Adolescent Group Flashcards
Updated 05/04/2024
Along with a DSM-5 Diagnosis, what other characteristics of the diagnosis should be included in reports ?
Factors Impacting Mental Health Management
- Severity of disability (functioning)
- Patient’s Ages (Developmental and Chronologic)
- Family’s Means to engage in therapies ($$$, work schedule, communication disorders, languages)
- Relevant Family Co-morbidities
- Relevant Patient Co-morbidities
ADOLESCENT PATIENT
=
DO A HEADSS
SERIOUSLY !
NEVER FORGET HEADSS
What psychosocial and medical issues are Adolescent Mothers more at risk of developing/having?
- Psychological, Physical and Sexual abuse
- Repeated pregnancies
- Low self-esteem
- Anxiety, mood, substance abuse and personality disorders
What are the fetus/newborn(s) of adolescent mothers at risk for, versus the general population?
- Prenatal Death
- Prematurity
- Low Birth Weight and IUGR
- Substance use associated disorders (e.g. FAS, nicotine withdrawal, SSRI withdrawal)
What are the children of adolescent mothers at risk for, versus the general population?
- Growth Delays
- Mood, Anxiety, Personality disorders
- Developmental delays
- Learning disorders
TRUE or FALSE
Regarding adolescent pregnancy, Paternal Involvement is associated with improved outcomes for both the Mother and Child (including those with a history of abuse)
TRUE
Studies have shown that the father being involved with the child’s life in any way is associated with improved psychiatric and health outcomes for both the Mother and Child.
Describe the Medical Home Model
The medical home is a “one-stop-shop” for the patient’s needs
- Accessible and developmentally appropriate
- Comprehensive and coordinated
- Family centered and culturally sensitive
- Compassionate
- Continuous
*Think Cancer Clinic at the KGH
What are the pediatrician’s general goals of care for an adolescent pregnancy?
- Refer to Pediatric Obstetrics Service (technically are ‘high risk’)
- Routine Antenatal care
- Routine Postpartum care
- Access to contraception (Approach this antenatally)
- Specific psychosocial screening (i.e. do a HEADSS)
What birth controls options involve
systemic hormone exposures?
- Oral Contraception
- Nuvaring
- Transdermal Patch
- IM Injection (Depo-provera)
- SubQ infusion device (not in Canada)
[Essentially everything EXCEPT for the IUD, diaphragm and Condoms]
What are the absolute contraindications for systemic hormonal birth control?
- Migraine with aura (progestin-only are ok)
- Clotting disorders or previous un-provoked clots NYD
- Coronary artery disease/cerebro-vascular disease
- Pregnancy
- Personal/Family history of hormone dependant cancers \
(i.e. gynecological, breast and liver)
TRUE or FALSE
Contraception induced amenorrhea is pathologic, and can cause long term issues?
i.e. you SHOULD have a period to be healthy
FALSE
Menses are not required for healthy functioning, and their scheduled released with contraceptive methods is a habitual notion, not a required physiologic one.
TRUE or FALSE
Systemic contraceptive methods cause weight gain
FALSE
- The weight gain observed by birth control is secondary to progesterone induced mild hyperphagia.
- Education on this phenomenon can encourage compliance and prevent unhealthy weight gain.
Give your step wise approach to initiating birth control
The CPS’ systematic Birth Control Initiation
- Ask about current knowledge and educate +/- of each birth control modality
- Detailed History for hematologic, neurologic, vascular, cancer disorders and complete a full HEADSS.
- Physical examination; birth control Initiation is NOT an indication for a pelvic exam. Blood pressure is a must.
- Encourage STI screening
- Pregnancy screen
- Condoms for 14 days after initiation is mandatory to prevent unwanted pregnancy, encourage routine condom use for STIs and optimised birth control.
- Prescribe annually to encourage compliance - this has been statistically shown to prevent unwanted pregnancy.
EPI BULLET
just one
30 % of adolescent females that do not want to get pregnant, also do not use contraception
What are the failure rates for the following modalities
- IUD
- OCP
- Nuvoring
- Transdermal Hormone Patch
- Depoprovera
- Condom/Diaphragm
in pregnancy prevention?
