CAMHS

Question 1

Genetic risk ADHD

Answer 1

Population risk - 5% children, 2.5% adults

Siblings - 2-3x baseline risk

Question 2

Prevalence of nocturnal eneuresis

Answer 2

15% of 5 year olds
7% of 7 year olds
5% of 10 year olds
2% of 15 year olds

Question 3

CAMHS ADHD (history)

Answer 3

• Clarify HPC (onset, duration, location)
• Hyperactivity (sit still, climbing)
• Inattention (teacher reports, concentration at home, not finishing tasks, forgetful, losing things)
• Impulsiveness (shouting out, interrupting, risky situations)
• Comorbidities (FHx, tics, language, social development, Police, mood)

Question 4

CAMHS ADHD (management)

Answer 4

• Explain diagnosis
• Clarify symptoms
• Explain medication (mechanism, side-effects, monitoring)
• Alternative treatments (environmental change, OT, parenting and teaching strategies)

Question 5

Sibling risk of ADHD

Answer 5

• Twice the risk (baseline risk is 3-5%, so sibling risk is 6-10%)

Question 6

Methylphenidate - side-effects and monitoring

Answer 6

• Baseline ECG, HR, BP, height and weight
• 3 monthly HR/BP, 6 monthly weight/height
• Common: appetite suppression, GI upset, insomnia, headache, tics, BP
• Severe: liver impairment, sudden cardiac death, leucopenia.

Question 7

Conduct disorder (history)

Answer 7

• Clarify HPC (onset, duration)
• Behaviour towards adults (arguments, defy rules, deceitful)
• Behaviour towards others (blame others, fights, cruelty to people/animals)
• Behaviour towards property (destructive, theft, run away, other crimes)
• Risk factors (FHx - psych, forensic, substances; developmental problems; abuse)
• Comorbidity (mood, enjoyment, anxiety, sleep, appetite, ADHD, learning, drug use)

Question 8

CAMHS ASD (history)

Answer 8

• Clarify HPC (onset, duration)
• Explore social interaction (eye contact, affection, friendships, imaginary play)
• Explore social communication (language development, repetitive speech, echolalia, accents, facial expression)
• Restricted/stereotyped behaviour (special interests, routines/rituals, repetitive movements, sensory sensitivity)
• Comorbidities (mood, sleep, appetite, anxiety, ADHD, epilepsy, LD)
• Risk (aggression, self-injury)
• Developmental history (pregnancy, milestones) and FHx

Question 9

CAMHS psychosis (history)

Answer 9

• Clarify HPC (onset, duration)
• Delusional beliefs
• Explore auditory hallucinations (quality, content, number, 2nd/3rd person, commentary, commands, insight)
• Hallucinations in other modalities
• Thought interference and passivity phenomena
• Mood (mood, sleep, appetite, enjoyment)
• PPHx, PMHx, substance use
• Risk (self and others)

Question 10

CAMHS psychosis (d/w consultant)

Answer 10

• Summarise case and formulation
• Differential diagnosis
• Management (drug screen, bloods, medication)
• Alternative treatments (education, CPN, CBT)
• Address concerns
• 35% conversion to SCZ

Question 11

CAMHS sexual abuse (d/w consultant)

Answer 11

• Summarise case and formulation
• Explain need to break confidentiality
• Acute management of presenting issue
• Urgent discussion with either social work or CP cons (who will alert other core agencies and arrange full history/forensic examination etc)
• Other children at risk
• Longer term management (full investigation, counselling, accommodation)

Question 12

CAMHS bullying and overdose (history)

Answer 12

• Explore current suicide attempt (chronology, final acts, intent, current feelings)
• Underlying stressors
• Explore bullying (name-calling, violence, rumours, disclosure)
• Psychiatric comorbidities (mood, enjoyment, sleep, appetite, nightmares/flashbacks, school avoidance)
• Risk (drugs, alcohol, self-harm, ongoing suicidality)

Question 13

CAMHS enuresis (history)

Answer 13

• Clarify HPC (onset, duration)
• Explore enuresis (daytime dryness, bowel problems, parental response)
• Identify stressors (home, school)
• Psychiatric comorbidities (mood, enjoyment, sleep, appetite, nightmares/flashbacks, school avoidance)
• Developmental history (pregnancy/delivery, delay, potty training)
• Medical causes (UTI, PMHx, medications)

Question 14

CAMHS selective mutism (explanation)

Answer 14

• Clarify likely diagnosis and DDx (anxiety, shyness)
• Identify stressors (home, school)
• Developmental history (pregnancy/delivery, delay, PMHx)
• Investigations (physical examination, ed psych Ax, SLT)
• Treatment (Behavioural therapy, SLT, family therapy, art/play therapy)
• Gain consent to share information with school

Question 15

CAMHS self-harm (discussion with student)

Answer 15

• Summarise case
• Explain difference between self-harm and suicide
• Reasons for self-harm
• Explain suicide risk assessment
• Exclude underlying mental disorder (depression, PD)
• Explain management plan (consider admission, safety plan, medication, CBT)