Adolescent Depression & Suicide - Allen Flashcards
By what percent have suicide rates risen over the last 50 years?
60%
(most strikingly in the developing world)
World Health Organization projects that depression will be the second most prevalent medical condition in the world by what year?
2020
(that’s only 5 years away, yikes!)
The Centers for Disease Control and Prevention reported that the rate of antidepressant use in the United States rose between 1988 and 2008 by what percent?
400%
For Americans ages 12 and over, how many are on antidepressant medication?
1 in 10
Women are how many times more likely to use an antidepressant than men?
2.5x
What percent of females and males with severe depressive symptoms take antidepressant medication.
40% of females
20% of males
What is the prevalence of mental health disorder diagnoses in Minnesota?
- 1 in 10 people on MN health plans have been diagnosed with a mental health disorder
- including 1 in 10 children/adolescents
In MN, what percent of psychiatric medications are prescribed by primary care?
>80%
What is the rate of suicide in the US?
12 per 100,000
Suicide is the 2nd leading cause of death under age 18.
What group is most at risk of suicide in the US?
white male over age 85
What group of adolescent/youth is at most risk of suicide?
American Indian youth ages 15-24
What four major mood disorders have increased risk of suicide?
- Major Depressive Disorder
- Persistent Depressive Disorder
- Bipolar 1 & 2 Disorder
- Disruptive Mood Deregulation Disorder
What are two key features of Major Depressive Disorder required for diagnosis?
- Persistent sadness (depressed mood)–in children or adolescents=irritable mood
- Loss of interest in activities once enjoyed
What is the main feature of Persistent Depressive Disorder required for diagnosis?
- Dysthymia
- Depressed mood for at least 2 years
- 1 year in children and adolescents
What are the main features of Bipolar Disorder required for diagnosis?
- Major depressive episode plus severe changes in mood to either extreme irritability, or overly silly and elated
- 1 → mania 7 days
- 2 → hypomania 4 days
What are the critera for Disruptive mood dysregulation 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
- Criteria A-D present 12+ months
- Criteria A & D present in 2 settings of 3: home, school, peers
- Restricted to age 6-18
Why did DSM-5 add Disruptive mood dysregulation disorder?
- Distinguishes children with milder mood dysregulation from childhood-onset bipolar disorder
- Intent is to reduce number of prescriptions such as lithium
- Less than 1% of diagnosed bipolar children develop bipolar disorder in adulthood
- more likely to develop unipolar depression or anxiety disorders as adults
Which is a core symptom of major depression necessary for the diagnosis?
a. Loss of interest in activities once enjoyed
b. Significant change in appetite or body weight
c. Difficulty sleeping or oversleeping
d. Psychomotor agitation or retardation
A
Hormonal changes around age 14 cause increase the chance of developing depression in girls by how much?
2x
What percent of adolescents ages 9-17 meet criteria for major depression?
5%
What comorbidities does depression often co-occur with?
ADHD
Conduct disorder
Delinquency
Drug/alcohol
Anxiety
Eating disorder
What three screening tools are helpful in the assessment of adolescent depression?
- PHQ-9
- Beck Depression Inventory
- Children’s Depression Inventory
What is the overall trend for depression in MN over the last 10 years?
Rates have decreased
What are key clinical decision points for depression in adolescents?
Is this depression:
- Caused by a medical condition or a medication?
- A reaction to a stressful life event?
- A depressive variant (e.g., bipolar, SAD, atypical)?
- Co-occurring with another mental disorder?
- Co-occurring with drug and alcohol use?
- Accompanied by suicide risk?
What are the key pharmacology practice recommendations for depression in adolescents?
- SSRIs should be reserved for moderate to severe depression
- fluoxetine (Prozac), citalopram (Celexa), and sertraline (Zoloft)
- Tricyclic antidepressants are contraindicated
- lack of proven efficacy
- potential risk of cardiac arrhythmia
- Antidepressant treatment should be maintained for 1 year
- Adolescents on ADD/ADHD medications should be monitored closely
What are the three goals of cognitive behavioral therapy that have been proven effective in the treatment of depression in adolescents?
Challenge maladaptive beliefs
Enhance problem-solving abilities
Increase social competence
Which of the following is a research based conclusion about treatment for adolescents with depression?
A. Combined treatment accelerates benefits of treatment
B. Treating patients longer makes only modest differences in overall benefit.
C. Adding CBT to medication has little benefit
D. SSRIs should never be prescribed given their potential to elevate suicide risk
A
What are some predisposing factors of adolescent suicide?
Previous suicide attempt
Psychiatric disorder
Sexual/physical abuse
Exposure to violent behavior
Family history of suicide or mood disorder
Gender male
Gay or Lesbian sexual orientation
What are four precipitating factors of adolescent suicide?
Substance abuse
Prior suicide attempt
Access to firearms
Social/Emotional Stress (eg., conflict with friends/family/law, despair, hopelessness)
You are treating a 17-year-old boy. Which of the following combinations of factors should immediately raise a red flag for both the potential to commit suicide and access to means?
A. The boy had a previous suicide attempt and has a family history of mood disorders
B. The boy has a history of physical abuse, a family history of suicide, and his father is a gun collector
C. The boy admits to smoking marijuana and likes to drive fast
D. The boy exhibits anxiety and talks about feeling hopeless and purposeless
A?
How should clinicians conduct themselves when interviewing suicidal adolescants?
- Ask about suicidal thoughts; be direct
- Be available & interested
- Listen
- Be non-judgmental; don’t argue
- Don’t act shocked
- Don’t offer glib reassurances, e.g. “Things will work out fine”, “You have your whole life ahead of you”
- Don’t be sworn to secrecy
- Take action; remove means, establish a safety contract
- Barrier between firearms and alcohol
- Enlist help
What are ten behavior patterns that clinicians should closely monitor for when there is concern for suicidality?
- Talking or in any other way communicating about a willingness to die or kill oneself;
- Increased substance abuse;
- Expressing a sense of purposelessness;
- Showing signs of anxiety, including agitation and changes in sleep patterns;
- Expressing feelings of being trapped in various personal situations;
- Expressing feelings of hopelessness;
- Withdrawing from social activities with friends and family;
- Showing unusual signs of anger;
- Engaging in reckless behavior;
- Exhibiting signs of mood changes
