Mental health

llbgurl's version from 2015-09-29 18:55


Question Answer
5% of children, 10-20% adolescentsdepression and suicide
higher incidence in minoritiesdepression and suicide
1:1 children, 1:2 young adult (increased in males)depression and suicide
major mood disorder onset14 years
depresive disorder onset8 years
detection low <20% of casesdepression and suicide
untreated episodeslength 7-9 months
reoccurs 60-70% as an adultdepression and suicide
depression high risk forsubstance abuse, high risk behaviors
precedes substance abuse by 4.5 yearsmajor depressive disorder
over 1/2 have comorbid conditionsdepression and suicide
+ history of depression most teenswho try to commit suicide
must rule OUT bipolardepression and suicide


Question Answer
must meet 5 criteria and must be present during the same 2 week period and represent change from previous functioning majordepressive disorder
depressed or irritablemajor depressive disorder
anhedoniamajor depressive disorder
weight loss or gainmajor depressive disorder
insomnia or hypersomniamajor depressive disorder
psychomotor agitation or retardationmajor depressive disorder
fatigue or energy lossmajor depressive disorder
feelings or worthelessnessmajor depressive disorder
decreased ability to think or concentratemajor depressive disorder
recurrent thoughts of deathmajor depressive disorder
suicidial ideationmajor depressive disorder
depressed mood or irritability for most of the day, for MORE DAYS THAN NOT, by subjective account or observation FOR ONE YEARDysthymic disorder
symptoms less severe than MDD but more peristentdysthymic disorder
2 or more of the following: poor appetite or overating, insomnia/hypersomnia, fatigue, poor concentration/difficult time making decisions, feeling hopeless dysthymic disorder
imbalance serotonin, dopamine, norepinephrine or excess cortisoldepression
school aged child with depressionsad, irritable, impulsive, crying spells, no one likes me, somatic complaints, acting out
often misdiagnosed as ADHDdepression
adolescent with depressionsad, hopeless, self hatred, anger, withdrawn, loss of pleasure, neuro vegetative sx - decrease in sleep/appetite/concentration, drugs, anxiety
united states task force screening ages12-18 years
center for epidemiologic studies in depression scale for childrenCES-DC
PHQ-9patient health questionnaire for adolescents
PMHhypothyroid, anemia, recurrent pain syndromes, school nurse visits, parent response to SSRIs
Lab test for depressionTSH, FT4, CBC with diff, urine tox screen, pregs test
GLAD-PCguidelines for adolescent depression in primary care, US and Canada
mild to moderate depressioncognitive behavior therapy skills building therapy
moderate to severe depressioncognitive behavior rx plus meds SSRI
should be used for 12 months after resolution of symptoms and never stopped abruptlyantidepressents
tricyclic antidpressentsAVOID, cardiac toxicity with overdose
2 week follow up when started onSSRIs
Prozaconly FDA approved med for txing depression in children ages 8 and OVER
Trial of an SSRIat least 8-12 weeks, no improvement cross taper and substitute another SSRI
celexa least activating
Luvox most activating
Start low, go slowantidepressents
Celexa, Prozac, Lexipro 5 mg starting dose
Zoloft 12.5-25 mg
Luvox 25 mg
Agitation and Insomnia Serotonin Syndrome, MUST EDUCATE WHEN STARTING SSRIs
common s/e SSRIs agitation, n/v/d, dizzy, chills
less common s/e SSRIsmuscle twitching, fever, confusion, sweating, seizures, delierium, coma
co-morbidity found frequently with depression anxiety
KySS guide remove drugs/alcohol and weapons
initial symptom is depression 20-40% bipolar disorder
90% or have one manic episode will have one more in life bipolar disorder
only 2.6% kids met critera for bipolar disorder
highest risk of suicide of all psychiatric disorders bipolar disorder
manic episodes preceding or following major depressive episodes bipolar disorder
no known cause for bipolar disorder
parents that are bipolar increase chance of kids that are bipolar
onset of symptoms before age 10 is rare bipolar disorder
high prevelance of ADHD with diagnosis bipolar disorder
severe mood changes, decrease need for sleep, compulsion to talk, attention moving from on thing to next, physically agitated, hypersexual, high risk behaviors, suicidial thought bipolar disorder
Question Answer
DDx: brain tumor, drugs, adhd bipolar disorder
psychiatrist/mental health provider critical in tx bipolar disorder
Tx with lithium alone or valproate anticonvulsants bipolar disorder
risperiode bipolar disorder
may potentiate manic repsonse antidperessent
excessive anxiety, worry or apprehension to generalized number of events anxiety
Behavioral/family interventions, play rx, SSRIs with comorbid social phobia anxiety disorder anxiety
irritable, over concern with competence, stomach complaints, somatic complaints, unexplained faituge and need for reassurance anxiety
more commmon in males 3:1 prior to adolescence but gender difference diappear AFTER adolescents Obsessive compulsive disorder
diagnosis can occur as young as 2 years old Obsessive compulsive disorder
chronic disease Obsessive compulsive disorder
Question Answer
high rates of comorbidity with anxiety, depression and substance abuse Obsessive compulsive disorder
