CPS Adolescent 2

Question 1

Which of the following dieting behaviours is most common amongst adolescents?

a) fasting, skipping meals, crash diets
b) self induced vomiting
c) laxatives
d) diet pills
e) smoking cigarettes

Answer 1

a) is the answer

fasting, skipping meals, crash diets - 22-46%
cigarettes 12-18%
self induced emesis- 5-12%
laxative and diuretic use- 1-4% 
diet pill 3-10%

all groups at risk for dieting, 36% of normal weight girl vs. 55/50% for obese/overweight girls

Question 2

Which of the following is not associated with dieting behaviours in teens?

a) smoking
b) early puberty
c) lower SES
d) vegetarianism

Answer 2

c) SES does not seem to affect, dieting in all groups

other important factors include psych, poor body image, poor family relationships/criticism of weight, certain sports, chronic illness including diabetes, substance use and unprotected sex; teasing, influence of friends, parents who diet.

Question 3

Which of the following is not a consequence of dieting in teens?

a) reduced growth
b) heavy periods
c) iron and calcium deficiencies
d) osteopenia/osteoporosis

Answer 3

b) menstrual irregularities, especially amenorrhea (secondary), even in absence of significant weight loss.

Question 4

Which of the following is true of dieting for teens?

a) structured weight loss programs improve self esteem
b) helps with long term weight loss
c) important psychochological consequences
d) unrelated to eating disorders

Answer 4

c) distractilbe, irritable, fatigue

a) false - decreases self esteem
b) the opposite - can actually gain more weight long term
c) can be the antecedent - need to figure out this relationship better.

most teenage dieting no consequences

no evidence that commercial weight loss programs good for kids, paediatric obesity program might be helpful in some cases.

Question 5

Which of the following statements is true?

a) UV radiation has a wavelength shorter than X rays
b) UV radiation is an invisible form of electromagnetic radiation
c) UVB and UVC contribute to darkening of skin
d) UV radiation is only carcinogenic when causing sunburn
e) Artificial UVR does not have any carcinogenic potential

Answer 5

b) true

a) false - UV is longer than X rays, shorter than visible light
c)false A (immediate darkening) and B (further darkening in the following days, activate melanocytes) contribute to skin darkening
d)false stimulate synthesis of melanin molecules. UVA - 315-400 UVB 280-315 UVC 100-280.
can be carcinogenic without causing sunburn

damages DNA, can cause mutations, erythema and sunburn are acute reactions
e) impossible to remove all carcinogenic potential from UVR

Question 6

Which of the following does not increase the risk of cutaneous malignant melanoma?

a) light skin, freckles,
b) second degree relative with CMM
c) multiple moles
d) easy to burn skin

Answer 6

b) 1st degree relative increases risk, or personal history of CMM

red or blond hair colour perhaps more associated than skin type
lots of typical/atypical nevi
UVR contributes to immunosuppression, which increases risk of CMM

Question 7

Which of the following statements is false?

a) CMM is the most common skin cancer
b) CMM incidence rates have increased significantly
c) few treatments for metastatic disease
d) Incidence of CMM is 15.2/100000

Answer 7

a) false, not most common but most deaths (75%)

rest true
increased in past 35 years
some advances in treatment but still not lots of treatment for metastatic disease

Question 8

Which of the following is least likely to be related to the reason for increased CMM rates?

a) increased sun seeking behaviour
b) decreased ozone layer
c) more tanning beds
d) changes in diagnostic criteria

Answer 8

d) changes in diagnostic criteria is likely less likely to be contributing than increased exposure to UV radiation, since mostly affects certain age and sex

Question 9

Which of the following is not associated with increased use of tanning facilities?

a) not having a risk for skin cancer
b) extreme risk taking
c) poorer self esteem
d) unhealthy lifestyle choices
e) parental use of tanning facilities

Answer 9

a)even having a known risk factor for skin cancer doesn’t influence use of tanning facilities
SES doesn’t affect either

the rest ARE associated with increased use of tanning beds
individual sports -

approx 1/4 of kids 13-19 have used tanning beds, doubles by age 14-15 then again at age 17