- IUD 0.2 - 0.8 % (local hormone)
- Depoprovera 6 % (systemic hormone)
- OCP 9 % (systemic hormone)
- Nuvoring 9 % (systemic hormone)
- Transdermal Hormone Patch 9 % (systemic hormone)
- Condom 18 % (barrier)
- Diaphragm 12 % (barrier)
Best results are any local/systemic hormone WITH condoms (synergistic impact on failure rates)
What evidence based positive effects are associated with recreational Cannabis use?
None
“While claims regarding the potential effectiveness of medical cannabis in children are widespread, few placebo-controlled clinical trials beyond those focused on DRE have included children[14] or yielded results to support such claims.”
https://cps.ca/en/documents/position/medical-cannabis-for-children-evidence-and-recommendations
What 4 physiologic changes have been observed on brain MRI/fMRI in the context of chronic cannabis use?
(when compared to controls)
- Decreased brain volumes
- Changes in folding patterns
- Decreased white matter
- Decreasing functional efficiency
What is the proposed molecular mechanism for THC-associated developmental changes?
- Growing neurons are exposed to excessive stimulation of the THC-receptors, prompting abnormal concentrations of dopamine/serotonin/norepinephrine.
- This results in an abnormal environment for neurons to grow appropriately, so the neurons are dysmorphic/not-optimized in the end.
- Since brain growth speed is inversely proportional to age, there is more damage at younger ages of exposure.
What medical conditions have demonstrated positive reduction in disease burden, with cannabinoid use ?
Positive Medical Response to Cannabinoids
- Drug-Resistant Epilepsy (36-49 % reduction in sz frequency)
- Autism (Improvements with daily functioning, through sedation)
- Cerebral Palsy (Improved spasticity; adults-only)
- Fragile X (Single study; improved socialisaton and reduced aggression)
- Nausea/Vomitting (third-line anti-emetic in cancer patients)
List 5 medical concerns with acute cannabis intoxication?
- Obtundation (airway concerns)
- Panic Attacks
- Drug induced psychosis
- Drug induced exacerbation of psychotic disorder
- Risk for trauma (i.e. driving/cycling impairment, susceptibility for abuse)
Since legalization, acute intoxications with toddlers has increased 34 %
EPI BULLETS
- 5.6 % of 12th graders report daily cannabis use
- 14 % of HS students report cannabis use in the last 30 days
- Chronic cannabinoid use is associated with a 40 % increase in lifetime risk for a psychotic event
What are the longitudinal concerns associated with chronic cannabinoid use in adolescence?
- Dependance and withdrawal
- Risky seeking behaviours
- Decreased IQ and processing speeds
- Psychotic episode risk
TRUE or FALSE
Patients with chronic disease have a DECREASED risk for engaging in voluntary sexual activities
FALSE
Adolescents with chronic diseases (i.e. DM, CP, epilepsy etc.) actually have higher (> 50 % incidence) rates of engaging in sexual acts when compared with their controls.
They also have higher rates of:
- Sexually transmitted infections
- Sexual abuse (2x the general risk)
List the CPS’ 3 goals of care for adolescents with chronic disease?
- Avoid exacerbations
- Educate to mitigate magnitude of exacerbations
- Empower self-care to decrease the baseline daily effects of their disease
*** An additional goal from another CPS statement include anticipatory guidance regarding sexual abuse. They don’t talk to eachother a lot I’ve discovered.
EPI BULLETS
- 15 % of youth in Canada have a chronic disease
- 89 % have mild disability, <3 % have severe disability
What is your approach to establishing a transition to the adult medical world for your patients with chronic disease?
The CPS’ Transition to the Adult System
- Involve adolescent in their own care as young as possible
- Educate Adolescent and Family on the patient’s condition; appraise their knowledge routinely
- Develop realistic social/educational/work potentials and encourage they meet their best potential
- Empower the adolescent (self-esteem/confidence are key)
- Ensure they are meeting their own adolescent developmental tasks of socialisation, school performance, autonomy
What are some preoccupations adolescents with chronic diseases can have?
- Guilt for cost on family
- Body image
- Relative absence of autonomy to peers
- Feelings of separation from others at school/sport/activities
- Mortality and death
- Ignored as a sexual person (feel incapable/unworthy)
- Baseline anxiety, mood and self-esteem issues
Despite this, adolescents with chronic diseases have shown to be more mature at an earlier age, and have clearer perspectives on stressors versus their peers. Embracing these notions can help alleviate their negative preoccupations.
