MENTAL HEALTH Flashcards
1
Q
What are the 4 primary presentations in ADHD?
A
Inattention
Hyperactivity
Emotional dysregulation
Impulsivity
2
Q
What are the top three mental health disorders?
A
Depression, anxiety and ADHD
3
Q
5-9% of children and 3-5% of adults are diagnosed with this mental health condition.
A
ADHD
4
Q
What might symptoms of inattention look like in a pediatric patient with ADHD?
A
- Fails to give close attention to details
- Difficulty sustaining attention**
- Does not seem to listen when spoken to directly
- Does not follow through on instructions
- Difficulty organizing tasks and activities
- Avoids or dislikes tasks that require sustained
mental effort - Loses things
- Easily distracted
- Forgetful
5
Q
What might symptoms of hyperactivity look like in a pediatric patient with ADHD?
A
- Fidgets with or taps hands and feet
- Leaves seat in situations that require remaining
seated - Runs about or climbs where it is inappropriate
- Unable to play or engage in leisure activities quietly
- Often “on the go”
- Talks excessively
- Has difficulty waiting his or her turn
- Interrupts or intrudes on others
- Blurts out answers
6
Q
What is the DSM-V criteria for diagnosing ADHD in pediatric patients?
A
<17 years old : 6+ symptoms
> 17 years old: 5+ symptoms
Symptoms must:
-be persistent for 6+ months
-be present before age 12
-be present in multiple settings (school, home, work)
-interfere with or reduce daily functioning
-not be better explained by another mental health condition
7
Q
What are some differential mental diagnoses for ADHD?
A
Conduct disorder
Bipolar disorder
Language disorder
Substance misuse
Sleep disorder
PTSD/stress reaction
8
Q
What are some differential physical diagnoses for ADHD?
A
Sensory impairment, esp. hearing
Seizure disorder
Iron deficiency
Environmental toxins (lead)
SE of meds
Hyperthyroidism
Congenital infection
In utero exposure to drugs/ETOH
Brain injury (trauma, infection)
Brain lesions
Sleep apnea
9
Q
Which mental health disorders are common comorbidities of ADHD?
A
- Oppositional defiant disorder ~60%
- Specific learning difficulties ~45%
- Speech-language disorder ~40%
- Anxiety ~30%
- Depression ~18%
- ASD 10% (autism spectrum disorder)
- Higher rates of seizure disorder, sleep disorder,
chronic tics/Tourette’s, enuresis, bipolar
disorder, substance use, PTSD
10
Q
How should you address mental health comorbidities of ADHD?
A
- Treat the most disabling condition OR the
condition most likely to respond to tx first - Severe depression, unstable bipolar disorder,
active substance use MUST be dealt with first
o Psychosocial treatments
o Medication
o Both - Then treat the other conditions
11
Q
Untreated ADHD can lead to difficulties in adulthood. Can you name some areas?
A
Academic concerns
Relationships
Poor self-esteem
Self-harm
Smoking & drug addiction
Traffic accidents
Legal difficulties
Occupational/vocational
12
Q
What is the rate of childhood victimization in the US? (From Berkowitz text, sorry)
A
1 in 7
15-20% of these undergo physical abuse
13
Q
In the context of physical abuse, what is a sentinel injury?
A
Minor injury under appreciated by the non- offending care taker (and often the PCP) that precedes/ is a warning sign of future more severe injury from physical abuse
i.e., bruise in pre mobile infant, subconjunctival hemorrhage
14
Q
What are some parental traits that can increase risk of physical abuse?
A
Unrealistic expectations (frustration and abuse result when unmet)
Poor impulse control
15
Q
What injury represents the most deadly form of abuse?
A
Head injuries
16
Q
How can head injuries result from physical abuse
A
-Direct blow
-Rotational movement/ shaking
-intracranial hemorrage (shaken baby)
-Diffuse axonal injury (shaken baby)
-Subdural hemorrage (shearing of bridging veins)
-Can lead to apnea, seizures, cerebral edema, hypoxic brain injury, retinal hemorrages
17
Q
What is the 2nd most fatal form of physical abuse
A
Abdo trauma, typically causes by blows
18
Q
What is important to note in history taking in a child presenting with an injury (that may raise alarm for physical abuse)?