Question 10

Which of the following is not linked?

a) ever tanning indoors and CMM
b) early life exposure to tanning indoors and CMM
c) early life exposure and squamous cell carcinoma
d) number of years of tanning and total hours tanning and CMM

Answer 10

c) false - early life exposure and basal cell carcinoma, chronic total exposure is more related to SCC BCC and SCC also linked to UVR, chronic/total exposure linked to SCC
SCC 25% of skin cancer deaths, non melanocytic
tanning beds increase SCC chance by 2.5 and BCC by 1.5

the rest are true

begin indoor tanning before age 35, 75% increased risk of CMM
WHO lists as potential carcinogen

Question 11

Which of the following is not a risk of artificial tanning?

a) erythema/sunburn
b) photodrug reactions
c) acne
d) infections

Answer 11

c) acne is not, the others are
also get aging of skin around eyes etc.

1/4 demonstrate adverse health effect

can get addicted to tanning since it simulates endorphins, can get withdrawal

Question 12

Which of the following is false of vitamin D?

a) conclusive evidence that vitamin D helps bone health
b) UV radiation is not a great source of vitamin D
c) may influence risk of DM1
d) conclusive evidence that it influences risk of cancer

Answer 12

d)false, only conclusive evidence for bone health, need to study relationship with MS, cancer, heart disease, glucose dysregulation, as well as how in prenatal period influences DM1 risk

a) true - only conclusive evidence that helps with bone health
b) not a great idea, lots of DNA damage as well as vitamin D

exposure is complicated by skin colour, amount of skin exposed, wavelength and degree of deficiency
articificial tanning further complicates the matter, intensity and variability of UVA and UVB

Question 13

Which of the following was a not a stipulation of the Cancer Society to tanning salons?

a) stop linking indoor tanning to benefits of vitamin D
b) pay a monetary penalty of 62500
c) acknowledge in promotions that tanning is not needed for vitamin D
d) not market to teenagers

Answer 13

d) the other 3 were stipulations by the Cancer Society

Question 14

Which of the following is not part of the legislation for tanning in Canada?
a) banned in Vancouver Island for children

Answer 14

is not banned in Canada, but working on legislation that bans them. should be prohibited for kids

Question 15

Which of the following statements is false?

a) students with a disability are more likely to be physically abused
b) more likely to be sexually abused
c) emotionally abused
d) all of the above

Answer 15

d)

BC study showed that 2x more likely to be physically abused (31% vs. 15%), sexually abused 19% vs 7%, 3x more likely to experience both physical and sexual abuse (12% vs 4%)

Question 16

Which of the following factors is likely not related to the increased probability of sexual abuse for disabled youth?

a) sex education in institutions and homes
b) decreased self-expression
c) viewed to be hypersexualized
d) low level of privacy

Answer 16

a) the opposite, these kids will have less of the sex education, makes them more vulnerable.

can be seen hypersexualized or less sexualized.

also vulnerable because of cognitive and other delays, harder to resist abuse/report abuse.

Question 17

Which of the following is not a likely a red flag for sexual abuse in the population of young people with chronic condition or disability?

a) unexplained UTI
b) sexual activity with peers
c) unexplained fear of physical exam
d) encopresis

Answer 17

b) not as likely, sexual activity with age inappropriate partners more likely a red flag for sexual abuse

other risks
unexplained UTI
STIs, vaginal/anal trauma, running away from home, sexually abusive behaviour towards others, somatic complaints with no organic cause.

Question 18

Which of the following is true of disclosure of sexual abuse in children with disability and/or chronic conditions?

a) the physician should lead the investigation
b) likely to be believed by police
c) most interpreters are trained in sexual vocabulary
d) should be conducted using the patient’s preferred communication method

Answer 18

d) - i.e. sign language, computer programs etc.
should advocate to have more training for interpreters in sexual vocabulary/language
The augmentative communication community partnerships Canada (lots of info) on website

the others are false - physician not job to investigate, one study showed disabled women less likely to be believed, more likely to be seen as promiscuous.

need to explain mandatory reporting.

