% psychotic, 1% sSCZ

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7
Q

what are the categories of RF for childhood psychosis?

A
  1. genetic (40% MZ)
  2. gestational
  3. environmental
  4. ethnic - afro caribbean
  5. early childhood hx
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8
Q

gestational features risk factors

A 
infection
complicated pregnancy
premature
LBW
seasonality
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9
Q

environmental risk factors

A

urban
migration
social exclusion
early cannabis

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10
Q

early childhood hx rfs

A
  1. solitary play
  2. speech delay
  3. receptive language probs
  4. motor delay
  5. minor physical anomalies
  6. hypersenstitive
  7. behaviour prob
  8. academic prob
  9. low premorbid IQ
  10. insecure attachment parent child relationship
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11
Q

phases of psychosis?

A
  1. premorbid - asymptomatic/mild deficit
  2. prodrome- at risk state
  3. psychotic
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12
Q

what is the prodrome?

A
  1. sustained deviation from expected developmental trajectory
  2. non specific sx to positive subsyndromal sx
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13
Q

insight in prodrome

A

yep

are not convinced of reality of sx

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14
Q

risk of psychosis with prodrome

A

risk of developing in next year

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15
Q

how do we assess the prodrome?

A

SIPS - structured interview of prodromal syndrome

CAARMS -comprehensive assessment of at risk mental states

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16
Q

prodromal syndrome course?

A
  1. continued unchanging symptoms
  2. remit spontaneously
  3. go to psychosis
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17
Q

psychotic symptoms in young people?

A
  1. insidious often
  2. vague symptoms
  3. florid
  4. negative symptoms
  5. often with affective symptoms
  6. in older is similar to adult
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18
Q

gender

A

males> females

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19
Q

tx response for child psychosis?

A

worse than for adult

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20
Q

severity of illness?

A

worse than adult

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21
Q

bio investigations

A
  1. wt/ht/BMI
  2. bloods - thyroid, FBC, renal, liver
  3. urine drug screen
  4. EEG - peri-ictal psychosis
  5. CT/MRI
  6. ECG
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22
Q

social investigations?

A
  1. collateral hx
  2. contact relevant agencies
  3. school
  4. family dynamics
  5. social background
23
Q

social investigations?

A
  1. collateral hx
  2. contact relevant agencies
  3. school
  4. family dynamics
  5. social background
24
Q

early onset psychosis?

A
25
Q

who gets brief psychotic symptoms?

A
  1. common
  2. 10-28% adult population
  3. 8% children have transient hallucinations
26
Q

brief psychotic symptoms and development of psychosis

A

not related

27
Q

prevalence of psychosis in kids

A

13yrs 0.009%
18yrs 0.2%
general population 3% psychotic, 1% sSCZ

28
Q

what are the categories of RF for childhood psychosis?

A
  1. genetic (40% MZ)
  2. gestational
  3. environmental
  4. ethnic - afro caribbean
  5. early childhood hx
29
Q

gestational features risk factors

A 
infection
complicated pregnancy
premature
LBW
seasonality
30
Q

environmental risk factors

A

urban
migration
social exclusion
early cannabis

31
Q

early childhood hx rfs

A
  1. solitary play
  2. speech delay
  3. receptive language probs
  4. motor delay
  5. minor physical anomalies
  6. hypersenstitive
  7. behaviour prob
  8. academic prob
  9. low premorbid IQ
  10. insecure attachment parent child relationship
32
Q

phases of psychosis?

A
  1. premorbid - asymptomatic/mild deficit
  2. prodrome- at risk state
  3. psychotic
33
Q

what is the prodrome?

A
  1. sustained deviation from expected developmental trajectory
  2. non specific sx to positive subsyndromal sx
34
Q

insight in prodrome

A

yep

are not convinced of reality of sx

35
Q

risk of psychosis with prodrome

A

risk of developing in next year

36
Q

how do we assess the prodrome?

A

SIPS - structured interview of prodromal syndrome

CAARMS -comprehensive assessment of at risk mental states

37
Q

prodromal syndrome course?

A
  1. continued unchanging symptoms
  2. remit spontaneously
  3. go to psychosis
38
Q

psychotic symptoms in young people?

A
  1. insidious often
  2. vague symptoms
  3. florid
  4. negative symptoms
  5. often with affective symptoms
  6. in older is similar to adult
39
Q

gender

A

males> females

40
Q

tx response for child psychosis?

A

worse than for adult

41
Q

severity of illness?

A

worse than adult

42
Q

bio investigations

A
  1. wt/ht/BMI
  2. bloods - thyroid, FBC, renal, liver
  3. urine drug screen
  4. EEG - peri-ictal psychosis
  5. CT/MRI
  6. ECG
43
Q

psych investigations

A
  1. risk assessment
  2. IQ
  3. insight
  4. SPS/CAARMS
  5. SAPS/SANS- schedule of assessment of +ve/-ve symptoms
44
Q

social investigations?

A
  1. collateral hx
  2. contact relevant agencies
  3. school
  4. family dynamics
  5. social background
45
Q

biological tx

A
  1. atypical antipsychotic
  2. start low go slow
  3. watch side effects
  4. tx co morbid probs
46
Q

s/e of antipsychotics?

A
  1. sedation
  2. weight gain
  3. hyperprolactinaemia
  4. EPSEs
  5. seizures
  6. diabetes
47
Q

psycho tx

A
  1. risk assessment + mangt
  2. collaborative
  3. psychoeducation
  4. +/- CBT
  5. coping skills
  6. social skills
  7. activity scheduling
48
Q

social tx

A
  1. family support and tx
  2. liaise with school and other agencies
  3. local support group
49
Q

px childhood psychosis

A
  1. 50% continuous
  2. 50% negative sx
  3. poorer than adult onset esp if premorbid impairment, -ve sx, long DUP
50
Q

incidence

A

increasing in adolescence

51
Q

ddx for psychosis in kids?

A 
SOAPDOME
Substance misuse
Organic
Anxiety
Psychotic

Developmental
Other - ADHD, CD, Attachment, eective mutism, tic, abuse, adjustment, bereavement
Mood
Eating

52
Q

what are the -ve symptoms?

A

5 As

Apathy
Affect blunted
Anhedonia
Alogia
Attention problems
53
Q

possible setting for managment

A

CAMHS OPD - wkly review
day hospital - intensive 5 day tx plan
in patient - risk high

Psych (23 decks)

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