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1. Child and Adolescent Psychiatry > Child Specific Notes: Deck 2 (suicide, anxiety, OCD, trauma, feed/eat, elimination) > Flashcards

Child Specific Notes: Deck 2 (suicide, anxiety, OCD, trauma, feed/eat, elimination) Flashcards

1
Q

when is the peak of hospitalizations due to suicide

A

between 15-19 years old

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2
Q

how does the rate of suicide attempts compare to the rate of completions

A

SA rates 15x higher than completions

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3
Q

what is the most common method of completing suicide in canada

A

hanging

(firearms in USA)

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4
Q

when does rate of SI increase in C&A

A

increases significantly after puberty

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5
Q

what % of kids 10-14 have experienced SI?

A

7-10 %

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6
Q

what % of kids 10-14 have shown suicidal behaviour (and seek care)

A

0.0015%

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7
Q

what % of kids 10-14 die by suicide

A

0.001%

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8
Q

what % of adolescents 15-19 have
1. experienced SI
2. has suicidal behaviour
3. die by suicide

A
  1. 14-20%
  2. 3-10%
  3. 0.013% M, 0.002% F
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9
Q

what is the most significant risk factor for suicide

A

having a psychiatric disorder

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10
Q

risk factors for suicide in youth

A

older
male
indigenous or caucasian
psychiatric d/o
multiple psych d/os
family history of suicide
previous suicide attempt

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11
Q

what intervention is most likely to decrease suicides per APA

A

24 hour crisis teams

theory is that SI is a coupled and brief experience–> if you can intervene briefly and immediately, then you can disrupt the coupling of SI with plan and means which is usually somewhat transient

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12
Q

what are the 3 most efficient categories of intervention for SI per APA

A
  1. limitation of access to lethal means
  2. preservation of contact with patients hospitalized for SA after hospitalizaiton
  3. implementation of emergency call centers
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13
Q

name 2 tools that have positive predictive value in identifying those at risk for suicide and suicidal behaviour in the near and long term

A

PHQ9 and CSSRS

*this is across diagnosis

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14
Q

what is the goal of suicide risk assessment

A

not to predict suicide but to appreciate the basis for suicidality and thus to allow for a more informed intervention

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15
Q

list warning signs for suicide

A

psychosis

suicidal communication or prep behaviours

marked change in functioning

service utilization

new and intense family concerns

evasive history

rapid changes in reported SI

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16
Q

what intervention has the most evidence for “preventing” suicide in adolescents with a history of self harm

A

group therapy (level 1a)

also CBT, DBT for BPD
family inclusive interventions

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17
Q

list 5 public health interventions aimed at preventing suicide

A
  1. means restriction
    –> bridge and subway barriers, firearms restriction, tylenol packaging restrictions, restrictions on sale of OTC drugs, pesticide regulations
  2. school based programs
    –> for teens, kids, staff; there have been significant results from school based awareness programs in decreasing SI and SA
  3. public awareness campaigns
    –> for gen pop, adult M, gay M
  4. gatekeeper training
    –> for school staff, crisis counsellors, veterans, indigenous people, gen pop
  5. media reporting guidelines
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18
Q

list medication/medical interventions that prevent suicide

A

lithium
–> in unipolar and bipolar patients

clozapine
–> in patients with SCZ

antidepressants
–> for patients with MDD taking SSRIs–> less robust evidence than for lithium and clozapine

ketamine
–> promising initial evidence

ECT
–> for patients with MDD

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19
Q

is there evidence that safety planning is effective

A

yes

RCT showed 50% decrease in suicidal behaviour after ED visit with increased follow up

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20
Q

what are the most common anxiety disorders in kids and teens (ranked from most to least common)

A

specific phobia (BII, animal)

SAD

PTSD

panic

separation

GAD

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21
Q

what is the earliest onset of anxiety disorders in kids? median onset?

