MRCPsych CASC: Assessment of School Refusal This MRCPsych CASC Sample Case assesses a child's refusal to attend school. It is important to consider several key factors when evaluating the situation. First, it is crucial to determine the age of the child and whether they desired to attend the scheduled appointment. It is also important to determine who is currently responsible for their care and if they have any connections to CAMHS (Child and Adolescent Mental Health Services) or social services. The duration of the child's refusal to attend school should also be considered, as well as the different perspectives on the cause of the refusal from the child, their parents, and the school. It is important to determine if the child is refusing other situations. If the child is exhibiting signs of separation anxiety, it is important to note that they may have worries about the safety of their caregiver and follow them closely in all situations. It is also important to assess the pote...

Preferred Choices for the Treatment of Bipolar Depression in Children The Maudsley Prescribing Guidelines in Psychiatry, 14th Edition, enlists lurasidone, olanzapine and quetiapine as the preferred choices of treatment for bipolar depression in Children. Mnemonic: LOQ Lurasidone  Olanzapine Quetiapine  See the Maudsley Prescribing Guidelines in Psychiatry for further details. 

Fragile X Syndrome Fragile x syndrome is characterised by large ears, velvety skin, flat feet, testicular enlargement after puberty, speech “cluttered” attentional deficit, hand flapping. Autistic traits. CGG repeats over two hundred. Support –MDT. Speech and language, physio, psychological techniques for teachers/parents, look at educational needs. family support –carers' assessment. Genetic Aberration A mutation on the X chromosome at the Xq27.3 site.  Fragile-X mental retardation -1 Gene FMR1 is a human gene that codes for a protein called Fragile-X mental retardation protein (FMRP) that may help regulate synaptic plasticity, important for learning and memory.  Prevalence 1 of every 1,000 males 1 of every 2,000 females Intellectual disability Mild to severe. Eighty per cent of boys with fragile X syndrome have an intelligence quotient lower than 80. Co-morbidities Attention deficit hyperactivity, learning disorders, autism spectrum disorders Physical Features long face, lon...

Staccato Speech Staccato speech is because of incoordination of larynx muscle of articulation. In this, each the patient utters each syllable separately, thus speaking in fragments of sentences. Pauses punctuate these sentences, which interrupt and destroying the flow of speech. Such speech is abrupt, broken, and usually quite hard to follow for extended periods, and may make the speaker look confused or focused on something else.  Scanning Speech Versus Staccato Speech In cerebellar dysarthria, the patient speaks slowly and deliberately, syllable by syllable, as if scanning a line of poetry, and it loses the normal prosodic rhythm, and we call it a scanning speech. Staccato speech is similar and has an explosive character & slurring of consonants.   Cause of Staccato speech Cerebellar lesions in multiple sclerosis produce staccato speech.

Child Psychiatry MCQ for MRCPsych Paper B A 7-year-old child came with his mother to your Outpatient clinic for assessment because of ongoing difficulties for the past 1 year. The mother shared that the child is always on the go and cannot sit still. Recently, he nearly had an accident when he dashed across the traffic junction. The school report card mentions he is inattentive most of the time. What psychometric tool will you apply in this case? CY-BOCS CONNORS ADOS DISCO CDI

The non-evidence-based treatments for Autism Spectrum disorders What are some non-evidence-based treatments for children with autism spectrum disorders? The following is a list of non-evidence-based treatments for autism spectrum disorders that are in common use.   Facilitated communication (not recommended) Holding therapy (not recommended) Sensory integration therapy,  Gluten-free/ casein-free diet,  Auditory integration training,  Chelation treatment,  Hyperbaric oxygen therapy,  Alternative biomedical treatments

The discrete trial format: It is one to one, Short and clear instructions, Planned, uses prompting and prompt fading, reinforcement.

The 1970s psychoanalytic approach: Applied Behavior Analysis (ABA), based on operant-conditioning, target behaviors (excess of unwanted and or deficits of wanted) are modified with reinforcement approximations ( shaping ). Applied behavior analysis, also called behavioral engineering, applying empirical approaches based upon the principles of respondent and operant conditioning to change behavior of social significance. It is the applied form of behavior analysis; the other two forms are radical behaviorism and the experimental analysis of behavior. (Wikipedia)

Holding therapy (Tinbergen 1983): A failure to bond Parent holds child to cause the autistic defense to crumble. Humanistic play therapy (Axline 1965): Encouraged the expression of feelings through play and unconditional positive regard. OPTIONS (Kaufman 1976) Parents spent every waking hour with child follow child lead

Physical illness (most common)  Anxiety and depression  Deliberately kept home by parents  Truancy Miserable conditions at school e.g. Bullying