Symposium 2 - Child and Adolescent Psychiatry Flashcards
What are the most common Psychiatric Presentations that are seen in CAMHS?
- Depression
- Anxiety
- Obsessive Compulsive Disorder
What percentage of depression occurs in 5-19 year olds?
Around 2.1%
Who can have and be affected by depression, for what reasons and how do we classify them?
Anybody can experience depression and it affects people of all ages, ethnicities and social backgrounds.
There will sometimes be a clear reason that someone becomes depressed, sometimes not, and there is often more than one reason.
These reasons will be different for different people.
See notes section for ICD-II classifications of depressive disorders.
What is Depression in a young person and its Causes?
It could be caused by any combination of factors that relate to
physical health, life events, family history, environment, genetic vulnerability, and biochemical disturbance.
Depression is persistent sadness. When it occurs, a young person (YP) feels alone, hopeless, helpless, and worthless. When this type of sadness is unending, it disrupts every part of
the YPS life. It interferes with the YP’s daily activities, schoolwork, and peer relationships. It can also affect the life of each family member.
E.g siblings get neglected when other child family is focusing on getting them through
What are some issues around diagnosing depression in young people?
- Depression often goes undiagnosed and untreated.
- Symptoms can be seen as normal emotional and psychological change that occurs during growth.
*Can be very tired even after 10 hours sleep, on phone scrolling for hours
What are some signs and symptoms of childhood depression?
- Changes in appetite – either increased appetite or decreased
- Changes in sleep – sleeplessness or excessive sleep
- Continuous feelings of sadness or hopelessness
- Difficulty concentrating
- Fatigue and low energy
- Feelings of worthlessness or guilt
- Impaired thinking or concentration
- Increased sensitivity to rejection
- Irritability or anger
- Loss of interest in hobbies and other interests
- Physical complaints (such as stomach aches or headaches) that do not respond to treatment
- Reduced ability to function during events and activities at home or with friends, in school or during extracurricular activities, or when involved with hobbies or other interests
- Social withdrawal
- Thoughts of death or suicide
- Vocal outbursts or crying
What changes in school may be seen in a young person with depression?
Some YP may continue to function reasonably well in structured environments but most with depression will suffer a very noticeable change in;
- Social activities
- A loss of interest in school (Anhedonia)
- Poor academic performance
- A change in appearance.
*Routine can force them to get up in the morning, give rest bite from negative thoughts
*Clinicians play important role in giving hope, if bullied at school how should a child want to go back to school.
What are some Maladaptive coping mechanisms young people may do?
- Taking drugs
- Alcohol
- Smoking
- Self-harm
*Girl has swapped self harm to vaping, is that better worse, parents disagree?
What are the trends seen in Suicide and Young People?
Although it’s uncommon in YP under age 12, some do attempt suicide - and may do so impulsively when they are upset or angry.
- Studies show that girls are more likely to attempt suicide.
- But boys are more likely to actually complete suicide when they make an attempt.
YP with a family history of violence, alcohol abuse, or physical or sexual abuse are at greater risk for suicide.
What are some Warning Signs of Suicide in young people?
- A focus on morbid and negative themes
- Frequent accidents
- Giving away possessions
- Increased acting-out behaviours
- Increased crying or reduced emotional expression
- Increased risk-taking behaviours
- Many depressive symptoms (changes in eating, sleeping, or activities)
- Social isolation
- Substance abuse
- Talking about death and dying
- Talking about suicide or feeling hopeless or helpless
What can be the issue of wanting to treat young people with depression?
- Danger being a doctor is being able to give medication too early - need to learn to not give too early
What increases the chance of Depression in a young person and if they experience major depression when are they to have another depression?
A YP has an increased chance of childhood depression if they have a family history of depression, particularly a parent who had depression at an early age.
Once a YP experiences major depression, they are at risk of developing another depression within the next five years.
What are the Treatments for young people with Depression?
Treatment options for YP with depression are similar to those for adults albeit modified for developmental age and stage.
They include psychological therapies and medication.
Usual pathway is for psychological therapies first and consider antidepressant medication as an additional option if symptoms are severe, or if there is no significant improvement with psychological therapy alone.
*If family member has had a good response to a medication might work well for child!
What is the most important part in CBT?
*Important part in CBT, T - trust you, B - behaviour, seeing a friend again, doing activity again (occupational health here. If T and B right then usually don’t need C or have matured in mind set and ready for treatment.
What is Anxiety and the difference between Anxiety and Fear ?
