Which of the following condition is associated with intractable epilepsy, autism-like features and skin lesions in children?
C. Tuberous sclerosis is an autosomal dominant genetic multisystem disorder characterised by widespread hamartomas in the brain, heart, skin, eyes, kidney, lung, and liver. Most features of tuberous sclerosis become evident only in childhood after 3 years of age. The affected genes TSC1 and TSC encode for proteins hamartin and tuberin respectively. Epilepsy is seen in 60–80% tuberous sclerosis cases and is thought to be secondary to changes of GABA receptors in dysplastic neurons, and enhanced excitation via glutamate receptors in cortical hamartomas. The epilepsy is generally of an early onset and is often intractable in severity. Hypomelanotic macules are the most common dermatological manifestation; they are seen in 90–98% of patients with tuberous sclerosis.
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During clinical assessment of temper tantrums in a child the most important initial step is to:
C. Temper tantrums are common in children between the ages of 18 months and 4 years. Tantrum behaviours range from simple crying to dramatic attention-seeking events such as breath holding and head banging in otherwise normal children. Often parents may be reinforcing tantrum behaviour without knowledge and may have an inconsistent approach to discipline and limit setting. Hence the first step in assessment of a family with a child throwing frequent temper tantrums is discovering why parents are not able to set consistent limits.
Controlled evaluations of family therapy in child psychiatric conditions have demonstrated significant beneficial effects for which of the following?
A. The strongest evidence base for using family therapy exists for anorexia nervosa in adolescents. By the end of family therapy sessions more than 50% adolescent girls reach a healthy weight; it is estimated that more than 60% achieve recovery on follow up. Encouraging parents to take an active role is seen as a vital component; not involving the parents in the treatment leads to the worst outcome and may delay recovery considerably. Other conditions with evidence base for the use of systemic family therapy include childhood mood disorders, substance abuse and conduct problems in children.
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Family therapy is indicated in all of the following situations in child psychiatry except:
D. Family therapy considers the symptoms in a child to be expression of family dysfunction. It can be used if such dysfunctions are evident during assessment, or if individual therapy fails or to manage family difficulties arising in the course of other treatments. As in other forms of psychotherapy, no blanket indications and contraindications can be listed for family therapy. But there are some instances in which therapists do not advise the family to undergo therapy. In families where parental marital relationship is breaking down, highly fixed psychopathology that blocks any communication in family sessions and extreme schizoid or paranoid pathology are some of the instances where family therapy does not come as first choice of psychotherapy.
Which of the following scales is used as a screening instrument to identify possible developmental difficulties that need further assessment?
B. Denver developmental screening test can be applied from birth to 6 ½ years to identify delays in personal, language, motor and social development in children. It is purely a screening tool and any children identified to have developmental delays should undergo further assessment. Neale analysis of reading is a specific test of educational attainment (reading accuracy and comprehension). Stanford Binet test measures IQ using norms starting from age 2 to adulthood. Wechsler intelligence scale for children tests IQ for children between ages 6 – 14 years. A preschool and primary school version to test children aged 3 – 7 is also available. British ability scales are tests of intelligence covering varied areas such as speed of processing, spatial imagery, short term memory, perceptual matching and application of knowledge.
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