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The principles of child psychiatric disorders are distinct from those of adult disorders.
The principles of child psychiatric disorders are distinct from those of adult disorders.
False
Most childhood disorders emerge from a single cause.
Most childhood disorders emerge from a single cause.
False
The maturation of children psychologically and socially has no impact on their disorders.
The maturation of children psychologically and socially has no impact on their disorders.
False
Only three interacting groups of factors contribute to child psychiatric disorders.
Only three interacting groups of factors contribute to child psychiatric disorders.
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Genetic factors account for the majority of child psychiatric disorders.
Genetic factors account for the majority of child psychiatric disorders.
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Genetic studies have produced no significant findings for child psychiatric disorders.
Genetic studies have produced no significant findings for child psychiatric disorders.
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The heritability of anxiety disorders is around 20%.
The heritability of anxiety disorders is around 20%.
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Thomas et al. conducted a cross-sectional study in New York.
Thomas et al. conducted a cross-sectional study in New York.
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The type and site of epilepsy have a significant impact on the psychological disorder.
The type and site of epilepsy have a significant impact on the psychological disorder.
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The age of onset of seizures has no impact on the child's response to epilepsy.
The age of onset of seizures has no impact on the child's response to epilepsy.
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Life events can only predispose to or provoke a disorder, but not protect against it.
Life events can only predispose to or provoke a disorder, but not protect against it.
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The concept of life events is only useful in adult psychiatry.
The concept of life events is only useful in adult psychiatry.
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Chronic stress has no causal role in the precipitation of psychiatric disorder.
Chronic stress has no causal role in the precipitation of psychiatric disorder.
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Children with conduct disorder have a decreased risk of experiencing negative life events.
Children with conduct disorder have a decreased risk of experiencing negative life events.
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Prolonged separation from or loss of parents has no effect on psychological development in infancy and childhood.
Prolonged separation from or loss of parents has no effect on psychological development in infancy and childhood.
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Bowlby's work suggested that prolonged separation from the mother was a minor cause of juvenile delinquency.
Bowlby's work suggested that prolonged separation from the mother was a minor cause of juvenile delinquency.
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Attachments are formed in the first 6 months of life.
Attachments are formed in the first 6 months of life.
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The Strange Situation Procedure is used to measure attachment in adults.
The Strange Situation Procedure is used to measure attachment in adults.
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Temperamental factors detected before the age of 5 years predisposed to later psychiatric disorder.
Temperamental factors detected before the age of 5 years predisposed to later psychiatric disorder.
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The 'easy children' group was more likely to develop behavioural disorders later in childhood.
The 'easy children' group was more likely to develop behavioural disorders later in childhood.
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Brain disorders are the least important risk factors for psychiatric problems in childhood.
Brain disorders are the least important risk factors for psychiatric problems in childhood.
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The prevalence of psychiatric problems in children with brain disorders is lower than in physically healthy children.
The prevalence of psychiatric problems in children with brain disorders is lower than in physically healthy children.
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The effects of brain lesions are less complex in childhood than in adult life.
The effects of brain lesions are less complex in childhood than in adult life.
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The immature brain is less able to compensate for localized damage than the adult brain.
The immature brain is less able to compensate for localized damage than the adult brain.
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Early brain damage always results in immediate manifestation of a disorder.
Early brain damage always results in immediate manifestation of a disorder.
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The consequences of head injury in childhood are highly specific and localized to one area of the brain.
The consequences of head injury in childhood are highly specific and localized to one area of the brain.
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Intellectual impairment is never a consequence of severe head injury in childhood.
Intellectual impairment is never a consequence of severe head injury in childhood.
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Epilepsy is never a cause of childhood psychiatric disorder.
Epilepsy is never a cause of childhood psychiatric disorder.
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Perinatal mental illness has been shown to have short-term effects on children.
Perinatal mental illness has been shown to have short-term effects on children.
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Children of parents with anxiety disorders have a lower rate of behaviour problems.
Children of parents with anxiety disorders have a lower rate of behaviour problems.
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Paternal depression has been shown to have no effect on the early years of life.
Paternal depression has been shown to have no effect on the early years of life.
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The effects of parental mental health disorders on children are inevitable.
The effects of parental mental health disorders on children are inevitable.