characterized by obessions and compulsions with NO pleasure from rituals Obsessive compulsive disorder
DDx: social phobia, trichotillomania, PDD, body dysmorphia Obsessive compulsive disorder
Mimic OCD sx carbon monoxide posioning, tumors, encephalities, praeder willi syndrome, stimulants, PANDAS
SSRI, therapy and defer if not causing harm or distress to child Obsessive compulsive disorder
repetitive fast unconscious movements or vocalizations Tic disorder
transient 12-24% of childrenTic disorder
chronic longer than 1 year occur in 1-2% kid Tic disorder
starts around age 7 vocal by age 9 Tic disorder
affects 10-15% of kids with affected first degree relative Tic disorder
simple or complex motor tics
blinking, twitching, shrugging of shoulders, tongue thrust, squinting simple tic
vocalization or pushing air through nose or throat = throat clearing vocal tics
obscene gestures and swearing RARE
congintive behavioral therapy disruptive tic treatment
sx that develop after a severe stressful event post traumatic stress disorder
demonstrate 3 behaviors to dx post traumatic stress disorder
avoid reminders or thoughts of trauma, amnesia, detachement from others, emotional construction, diminished interest in normal routine post traumatic stress disorder
Question Answer
2 symptoms of increased arousal post traumatic stress disorder
sleep disturbance, hypervigilance, difficulty concentrating, exaggerated startle response, agitated/disorganized behavior, irritability/anger outburst post traumatic stress disorder
Question Answer
social services, mental health specialist, beta blocker to decrease somatic c/o, SSRIspost traumatic stress disorder
most common diagnosed behavioral problem in child hoood hyperactivity/attention disorders
AAP guidelines now 4-18 years of age hyperactivity/attention disorders
cardinal features: INATTENTION, DISTRACTED, IMPULSIVE, OVERACTIVE hyperactivity/attention disorders
sx occur in 2 or more SETTINGS and sx have persisted more than 6 MONTHS hyperactivity/attention disorders
must meet SIX of NINE criteria at level significantly more than expected for expected age hyperactivity/attention disorders
some symptoms MUST be present before age 7 hyperactivity/attention disorders
ddx:allergies, h/v problems, seizures/absent, brain tumor, high lead levels, thyroid, OSA hyperactivity/attention disorders
must obtain input from both parents and teachers hyperactivity/attention disorders
12-50% have additional psych disorders hyperactivity/attention disorders
speech and language problems hyperactivity/attention disorders
seizures, CNS trauma, neurologic degeneration hyperactivity/attention disorders
biomedical conditions: MR, Fragile X, Tourette syndrome, neurofibromatosis hyperactivity/attention disorders
increase availability of neurotransmitters to increase focus and attention both short and long acting based on preperations psychostimulants
ritilian, concerta, focalin methylphenidate
adderal, vyvanase, dexedrine mixed salts of dextro and levoamphetamines
strattera selective NOREPI reuptake inhibitor
intunivadjunct to other meds for hyperactivity/attention disorders
chronic negative circumstances, harsh discipline/neglect, 1-10% of kids, more common in malesconduct disorder
hitting, kicking, bitting conduct disorder
physical cruelty to animals conduct disorder
physical destruction - FIRE setting conduct disorder
yelling, whinning, threatning conduct disorder
truancy or running away from home conduct disorder
disobedience, lying, cheating conduct disorder
deviant sexual behavior conduct disorder
multifaceted behavior programs with parent involvement, safety, social services, mood stabilizers explosive behaviors conduct disorder
parenting and family dysfunction oppositional defiant disorder
more common in boys than girls BEFORE puberty equal after oppositional defiant disorder
actively defies adults oppositional defiant disorder
argumentative, angry, resentfuloppositional defiant disorder
easily loses temper oppositional defiant disorder
blames others for their mistakes oppositional defiant disorder
deliberately tries to annoy others oppositional defiant disorder
positive parent stratigies, consistent healthy discipline, parent/child training programs oppositional defiant disorder
intent to harm others aggression
males more than females, peaks in adolescence aggression
harsh discipline, maltreatment, seperated from parents, lack of maternal responsiveness, parental rejection aggression
destruction of property aggression
name calling aggression
physical pestering aggression
hitting, bitting, kicking aggression
bad language aggression
aggresive sexual behavior aggression
hostility aggression
therapy, parenting classes/effective discipline, early intervention = IMPERATIVE aggression
tobacco and alcohol first tried substance abuse
30-50% who try smoking will become regular smokers substance abuse
16% of adolescents who try alcohol meet the criteria for dependence
parents abuse, peers use, available drugs, low self esteem/depression, poor relationship parents, low academic performance, external locus of control substance abuse
Question Answer
hyperexcitability, unexplained lethargy substance abuse
close relationship with adult, good progress in school, positive outlook, healthy expectations, self esteem and internal locus of control