Question 19

Respect for privacy for teens can be modelled in all but which of the following ways?

a) draping for physical exam
b) using rewards for cooperating
c) chaperoning of physical exam and procedures
d) promoting institutional culture of patient privacy

Answer 19

b) using rewards or consequences for cooperating is not a good idea, can make it harder for young people to identify abuse

quick intervention if abuse occurs, work with institutions to identify abuse, anticipatory guidance on sexuality in youth, to help identify risks etc.

Question 20

Which of the following statements is false?

a) The age of consent in Quebec is 14
b) The age of consent in Ontario is 16
c) Dedicated adolescent units are a better option for most teens
d) Minority and Aboriginal teens may have more difficulties than their peers when hospitalized

Answer 20

b) The Age of Consent law : consent for medical treatment depends on mental capacity, not age.
Quebec - age of 14, everywhere else, not based on age
most teens will chose to work in collaboration with their parents or another important figure in their life to make health care decisions.

the rest true - dedicated teen units better option, not realistic for Canada, teens often don’t fit in, loss of privacy, loss of cultural support, should offer translator, encourage family support etc. , also risk of adolescent specific issues getting missed when non adolescent units/working with people that are not trained in adolescent issues.

Question 21

Which of the following has not been reported to be associated with teens living with a chronic condition?

a) increased depression
b) increased social problems
c) lower unemployment rates as adults
d) increased stress

Answer 21

c) is the answer, actually reported to have higher unemployment as adults

15% of youth in N.A have chronic health condition

increased stress with death, school concerns, the future; some do repot being emotionally healthy, better perspective/maturity on life

need to address sexuality - effect of condition on sexuality, how pregnancy would be affected by their disease/treatment

Question 22

Which of the following statements is true?

a) children with cognitive disabilities should be let out of transition programs
b) important to teach skills of negotiation and communication that are needed in the adult system
c) preparation for transition should not occur prior to adolescence
d) community health clinics are not useful for youth with chronic health conditions

Answer 22

b) important to teach these skills as the teen approaches the age where they need to start transitioning, important to know the services

the rest false

a) actually more important for these kids
c) false, should start in childhood, families need to be informed participants, increase the amount of info as child enters adolescence.
d) these clinics a great resource

Question 23

Which of the following is not part of the on-track program for transition?

a) typically start around age 14
b) educational, vocation and personal planning
c) health active living
d) foster personal autonomy and independence

Answer 23

a) false, start around age 10-12 for discussion about transition

the rest are true

additional strategies, talk to teens alone, teach them to present history, ask questions and advocate for themselves (helps to transition from family centred multi d to patient lead care, group meetings, certificate of transition, acknowledge graduation. educational materials. transition should work at the youth’s pace. tools online include my health passport, others in the website

Question 24

How many children diagnosed with a chronic health condition may reach the age of 20 years?

a) 80%
b) 88%
c) 90%
d) 98%

Answer 24

d) now it’s 98%

Question 25

Which of the following statements is false?

a) teens with chronic health conditions more likely to be sexually abused
b) students with a chronic health condition can have poor attendance at school, as much as 30% in one study
c) sexual activities in teens with chronic health conditions may be higher than their healthy peers
d) teens with chronic health conditions are less likely to have an STI than their healthy peers

Answer 25

d) false, more likely to have an STI than peers, the rest are true

Question 26

Which of the following conditions does not cause premature pubertal development?

a) Turner syndrome
b) cerebral palsy
c) spina bifida
d) McCune albright syndrome
e) Neurofibromatosis

Answer 26

a) Turner causes delay

the others can cause precocious puberty.
CF can cause sterility, as well as certain spinal cord lesions and cancer in men

Question 27

Which of the following conditions does not contradict combined OCP?

a) diabetes
b) cyanotic heart disease
c) asthma
d) liver disease
e) post transplantation

Answer 27

c) is the answer, the others may contraindicate the use of contraception

need to warn teens of risks of contraception and risks of pregnancy in their case

(not from statement directly)
cardiac contraindications to estrogen containing contraception
- pulmonary hypertension
- artificial valves
- cyanosis
- certain arrythmias
-previous thrombosis
-migraines

i think it’s diabetes with end organ findings not all diabetes ?

gyne exam in sexually active only, external exam in all
also take care of pain control, don’t underestimate it.