Anxiety and fear-related disorders are characterised by excessive fear and anxiety and related behavioural disturbances, with symptoms that are severe enough to result in significant distress or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning.
Fear and anxiety are closely related phenomena; fear represents a reaction to perceived imminent threat in the present, whereas anxiety is more future-oriented, referring to perceived anticipated threat. A key differentiating feature among the Anxiety and fear-related disorders are disorder-specific foci of apprehension, that is, the stimulus or situation that triggers the fear or anxiety. The clinical presentation of Anxiety and fear-related disorders typically includes specific associated cognitions that can assist in differentiating among the disorders by clarifying the focus of apprehension.
*Fight freeze flight = Anxiety
* Small feeling of anxiety vs episode or debilitating illness is different
What conditions does Anxiety or Fear-related disorders include?
- Generalized Anxiety Disorder
- Panic Disorder
- Agoraphobia
- Specific Phobia
- Social Anxiety Disorder
- Separation Anxiety Disorder
- Selective Mutism
- Other Specified Anxiety or Fear-Related Disorders
What are some Physical Symptoms of Anxiety?
- Breathing more quickly (shallow, short breaths)
- Feeling faint, lightheaded or having shaky legs
- Racing heart
- Feeling sick and having a churning or upset stomach
- Restlessness or fidgetiness
- Tense and tight muscles
- Headaches
- Insomnia (trouble sleeping)
What are some Psychological Symptoms of Anxiety?
- Intensely worrying thoughts
- Feelings of anger or upset
- Feeling afraid, as if something awful might happen
- Intrusive thoughts (unpleasant thoughts that you can’t get rid of) that keep coming back
What are some Behaviour Symptoms of Anxiety?
- Repeatedly checking things
- Seeking reassurance from others
- Putting off doing things
- Avoiding certain situations or things
Why do anxiety symptoms happen?
The ability to experience anxiety is a natural part of the way we keep ourselves safe.
When we feel like we might be in danger our brain signals our body to get ready to deal with it immediately.
This can result in a range of different feelings in your mind and body, and can also lead to changes in your behaviour.
- In some we are trying to re-wire their nervous system and parasympathetic system to stop fight or flight (usually from their care givers).
- Breathing is useful in this.
How may Generalized Anxiety Disorder (GAD) present in young people?
YP with GAD worry excessively about a variety of things, such as family problems, relationships with their peers, or performance in school or sports.
How may Social Anxiety Disorder present in young people?
Social anxiety disorder is also called social phobia. It’s characterised by an intense fear of social and performance situations. Without treatment, social anxiety can impair a YP’s performance in school as well as their ability to socialise and make or maintain relationships.
*Young man treated with SSRI and low dose antipsychotic and now can make friends etc
How may Panic Disorder present in young people?
YP may experience dread or fear over small things, or for no reason at all when no real danger is present.
Significant amounts of time are spent worrying over having another one or losing control.
Intense physical reaction to stress with subsequent avoidance behaviours to try to prevent them from happening.
*A true panic attack - you think you are going to die, you don’t know it will pass and you will do everything to avoid it happening again. Issues with parents, schools, friends etc.
What are Specific Phobias and how do they present in young people?
- Intense and irrational fear of a certain thing or situation.
Common phobias in children include:
- Animals
- Storms
- Water
- Heights
- Bloods
- Darkness
- Medical procedures
*Had some kids scared of babies crying, sensory overload, need out etc
How may Separation Anxiety Disorder (SAD) present in young people?
Between the ages of 18 months and three years, it’s very common for children to feel some anxiety when a parent leaves the room or their line of sight.
Older children also experience SAD.
It may take them longer than most YP to calm down.
Psychically and psychologically they can experience,
- e.g., extreme homesickness and feelings of misery over not being near loved ones.
*Have to starts low with management given and not judge parents decisions (we will never understand how hard)
How is Anxiety Treated in young people?
Treatment options for YP with anxiety are similar to those for adults albeit modified for developmental age and stage.
- Psychological therapies (CBT) can help YP with anxiety unlearn avoidance behaviours. It also helps them learn more helpful patterns of thinking.
- Antidepressant medication is considered if symptoms are severe, or if there is no significant improvement with psychological therapy alone.
What is OCD and how can it present in young people?
Obsessive-Compulsive Disorder is characterised by the presence of persistent obsessions or compulsions, or most commonly both.
Obsessions are repetitive and persistent thoughts, images, or impulses/urges that are intrusive, unwanted, and are commonly associated with anxiety. The individual attempts to ignore or suppress obsessions or to neutralize them by performing compulsions. Compulsions are repetitive behaviours including repetitive mental acts that the individual feels driven to perform in response to an obsession, according to rigid rules, or to achieve a sense of ‘completeness’.