A
-Changing history
-History inconsistent with injuries sustained
-History does not match developmental capabilities of child
-Unwitnessed injuries (esp. in pre- ambulatory kids)
19
Q
What kinds of bruises are suspicious for physical abuse?
A
Usually, accidental bruises in children are over bony prominences (forehead, elbow, shins).
Be suspicious of bruises to soft area (cheeks, ear pinna) or protected areas (inner thigh, neck)
20
Q
What burn patterns should raises suspicion for physical abuse?
A
-Immersion burns (glove/ stocking/ donut pattern- differs from splash/ spill, which has irregular drip pattern)
-marks that appear to result from hot objects held against child (i.e., cigarette)
21
Q
What kind of fractures raise suspicion for physical abuse?
A
-long bone fractures of humerus and femur (esp in preverbal/ preambulatory child)
-metaphyseal lesions
-fractures of rib, sternum, scapula
22
Q
Name some medical conditions that can mimic abuse.
A
o Bullous impetigo may resemble burns
o Coagulopathy may results in bruises
o Leukemia, thrombocytopenia, aplastic anemia are associated with bruising
o Osteogenesis imperfecta or rickets may result in many #
o Bone cysts and osteoporosis caused by inactivity (i.e., due to CP, paralysis) may predispose to development of pathological fracture
o Congenital melanocytosis (large blue gray spots on back and buttocks)
23
Q
What are general treatment measures for children in which you suspect physical abuse?
A
- Medical stabilization
- Thorough, objective documentation of findings
- Psychosocial investigation (often requires SW)
- May have in home evaluation
- Need to report (even if unsure abuse has occurred)
24
Q
What is one thing we can do to prevent physical abuse?
A
- Anticipatory guidance re expected development and expectations (infant colic, toddler toilet training and tantrums)
25
What are risk factors for intimate partner violence (IPV)
personal hx of maltreatment as child, adolescent or young adult, disparity of status (educational, professional) between partners, high level of dependence of one partner on other, substance use, low self- esteem, pregnancy
26
What are common clinical presentations for IPV?
* May present for care for themselves or children
* 1/3 of people injured by partner seek care for their injuries
* Skin injuries most common (esp. head, neck, face)
* Patient may fabricate stores to explain injuries
* Children may manifest effects of trauma: stress, disrupted caregiver attachment, anxiety, fear, hypervigilant; may have difficulty with aggression and peer relationships
* Adult or adolescent victims of IPV often present with vague symptoms, and those who have been abused are more likely to present with gyne complaints (recurrent STIs, vaginal bleeding, chronic pelvic pain)
* May also present with non specific symptoms- sleeping difficulties, appetite changes, weight loss, chronic pain, syncope
27
Describe the cycle of violence in IPV
o Tension building: Abuse uses verbal, emotional, physical threats
o Violent episode: Physical/ sexual/ emotional/ psychological assault
o Honeymoon phase: Abuser apologizes and assures it will not happen again; re-bonding occurs
These escalate over time; violence becomes more frequent and more severe and honeymoon phase shortens
28
What factors increase the risk of harm in IPV?
o Threats to harm or kill victim or another person
o Use of alcohol or drugs during the incident
o Use of weapon
o Victim reports abuse or attempts to leave relationship
29
T/ F most people will tell you if they are being abused
False. You need to screen and ask
30
What is the management for a patient presenting with IPV?
* Safety assessment (pattern of escalating violence, weapons available, comfort level of victim to return home)
* Emergency safety plan
* SW- IPV shelter, hotline, advocacy organization
* Collect money, care keys, house keys, important documents
* Ask neighbors to contact police if violence heard in home
* Establish a code that victim can use to communicate to others violence is occurring that prompts the contact to take certain action on use of code
* Disarming or removing weapons from home
* Need to report child abuse that is occurring; refer child to trauma focused mental health services
31
Children exposed to IPV have an increase risk of adult morbidity, including....
substance use disorder
obesity
depression
suicide attempts
and many more
32
Define child sexual abuse
Child sexual abuse involves sexual activity that children/adolescents cannot consent to due to their age/developmental level. Age disparity exists, and the intent is sexual gratification of the older perpetrator. May or may not include physical contact (i.e.. - includes acts of exhibitionism and involvement in pornography)
Differentiated from “sexual play” by the developmental levels of the participants and the coerciveness of the behavior.