What deems a Diet as “unhealthy”?
One of the following contexts are in place
- Chronic dieting (> 10 diets/years)
- Fad dieting (e.g. non-Rx ketogenic, paleo, grapefruit)
- Fasting practices (despite recent evidence in adults)
- Meal skipping
- Cigarette use for dieting
- DSM-5 criteria for an Eating Disorder
What types of diets can be encouraged by a pediatrician ?
(2 answers)
- Therapeutic diets as per underlying disease
- When the diet is a shift from poor eating habits to normal healthy ones (e.g. those who call cutting junk a diet)
- Cultural diets with appropriate supplementation
(i.e. veganism, vegetarianism, dairy exclusion)
Are all dieting practices in adolescents consistent with an eating disorder ?
NO
Although adolescents that diet (particularly pre-teens) have a 5-18x increased risk for progressing to an eating disorder.
To diagnose an Eating Disorder refer to the DSM-5 criteria.
What is the best evidence based therapy for patients with Eating Disorders?
Define it
Family Based Therapy
Defined as the child being empowered through the parents to overcome the behaviours associated with their eating disorder at home/school/with friends, as an outpatient.
Describe 2 ways to determine a Treatment Goal Weight
(re: eating disorders)
- Weight for the same percentile as the patient’s height
- i.e. TGWt %ile = Ht %ile for Age*
- Weight as determined by the Age’s 50th %ile for BMI
- i.e. TGWt = 50th %ile BMI for Age*
- Weight at which the patient had their last period (not ideal)
i. e. TGWt = Weight during last period + 2 kg - Previous Weight prior to the development of illness
- There is no correct answer for the BEST option, as per the CPS. Just know 2 of these to apply in case some information above isn’t available.*
What is the goal weight gain for a refeeding eating disorder patient?
0.2 - 0.5 kg/week
(~0.5 - 1 lbs/week)
How should parents and healthcare workers respond to negative eating disorder behaviours during treatment/onward?
- ZERO Tolerance to any behaviours; they are to be stopped with consequences. No warnings allowed.
- Reasonable modifications to the magnitude of consequences should be applied
(e.g. if a girl is bullied at school, and then goes home to purge, the consequences can be less than those of primarily engaging in the activity)
- Consistent improvement is to be rewarded
- Remind Parents and the Patient that persistence of symptoms throughout treatment is expected, NOT a sign of their failure.
List a resource that parents can access for help with their child’s eating disorder?
When asked during an OSCE for a resource, they will fact check you later. There’s no best answer, but you need to have your own strategy in your back pocket.
CPS endorses a book called “Help your teenager beat their eating disorder” and a website called “Maudsley Parents”.
You have a new diagnosis of an Eating Disorder what’s your management approach?
(I’ll put the step-wise suggestions as per CPS)
Have the patient present for all these discussions
- Assess for hospitalization (Note concerning physiologic changes )
- Identify eating disorders as a psychiatric issue and NOT the fault of any one event, person or upbringing.
- Refer to Nutritionist/Dietician and/or specialized center
- Encourage all caregivers to be “on the same page”
- Advise refeeding will be difficult to all parties
- Provide access to supportive materials for reading for each party
- Establish a list of behaviours, highlight the negative physiologic importance of them
- Establish a plan, sometimes referred to as a contract, for privileges to be allowed based on activity.
- Follow-up as per physiologic/psychologic baseline (suggest weekly/biweekly)
What the criteria for admission to hospital for Eating Disorder Management?
Any of the following
- HR < 40 bpm or other arrhythmia present
- BP < 80/60 mmHg or sympt. of Orthostatic Hypotension
- Weight < 70th % ile for height or BMI < 15
- Signs of severe malnutrition (think vitamins, anasarca etc)
- Outpatient refeeding syndrome
- Failure of Outpatient Therapy
How does one weigh a patient with an eating disorder in the outpatient setting ?
The CPS suggests
- Interview the patient alone/chaperoned
- Provide gown, ask to dress down to only underwear then leave the room.
- Have patient void, with their appropriate parent attending, to assure a full bladder is emptied.
- Have numbers recorded without patient seeing them, giving non-specific good/bad feedback as to the result.