A

earliest 6 years

median 11 years

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22
Q

where does fear originate

A

amygdala

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23
Q

where does worry originate

A

cortico-striatal-thalamic-cortical loop

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24
Q

what are the most common comorbidities with separation anxiety in C&A

A

GAD, specific phobia

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25
how does the dx of separation anxiety differ between kids and adults
in kids must have sx for 4 weeks in adults must have sx for 6 months
26
how do you treat separation anxiety
most evidence is for CBT/exposure treatment with family involvement and early intervention can also consider: fluoxetine fluvoxamine (?sertraline?) if meds are indicated do NOT recommend clonazepam
27
in separation anxiety with school refusal, in addition to fluoxetine or fluvoxamine, what other meds might you consider
citalopram adjunctive imipramine do NOT recommend alprazolam
28
list 3 anxiety rating scales for kids
MASC-2 (multidimentional anxiety scale for children) CSAS (childrens separation anxiety scale) SCARED (screen for child anxiety related emotional disorders)
29
how do you treat selective mutism
CBT type approach with systematic desensitization, social skills training, systematic reinforcement of speech behaviour possibly fluoxetine but limited evidence
30
name a screening tool for selective mutism
selective mutism questionnaire
31
name a screening tool for specific phobias
specific phobia questionnaire
32
when is the mean age of onset for SAD
12
33
name a rating sale for social anxiety
liebowitz social anxiety rating scale
34
name two rating scales for panic disorder
panic and agoraphobia scale panic disorder severity scale
35
desribe the bimodal onset of GAD
one peak at 10-14 years and one peak at 31-32 years
36
how does diagnosis of GAD differ between C&A and adults
in adults, you need excessive worry AND 3+ of other sx in kids/teens, only need excessive worry plus ONE other additional symptom
37
name 3 co-occurring conditions with anxiety that require an adapted CBT protocol
comorbid ADHD, aggression, SUD require adapted protocols
38
how do you treat GAD in C&A population
*psychological treatments are preferred *combo is better than either therapy or meds alone meds: fluoxetine fluvoxamine sertraline do NOT recommend alprazolam for GAD alone *if school refusal, consider citalopram, adding imipramine to CBT or alprazolam
39
other than CBT, list other nonpharm treatments for GAD in C&A
attention bias modification MBCT social effectiveness training (SAD) ERP family based CBT metacognitive tx (OCD) etc
40
is there a trial of a med specifically in separation anxiety
yes, the CAMS trial looked at sertraline vs CBT in separation anxiety combo was better than either alone (either alone were equal to each other)
41
list 5 rating scales for GAD
GAD-7 HAM-A Beck Anxiety Inventory Penn State Worry Questionnaire SCAREDD
42
what impact does family accommodation have on treatment for OCD
decreases response to treatment
43
what obsessions indicate the person will have a poorer response to SSRIs
hoarding and symmetry
44
list factors that suggest a poor prognosis in OCD
early age of onset yielding to compulsions hospitalization bizarre compulsions less insight comorbidities
45
what % of people w OCD have sx that remit without treatment
20-40%
46
what % of those with OCD have a suicide attempt
25%
47
how do you treat OCD in C&A
psychotherapeutic approaches are preferred --> CBT ERP (or combo) for meds: level 1 fluoxetine clomipramine level 2 citalopram fluvoxamine paroxetine sertraline can consider adjunctive aripiprazole consider adjunctive riluzole (glutamate antagonist)
48
what med can be added to ERP that might make it more effective to treat OCD
d-cycloserine
49
name a trial that looked at treatment of OCD in C&A
POTS study showed the combo was better than CBT alone which was better than meds alone all were better than placebo med was sertraline
50
what are neuroanatomical changes in OCD
smaller caudate, but caudate shows more activity hyperactivity in anterior cingulate inhibitory CSTC pathway is implicated
51
list cognitive schemas present in OCD
thought action fusion increased sense of vulnerability enhanced responsibility for own and others wellbeing
52
name the rating scale used for C&A OCD
CY-BOCS
53
what is defined as response to an intervention in OCD
decrease of 25% or more on the CY-BOCS
54
how do you treat PANDAS (including neuropsych symptoms)
i'm not gonna learn all this.... but basically NSAIDS and corticosteroids consider high dose IVIG or other corticosteroid sparing agent CBT and supportive therapy consider strep prophylaxis (some controversy )
55
is there any pharmacological treatment for the core symptoms of reactive attachment disorder or disinhibited social engagement disorder
no
56
neglect has to be before what age to predispose to DSED
before age 2 no evidence that neglect after this is associated with DSED
57
what is the treatment approach to RAD