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Mothers who misuse alcohol or drugs have no impact on their children's development.
Mothers who misuse alcohol or drugs have no impact on their children's development.
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Parenting has no impact on the effects of parental depression on children.
Parenting has no impact on the effects of parental depression on children.
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Antenatal depression and anxiety have no association with later childhood disturbances.
Antenatal depression and anxiety have no association with later childhood disturbances.
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The causes of the effects of parental mental health disorders on children are purely environmental.
The causes of the effects of parental mental health disorders on children are purely environmental.
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The response to initial separation is used to measure attachment in children.
The response to initial separation is used to measure attachment in children.
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Securely attached children are more likely to develop externalizing problems.
Securely attached children are more likely to develop externalizing problems.
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The effect of separation on young infants is dependent on a single factor.
The effect of separation on young infants is dependent on a single factor.
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Reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED) are described in DSM-5 as a single disorder.
Reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED) are described in DSM-5 as a single disorder.
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Paternal criminality is a protective factor for psychiatric disorder in childhood.
Paternal criminality is a protective factor for psychiatric disorder in childhood.
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Good parenting is a risk factor for psychiatric disorder in childhood.
Good parenting is a risk factor for psychiatric disorder in childhood.
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Verbal abuse is a protective factor for psychiatric disturbance in children.
Verbal abuse is a protective factor for psychiatric disturbance in children.
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High-quality alternative childcare is associated with increased levels of behavioural problems.
High-quality alternative childcare is associated with increased levels of behavioural problems.
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Exposure to a large amount of alternative care has no correlation with behavioural problems.
Exposure to a large amount of alternative care has no correlation with behavioural problems.
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About 80% of infants are securely attached.
About 80% of infants are securely attached.
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Around 10-15% of children are bullied once or more a week.
Around 10-15% of children are bullied once or more a week.
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Bullies are more likely to be girls than boys.
Bullies are more likely to be girls than boys.
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Victims of bullying have a lower prevalence of agoraphobia and generalized anxiety.
Victims of bullying have a lower prevalence of agoraphobia and generalized anxiety.
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Cyber-bullying is a rare method through which to victimize other peers.
Cyber-bullying is a rare method through which to victimize other peers.
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Good teacher-student relationships are a predictor of the onset of childhood psychiatric disorder.
Good teacher-student relationships are a predictor of the onset of childhood psychiatric disorder.
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Bullies are at a lower risk of young adult psychiatric disorders.
Bullies are at a lower risk of young adult psychiatric disorders.
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Victims of bullying have a lower risk of depression and suicidal ideation.
Victims of bullying have a lower risk of depression and suicidal ideation.
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Social media contact reduces the risk of bullying and victimization.
Social media contact reduces the risk of bullying and victimization.
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The children of divorced parents have more psychological problems than the children of parents who are not divorced, primarily due to the economic difficulties that follow the divorce.
The children of divorced parents have more psychological problems than the children of parents who are not divorced, primarily due to the economic difficulties that follow the divorce.
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Children's psychological problems after parental divorce are generally more severe than those of children who remain in conflictual marriages.
Children's psychological problems after parental divorce are generally more severe than those of children who remain in conflictual marriages.
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The age of the child at the time of parental death has no impact on their response to bereavement.
The age of the child at the time of parental death has no impact on their response to bereavement.
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Parental death is associated with a single negative outcome in children.
Parental death is associated with a single negative outcome in children.
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Children who experience the death of a parent before the age of 5 are more likely to have suicidal thoughts and actions.
Children who experience the death of a parent before the age of 5 are more likely to have suicidal thoughts and actions.
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The effects of parental divorce on children are generally evident within the first year after the divorce.
The effects of parental divorce on children are generally evident within the first year after the divorce.
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The majority of children who experience parental divorce show a decline in their well-being.
The majority of children who experience parental divorce show a decline in their well-being.
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Parental divorce is associated with a single negative outcome among children, but the effect size is small in magnitude.
Parental divorce is associated with a single negative outcome among children, but the effect size is small in magnitude.
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Bereavement may have long-term effects on development, especially if the child was old at the time of the parent's death, and if the death was sudden or violent.
Bereavement may have long-term effects on development, especially if the child was old at the time of the parent's death, and if the death was sudden or violent.
