S-Z Flashcards
(40 cards)
What is School refusal?
Child motivated refusal to attend school and behavioral difficulties when in school.
What is the aetiology of School refusal?
Separation anxiety disorder persisting over 3-4y, environmental factors such as depravation, abuse, neglect, bullying, and academic performance related.
What is the epidemiology of School refusal?
Peaks at age of school changes, 5-11, sometimes 14-15. Higher in lower SES. May coexist with separation anxiety disorder, depression etc.
What would you find in the history/ exam of School refusal?
Structured interview
School avoidance pattern: refusing to go, leaving early, being ill, crying, clinging, tantrum, distressed during school.
· Internalization: worrying, fatigue, somatization, stress.
· Externalization: crying, clinging, screaming, behavioral
Screen for depression (low mood, anhedonia, unworthiness feeling), other organic causes, and for behavioral problems (sleep, eating, conduct disorder, substance abuse).
How would you investigate School refusal?
If organic cause suspected, FBR, TFT, urine dip, glucose.
Urine toxicology if indicated and ?substance abuse
MRI/CT if neurological cause suspect. Assess hearing and vision if concerned.
What is the management of School refusal?
Early stepwise return to school with positive reinforcement. CBT.
Medical TX if medical problem, SSRI (fluoxetine) may be appropriate in children with signs of depression.
What are the complications and prognosis of School refusal?
Deteriorating school performance, social isolation, family issues.
Likely to solve unless long standing.
What is Sleep related disorders?
Night terrors: disturbance in the stricture of sleep
Nightmares: frightening dreams
Difficulty sleeping without parent.
What is the aetiology of Sleep related disorders?
Night terrors: may be due to fever, stress, medication, lack of sleep.
Nightmares: stressful event, drugs, fever, fhx.
Difficulty: separation anxiety.
Associated with LD, depression, PTSA, ASD, ADHD.
What is the epidemiology of Sleep related disorders?
NT usually 4-12y onset, NM usually 3-6yo, DIFF common in toddlers.
What would you find in the history/ exam of Sleep related disorders?
NT: recurrent episodes of intense crying and fear about 1h30 during the night after falling asleep. Lasts 2 min. Following terror, hard to rouse, disoriented up to 10 min. During terror may have tachypneic, sweating, but does not remember in the morning. During the transition from non-REM to REM sleep with sudden autonomic activation.
MN: usually occur in the middle of the night. Threat to the child, loss of control or dear of injury. Child is alert on waking. Stress in the day. Occur during REM.
How would you investigate Sleep related disorders?
EEG if associated nocturnal seizures.
What is the management of Sleep related disorders?
Parental reassurance.
NT: ensure sleeping in safe environment, regular bedtimes, wake child after 1h30 to avoid terror, keep a record of times when occurring.
NM: relax child, psych consultant if possible PTSD etc.
DIFF: routines for sleeping, in extreme cases sedate for a few nights followed by increasing length of item between leaving room and returning, until child falls asleep before return.
What are the complications and prognosis of Sleep related disorders?
Distress.
Usually outgrown.
What is Tics?
TICS: stereotyped movement of muscle groups with no clear function
Tourette’s: chronic idiopathic syndrome with both motor and vocal tics beginning before adulthood.
What is the aetiology of Tics?
Genetic: higher concordance in twins, higher in first degree relative.
Acquired: ? Abs to GBS?
Associated with ADHD in 30%, OCD in 20%.
What is the epidemiology of Tics?
3-15% of children. Declining by adolescence. Usual onset 7-9y. Tourette 1%.
What would you find in the history/ exam of Tics?
Simple: brief movements of few muscle groups, may be transient <1y or chronic>1y.
Complex tics: coordinated movements involving several muscle groups, or coprolalia (outburst of obscenities). Worsened by stress and reduced by absorbing activities.
Tourette: Multiple motor and vocal tics. Occur more than once a day for over a year, vary in nature. Rage attacks may occur, with unpredictable outbursts, out of proportion to stimulus, threatening destruction and self injury, with near immediate remorse.
?due to reduction in basal ganglia inhibition of undesired motor programs.
How would you investigate Tics?
Usually none. In specific cases, exclude things. ASOT may be required if sudden onset. TFT to exclude hyperthyroidism. Serum ceruloplasmin to screen for Wilsons. EEG to check absence seizures.
Assess mental health, ADHD and OCD.
What is the management of Tics?
MDT approach: supportive parental education, behavioral and psychotherapy to reduce habit
Medical treatment may include neuroleptic drugs in low dose or dopamine agonists.
Treat comorbid psych disease (OCD: SSRI, ADHD: atomoxetine if tics present)
What are the complications and prognosis of Tics?
Stigma, embarrassment, social withdrawal
Worsen throughout childhood but usually remit by 18.
What is Visual impairment?
Decrease visual acuity (<6/18 on Schnellen). Blind if <3/18).
What is the aetiology of Visual impairment?
Developed countries mainly genetic, developing countries mainly acquired.
What is the epidemiology of Visual impairment?
10-20/10000 UK.
