Exam 3 Blue Print Flashcards
Predisposing characteristics that may suggest mental illness.
Pediatric mental illness have been linked with
School failure, Suicide, Substance abuse, violence, homelessness and incarceration
Barriers to mental health service
Stigma among families to bring up mental health concerns with doctors
Inadequate identification of youth with mental health issues
Mental health provider shortage
Inadequate coverage of mental health services by both public & private health insurance programs
Complex & fragment services
SCHIP Children’s Mental Health Parity Act
S. 1337 is a bill to ensure the parity of mental & medical care in programs operated under the SCHIP. The bill requires that states offering both medical & mental health coverage to children offer mental health coverage that is not more restrictive than medical coverage in terms of “financial requirements & treatment limitations.”
Mental Health Parity Act of 2007
S. 558/H.R. 1424 improves the mental health of all Americans, esp. children & adolescents.
Requires business that offer mental health insurance to provide equal coverage for both physical & mental health services.
Requires parity in co- payment, deductible, out-of-pocket expenses, covered hospital days, outpatient visits, & substance abuse treatment.
Implications for sleep
Sleep: Pearls for Primary Care
change in sleep pattern may be an early symptoms of mental illness
Sleep debt destabilizes frontal lobe
Lack of sleep worsens all mood disorders.
Parent with sleep debt is more irritable.
Sleep diary may be useful
Consider role of media/ phone
Consider obstructive sleep apnea
Work on sleep first or simultaneously
Psycho-social Emergencies
Suicidal or Homicidal intent Psychosis Drug over dose Dangerous or destructive, out-of-control behavior Panic attack Abuse/ Neglect
Characteristics of social phobia vs anxiety disorder
Anxiety disorder
Cognitive disturbance -interference with academic performance, attentional biases (toward threat), cognitive biases (negative spin on ambiguous situations)
Physical symptoms
sleep, aches/pains
Social & emotional deficits- interference, low self-esteem, loneliness
Characteristics of social phobia vs anxiety disorder
Social Phobia
Range of associated features: being overly sensitive to criticism, having low levels of self-esteem, having inadequate social skills.
School performance may be impaired due to test anxiety & failure to participate in classroom activities.
Social anxieties can result in school refusal.
Characteristics of GAD
Children tend to be perfectionisitic, worrying about what others will think of them or their performance
Engage in excessive approval seeking and frequent solicitations of reassurance.
Contribute to physical symptoms: headache, dizziness, shortness of breath, upset stomach and problems with sleeping.
May develop nervous habits such as nail biting and hair pulling
Characteristics of separation anxiety
Excessive distress when sepration from attachment figure is anticipated
Excessive worry about losing or possible harm to figure
Excessive worry that an event will lead to separation
Reluctance or refusal to go to school because of separation fear.
Excessive fear or reluctance to be alone
Reluctance or refusal to go to sleep without being near attachment figure
Nightmares involving theme of separation
Complaints of physical symptoms occurs/ is anticipated
Clinical characteristic of Bipolar disorder
Experiencing episodes of intense mania & depression
Mania symptoms
severe or rapid changes in mood, extremely irritable or overly silly, elated mood, overly inflated self-esteem, grandiosity, exaggerated beliefs about personal talents/abilities, increased energy, decreased need for sleep, able to go with very little/no sleep for days without tiring, talks too much, too fast, changes subjects too quickly, distractibility, hyperactivity, attention shifts from one thing to another quickly, increased sexual thoughts, feelings, behaviors or use of explicit sexual language, increased goal directed activity or physical agitation, excessive involvement in risky, daredevil behaviors/ activities.
Clinical characteristic of OCD
Recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance as intrusive and inappropriate and that cause marked anxiety. Not simply excessive worries about real-life problems. Person attempts to ignore, suppress or neutralize thoughts.
Compulsions- repetitive behavior or mental acts that the person feels driven to perform in response to an obsession, which are aimed to reduce distress.
Clinical characteristic of PTSD
Traumatic event is re-experienced, recurrent & intrusive recollections.
Recurrent & distressing dreams, acting or feeling as if event were recurring (reenactment).
Intense distress at exposure to internal or external cues that resemble an aspect of the event
Physiological reactivity on exposure to cues.
Common obsession and compulsion
Obsessions- contamination, harm to self or others, need for symmetry/order, religious or moral concerns, sexual or aggressive, lucky or unlucky numbers
Compulsions- cleaning, checking, counting, repeating, ordering, straightening, praying, confessing, reassurance seeking, touching, tapping, or rubbing, hoarding.
Manifestation of Depression in Adolescents
Mood/behavioral changes such as sadness & tearfulness
Hopelessness
Inability to concentrate
Loss of energy
Sleep and/or appetite changes
Self-criticism & low self-esteem
Suicidal crises
Withdrawal from family/social activities
Irritability (fights, moodiness, etc.)
School underachievement, failure, truancy
Substance use and abuse (self-medication)
Frequent aches and pains, somatic symptoms- increased # physician/ER visits, increase in medical testing
Diagnosis of Major Depressive Disorder
- depressed or irritable mood
- diminished interest or pleasure in activities
3.appetite/ weight changes
4.sleep pattern disruption
5.psychomotor agitation or retardation
6.fatigue or loss of energy
7, feelings of worthlessness or excessive /inappropriate guilt. - diminished ability to think or concentrate, or indecisiveness.
- recurrent thoughts of death/ suicidality
symptoms present for 2 weeks or more
Intervention for depression including 1st line meds
Mild depression- supportive psychotherapy is =effective to CBT or IPT.
Severe symptoms & suicidal ideation/behaviors supportive psychotherapy is not as effective as CBT or IPT.
Active support & monitoring for 6-8 weeks(every 1-2 wk)
Moderate Depression- Initiate antidepressant treatment and/or psychotherapy, monitor for symptoms & adverse events, consider ongoing MH consultation.
After 6-8 wk with partial improvement consider adding meds or increasing meds, adding therapy if not on therapy, consulting with MH. Provide education, review safety plan and continue monitoring.
1st line treatment is SSRI. FDS approved pediatric depression is Fluoxetine (7-17 yr) starting dose 10mg/day increase by 10-20 Effective dose 20 mg, max 60mg Escitalopram (12-17 yr) starting dose 5mg/day increase by 5mg, Effective dose 10 mg Max 20mg
Side effects of pharmacology management
Overall, SRIs & antidepressants in general have been well tolerated by both children & adolescents.
Most common side effects - gastrointestinal, insomnia or somnolence, vivid dreams, nightmares, restlessness, diaphoresis, headaches, akathisia, changes in appetite & sexual dysfunction.
3-8% esp. children may show increased impulsivity, agitation, irritability, silliness, and behavior activation.
Rare side effects- Serotonin syndrome & increased suicidality are side effects of antidepressants.
Characteristic of Central Auditory Processing Disorder vs Dyslexia
Dyslexia a language and reading disability.
Central Auditory Processing Disorder- difficulty processing and remembering language-related tasks.
Differential Diagnosis of mild, moderate, intermittent, or severe asthma
Airflow obstruction, episodic; allergens; bronchiolitis, chest pain, chest tightness, conjunctivitis, cough, eczema, family history of allergy, family history of eczema, dermatitis, fatigue, mucosal swelling, nasal polyps, otitis, pneumonia, rhinitis, shortness of breath, sinusitis, sleep disturbance, sneezing, upper respiratory infection, wheezing.