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The importance of the school environment has been recognized in promoting mental health in children, but not in teachers.
The importance of the school environment has been recognized in promoting mental health in children, but not in teachers.
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Rates of childhood psychiatric disorder are lower in areas of social disadvantage.
Rates of childhood psychiatric disorder are lower in areas of social disadvantage.
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Bullying often takes place outside the school context and is prevalent across schools in both high- and low-income countries.
Bullying often takes place outside the school context and is prevalent across schools in both high- and low-income countries.
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The size of the school and the age of its buildings are important factors that affect rates of psychiatric disorder.
The size of the school and the age of its buildings are important factors that affect rates of psychiatric disorder.
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Only victims of bullying are at risk for psychiatric problems in childhood and beyond.
Only victims of bullying are at risk for psychiatric problems in childhood and beyond.
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Olweus's definition of bullying emphasizes unintentional or accidental acts that are carried out repeatedly and over time.
Olweus's definition of bullying emphasizes unintentional or accidental acts that are carried out repeatedly and over time.
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The effects of neighbourhood on childhood psychiatric disorder are only indirect.
The effects of neighbourhood on childhood psychiatric disorder are only indirect.
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Social and cultural factors have a minimal impact on the development of children.
Social and cultural factors have a minimal impact on the development of children.
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In the early years of childhood, social factors act directly on the patterns of family life.
In the early years of childhood, social factors act directly on the patterns of family life.
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When treating an acute episode of schizophrenia, it is recommended to initiate antipsychotic medication at the highest end of the licensed dose range.
When treating an acute episode of schizophrenia, it is recommended to initiate antipsychotic medication at the highest end of the licensed dose range.
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In the maintenance and relapse prevention phase of schizophrenia treatment, it is recommended to withdraw medication abruptly.
In the maintenance and relapse prevention phase of schizophrenia treatment, it is recommended to withdraw medication abruptly.
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In the treatment of schizophrenia, psychological interventions are only necessary during the acute episode.
In the treatment of schizophrenia, psychological interventions are only necessary during the acute episode.
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Depot formulations of antipsychotic medication are not recommended for patients with adherence issues.
Depot formulations of antipsychotic medication are not recommended for patients with adherence issues.
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In the treatment of schizophrenia, sedation is usually achieved through increasing the dose of antipsychotic medication.
In the treatment of schizophrenia, sedation is usually achieved through increasing the dose of antipsychotic medication.
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The choice of antipsychotic medication is based solely on the patient's medical history.
The choice of antipsychotic medication is based solely on the patient's medical history.
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Study Notes
Causes of Child Psychiatric Disorders
- Most childhood disorders emerge from a complex interaction between neurodevelopmental vulnerabilities and environmental factors
- Four interacting groups of factors contribute to the development of psychiatric disorders in children:
- Heredity
- Temperament
- Physical impairment (especially brain damage)
- Environmental factors in the family and society
Genetic Factors
- Children with psychiatric problems often have parents who suffer from a psychiatric disorder
- Genetic factors account for a significant part of this association (around 40% heritability)
- Population-based twin studies indicate a significant genetic contribution to some psychiatric disorders, especially ASD, hyperactivity, and anxiety disorders
Temperament and Individual Differences
- Temperamental differences in early childhood can predispose to later psychiatric disorder
- Two groups of children:
- "Difficult children" who respond to new stimuli with withdrawal, slow adaptation, and intense behavioral response
- "Easy children" who respond to new stimuli with a positive approach, rapid adaptation, and a mild behavioral response
- Later studies confirm an association between temperamental styles and subsequent childhood psychopathology
Brain Disorders
- Brain disorders, such as traumatic injury, epilepsy, infections, tumors, neurodegenerative conditions, are important risk factors for psychiatric disorder
- The prevalence of psychiatric problems is higher in children with brain disorders (around 34%)
- Children with brain injury are more likely to develop psychiatric disorder if they encounter adverse psychosocial influences
- The effects of brain lesions are more complex in childhood due to the brain's developmental stage