An obsession is a thought, image or urge that keeps coming into your mind even though you may not want it to.
Examples include thinking you:
- Are unclean or might spread disease
- Might get hurt or hurt someone else
- Might have an illness
- Are convinced something bad will happen to someone.
- Having an obsession often leads to feelings of anxiety or discomfort and you might then get the urge to ‘put it right’. This is where compulsions come in.
How is OCD diagnosed?
In order for obsessive-compulsive disorder to be diagnosed, obsessions and compulsions must be time consuming (e.g. taking more than an hour per day) or result in significant distress or significant impairment in personal, family, social, educational, occupational or other important areas of functioning. If functioning is maintained, it is only through significant additional effort.
Developmentally normative preoccupations (e.g., worrying about interacting with strangers in young children) and rituals (e.g., skipping over cracks in a sidewalk) should not be attributed to a presumptive diagnosis of Obsessive-Compulsive Disorder and are differentiated from obsessions and compulsions characteristic of Obsessive-Compulsive Disorder because they are transient, age-appropriate, not time-consuming (e.g., taking more than hour per day), and do not result in significant distress or impairment.
What sort of Insight do OCD patients have?
Individuals with Obsessive-Compulsive Disorder vary in the degree of insight they have about the accuracy of the beliefs that underlie their obsessive-compulsive symptoms. Although many can acknowledge that their thoughts or behaviours are untrue or excessive, some cannot, and the beliefs of a small minority of individuals with Obsessive-Compulsive Disorder may at times appear to be delusional in the degree of conviction or fixity with which these beliefs are held (e.g., an individual is convinced that she will become seriously ill if she does not maintain her washing rituals). Insight may vary substantially even over short periods of time, for example depending on the level of current anxiety or distress, and should be assessed with respect to a time period that is sufficient to allow for such fluctuation (e.g., a few days or a week).
When does the onset of OCD occur, and who is more likely to have it?
Onset before age 10 is more common among males (approximately 25%), whereas adolescent onset is more likely among females.
Younger age of onset is associated with greater genetic loading and poorer outcomes due to interference of symptoms with achieving developmental milestones (e.g., forming peer relationships, acquiring academic skills).
Although childhood-onset Obsessive-Compulsive Disorder typically follows a chronic course, particularly if left untreated, symptoms tend to wax and wane and many (approximately 40%) experience full remission by early adulthood.
What are common myths and misuses of OCD?
OCD is a disorder where a YP experiences obsessions and/or compulsions that affect their everyday life.
Some YP use the phrase OCD to describe being very tidy or having a very specific routine.
However, just being tidy or precise does not mean that you have OCD.
In YP with OCD, these habits are unpleasant and upsetting and can have a huge and negative affect on their lives.
*Significant functional impairment, can have other disorders pre-dating it
What are Compulsions in OCD?
Compulsions are things you feel you need to do to control your ‘obsessions’, even though you may not want to. It can be hard to stop yourself from doing these compulsions.
Often, a compulsion means doing something again and again. This is also known as a ‘ritual’.
Doing the compulsion will probably make you feel as though you can stop or reduce your anxiety about what you fear may happen.
What are the Risk Factors for Developing OCD?
Genes – OCD is a complex disorder. Studies have shown that there are different genetic risk factors involved in whether someone develops OCD. People who have a relative with OCD are more likely to develop OCD than people who don’t.
Stress – Stressful life events like someone dying or getting sick, can bring on OCD. This is the case in about one or two in every three people who develop OCD.
Life changes – Big events in someone’s life can be a catalyst for developing OCD. E.g. puberty, moving house or changing school.
Brain changes – If you have the symptoms of OCD for more than a short time, researchers think that there may be changes in how a chemical called serotonin works in your brain. We don’t know if these changes cause OCD, or are caused by OCD.
Personality – If you are a neat, meticulous, methodical person with high standards you may be more likely to develop OCD. These qualities are normally helpful, but can slip into OCD if they become too extreme.
Ways of thinking – Nearly all of us have odd or distressing thoughts or pictures in our minds at times. For example, thinking about stepping out in front of a car when you’re on a busy street, even if you don’t actually want to. Most of us quickly dismiss these ideas and get on with our lives. But, if you have particularly high standards of morality and responsibility, you may feel that it’s terrible to even have these thoughts. So, you are more likely to watch out for them coming back, which makes it more likely that they will.