Question 28

Which of the following is true?

a) youth in custodial facilities are governed by federal government
b) more youth in custody have required medical attention than youth not in custody
c) if a child is sent to an adult court, they no longer retain the rights of the child
d) while in custody, the institution does not have a role in providing health care for individuals

Answer 28

b) true

a) false governed by provincial government
c) false, they are judged as an adult but retain the rights of a child in their province
d) false, they are obliged to pay attention to health problems

common problems: skin conditions, URTI, STIs, contraception, pregnancy, mental health/violence, substance abuse, respiratory, dental, endocrine and urological problems.

a high percentage of people in facilities need physical or mental health care 23-50%

Question 29

Which of the following statements is false?

a) an advisory committee should set the health policies in custodial facilities
b) larger custodial facilities should have a physician on site
c) the health program in facilities must be lead by a health care professional
d) smaller custodial facilities should consult a physician in a community clinic

Answer 29

c) in smaller settings, does not need to be a health care professional if not available, do need a designated staff member to oversee the health policy

the rest true
a) can be on or offsite, includes a team, in smaller settings may be a consultant group
larger sites should consult a physician

Question 30

Which of the following is not a symptom of opioid withdrawal?

a) myalgias
b) consipation
c) diarrhea
d) depression
e) nausea
f) chills
g) autonomic instability

Answer 30

b) is not, the rest are, rarely can also have cardiac etc.

benzo withdrawal - at risk of seizures, need medically supervised setting

need health assessment within 72 hours, medical history and physical as well as mental health assessment, record a plan on the chart to ensure that it is carried out, tell the youth +/- family as they consent

Question 31

Which of the following is false?

a) youth in custodial facilities do not have the same rights to confidentiality as other youth
b) support youth in their efforts to quit smoking
c) custodial facilities should have a medical room
d) should have safe place to store medications

Answer 31

a) false, need to make every effort to protect confidentiality and get consent for different activities; including telling their families/other doctors - should give their record to these people if the youth consents

need to have someone trained in CPR/first aid, as well as violent behaviour, have a 24/7 emergency plan present

also need to have anticipatory guidance, i.e. nutrition, pregnancy, sexual health.

Question 32

Which method of treatment for anorexia nervosa is most supported by evidence?

a) individual therapy
b) inpatient monitoring
c) group therapy
d) family based treatment

Answer 32

d) family based treatment so far most evidence of being effective: parents are given the responsibility to help restore their child’s weight; ongoing involvement with school/friends/etc.
- unclear if this is the best approach in all families or if we can predict who is most likely to respond to FBT

Question 33

Which of the following statements is false?

a) physicians assessing a youth with anorexia should talk to the youth first
b) eating disorders are caused primarily by environmental factors
c) goal of weight gain should be 0.2-0.5 kg/week
d) many families need to restrict exercise in the initial stages of treatment to start encouraging weight gain

Answer 33

b) false, though to be combo of genetics and environmental

visit biweekly/weekly to keep monitoring

Question 34

Which of the following eating disorder behaviours can be kept private from parents?

a) hemetemesis
b) hypokalemia
c) purging
d) recent fainting

Answer 34

c) some confidentiality, but limits, the others should be disclosed since can pose a danger to life. also SI needs to be disclosed.

