105b/106b - Anxiety and Mood Disorders in Children 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
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
Escitalopram
(Both are SSRIs)
What is the only FDA appreved medication for non-OCD anxiety disorders?
How effective is this medication?
Duloxetine
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
(present in clinical depression, but not in demoralization)
A perosn 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 = 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
