Symposium 4 - Child and Adolescent Psychiatry I

Question 1

What is Developmental Psychopathology?

Answer 1

Processes that go wrong during development resulting with problem thinking/behaviour
Role of genes, biological processes and life experiences

Question 2

What are the genetic factors of mental illness?

Answer 2

ADHD + Autism are highly genetic

Depression and anxiety substantially genetic

Question 3

What intra-uterine and perinatal factors can affect a child’s mental health?

Answer 3

Maternal health
Substance misuse
Toxins 
Drugs (antipsychotics)
Epigenetics 
Endocrine environment (androgens)
Prematurity
Twinning

Question 4

What are the affects of Fetal alcohol syndrome?

Answer 4

Growth retardation - body, eyes, head, cerebellum

Neuro-developmental effects - Sensorimotor, cognitive development, executive function

Question 5

How does White matter connectivity affect mental health?

Answer 5

Low connectivity associated with cognitive instability (ADHD) - poor concentration, distractibility

Question 6

What physical neurological changes are seen in Fetal Alcohol syndrome?

Answer 6

White matter connectivity

Gray matter gyrification

Question 7

What are the mental health outcomes for children with fetal alcohol syndrome?

Answer 7

Variable
Learning difficulties
ADHD or ADD or Hyp-Imp subtypes
Anxiety disorders

Question 8

What are Hyp-Imp subtypes?

Answer 8

Difficulties remaining still when self control is needed

Act in response to immediate stimuli without consideration

Question 9

What is ADD?

Answer 9

Distractibility

Sustaining attention to tasks without immediate rewards is hard

Question 10

What childhood environmental factors can affect mental health?

Answer 10

Carer - child relationship
Parenting skill/mental disorder 
Marital harmony
Nutrition, poverty
Abuse
Neglect
Discipline
Day care
Peer relationships
Life events
Early life stress

Question 11

What is Attachment?

Answer 11

Proximity-seeking behaviour
Secure or insecure
Bonding good for mental health

Question 12

How does early life stress impact the brain?

Answer 12

Influences function of limbic circuit + amygdala
Determines subsequent patterns
Early life stress influences mood and patterns of response to threat

Question 13

How does early adversity affect dopamine?

Answer 13

Early adversity decreases Dopamine response
Decreasing reward sensitivity
Increasing behaviour required to elicit reward
Increased tolerance leading to increased behaviour

Question 14

The reward deficiency model affects what?

Answer 14

Addiction - leads to:
 - Obesity
 - Drug + alcohol
 - Gambling
 - Porn
Increased delay-aversion

Question 15

Outline delay aversion?

Answer 15

Theory to explain ADHD - inability to wait and maintain attention in the absence of immediate reward

Question 16

How does school refusal differ from truancy?

Answer 16

Fear of leaving home/going to school vs unwillingness

Question 17

What paediatric mental health problems are associated with being out of school?

Answer 17

Anxiety
Conduct disorder
Autism
Depression
OCD

Question 18

What are the effects of mental health issues on school attendance?

Answer 18

Learning difficulties 
Emotion issues
Anxiety
Lack of energy 
Sensory issues 
Preoccupation

Question 19

What are the main anxiety disorders?

Answer 19

Separation anxiety - at doorstep

Social phobia - at school gate

Question 20

What are the features of anxiety disorders?

Answer 20

Anxious thoughts and feelings
Autonomic symptoms
Avoidant behaviour

Question 21

What are the motivational factors affecting school attendance?

Answer 21

Bullying
Learning difficulties
Lack of friends 
Lack of attention
Maternal depression

Question 22

What is the neurophysiology of anxiety disorders?

Answer 22

Amygdala activity suppressed by right ventrolateral amygdala when labelling emotions
Reducing connectivity

Question 23

What is the treatment for anxiety disorders in children?

Answer 23

Behavioural - CBT
SSRIs i.e. Fluoxetine
Contain anxiety and return to school ASAP

Question 24

What is an emotional contagion?

Answer 24

Fearful child leads to the same in the parent then the doctor

Question 25

What is the principle of CBT?

Answer 25

Thoughts lead to feelings Feelings lead to behaviour (which effects the environment) Leads to worse thoughts

Question 26

What are the long term benefits of CBT?

Answer 26

Challenge - Success - Self confidence - Resilience

Question 27

What are the long term effects of no behavioural treatment?

Answer 27

Challenge - Avoidance - Low self confidence - Vulnerability

Question 28

What other behavioural therapies are used in children?

Answer 28

Psychoeducation Goal-setting Motivating Externalising

Question 29

What is the prevalence of ASD?

Answer 29

1% M:F 3:1

Question 30

What is the physiology of ASD?

Answer 30

Synaptic protein dysfunction GABA, glutaminergic Brain development

Question 31

What are the distinctive features of ASD?

Answer 31

``` Social: - Reciprocal conversation - Expressing emotional conver - Non-verbal communication Repetitive behaviour: - Mannerisms, obsessions - Inflexible behaviour ```

Question 32

What non-verbal cues are associated with ASD?

Answer 32

Declarative pointing Modulated eye contact Facial expression

Question 33

What are the features of lower IQ ASD?

Answer 33

Decreased Joint attention, Emotional response, movements

Question 34

What are the features of higher IQ ASD?

Answer 34

Increased conversation, empathy, Interests

Question 35

What clinical issues are associated with ASD?

Answer 35

``` Learning disabilities Hyperactivity School avoidance Aggression, temper Self injury and suicide OCD Anxiety ```

Question 36

What are the causes of ASD?

Answer 36

Co-morbid with: Rubella, Callosal agenesis, Down's, Fragile X, Tuberous sclerosis

Question 37

How is ASD managed?

Answer 37

Establish needs, the can't and the won't Decrease the demands Early recognition and acknowledgement

Question 38

What are the features of Oppositional defiant disorder?

Answer 38

``` Refusal to obey adults Argues with adults Loses temper Deliberately annoys people Touchy or easily annoyed Spiteful or vindictive ```

Question 39

How does ODD differ from ADHD?

Answer 39

ODD - temperament, learned behaviour, more likely due to impaired parenting and adversity ADHD - resistant to management, genetic, poor cognitive control and impulsion

Question 40

How are Hard to Manage children managed?

Answer 40

Multi-Systemic Therapy | Parent training

Question 41

What outcome risks are associated with H2M children?

Answer 41

Antisocial behaviour Substance misuse Long-term mental health issues

Question 42

Outline parent training in H2M children?

Answer 42

Structured Based on Social learning theory Focus on positive reinforcement of desired behaviour and developing relationships