Environmental Factors
- Life events, such as separation, divorce, or the death of a parent, can predispose to psychiatric disorder
- The psychological impact of life events is influenced by factors such as temperament, cognitive style, and previous life experience
- Chronic stress, poverty, and discrimination can also contribute to the development of psychiatric disorder
Family Influences
- A stable and secure family background with emotional warmth, acceptance, and constructive discipline is essential for healthy psychological development
- Prolonged separation from or loss of parents can have a profound effect on psychological development in infancy and childhood
- Poor relationships in the family, including overt conflict between parents, can have adverse effects on children
- Maternal deprivation and attachment: Bowlby's work on attachment suggests that internal models of self, others, and relationships are formed in early childhood and persist through life
Attachment
- Attachments are formed in the second 6 months of life
- Secure attachment is associated with healthy psychological development and is characterized by an appropriate balance between security and exploration
- Insecure attachments (avoidant, disorganized, resistant-ambivalent) are associated with increased risk of psychiatric disorder
- Attachment styles tend to be stable across childhood and adolescence
Family Risk Factors
- Multiple risk factors, including severe marital conflict, low social status, paternal criminality, and parental psychiatric disorder, increase the risk of psychiatric disorder in children
- Placement in care away from the family also increases the risk of psychiatric disorder
Protective Factors
- Good parenting, strong affectionate ties within the family, sociability, and the capacity for problem-solving in the child reduce the risk of psychiatric disorder
- Support outside the family from individuals, school, or church can also be protective
Effects of Parental Separation
- Children of divorced parents have more psychological problems than those whose parents are not divorced.
- Two main effects of childhood parental separation: economic difficulties and exposure to interpersonal conflict.
- Distress and dysfunction in children are greatest in the year after the divorce, but diminish after 2 years.
- Parental divorce is associated with multiple negative outcomes among children, although effect sizes are small in magnitude.
Effects of Death of a Parent
- Children's response to parental death varies with age.
- Children under 4-5 years old react with despair, anxiety, and regression to separation.
- Children aged 5-11 years become depressed and overactive, and may show disorders of conduct.
- Children over 11 years old respond similarly to adults.
- Bereavement may have long-term effects on development, especially if the child was young at the time of the parent's death.
Social and Cultural Factors
- Family has the most effect on children's development, but wider social influences are also important.
- Rates of childhood psychiatric disorder are higher in areas of social disadvantage.
- Important features of inner-city life include lack of play space, inadequate social amenities, exposure to violence, overcrowded living conditions, and lack of community involvement.
Effects of School
- Schools can play a crucial role in promoting mental health in children and teachers.
- Rates of child psychiatric referral and delinquency vary between schools.
- Factors that don't affect rates of psychiatric disorder include the size of the school and the age of its buildings.
Bullying and Teacher-Pupil Relationships
- Bullying often takes place within the school context and is prevalent across schools.
- Both bullies and victims of bullying are at risk for psychiatric problems in childhood and beyond.
- Being involved in bullying can result in serious long-term consequences and adjustment problems.
- Around 2-8% of children are bullied once or more a week.
- Victims of bullying are at a higher risk of emotional problems, disruptive behaviors, and psychiatric disorders.
Acute Episode of Schizophrenia
- Initiate antipsychotic medication at the lower end of the licensed dose range
- Avoid using loading doses (‘rapid neuroleptization’)
- Use adjunctive benzodiazepines if sedation is needed
- Choose the drug based on patient preference, effects of previous treatments, and relative liability of the drug to cause serious side effects (especially extrapyramidal and metabolic syndromes)
- Titrate the dose within the licensed range, monitoring for effects and side effects
- Aim to achieve the optimum dose with good adherence for 2 weeks
- If no response at that time, consider changing the drug
- Record the indications for medication, the anticipated benefits and time course, and discussions with the patient and carers
- Consider psychological interventions whenever medication is being introduced or changed
Maintenance and Relapse Prevention
- Continue medication for a year, or longer, using the same principles as for the acute episode
- Ensure that the dose, duration, and adherence are adequate before switching drug
- Withdrawal of the drug should be gradual, and the mental state should be monitored
- Continuous treatment is more effective than intermittent treatment
- Monitor adherence regularly
- Monitor for side effects, including metabolic syndrome, regularly
- Consider depot formulations, especially if adherence is a problem
- Always consider psychological interventions together with pharmacological options
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Description
Understanding the causes of child psychiatric disorders, including the interaction between neurodevelopmental vulnerabilities and environmental factors, as well as developmental aspects.