Define the Treatment Goal Weight in treatment of Anorexia Nervosa
Treatment Goal Weight
The weight required for the body to obtain normal physiologic functioning on a biochemical and clinical level.
The TGW can be determined through
- Previous growth curves (growth potential)
- Mathematically with several different equations
- Bone Aging (if above aren’t readily available/applicable)
If you do NOT have the aforementioned information, TGW is not determined, but you follow the physiology on a clinical level to determine when normalcy is met.
How often must a Treatment Goal Weight be reassessed for the management of Anorexia nervosa?
Every 3 to 6 months
OR
A significant change in physiology or general health occurs.
EPI BULLETS
- 17 % of houses in Canada have a firearm
- Odds ratio of completing suicide is 3.24 if a firearm is accesible
- Gang Involvement is associated with a +20 % chance of being faced with gun violence; +11 % if previously involved with gangs; + < 1 % if no gang involvement
- Firearm access and home violence synergistically increase the risk for homicide
- California study showed that risk for gun-related events increased with children with military parents
What developmental risk factors for Children and Adolescents place them at risk for firearm associated injury?
CHILDREN:
- Poor cognitive understanding of cause/effect associated with the danger of a firearm.
- Poor coordination of holding the weapon means simply handling the gun is dangerous.
ADOLESCENT:
- Poor self-regulation and forethought increases the odds they will engage in dangerous activities with the firearm (e.g. shooting stuff in backyard, making youtube videos with armed guns)
What advice should a pediatrician give regarding the use of faux guns?
Faux guns include air guns, paintball guns or potato cannons
The recreational use at home should be completely discouraged. These activities should be done always under supervision in an appropriate recreational facility.
Injuries suffered from a faux-gun should be treated in the same ATLS format as a gunshot wound.
What “social” habits/behaviours should be screened for during adolescent evaluations as per the Greig Health Record ?
CPS endorses the GHR so we gotta know it
- Gambling
- Gaming habits
- Sexting/Online sexual presence
- Phone/Screen time
-
Supplements (work-out, diet pills etc.)
- Smoking (e-cigarettes, cigarettes, hookah etc.)
- Marijuana and Prescription/Illicit drugs
- Alcohol
All of the above are assessed in the CPS Statements with CBT approaches like the 5 A’s; Ask, Advise, Agree, Assist, re-Assess.
What are the definitions of TRUE vs. RELATIVELY homeless youths?
True or (absolute) homeless are the classic image of a homeless person. Seeking homeless shelters, living in makeshift shelters or abandoned buildings.
Relatively homeless are more common, and called the hidden/secret/invisible homeless. They obtain shelter in homes through couch-surfing, risky behaviours (e.g. survival sex, crime engagement, illegal labour).
EPI BULLETS
- Canadian Prevalence of homelessness (True/Relative) is ~150,000
- Abused Females are 4x more likely the become street involved
What psychosocial risks are associated with Street Involved Youth specifically?
- Survival Sex
- Illegal activities (survival crime)
- Poor access to Healthcare/Social assistance
- Psychological/Psychiatric disorders/traits
What medical risks are associated with Street Involved Youth specifically, and must be screened for?
- Poor asthma control
- Nutritional deficiencies (think vitamins, essential metabolites)
- Tuberculosis consideration
- Staphylococcus aureus infections (always cover for it)
- Foot and Skin care
- Dental Health
- Sexually Transmitted Diseases and access to birth control
- Substance abuse
- Trauma from gang activities/abuse
What barriers does the CPS Identify as important to address for Street Involved Youth?
- Anger/Distrust for Adults, Authority and “The System”
- Knowledge on Where/How to access help
- Adult consent required for some therapies (province dependant)
- Health insurance access
- Drug coverage
- Drug dosing/administration feasibility
EPI BULLETS
- 1 / 5 teens have sexted or posted sexual media
- 50 % have received a sext
- 40 % have sent a sext
What is the CPS’ practice stance on sexting ?
Sexting is a risky behaviour
The management for all risky behaviours by the CPS is the 5 A’s
- Ask about sexting
- Advise about the negative consequences
- Agree on a plan to stop sexting
- Arrange for patients to cope/respond to requests to sext
- Assist with any problems faced after implementation
- Advocate for schools to educate on sexting risks
TRUE or FALSE
STI screening is required for all teens
Sort of both
- Gonorrhea and Chlamydia screening for ALL sexually active females, and those males with risk factors (unprotected sex)
- HIV Screening for ALL sexually active adolescents > 15 y.o.
