CPS statements - Adolescent Flashcards
4 ways to calculate target goal weight in anorexia nervosa
- return on menstruation weight + 2kg
- median BMI (50th percentile BMI for age and sex)
- premorbid growth percentiles
- based on weight at same percentile as height percentile
Effects of cannabinoids on adolescent brain
- impacts on frontal cortex
- impacts on dopaminergic systems involved in maturation of cortical neuronal networks (toxic changes to neurons)
- structural changes including lower brain volumes
Cannabis withdrawal syndrome
- Experiencing at least 2 of 5 psycholgoical sx :
- irritability
- anxiety
- depressed mood
- sleep disturbances
- appetite changes - Experiencing at least 1 physical sx:
- abdo pain
- shaking
- fever
- chills
- headache
- diaphoresis - heavy use
- sx occur 24-72 hr after last use and persist for 1-2 weeks up to 1 month
Counselling for cannabis
8 As
- Assure confidentiality
- Ask about cannabis
- Answer questions
- Assess impacts
- Appraise willingness to change
- Assist with goal setting
- Arrange a follow up
- Acknowledge parental concerns when they arise
Tiers of contraception
1st tier: LARC e.g. IUD
2nd tier: hormonal = depend on consistent use
3rd tier: used at time of intercourse e.g. barrier
Hormonal contraceptions and bone
- DMPA associated with decreased bone mineralizations
- pills with estrogen < 30 mcg associated with poorer bone mineralization
Estrogen containing contraceptives increase risk of VTE and stroke by how much
VTE: 2-4x
Stroke 1.5-2x
Starting contraception when to do pregnancy test
- if starting contraceptive and not in first 7 days past menstrual period
check it and then screen again in 21 days
Most important risk factors for unhealthy weight control behaviours
- dissatisfaction with weight
- obesity
- low self esteem
Risks of e-cigarettes
- nicotine dependency
- risk for acute cardiac events (dripping –> larger bolus)
- asthma/bronchitis due to particulates in aerosol
- filler materials (propylene glycol and glycerin): mouth and throat irritation and dry cough
Family based therapy initial goal
- slow weight restoration is initial goal
Youth are at risk for firearms-related injury because (RFs)
- lack experience
- lack cognitive development
- lack impulse controle
- incompletely developed self-regulation skills
- cannot differentiate real from toy, understand consequences
Pathologic gambling
Impulse control disorder
- persistent and recurrent maladaptive gambling behaviour
- deleterious legal, financial, physical and psychosocial consequences
- NOT better accounted by a manic episode
RFs for developing a gambling problem
- depression
- loss
- abuse
- impulsivity
- antisocial traits
- learning disabilities
Screen for gambling behaviours especially when…
- parental concerns
- academic performance is suffering
- sleep problems
- money/possessions go missing
- substance misuse
- impaired relationships
- any comorbidities associated with gambling (substance use, conduct disorder, personality disorders, mood disorders)
Primary prevention vs. secondary prevention in adolescent behaviours
Primary prevention: discouraging the behaviour (e.g. delaying sex)
Secondary prevention: minimizing the consequences (e.g. using condoms)
Children of adolescents are at risk for…
- increased risk of prenatal death
- increased risk of premature birth
- increased risk of low birth weight
- growth and development esp cognitive and speech and language delays
- higher risk of accidental injury and neglect
- challenges with behaviour and in school
- higher risk of substance use, sexual activities, struggle acadmeically as teens
Adolescent mothers at risk for
- higher rates of mental health disorder
-repeat pregnancy - substance use
- IPV
lower self-esteem - lower SES+income
- lower educational attainment
- lower social support
- higher substance use, smoking and STI
Factors increasing risk of abuse for youth with disabilities
- institutions
- Societal factors
- educational factors
- health care factors
- disability-specific factors
Street involved youth barriers to health care
Individual barriers: money, transportation, knowledge, drust of authrotiy figures, confidentiality,
Systems-levels; adult consent, health card, address, poorly coordinted services that are difficult to access
Factors making teen more likely to quit smoking
- older teenager
- male
- teen pregnancy and parenthood
- scholastic success
- team sport participation
- peer and family support
- CYP2A6 slow nicotine metabolicse
Factors making teen less likely to quit smoking
- nicotine addiction
- mental health conditions
- substance use
- chronic illness
- family stress
- peer and family tobacco use
- overweight/preoccupation with weight
- developmental drive to experiment
- fear of peer rejection
- perceived lack of privacy and autonomy
Interventions with strongest level of evidence for smoking cessation
- individual counselling
- motivational enhancement
- CBT
Nicotine effect on adolescent brain
- changes in neural connectivity in brain (e.g. emotional regulation)
- higher risk for addiction
- epigenetic changes that sensitize brain to other drugs
- increase impulsiveity, decrease attention performance
Evidence for SSRIs in adolescent depression and which drug
- 40-70% response rates
- best evidence for fluoxetine (and fluoxetine is only drug that showed evidence in < 12 yrs)
(other options = sertraline, citalopram, escitalopram for older kids)
SSRI side effects
- GI symptoms
- sleep changes
- restlessness
- appetite changes
- sexual dysfunction
- behavioural activation may occur (monitor for hypomania)
rare SE: bleeding risk, SIADH, serotonin syndrome
Serotonin syndrome toxicity symptoms
SHIVERS
- shiver
- hyperreflexia, myoclonus and ataxia
- increased temp
- vital sign instability
- encephalopathic/
- restless
- sweating
Citalopram specific side effects
- dose dependent QT interval prolongation and risk of arrhythmia (for dosages > 40mg/day)
SSRIs with evidence in anxiety for teens
similar effectiveness btw fluoxetine, fluvoxamine and paroxetine
Non-medical issues addressed by transition care
- emotional health
- reproductive health
- social impacts
- employment/cognitive
two core principles of transition planning
- start early in childhood (increasing levels of responsibility given to child)
- collaboration with adult HCPs
Risk factors for increased risk of suicide
- mental illness
- prior deliberate self-harm or suicide attempt
- impulsivity
- precipitating factors
- family factors
- lack of connection to psychosocial support
