103b: Pediatric Depression and Anxiety Disorders Flashcards
What is the most effective treatment for anxiety?
Combination treatment is most effective! (80% response rate)
- SSRI or CBT alone 55-60%
- Placebo <25%
What behaviors/characteristics are common of all anxiety disorders?
- Hypervigilance
- Reactivity to novel situations
- Biased interpretation of experiences as threatening
- Avoidance coping
- Catastrophic reactions
- Parental accommodation
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
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
What is the course of depressive disorders?
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)
Which medications are approved to treat teen depression?
Fluoxetine (Prozac)
Escitalopram
(Both are SSRIs)
What is the only FDA appreved medication for non-OCD anxiety disorders?
How effective is this medication?
Duloxetine (SSNRI)
But SSRIs are much more effective and are used off-label for anxiety
What are the symptoms of depression?
SIG-E-CAPS
- Sleep disturbance
- Interest (loss of; anhedonia)
- Guilt
- Energy (dereased)
- Concentration (decreased)
- Appetite (decreased)
- Psychomotor activity
- Suicidal ideation
What is the role of CBT in the treatment of depression?
Equal to placebo
And combination therapy (CBT + medication) is equal to medication alone
What are the treatment goals for depression?
Complete remission of symptoms
- Do as much as possible as early as possilble
List some of the phsyical symptoms of anxiety disorders
- 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
What symptom can differentiate demoralization and clinical depression?
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
The ordering of treatment benefit in the Treatment of Adolescents with Depression Study (TADS) is which one of the following?
- Combination treatment > medication = cognitive behavioral therapy > placebo
- Combination treatment > medication > cognitive behavioral therapy > placebo
- Combination treatment = medication > cognitive behavioral therapy > placebo
- Combination treatment = medication > cognitive behavioral therapy = placebo
d. Combination treatment = medication > cognitive behavioral therapy alone = placebo
Takeaway: antidepressants are important!!
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
a. anxiety before puberty and depression after puberty
Based on the Child/Adolescent Anxiety Multimodal Study (CAMS) which statement of regarding treatment of anxiety is true?
- Medication treatment is equivalent to placebo
- Cognitive behavioral therapy is equivalent to placebo
- Medication and CBT are equivalent
- Medication is better than cognitive behavioral treatment
- Cognitive behavioral therapy is better than medication treatment
c. Medication and CBT are equivalent
What are the 3 potential treatment targets for anxiety?
How do we treat each target?
- 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
What is separation anxiety disorder?
-
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
What is generalized anxiety disorder?
-
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
what is Social anxiety disorder?
- Social Anxiety Disorder = fear of social or performance situations; can be specific or generalized
what is obsessive compulsive disorder?
-
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
