What distinguishes child from adult psychiatry?
Age
development and cognitive ability
emotional understanding
willingness to engage
children must be viewed in context of their families
cultural context for children - mismatches between child and carer
presented through services
What may affect when a child presents?
age - dynamic lives, friendships
frequency as referral impacts family
severity and risk
individual characteristics
impact on others
family and social circumstances
Where might child mental health services exist?
health sector - specialist
local authority like schools and communities
voluntary
services often change
What psychological factors may impact a Childs mental health?
attachment between child and carer
emotional understanding
learning
cognitive understanding and reasoning
What are the different types of attachments?
(after r/o ASD, ADHD)
secure - values relationships, confident
insecure avoidant - doesn’t value, independent
insecure anxious - values but sees as unpredictable so strategies to secure attention, confidence depends on praise from others
Insecure ambivalent - values unsure about how secure they are
Disorganised - doesn’t value, not confident in themselves (PD)
What are some social factors that may affect a Childs mental health?
abuse
trauma
sickness
loss
family history
financial
parenting (compromised by abuse, substance misuse, etc)
What is resilience and what may influence it?
ability to adapt that your parents should help build
temperament, IQ, social skills, empathy, humour, parenting
What factors may impact interactions of taking histories from children?
Environmental - privacy, noise, access to toys
child factors - feeling safe, willingness to engage, IQ, communication barriers, emotional development
clinician factors - setting enough time, use of jargon, non-verbal communication, avoid patronising
What factors from a history is more important when assessing children?
PC
developmental Hx
family Hx
social Hx
school
observing child and carers
What are some common MH disorders in children?
GAD
separation anxiety
phonic disorders
OCD
PTSD
depression
How might GAD present in a child?
- free floating anxiety
- fears of death, loss of child or parents
- panic attacks of sudden onset
- somatic nausea, abd pain, sickness, headaches, palpitations, tension
*may be only presentation
How might separation anxiety present in children?
*at threat of separation from attachment figure (mum usually)
- somatic manifestations
- nightmares with separation themes
- refusal to go to school
How might OCD manifest in children?
- obsessions: intrusive persisting, awareness of illogicality, resistance to them (counting, urge to wash, touch wood certain number of times)
- compulsions: related to thoughts
How might PTSD manifest in children?
- persistent re-experiencing
- avoidance of stimuli or numbing of responsiveness
- increased arousal (sleep disturbance, irritable, poor concentration)
How is anxiety disorders treated in children?
- behaviour therapy - systematic desensitisation, flooding, response prevention
- psychotherapies - brief psychodynamic, family and cognitive therapy
- anxiolytics - fluoxetine (licensed for children)
How might mood disorders manifest in children?
*low mood may not be pervasive in depressive illness
- risk to self harm main concern!!
- boys masked by anger
- anhedonia or lower levels of enjoyment
- biological not consistent appetite, sleep patterns
- concentration and motivation usually worse!!
*can be with anxiety
How might depressive disorders be treated?
- CBT
- SSRI fluoxetine
- manage underlying ASD, ADHD
What are the features of behavioural problems?
- parenting often issue
- majority grows out of it but few may persist with significant effects
What is oppositional disorder?
uncooperative, unwilling to comply with requests, frequent temper tantrums
- wilful, defiant, aggressive aggression
- unless manages, tends to escalate!!
What is conduct disorder?
socialised and unsocialised types
- socialised: less serious and phasic
- unsocialised: potentially leads to criminality and later diagnosis of antisocial PD
- lying, stealing, truanting (away from school), violence to people and animals
What are risk factors for conduct disorders?
- lack of clear boundaries, inconsistent parenting
- rejection
- family conflict
- child abuse
- child temperament
- comorbid learning or developmental difficulties
How might you treat conduct disorders?
consistent care and parenting (psychoeducation)
behavioural therapy
school-based interventions
community interventions like groups
How might eating disorders present in children?
v rare in pre-adolescent period
increasing adolescence period
similar to adult presentation
delayed puberty and growth!!
prognosis worse if younger or male
What are some features of psychotic illness seen in kids?
hallucinations
delusions
thought disorder
consider substance misuse!!
rare before puberty, strong family history!!
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The Law16
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Psychosis19
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Personality Disorders16
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Mood disorders29
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Antidepressants17
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Mood Stablisers9
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Antipsychotics21
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Anxiety Disorders32
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Anxiolytics13
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Eating Disorders22
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Autism and ADHD25
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Psychotherapy35
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CAMHS25
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Substance misuse27
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Self harm18
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ECT10
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Peri-natal Psychiatry18
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Medically unexplained symptoms6
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Organic Psychiatry8
