Adolescent depression and suicide

Question 1

Burden of Disease for suicide?

Answer 1

risen 60% in past 50 years

- in 2020 it will be the 2nd most prevalent medical condition in the world

Question 2

Anti-depressant meds stats?

Answer 2

Females 2.5 times more likely to be on them

• except ages 12-17
• 23% of women 40-59 are on them
• non-hispanic white are more likely to be on them

Question 3

Burden of suicide in US?

Answer 3

2nd leading cause of death of plp under 18

- 12/100,000 in US

Question 4

Who is most at risk for suicide?

Answer 4

White males over the age of 85.

-most at risk American Indian group are youth

Question 5

What are the 4 major DSM5 mood disorders for children and adolescents?

Answer 5

• MDD
• Persistent Depressive disorder
• Bipolar 1 and 2
• Disruptive mood deregulation disorder

Question 6

What is a manic episode?

Answer 6

Abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently elevated activity or energy lasting at least 1 week.

Question 7

What are the DX criteria for mania?

Answer 7

At least 3 of the following: (DIG FAST)

1. Distractibility
2. Irresponsibility (seeks pleasure without regard to consequences
3. Grandiosity- inflated self-esteem
4. Flight of ideas- racing thoughts
5. increased goal-directed Activity/psychomotor agitation
6. decreased need for SLEEP
7. Talkativeness or pressure speech

Question 8

What is a hypomanic episode?

Answer 8

Like mania but mood disturbance is not severe enough to cause marked impairment in social and or occupational functioning or to be hospitalized.

• no psychotic features
• Lasts at least 4 consecutive days

Question 9

What is bipolar 1 disorder?

Answer 9

Presence of 1 mani episode +/- hypomania or depressive episode

Question 10

What is Bipolar 2 disorder?

Answer 10

presence of hypomania and a depressive episode.

Question 11

What is cyclothymic disorder?

Answer 11

Milder form of bipolar disorder lasting at least 2 years, fluctuating between mild depressive and hypomanic symptoms

Question 12

What is disruptive mood dysregulation disorder?

Answer 12

is the middle ground between mood dysregulation and childhood onset Bipolar disorder
- onset must be before 10
- A. Severe recurrent temper outbursts-verbal or physical–out of proportion to situation
B. Temper outbursts inconsistent with developmental age
C. Temper outbursts on average 3+ times week
D. Mood between outbursts persistently irritable or angry

Question 13

What are some adolescent depression comobidities?

Answer 13

ADHD
CD
delinquency
Dr/ETOH
anxiety 
eating disorder

Question 14

What are some assessments to screen for adolescent depression?

Answer 14

• PHQ-9
• Beck Depression inventory
• Children’s depression inventory
• Clinical interview

Question 15

What pharmocologically can we give to adolescents for depression?

Answer 15

SSRI’s

1. fluoxetine (Prozac)
2. citalopram (Celexa)
3. sertraline (Zoloft)
   - TCA’s are contraindicated
   - keep on SSRI’s for a year
   - monitor pts on SSRI’s and ADHD meds

Question 16

What are the 3 main goals of CBT?

Answer 16

• Challenge maladaptive beliefs
• enhance problem solving abilities
• increase social competence

Question 17

FDA findings on kids with antidepressants?

Answer 17

4% became suicidal compared to 2%

• most common after starting meds or after dose increase
• prozac lowest with Effexor highest risk

Question 18

Adverse affects of SSRI’s?

Answer 18

Restlessness
dizziness 
drowsiness
GI distress 
Headache 
tremor 
- SIAHD, anorgasmia and decreased libido)

Question 19

What is SIAHD?

Answer 19

Syndrome of inappropriate Antidiuretic hormone secretion

- increased blood volume and hyponatremia