*aim of treatment is to provide the child with an emotionally available attachment figure* 1. If Hx foster care/adoption/institutional rearing, routinely ask about attachment & reticence w/ strangers. 2. Obtain direct evidence from Hx child’s patterns of attachment w/primary caregivers and observe interactions w/caregivers. Can use a structured observational paradigm to compare behaviours w/familiar and unfamiliar adults. 3. Psych assessment to r/o comorbid disorders. 4. Assess safety of current placement as high risk for being re-traumatized. 5. Aim of Rx is to provide child w/emotionally available attachment figure. 6. For DSED, limit contacts w/non-caregiving adults to reduce signs of d/o. 7. Adjunctive interventions if aggressive or oppositional behaviour present. 8. No pharmacological Rx for core features of RAD or DSED. 9. No physical restraints or coercion of trauma, or promotion of regression for “reattachment” as not evidence based and asso’d w/serious harm, including death.
58
PTSD can occur at any age after...
after 1 year old
59
are there any preventative strategies for PTSD
no debriefing is NOT recommended *screen and treat is preferred
60
what is a protective factor in development of PTSD
social support is PROTECTIVE against PTSD except in the event of poor attachment hx
61
list factors that suggest good prognosis in PTSD
rapid onset of sx short duration of less than 6 mo better premorbid functioning strong social connections no comorbidities
62
how does PTSD diagnosis differ in kids under 6 compared to everyone else
If <6yo, can occur to parent/caregiver, either ≥1 in intrusion, ≥1 in avoidance or -ve alterations in cognition, and ≥2 alteration in arousal/reactivity, can be seen through nightmares/frightening dreams w/o recognizable content, repetitive play, re-enactment, socially withdrawn behaviours, developmental regression.
63
what % of those with acute stress disorder develop PTSD
50%
64
what intervention in acute stress disorder has some evidence for preventing transition to PTSD
CBT/TF-CBT dont do it before 2-3 weeks after trauma
65
what meds might have some protective effects post trauma
propanolol and morphine but cochrane review says not enough evidence propanolol prevents PTSD
66
what % of children experience a MH disorder
20%
67
what are the most common MH disorders in kids
anxiety
68
what are the two leading causes of death among Canadian youth
accidents = #1 suicide = #2 25% of all deaths aged 15-24 are suicide
69
how does the risk of dying by suicide change for indigenous youth
indigenous youth die by suicide 5-6x more than non indigenous youth
70
how many kids in canada actually receive appropriate MH service
1/5
71
who has a better prognosis in functional neurological disorder, kids or adults
kids kids also have better. prognosis than adolescent
72
when is the avergae age of onset for anorexia nervosa
ages 14-18 years rare before puberty rare after 40
73
list indications for admission for C&A with AN
weight <75% IBW HR <50bpm daytime, <45bpm overnight sBP < 90mmHg orthostasis (HR above 20bpm, BP >10mmHg) arrhythmia temp below 35.5 celsius hypoK, hypoMg, hypoPhos body fat less than 10% acute food refusal failed response to outpatient treatment
74
should meds be used as the primary treatment for AN
no--> risk of orthostasis and bradycardai
75
below what body weight are SSRIs ineffective
below 80% IBW
76
what symptoms in AN might improve just with weight gain
OCD and depression sx
77
what are the first goals of treatment for AN in C&A
NUTRITIONAL REHAB psychoeducation support **antidepressants and psychotherapy do not work in the context of malnutrition**
78
what is the first line psychotherapeutic treatment for AN in C&A
Maudsley Family Therapy
79
who is the idea candidate for Maudsley family therapy for AN
aged under 18 ED less than 3 years duration dx of AN
80
what is phase 1 of maudsley family therapy
weight restoration --> parents take on responsibility to refeed youth externalization of illness aim to return to healthy weight within 3 mo
81
what is phase 2 of maudsley family therapy
returning control of eating to the adolescent
82
what is phase 3 of maudsley family therapy
establishing healthy adolescent identity (initiated once above 95% IBW)
83
how much weight are you hoping a kid with AN will gain per week as an inpatient? outpatient?
inpatient: 2-3 pounds/wk outpatient: 0.5-1 pound/week
84
after first line maudsley family therapy, what are the second line therapies for AN in C&A
Family based treatment --> adolescent focused therapy if FBT not available CBT IPT MET
85
third line for treatment of AN in C&A
SSRIs or AAPs for comorbid disorders benzoes before meal can decrease anxiety
86
name two rating scales for AN
Eating Attitudes Test (EAT-26) Eating Disorder Diagnostic Scale (EDDS) --> ages 13-65, screens for AN, BN, BED
87
list the psychotherapies found to be effective in binge eating disorder
CBT IPT DBT should be offered to adolescents
88
list meds for binge eating disorder
sertraline citalopram fluoxetine imipramine topiramate vyvanse--> for mod-severe BED but be careful cuz can worsen BN
89
how do you treat BN in C&A
1st line = Family based treatment (FBT) > CBT for adolescent > IPT as alternative there is growing evidence for DBT 2nd line = SSRIs, may be useful for comorbid d/o --> FLUOXETINE has best evidence
90
indications for admission in BN
syncope K below 3mmol/L esophageal tears cardiac arrhythmias suicide risk intractable vomiting hematemesis failure to respond to outpatient treatment hypothermia
91

1. Child and Adolescent Psychiatry (32 decks)

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