- HIV screening for sexually active youth ( < 15 y.o.) if they have risk factors
List 4 risk factors for Melanoma
- Fair skin (baseline pallor, red hair, freckling)
- Several nevi (moles)
- Family History of skin cancers
- Frequent sun exposure
What benefits do tanning beds provide?
None
- There’s NO worthwhile Vitamin D production, which should be supplemented daily for all Canadians*
- (400 IU routine, 600 IU for the Northern, Dark skinned, chronic diseased patients)*
True or False
Skin cancer risk is proportional to tanning bed exposure-time
True
- Think of tanning bed time like pack-years*
- The intensity, duration and the frequency of exposures are all proportional to cancer risk.*
Which of the following activities can develop patterns of addiction (dependance, withdrawal, fMRI changes)
- Cigarettes
- Marijuana/THC Products
- E-cigarettes/Vaping
- Tanning Beds
All of the above
- These exposures have been found to actually increase endorphin release in the brain through various mechanisms of improved self-esteem. B-endorphins have been specifically seen to rise with tanning bed exposures - yes really!.*
- We must address appropriately with screening for dependency and withdrawal when removed as a stimulus.*
True or False
Tanning Bed intensity and proper function is annually regulated
False
Tanning beds are regulated at the manufacturer level, and tanning facilities are inspected once (when opened or when renovated). The beds themselves can have ANY functional capacity, so you don’t know what exposures you’re getting after their inspection.
There’s no legislation to protect the consumer
List the 3 essential recommendations from the CPS regarding Tanning beds
- Ask about tanning bed use from age 14 and above, or if suspected based on history/physical exam
- Actively discourage use
- Advocate for government regulation
What are the key differences between cigarettes and the following tobacco/nicotine sources
- Cigars
- Shisha
- Beedi
- Chewing
- E-cigarettes
- Cigars
- 4x more nicotine so higher risk for toxicity
- Oropharyngeal cancer risks.
- More $$$
- Shisha/Hookah:
- Increased esophageal cancer risks
- Coal accelerant exposure
- Water does NOT filter anything
- Herpes labialis
- Beedi (south-asian mini cigars)
- 3-5x more nicotine
- Chewing Tobacco/Snuff:
- Massive oropharyngeal disease risk (infections, cancers, dentition disease, rhinitis)
- E-cigarettes:
- Very high risk for nicotine toxicity.
- E-cigarette associated RDS.
- Burning risk.
- NOT to be used as a means of cessation.
What topics does the CPS suggest to address with patients for evidence based prevention of smoking?
- Impact on fetus if pregnant
- Cosmetic outcomes (e.g. poor scarring, skin color, smell, breath, teeth yellowing/gum disease)
- Performance in School/Sport (e.g. addiction associated anxiety on attention, poor physical performance)
- Financial Cost and potential for the same funds
- Personal short/long-term health risks
- Impact your smoking has on others around you
- Being manipulated by Big Tobacco (seriously that’s something they wrote for adolescents)
List the best evidence based interventions to prevent or stop smoking behaviours
(as per the CPS)
- Face-to-face counselling with easy, routine follow-up through text/e-mail/phone calls
- Education on smoking’s negative impact of on factors important to the patient (e.g. cosmetics, money, sports performance)
- Advocate for Taxation of smoking products, educational labels, access restriction, youth marketing restriction, smoke-free spaces.
EPI BULLET
Another lonely one
- 90 % of adult smokers started at < 18 years old
What is your medical management plan when assisting a patient quit smoking?
(When they have commited to start quitting)
After establishing behavioural therapies/interventions for addiction cessation the following step-wise Rx can be used
- Nicotine Replacement Therapy (NRT) (patch or gum only, inhaled replacements aren’t approved for adolescents)
- Buproprion (if no seizures, eating disorders or recent head trauma)
- Varenicline (if no somnambulism)
Do NOT prescribe Clonidine, Nortriptyline, Cytisine as they are not studied in adolescents
What are positive factors that can facilitate smoking cessation?
