child psychosis Flashcards
(53 cards)
1
Q
VEOP?
A
very early onset psychosis
2
Q
VEOP?
A
very early onset psychosis
3
Q
early onset psychosis?
A
13-18
4
Q
who gets brief psychotic symptoms?
A
- 10-28% adult population
2. 8% children have transient hallucinations
5
Q
brief psychotic symptoms and development of psychosis
A
not related
6
Q
prevalence of psychosis in kids
A
13yrs 0.009%
18yrs 0.2%
general population 3% psychotic, 1% sSCZ
7
Q
what are the categories of RF for childhood psychosis?
A
- genetic (40% MZ)
- gestational
- environmental
- ethnic - afro caribbean
- early childhood hx
8
Q
gestational features risk factors
A
infection complicated pregnancy premature LBW seasonality
9
Q
environmental risk factors
A
urban
migration
social exclusion
early cannabis
10
Q
early childhood hx rfs
A
- solitary play
- speech delay
- receptive language probs
- motor delay
- minor physical anomalies
- hypersenstitive
- behaviour prob
- academic prob
- low premorbid IQ
- insecure attachment parent child relationship
11
Q
phases of psychosis?
A
- premorbid - asymptomatic/mild deficit
- prodrome- at risk state
- psychotic
12
Q
what is the prodrome?
A
- sustained deviation from expected developmental trajectory
- non specific sx to positive subsyndromal sx
13
Q
insight in prodrome
A
yep
are not convinced of reality of sx
14
Q
risk of psychosis with prodrome
A
risk of developing in next year
15
Q
how do we assess the prodrome?
A
SIPS - structured interview of prodromal syndrome
CAARMS -comprehensive assessment of at risk mental states
16
Q
prodromal syndrome course?
A
- continued unchanging symptoms
- remit spontaneously
- go to psychosis
17
Q
psychotic symptoms in young people?
A
- insidious often
- vague symptoms
- florid
- negative symptoms
- often with affective symptoms
- in older is similar to adult
18
Q
gender
A
males> females
19
Q
tx response for child psychosis?
A
worse than for adult
20
Q
severity of illness?
A
worse than adult
21
Q
bio investigations
A
- wt/ht/BMI
- bloods - thyroid, FBC, renal, liver
- urine drug screen
- EEG - peri-ictal psychosis
- CT/MRI
- ECG
22
Q
social investigations?
A
- collateral hx
- contact relevant agencies
- school
- family dynamics
- social background
23
Q
social investigations?
A
- collateral hx
- contact relevant agencies
- school
- family dynamics
- social background
24
Q
early onset psychosis?
A
25
who gets brief psychotic symptoms?
1. common
2. 10-28% adult population
3. 8% children have transient hallucinations
26
brief psychotic symptoms and development of psychosis
not related
27
prevalence of psychosis in kids
13yrs 0.009%
18yrs 0.2%
general population 3% psychotic, 1% sSCZ
28
what are the categories of RF for childhood psychosis?
1. genetic (40% MZ)
2. gestational
3. environmental
4. ethnic - afro caribbean
5. early childhood hx
29
gestational features risk factors
```
infection
complicated pregnancy
premature
LBW
seasonality
```
30
environmental risk factors
urban
migration
social exclusion
early cannabis
31
early childhood hx rfs
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
phases of psychosis?
1. premorbid - asymptomatic/mild deficit
2. prodrome- at risk state
3. psychotic
33
what is the prodrome?
1. sustained deviation from expected developmental trajectory
2. non specific sx to positive subsyndromal sx
34
insight in prodrome
yep
| are not convinced of reality of sx
35
risk of psychosis with prodrome
risk of developing in next year
36
how do we assess the prodrome?
SIPS - structured interview of prodromal syndrome
| CAARMS -comprehensive assessment of at risk mental states
37
prodromal syndrome course?
1. continued unchanging symptoms
2. remit spontaneously
3. go to psychosis
38
psychotic symptoms in young people?
1. insidious often
2. vague symptoms
3. florid
4. negative symptoms
5. often with affective symptoms
6. in older is similar to adult
39
gender
males> females
40
tx response for child psychosis?
worse than for adult
41
severity of illness?
worse than adult
42
bio investigations
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
psych investigations
1. risk assessment
2. IQ
3. insight
4. SPS/CAARMS
5. SAPS/SANS- schedule of assessment of +ve/-ve symptoms
44
social investigations?
1. collateral hx
2. contact relevant agencies
3. school
4. family dynamics
5. social background
45
biological tx
1. atypical antipsychotic
2. start low go slow
3. watch side effects
4. tx co morbid probs
46
s/e of antipsychotics?
1. sedation
2. weight gain
3. hyperprolactinaemia
4. EPSEs
5. seizures
6. diabetes
47
psycho tx
1. risk assessment + mangt
2. collaborative
3. psychoeducation
4. +/- CBT
5. coping skills
6. social skills
7. activity scheduling
48
social tx
1. family support and tx
2. liaise with school and other agencies
3. local support group
49
px childhood psychosis
1. 50% continuous
2. 50% negative sx
3. poorer than adult onset esp if premorbid impairment, -ve sx, long DUP
50
incidence
increasing in adolescence
51
ddx for psychosis in kids?
```
SOAPDOME
Substance misuse
Organic
Anxiety
Psychotic
```
Developmental
Other - ADHD, CD, Attachment, eective mutism, tic, abuse, adjustment, bereavement
Mood
Eating
52
what are the -ve symptoms?
5 As
```
Apathy
Affect blunted
Anhedonia
Alogia
Attention problems
```
53
possible setting for managment
CAMHS OPD - wkly review
day hospital - intensive 5 day tx plan
in patient - risk high