P/E orthostatic vitals, weight after peeing

if outpatient doesn’t work, may need inpatient.
in less severe cases can consider meeting with youth individually followed by meeting with parents.
supervise meals and snacks, gradual return to responsibility.
parents need to be in charge until weight is better

5% of canadian girls have eating disorder before adulthood

Question 35

Which of the following statements is true?

a) gay teens are more likely to start using drugs at an earlier age , including ketamine, crystal meth and cocaine
b) more boys than girls identify as bisexual , homosexual
c) the majority of transgendered youth are homosexual
d) the majority of homosexual youth struggle with gender identity

Answer 35

a) is true

b) 1.5% % of boys vs. 3% of girls identified as such, remember that more people have had asex with someone of the same gender than specified here.
c) can identify as homosexual, heterosexual or bisexual
d) most people both gay and straight have gender identify that matches their anatomy

Question 36

Harassment of gay and lesbian youth includes all but which of the following?

a) physical assault for 1/2 of gay men and 1/5 of lesbian girls in high school
b) 5-10x more likely to be threatened by a weapon at school
c) higher risk of dropping out of school and getting kicked out of home
d) 2-7 x more likely to attempt suicide

Answer 36

b) is false, 2-4 x more likely to be threatened by a weapon at school

the rest are true

ethnic minorities, more likely to be threatened.

Question 37

Which of the following does not increase the risk of suicide in gay youth?

a) family conflict and having run away from home
b) conflicted about orientation
c) older age when gay identity discovered
d) not able to disclose to anyone

Answer 37

c) false, actually young age increases the risk of suicide

parents might come to you, teens who have disclosed sexual orientation unlikely to be just “going through a phase”.

Question 38

Which of the following is false of gay and lesbian teens?

a) increased risk of STIs
b) more likely to have had multiple partners
c) more likely to have had nonconsensual sex
d) less likely to have had sexual intercourse

Answer 38

d) is false, more likely to have had intercourse

women who are not IV drug users and who have had sex only with women have the lowest risk of HIV and other STIs, but many sexually active lesbian adolescents have had sexual intercourse with men (therefore need to continue to consider contraception for these girls).

Question 39

Which of the following is not an increased risk of gay teen boys who have had unprotected anal intercourse?

a) HIV
b) parasites
c) HPV
d) hepatitis
e) herpes

Answer 39

e) not on the list in this paper (but likely still increased risk)

NOT usually - (or EVEN MOST OF THE TIME) full work up (not usually warranted) O and P, chlamydia/gonorrhea (urethral swab or urine), syphillis (VDRL), anal cytology, stool culture, HIV

HPV vaccine consider for both genders.

no longer do paps for adolescent girls.

Question 40

Which of the following is not true?

a) methadone programs are not related to decreased mortality from natural causes in this population
b) needle exchange programs have decreased the annual seroprevalence of HIV compared to areas that have not introduced such programs
c) methadone programs are related to decreased mortality from overdoses in this population
d) supervised injecting facilities have been successfully implemented in Switzerland, Netherlands and Vancouver

Answer 40

a) false - they are related to decreased mortality from overdose and natural causes

the rest are true

Question 41

Which of the following substances was used most commonly by adolescents in Ontario?

a) cannabis
b) alcohol
c) cocaine
d) heroin

Answer 41

b) is the answer

2/3 used alcohol, 1/3 used cannabis

Question 42

Which age group has the highest rates of gonorrhoea and chlamydia in Canada?

a) 15-19 year old girls
b) 15-19 year old boys
c) 17-21 year old girls
d) 17-21 year old boys

Answer 42

a) 15-19 year old girls have highest gonorrhoea and chlamydia rates

15-24 year olds have highest STI rates in Canada
median age for intercourse is 17 years old
30% of boys and girls have had oral sex by grade 9

Question 43

Which of the following statements is true?
a) the perception of harm from risk activities is proportional to amount of use
b) the DARE program of zero tolerance is more effective than alcohol harm reduction programs in multiple U.S. studies
c) giving condoms to women involved in prostitution is an example of primary
prevention
d) harm reduction strategies can be helpful for both prevention and intervention of behaviour with potential health risks
e) abstinence only education programs are most effective at reducing unintended teen pregnancy

Answer 43

d) is true

the rest are false

a) the opposite, inversely proportional to level of use
b) the opposite, the harm reduction programs are better, but only in kids that haven’t started drinking yet (programs targeted to grade 5-6), in those who are already drinking harmfully, doesn’t help, these are active learning programs which focus on skills training and alcohol education, reduces alcohol misuse and alcohol related harms
c) secondary prevention
e) is false, harm reduction (i.e. delayed sex, contraception and condoms) more likely to reduce teen pregnancy in a recent review

primary vs. secondary prevention need different approaches

Question 44

Which of the following is not an example of a motivational interviewing technique?