- Advanced Age
- Pregnancy
- Male
- Scholastic and Sports Success
- Psychosocial/Cessation Support in Family
- CYP2AG nicotine rapid metabolizer (How the heck are we supposed to know that)
What are negative factors that can deter smoking cessation?
Adolescent specific:
- Perceived lack of autonomy
- Fear of peer rejection (peer pressure)
- Normal developmental drive to experiment
General:
- Presence of addiction with withdrawal symptoms
- Psychiatric comorbidities
- Marijuana, Illicit Drug or Alcohol use
- Chronic Illness
- Peer/Family Tobacco use
- Weight concerns (Over or underweight)
EPI BULLETS
- Patient age is proportional to smoking prevalence
- Policy changes resulted in 2-3x less adolescent smoking since 1999
- 6/10 adolescent smokers seriously want to quit in next 6mo
- LGBTQ and Indigenous adoles. are 5x more likely to smoke
What are 6 risk factors for smoking initiation?
CPS endorses the following
- Parental smoking
- Low socioeconomic status
- Lack of parental support in smoking cessation
- Misinformation regarding smoking health risks
- Easy access to cigarettes
- Previous experience/experimentation in smoking
- Psychologic/Psychiatric disorders
- Poor school performance/low self-esteem
- Adverse Childhood Events
- Substance abuse
What are the acute concerns for tobacco use?
- Nicotine toxicity
- Contaminant effect on body (e.g. e-cigarette additives)
- Predisposition to addiction
- Lung/Cardiac/Anxiety disease exacerbation
What does smoking do to patients with Cystic Fibrosis?
(for education/advisement stations)
- More admissions for chest infections & decompensation
- Hastened decline in lung function
- Nutritional deficits requiring MORE enteral supplementation (inconvenient day-to-day)
What does smoking do to patients with Juvenile Idiopathic Arthritis?
(for education/advisement stations)
- Worsened osteopenia
- Increased risk and magnitude of cardiovascular** disease**
- Identified Premature Death risk increase
What does smoking do to patients with Sickle Cell Anemia?
(for education/advisement stations)
- More Acute Chest Syndrome
- More Strokes
- Hastened renal disease progression
What does smoking do to the general cancer patient?
(for education/advisement stations)
The risks associated with having a cancer and being on chemotherapy (e.g. clots, strokes, poor healing, infections) are amplified.
What does smoking do to patients with diabetes mellitus?
(for education/advisement stations)
Diabetes Mellitus is a microvascular disease, so it’s synergistic with the vascular damage caused by smoking.
Morbidity and Mortality of DM issues* are increased by 50-75 %
*renal, retinal, cardiovascular, neuropathic vascular diseases
List the CPS‘ 5 A’s for effective risky behaviour counselling
ASK about the behaviour
ADVISE of the health risks and benefits of decreasing/ceasing
ASSESS their motivation to decrease/cease
ASSIST them in cessation
ARRANGE for follow-up
What are the 3 Methods to treat Anxiety in the Pediatric (and adult) populations as proposed by the CPS ?
Anxiety Management Modalities to Consider
- Psychoeducation
- Psychotherapy (CBT, Family therapy)
- Pharmaco-therapy
Describe “Positive Parenting”
as per the CPS
Positive Parenting
The definition is not outright given, its purpose is to encourage healthy responses to the child’s behaviors and create a positive environment at home.
Positive Parenting is an arbitrary label given to the process of following through with Psychoeducation.
Give 4 examples of “Positive Parenting” provided by the CPS
Inexhaustive Positive Parenting Methods
- Recognize and describe emotions and/or somatizations
- Addressing emotions, and ‘avoid avoiding’.
- Validate anxieties and counter with small manageable solutions.
- Encourage and facilitate friendships/play (playdates, clubs, sports)
- Consistent, specific and unique praise, not generic applauds.
- Encourage autonomy when possible
- Liase with teachers, other parents, activity coordinators
- Model healthy coping mechanisms (preventive, reactive and reflective)
EPI BULLETS
- Pre-pandemic incidence of pediatric anxiety was 12.9 % (doubled over 7 years)
- Cochrane review showed Primary Anxiety Remission in children who engaged in CBT versus inaction/waitlisted kids (OR 5.45 95% CI, n = 6000)
When are SSRIs and SNRIs indicated for the management of Anxiety?
