103b: Pediatric Depression and Anxiety Disorders

Question 1

What is the most effective treatment for anxiety?

Answer 1

Combination treatment is most effective! (80% response rate)

• SSRI or CBT alone 55-60%
• Placebo <25%

Question 2

What behaviors/characteristics are common of all anxiety disorders?

Answer 2

• Hypervigilance
• Reactivity to novel situations
• Biased interpretation of experiences as threatening
• Avoidance coping
• Catastrophic reactions
• Parental accommodation

Question 3

The age of onset of panic disorder occurs during which stage of development?

a. before puberty
b. after puberty
c. older adolescence and young adulthood
d. middle age

Answer 3

c. older adolescence and young adulthood
* Panic Disorder (16-25 yrs) = attacks of anxiety that result in physical symptoms ® increased HR, pounding heart, hyperventilation, SOB, choking sensation, chest discomfort, abdominal pain, etc

Question 4

What is the course of depressive disorders?

Answer 4

Recurrent; tend to come in episodes

Each episode increases the likelihood of furture episodes

Increased likelihood of developing comorbid disorders (conduct, alcohol use, substance use)

Question 5

Which medications are approved to treat teen depression?

Answer 5

Fluoxetine (Prozac)

Escitalopram

(Both are SSRIs)

Question 6

What is the only FDA appreved medication for non-OCD anxiety disorders?

How effective is this medication?

Answer 6

Duloxetine (SSNRI)

But SSRIs are much more effective and are used off-label for anxiety

Question 7

What are the symptoms of depression?

Answer 7

SIG-E-CAPS

• Sleep disturbance
• Interest (loss of; anhedonia)
• Guilt
• Energy (dereased)
• Concentration (decreased)
• Appetite (decreased)
• Psychomotor activity
• Suicidal ideation

Question 8

What is the role of CBT in the treatment of depression?

Answer 8

Equal to placebo

And combination therapy (CBT + medication) is equal to medication alone

Question 9

What are the treatment goals for depression?

Answer 9

Complete remission of symptoms

• Do as much as possible as early as possilble

Question 10

List some of the phsyical symptoms of anxiety disorders

Answer 10

• Tension headache
• Hyperventilation/shortness of breath
• Lump in throat/fear of gagging, choking, swallowing, vomiting
• Chest pain
• Abdominal pain
• Bowel and bladder urgency
• Tingling at finger tips

Question 11

What symptom can differentiate demoralization and clinical depression?

Answer 11

Anhedonia is present in clinical depression, but not in demoralization

A person who is demoralized but not depressed shows improved affect when thinking about something they enjoy

BUT according to DSM III, any unhappiness with sufficient number of symptoms can qualify as depression

Question 12

The ordering of treatment benefit in the Treatment of Adolescents with Depression Study (TADS) is which one of the following?

1. Combination treatment > medication = cognitive behavioral therapy > placebo
2. Combination treatment > medication > cognitive behavioral therapy > placebo
3. Combination treatment = medication > cognitive behavioral therapy > placebo
4. Combination treatment = medication > cognitive behavioral therapy = placebo

Answer 12

d. Combination treatment = medication > cognitive behavioral therapy alone = placebo

Takeaway: antidepressants are important!!

Question 13

The age of onset of anxiety and depression is associated with which stages development?

a. anxiety before puberty and depression after puberty
b. anxiety and depression both before puberty
c. anxiety and depression after puberty
d. anxiety and depression both after puberty

Answer 13

a. anxiety before puberty and depression after puberty

Question 14

Based on the Child/Adolescent Anxiety Multimodal Study (CAMS) which statement of regarding treatment of anxiety is true?

1. Medication treatment is equivalent to placebo
2. Cognitive behavioral therapy is equivalent to placebo
3. Medication and CBT are equivalent
4. Medication is better than cognitive behavioral treatment
5. Cognitive behavioral therapy is better than medication treatment

Answer 14

c. Medication and CBT are equivalent

Question 15

What are the 3 potential treatment targets for anxiety?

How do we treat each target?

Answer 15

• Anxiety symptoms (anxiety, distress)
  
  • CBT and medication
• Accumulated disability (poor adaptation and coping)
  
  • Life skills training
• Maladaptive behaviors (sucicidal and self-injurious, substance)
  
  • Behavioral treatments

Question 16

What is separation anxiety disorder?

Answer 16

• Separation Anxiety Disorder (0-3 yrs) = excessive concern regarding separation from home or from attachment figures; think that bad things w/ happen to them or to the parent and can’t be alone
  
  • must cause impairment or distress and has to be present for 6 months
  • can be diagnosed over the age of 18

Question 17

What is generalized anxiety disorder?

Answer 17

• Generalized Anxiety Disorder (6-12 yrs) = excessive worry and apprehensiveness about everything; restless, fatigued at end of school day, concentration problems (choking on tests/poor test takers), sleep problems
  
  • are unable to control the worry and w/ have impairment or distress

Question 18

what is Social anxiety disorder?

Answer 18

• Social Anxiety Disorder = fear of social or performance situations; can be specific or generalized

Question 19

what is obsessive compulsive disorder?

Answer 19

• Obsessive Compulsive Disorder = prominent obsessions or compulsions w/ dirt/germs or other contamination, ordering and arranging, checking, or repetitive acts
  
  • must be impairing or time consuming