a) how does drinking on the weekends affect your homework
b) what are some of the things you would like to change
c) it sound like you are upset about your recent break-up, are you more likely to drink when you are upset?
d) drinking can lead to liver disease , and it is illegal for children under the age of 19 to drink

Answer 44

d) is not, the rest are

motivational interviewing was shown in one ER study to reduce drinking and driving, alcohol related injuries and problem after 6 months

adolescents identify health care providers are credible sources of health info

Question 45

True or false - girls are 2x more likely to have depression than boys in their childhood years

Answer 45

false - equal in the pre-pubertal/childhood year, 2x more likely in post pubertal/adolescent years
prevalence is 1-2% in pre pubertal and 3-8% in post pubertal

Question 46

Which of the following treatments does not have any evidence in the childhood years for depression treatment?

a) CBT
b) Interpersonal therapy
c) fluoxetine
d) sertraline
e) all of the above have good evidence

Answer 46

b) interpersonal therapy - no evidence for use in childhood years

some evidence for CBT, and some for SSRIs fluoxetine, sertraline and citalopram

Question 47

Which of the following does not have good evidence in the adolescent years for depression treatment?

a) CBT
b) Interpersonal therapy
c) fluoxetine
d) sertraline
e) all of the above have evidence

Answer 47

e) all have evidence in teenagers

good evidence: CBT, IPT
SSRIs - fluoxetine - good evidence
sertraline and citalopram - some evidence
(from guidelines for adolescent depression)

Question 48

Name some common symptoms of depression in children:

Answer 48

- Somatic complaints
• Psychomotor agitation
• Mood-congruent hallucinations
• School refusal
• Phobias / separation anxiety /
increase in worrying

meanwhile for teens: Low self esteem, apathy, boredom
• Substance use
• Change in weight, sleep or grades
• Psychomotor depression /
hypersomnia
• Aggression / antisocial behavior
• Social withdrawal

Question 49

Which of the following is not true of depression in childhood compared to adolescence?

a) more likely to use lethal means of suicide
b) may not understand the permanence of death
c) may be at increased risk of bipolar disorder
d) all of them are true

Answer 49

a) in fact adolescence more likely to use lethal means than younger kids

also, adolescent depression more likely to have adult depression

Question 50

Name some ways that one can ensure active monitoring of patients with depression

Answer 50

Schedule frequent visits (frequency recs to be determined)
• Prescribe regular exercise and leisure activities
• Recommend a peer support group
• Review Self-Management goals
• Follow-up with patients via telephone
• Provide patients and families with educational materials

Question 51

Which of the following SSRIs has FDA approval for use in children and adolescents depression?

a) fluoxetine
b) sertraline
c) citalopram
d) none of the above

Answer 51

Medication may be needed if the child has
severe or persistent depression or has co-morbid anxiety disorders (e.g. panic, separation anxiety, social
phobia, GAD or OCD). approved for 7 and older
because may have mixed picture in younger kids, SSRIs an lead to increased agitation, irritability, poor sleep

do have recent positive studies for sertraline and citalopram (RCTs)

Question 52

Which of the following SSRIs has FDA approval for use in adolescent OCD?

a) fluovoxamine
b) sertraline
c) all of the above

Answer 52

c) all of the above - both of these have approval for OCD,RCTs also for anxiety are positive using these meds also

Question 53

you are about to start a 14 year old girl on fluoxetine for her depression. What are 5 points you should cover with her and her family prior to starting treatment

Answer 53

1. complete psychiatric assessment and education for the family
2. FDA review of SSRi safety, including suicidality
3. common side effects
4. risk of withdrawal if stopped abruptly
5. need to continue it for 6-12 months after resolution of symptoms
6. importance of supervision and medication handling by adults

Question 54

Name the common side effects of SSRIs:

Answer 54

Dry mouth, Constipation, Diarrhea, Sweating, Sleep disturbance, Sexual dysfunction, Irritability, “Disinhibition” (risk-taking behaviors, increased impulsivity, or doing things that the youth might not otherwise do), Agitation or jitteriness, Headache, Appetite changes, Rashes

SERIOUS side effects: Serotonin syndrome (fever, hyperthermia, restlessness, confusion, etc.), Akathisia, Hypomania, Discontinuation syndrome (dizziness, drowsiness, nausea, lethargy, headache

monoaminooxide inhibitors - contraindication to SSRI

Question 55

Give 2 examples of when you would switch a patient’s SSRI

Answer 55

1. still lots of symptoms after being on MAXIMUM dose for 4-6 weeks (look at chart for max doses)
2. significant side effects

when switching, need to taper the first med

vs when to consider 2nd line med: if fails 2 SSRI PLUS a course of CBT/IPT. refer to mental health at this point also

Question 56

What is the appropriate way to taper fluoxetine

Answer 56

by 10 mg every 1-2 weeks

may start a 2nd med but should warn about negative side effects (i.e. serotonin syndrome)

Question 57

A patient has stabilized on 30 mg of fluoxetine (prozac). What is the next step?

a) stop the medication and monitor for symptoms monthly
b) taper the medication and monitor for symptoms weekly
c) continue the medication for 6-12 months then reassess
d) continue the medication for 6-12 months with follow up as clinically indicated

Answer 57

statement says that after 12 weeks follow up as clinically indicated

d) continue the medication for 6-12 months after stable
some teens may need up to 2 years on the dose
follow up schedule: initially do weekly follow up for first 4 weeks of treatment, then every 2 weeks for a month, then monthly until 3 months, then as needed
should do MONTHLY follow up to ensure still effective
do parent/teen symptom questionnaires every 3 months
evaluate the medication, symptoms and any side effects at every visit
when you do decide to stop medication, need to taper slowly
**nice flowsheet in this document

Question 58

What is the black box warning from the FDA regarding SSRIs?

Answer 58

overall in the studies, no completed suicides in the studies
more spontaneous reporting of suicidal ideation in the treatment group (4/100 vs 2/100)
however, overall, treating depression lowers the risk of suicide more than the medication increases the risk. 1% increase in prescriptions results in 0.23/100000 decrease in adolescent suicides
CPS statement talks about how to monitor, very important not to let the kids sit at a low dose for too long with symptoms - i.e. want to reach an effective dose within 1-2 weeks
suicide ideation overall quite common in teens, not as predictive as in older people - 12% girls, 5% boys suicide attempts (!!) in one US study, 17% have suicidal ideation

Question 59

A parent of a depressed teen wants to know what they can do to reduce the risk that this will happen. What do you tell them.

Answer 59

1. make the home safe - remove risky objects (including ropes)
2. ask about suicide - asking about it won’t make it happen
3. look for warning signs - death theme, giving things away
4. watch for drinking - drinking will increase the chance of suicide
5. develop a suicide ER plan

with treatment, depression should get better in weeks/months, without treatment can go on for years

Question 60

Which of the following is not a risk factor for completed suicide?

a) female sex
b) no social supports
c) organized plan
d) first degree relative with suicide

Answer 60

a) male sex is a risk factor for completed suicide, although females attempt more

SAD PERSONS to predict risk for high risk attempters :

S: sex - females attempt more males complete more
A: age - over 16
D: depressed or other comorbidities
P: previous attempts
E: ethanol or other substance use
R: loss of rational thinking
S; social supports lacking
O:organized plan (highly lethal plan/may conceal the plan)
N: No spouse
S: sickness/stressors
F: family history
**not a scientifically validated tool but can be helpful

Question 61

Give some examples of systems based harm reduction strategies

Answer 61

needle exchange - reduce HIV

methadone

Question 62

primary prevention vs secondary prevention for harm reduction

Answer 62

remember that the approach needs to be different
primary prevention - more likely to be effective in younger kid who is not taking part in an activity yet
vs. secondary in an older kid (i.e. protection for sex).