What are some examples of OCD?
Some examples of compulsions include:
- Washing
- Checking
- Touching
- Ordering, arranging or lining things up
- Counting
- Thinking certain thoughts
If you have compulsions you might find yourself trying to avoid any situation that could set off obsessive thoughts.
What are the treatments for OCD in young people?
One of the most helpful psychological treatments for OCD is cognitive behavioural therapy (CBT). This is a treatment that
helps you to change the way you think and behave.
Exposure and response prevention (ERP) is a type of CBT that aims to stop compulsive behaviours and anxieties from
strengthening each other.
Selective Serotonin Reuptake Inhibitors (SSRIs) is a type of antidepressant that can be effective in treating OCD.
*For exams, psychological therapy and medication
What is one of the most important things you can give a Young Person with Psychiatric Problems?
Need to give hope!
What helps to form an Infants brain and how?
A child’s experiences at early life forms the foundation for all future learning, behaviour, health. Neuron circuits grow and the more they are used grow stronger based upon experiences and less fade away through pruning. Neurons form strong connections for motor skills, behaviour, memory, visual and language.
What is Developmental Psychopathology?
Developmental psychopathology is an approach or field of
study designed to better understand the complexities of human development.
Looks at;
- How are individuals similar to and different from each
other in the healthy and maladaptive paths they take as they grow older?
- accounts for why individuals experience differences in psychological functioning over time?
- What characteristics within (genes, personality) and outside (family relationships, neighbourhoods) the individual are responsible for similarities and differences in psychological development over time?
- What consequences do people’s histories of experiences, coping, and adjustment have on their subsequent mental health?
- Understanding why sone children develop disorders or maladaptation whereas other children develop normally necessitates considering a whole host of factors that undermine or foster healthy adjustment.
What is Bronfenbrenner’s ecological systems theory ?
Child development can be affected by both their immediate family and peers, but also by wider socio-economic and cultural factors.
What is the Attachment theory and the 3 types of insecure seen within it?
A strong emotional bond to primary care giver in life is critical to development. Strong bond and feel attached gives us chance to explore world and feel secured knowing we can return. People secure can trust and do better in life.
3 types of insecure;
- anxious avoidance
- anxious ambivalent
- anxious disorganised
What is the template for Formulations?
In formulation, ontological (diagnostic hierarchy), causal (biopsychosocial model) and meaning (verstehen) perspectives combine to give an overall picture of an individual case and a basis for treatment and care
4P factor model;
- Predisposing (Vulnerabilities that can lead to problem)
- Precipitating (Increase risk of problem)
- Perpetuating (Keep problem going)
- Protective
- Biological
- Psychological
- Social
*Formulation helps to think about perpetuating factors. While a lot could be down to circumstances and parents doesn’t mean cant be neurological developmental issue, need to be thorough to differentiate.
What are the essential features required for autism in the ICD-11?
- Persistent deficits in initiating and sustaining social communication and reciprocal
social interactions that are outside the expected range of typical functioning given
the individual’s age and level of intellectual development. Specific manifestations
of these deficits vary according to chronological age, verbal and intellectual
ability, and disorder severity. - Persistent restricted, repetitive, and inflexible patterns of behaviour, interests, or
activities that are clearly atypical or excessive for the individual’s age and
sociocultural context. - The onset of the disorder occurs during the developmental period, typically in
early childhood, but characteristic symptoms may not become fully manifest until
later, when social demands exceed limited capacities. - The symptoms result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning.
What is the ADOS-2?
ADOS-2;
- Standardized, play-based, observational assessment
- Elicit particular types of behaviors, communication, and social interactions
- Presence of behaviors related to ASD rated by a formally trained clinician
- Algorithm indicates likelihood of ASD
- Purpose = DIAGNOSTIC TOOL
- Goal = Answer the question:
“Does this child have ASD, yes or no?”
- 5 Modules based on developmental and
language level, and chronological age
What features are distinct in this photo?
Fragile X (distinctive long face, prominent ears
What features are distinct in this photo?
P-10 syndrome - large circumference of heard (linked to cancers, thyroid colon)
What features are distinct in this photo?
Ashley Mark Hills or hyperpigmented macules found in tuberous sclerosis (dominant condition) - Associated with non cancerous growths, seizures and neurodevelopmental disorders
What are some advantages of autism?
- Often visual thinkers and learners
- Memory for facts and figures
- Specialised areas of interest and knowledge
- Logical Problem Solvers
- Creative and out-of-the-box thinkers
- Observant