Pharmacotherapy is indicated in children 6 - 18 years old with Moderate-Severe disability +/- concomitant CBT.
Psychotherapy should be the primary management with pharmacotherapy as an adjuvant to facilitate psychotherapy.
Not CPS Statement Based
What are the side effects and trade names for the following drugs?
- Citalopram
- Escitalopram
- Fluvoxamine
- Sertraline
- Fluoxetine
- Venlaxafine
- Duloxetine
All anti-depressants have a tiny but relevant risk for Suicidality, Mania, Bleeding, Serotonin Syndrome,
Selective Serotonin Reuptake Inhibitors
- Citalopram (Celexa) - prolonged QTc
- Escitalopram (Cipralex)
- Fluvoxamine (Luvox)
- Sertraline (Zoloft)
- Fluoxetine (Prozac)
GI upset, Hyperactivity, Sexual dysfunction, Weight changes, myalgias, headache
Selective Norepineph. Reuptake Inhibitors
- Venlaxafine (Effexor)
- Duloxetine (Cymbalta)
Weight, Energy and Sleep changes, Sexual dysfunc., Dry Mouth, Hypertension, Tachycardia, Myalgia
Remember to practice using the following testing tools for your exam
[Available for free from the CPS]
List the 5 themes for Policy Makers, that the CPS requests regarding Social Media Regulation
The CPS suggest Policy Makers
- Improve Age-Verification Standards
- Publicize and fund research into social-media’s impact on children
- Regulate data collection/use from/for minors
- Mandate critical appraisal of social media be implemented in formal education
- Restrict harmful advertising being directed at minors
List the 4 points the CPS requests from Social Media Developers
CPS’ Request from Social Media Developers
(1) Transparency on data collection and use
(2) Prioritize Child and Youth Health when developing new programs
(3) Ensure youth have greater control over the content they view
(4) Make infrastructure that protects youth from hateful content & bullying.
(5) Make infrastructure that protects youth from harmful interactions and sexual exploitation
Points 4 and 5 are consolidated by the CPS, but I want to highlight the importance of not just shielding children from hate speech but also the real risk of being groomed online for eventual physical abuse.
What is the adolescent diagnostic criteria for Gender Dysphoria ?
(as per the DSM-V)
DSM-V Diagnostic Criteria for Adolescent Gender Dysphoria
Criteria A - Marked gender (≥6 months) manifested by 2/6:
- Marked incongruence between one’s experienced/expressed gender and their current or anticipated physical characteristics
- A strong desire to remove/prevent incongruent sexual physical characteristics
- A strong desire to have the sexual characteristics of another gender
- A strong desire to be of another gender
- A strong desire to be treated as another gender
- A strong conviction that one has the typical feelings and reactions of the other gender
Criteria B - The condition is associated with clinically significant distress and functional impairment
TRUE or FALSE
Hormone/Puberty Blockade is reversible, and default endogenous hormone production will resume upon drug cessation
TRUE
Several studies have demonstrated reversibility of puberty blockade, but the CPS does NOT endorse a specific cut-off age of when this reversibility stops. The default hormonal pattern will resume by 6 months post-GnRHa cessation.
At what age does a parent stop having the arbitrary right to view their child’s medical record **without the child’s consent **?
i.e. at what age do we start respecting a child’s privacy
Québec : 14 years old
Newfoundland : 16 years old
Other Provinces : When the child is deemed a mature decision-maker.
This protects a physician from an adolescent who requests confidentiality against medical advice. If the child refuses to acknowledge the gravity of an issue, and the need for their guardians’ invovlement, that is recognized as a risk to themselves.
https://cps.ca/en/documents/position/privacy-and-confidentiality-in-adolescent-health-care
When should you present your personal policy in respecting adolescent confidentiality to parents and patient ?
As soon as possible
This allows you to prepare the family for the expectation that you will speak with the adolescent privately for a HEADSS, collateral history taking and abuse screening. This means explaining how you will do it, whether you get another person present and where the conversation will take place.
Remember: “Should a physician feel uncomfortable about being alone with a patient or reviewing certain sensitive topics, it is appropriate to consider a chaperoned discussion with another HCP present”
https://cps.ca/en/documents/position/privacy-and-confidentiality-in-adolescent-health-care
