Psych

Question 1

What is ADHD?

Answer 1

Condition incorporating features relating to inattention and/or hyperactivity/impulsivity that are persistent

Question 2

What are the sub-types of symptoms for ADHD?

Answer 2

Inattention

Hyperactivity/impulsivity

Question 3

When are most children diagnosed with ADHD?

Answer 3

Between 3 and 7

Question 4

What are the symptoms of ADHD?

Answer 4

Inattention
Fail to pay close attention to details or make careless mistakes in schoolwork
Have trouble staying focused in tasks or play
Appear not to listen, even when spoken to directly

Hyperactivity and impulsivity
Fidget with or tap his or her hands or feet, or squirm in the seat
Have difficulty staying seated in the classroom or in other situations
Be on the go, in constant motion
Run around or climb in situations when it’s not appropriate

Question 5

How do you diagnose ADHD?

Answer 5

Medical exam

ADHD criteria from the Diagnostic and Statistical Manual of Mental Disorders DSM-5, published by the American Psychiatric Association

ADHD rating scales to help collect and evaluate information about your child

Question 6

What is the treatment for ADHD?

Answer 6

Methylphenidates (blocks reuptake of dopamine)
Methylphenidate

Amphetamines (Increase release of dopamine)
Lisdexamfetamine
Dextroamphetamine

Question 7

What are the side effects of methylphenidate?

Answer 7

1. Abdominal pain
2. Nausea
3. Dyspepsia
4. In children, weight and height should be monitored every 6 months

Question 8

What should you do before starting a child on ADHD medication?

Answer 8

Baseline ECG

Question 9

What is autism spectrum disorder?

Answer 9

Autism spectrum disorder is a condition related to brain development that impacts how a person perceives and socializes with others, causing problems in social interaction and communication

Question 10

What 4 seperate disorders does autism spectrum disorder include?

Answer 10

1. Autistic disorder (autism)
2. Asperger’s disorder
3. Childhood disintegrative disorder
4. Pervasive developmental disorder not otherwise specified

Question 11

What is the epidemology of autism spectrum disorder?

Answer 11

ASD is three to four times more common in boys than girls.

Around 50% of children with ASD have an intellectual disability

Question 12

What conditions are associated with autism?

Answer 12

1. Fragile X syndrome
2. ADHD
3. Down’s syndrome
4. Muscular dystrophy
5. Neurofibromatosis
6. Tuberous sclerosis

Question 13

What are the symptoms of autism?

Answer 13

Impaired social communication and interaction

Repetitive behaviours, interests, and activities

ASD is often associated with intellectual impairment or language impairment.

Attention deficit hyperactivity disorder (35%) and epilepsy (18%) are also commonly seen in children with ASD.

ASD is also associated with a higher head circumference to the brain volume ratio.

Question 14

When does autism typically develop?

Answer 14

Before the age of 3

Question 15

How do you diagnose autism?

Answer 15

1. Consider assessment for possible autism when a person has: one or more of the following:
   
   • Persistent difficulties in social interaction
   • Persistent difficulties in social communication
   • Stereotypic (rigid and repetitive) behaviours, resistance to change or restricted interests, and
2. One or more of the following:
   
   • Problems in obtaining or sustaining employment or education
   • Difficulties in initiating or sustaining social relationships
   • Previous or current contact with mental health or learning disability services
   • A history of a neurodevelopmental condition (including learning disabilities and attention deficit hyperactivity disorder) or mental disorder

Question 16

What is the treatment for autism?

Answer 16

1. Educational and behavioural management
   
   • Applied behavioural analysis
   • ASD preschool program
2. Medical therapy
   
   • SSRIs - reduce repepative disorder
   • Antipsychotics - reduce agression
3. Family counselling

Question 17

What are the signs of annorexia nervosa?

Answer 17

Reduced body mass index

Bradycardia

Hypotension

Enlarged salivary glands

Lanugo hair

Question 18

What are the ions in annorexia nervosa?

Answer 18

Hypokalaemia

Low FSH, LH, oestrogens and testosterone

Raised cortisol and growth hormone

Impaired glucose tolerance

Hypercholesterolaemia

Hypercarotinaemia

Low T3

Question 19

How do you diagnose anorexia nervosa?

Answer 19

1. Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.
2. Intense fear of gaining weight or becoming fat, even though underweight.
3. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.

Question 20

What is the treatment for anorexia nervosa?

Answer 20

• *For adults with anorexia nervosa, NICE recommend we consider one of:**
• individual eating-disorder-focused cognitive behavioural therapy (CBT-ED)
• Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)
• specialist supportive clinical management (SSCM).
• *In children and young people, NICE recommend**
• ‘Anorexia focused family therapy’ as the first-line treatment.
• Cognitive behavioural therapy.

Question 21

What is bulimia nervosa?

Answer 21

Bulimia nervosa is a type of eating disorder characterised by episodes of binge eating followed by intentional vomiting or other purgative behaviours such as the use of laxatives or diuretics or exercising

Question 22

What is the DSM 5 diagnostic criteria for bulimia nervosa?

Answer 22

Recurrent episodes of binge eating

A sense of lack of control over eating during the episode

Recurrent inappropriate compensatory behaviour in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise.

The binge eating and compensatory behaviours both occur, on average, at least once a week for three months.

Self-evaluation is unduly influenced by body shape and weight.

The disturbance does not occur exclusively during episodes of anorexia nervosa.

Question 23

What is the management for builima nervosa?

Answer 23

Referral for specialist care is appropriate in all cases

1. Guided self-help for adults

If bulimia-nervosa-focused guided self-help is unacceptable after 4 weeks of treatment

1. Individual eating-disorder-focused cognitive behavioural therapy (CBT-ED)
2. Children should be offered bulimia-nervosa-focused family therapy (FT-BN)

Pharmacological treatments

1. Have a limited role - a trial of high-dose fluoxetine is currently licensed for bulimia but long-term data is lacking