Core symptoms of depression.
- low mood
- anhedonia
- low energy
Lasting for >3 weeks
Symptoms of depression in children and adolescents.
Core symptoms and:
- anxiety
- clinginess
- irritability
- avoiding social situations
- hopelessness
- poor sleep
- poor appetite
- poor concentration
- abdominal pain
Management of depression in children and adolescents.
Referral to CAMHS:
- full assessment to establish diagnosis
- CBT
- fluoxetine first line
- intensive psychological therapy
Admission may be required where there is high risk of self-harm, suicide or self-neglect.
How is anxiety assessed in children and adolescents?
- GAD-7 questionnaire
- assess for comorbid mental health conditions (e.g. depression, OCD)
- assess for environmental triggers and contributors
Management of GAD in children and adolescents.
Referral to CAMHS
- counselling
- cognitive behavioural therapy
- sertraline
Self-help advice for depression and anxiety.
- balanced diet
- increase physical activity
- avoid alcohol, caffeine and drugs
- sleep hygiene
What are obsessions?
Unwanted and uncontrolled thoughts and intrusive images that the person finds very difficult to ignore.
Examples include overwhelming fear of contamination with dirt or germs, or explicit images that keep appearing in their mind.
What are compulsions?
Repetitive actions the person feels they must do, generating anxiety if they are not done. They are often a way for the person to handle the obsessions.
Examples include checking all electrical equipment is turned off to settle the obsession about the house burning down.
Associations of OCD.
Strongly related to other mental health issues:
- anxiety
- depression
- eating disorders
- autistic spectrum disorder
- phobias
Management of OCD in children and adolescents.
Referral to CAMHS:
- patient and carer education
- cognitive behavioural therapy
- exposure response therapy
- SSRI medications
What is autistic spectrum disorder (ASD)?
Disorder characterised by a deficit in:
- social interaction
- communication
- flexible behaviour
The autistic spectrum has a significant range.
Features of ASD (social interaction).
- lack of eye contact
- delay in smiling
- avoids physical contact
- unable to read non-verbal cues
- difficulty establishing friendships
- not displaying a desire to share attention (i.e. not playing with others)
Features are usually observable before the age of 3 years.
Features of ASD (communication).
- delay, absence or regression in language development
- lack of appropriate non-verbal communication (e.g. smiling, eye-contact)
- difficulty with imaginative or imitative behaviour
- repetitive words or phrases
Features are usually observable before the age of 3 years.
Features of ASD (flexible behaviour).
- greater interest in objects, numbers or patterns
- stereotypical repetitive movements (hand-flapping, rocking)
- intensive and deep interests that are persistent and rigid
- repetitive behaviours
- anxiety and distress with experiences outside their normal routine
- restricted food preferences
Features are usually observable before the age of 3 years.
How is ASD diagnosed?
Diagnosis should be made by a specialist in autism:
- paediatric psychiatrist
- paediatrician
A diagnosis can be made before the age of 3 years; involving a detailed history and assessment of the child’s behaviour and communication.
Management of ASD.
Management involving MDT:
- CAMHS
- SALT
- dieticians
- paediatricians
- social workers
- SEND (ie. school)
- charities (e.g. National Autistic Society)
What are the features of ADHD?
Features consistent across various settings:
- short attention span
- quickly moving from one activity to another
- quickly losing interest in a task
- constantly moving or fidgeting
- impulsive behaviour
- disruptive or rule breaking
Management of ADHD.
Biological:
- methylphenidate
- dexamfetamine
- atomoxetine
Psychological:
- SEND support in school
- psychological support
Social:
- parent education
- healthy diet (dietician input)
- exercise
What are the features of anorexia nervosa?
Person feels overweight despite evidence of normal or low body weight.
Involves obsessively restricting calorie intake with the intention of losing weight.
Signs of anorexia nervosa.
- excessive weight loss
- amenorrhoea
- Lanugo hair
- hypokalaemia
- hypotension
- hypothermia
- solitude
Complications of anorexia nervosa.
Cardiac complications:
- arrhythmia
- cardiac atrophy
- sudden cardiac death
Features of Bulimia nervosa.
Normal body weight that fluctuates, due to binge eating followed by ‘purging’ (e.g. vomiting, taking laxatives).
Signs of bulimia nervosa.
- hypochloraemic metabolic alkalosis
- hypokalaemia
- erosion of teeth
- swollen salivary glands
- mouth ulcers
- GOR
- Russel’s sign
Features of binge eating disorder.
Episodes where the personal excessively overeats, but does not purge.
Patients are likely to be overweight.