33
What is Canada's age of consent to sexual activity?
16
34
Is there any exception to this age of consent?
A 14 or 15 year old can consent to sexual activity as long as the partner is less than five years older and there is no relationship of trust, authority or dependency or any other exploitation of the young person. This means that if the partner is 5 years or older than the 14 or 15 year old, any sexual activity is a criminal offence.
There is also a "close in age" exception for 12 and 13 year olds. A 12 or 13 year old can consent to sexual activity with a partner as long as the partner is less than two years older and there is no relationship of trust, authority or dependency or any other exploitation of the young person. This means that if the partner is 2 years or older than the 12 or 13 year old, any sexual activity is a criminal offence.
35
Does this mean a 16 year old can consent to sexual activity with anyone?
No
A 16 or 17 year old cannot consent to sexual activity if:
their sexual partner is in position of trust or authority towards them, for example their teacher or coach
the young person is dependent on their sexual partner, for example for care or support
the relationship between the young person and their sexual partner is exploitative
36
What is the estimated prevalence of child sexual abuse
20-25% of women and 10-15% of men
37
What is the mean time from onset of sexual abuse to disclosure of abuse?
3 years (due to many reasons - Coercion/threats, feelings of guilt/personal responsibility, not realizing the relationship is harmful initially, fear of family disruption)
Children may not disclose, abuse is incidentally discovered due to symptoms such as vaginal discharge
38
Who are the most common perpetrators of child sexual abuse?
Often the perpetrators are known by the targets
37% of perpetrators are biological parents
23% non biological parent
39
How does child sexual abuse often present?
Most cases found when child discloses
May have no physical or behavioral symptoms
Physical symptoms
-anogenital bleeding, pain, swelling, dysuria, vaginal discharge, difficulty passing stool, scarring, STIs, pregnancy
-More common: nonspecific symptoms of headache, abdo pain, fatigue
Behavioral symptoms
-Sleep disturbances, hyperactivity, enuresis, encopresis, decreased appetite, depression, sexualized behavior
-School failure, delinquency, suicide attempts
40
Should you conduct the history for a child who discloses sexual activity?
Ask thought out, non-leading questions, make effort to have the child questioned a minimal number of times.
Interviews should be performed by someone with professional expertise in the field – could be a care provider, SW, psychologist, rape counselor, detective or attorney.
41
T/F A normal PE rules out sexual abuse
False
42
T/F if an episode of sexual abuse occured in the last 72 hours, forensic evidence can be collected.
True
If within 72 hours, forensic evidence should be collected
For adolescents, DNA evidence can be collected up to 120 hours after assault – usually involves vaginal washings of dried secretions and submission of clothing
1-5% of children sexually abused acquire a STI – STI testing based on risk assessment.
Use cultures rather than NAAT, as they hold up better in court
43
What are some conditions that can be mistaken for sexual abuse?
Genital
-Accidental trauma (i.e., from straddle injury/ falls)
-Lichen sclerosis (hypopigmented figure 8 in anogential area)
-Urethral prolapse (F age 4-8)
-Labial adhesions
-Congenital malformations
-Hemangioma
-Candida (can mimic STI)
Anal
-IBD
-hemorrhoids
-anal or perirectal abcess, strep infection
44
Outline the general management when caring for children who have experienced sexual abuse.
Address medical problems such as traumatic injuries
Offer adolescents pregnancy counselling, STI prophylaxis and emergency contraception
Crisis intervention through referral to appropriate counselling services
Report disclosure to appropriate agencies
May be required to testify in court – very careful and clear documentatio
45
What are some components of your physical exam if you are assessing a pediatric patient for ADHD?
Plot growth (HT, WT, head circ.) - growth can be slightly reduced 1-2%.
Inspection for minor congenital anomalies or dysmorphia
Neuro exam including affect, speech, hearing and vision
CVS/Resp
Observation of the child's behaviour during the office visit
46
You have just diagnosed a patient with ADHD. If you suspect this patient may have an eating disorder (decreased nutrients), would you still treat with stimulants?
No, stimulants are contraindicated if the eating disorder is severe, especially in adolescents and youth. The brain does not have the capability to utilize the stimulants in the context of starvation.
-as per guest speaker
47
Which investigations are recommended when you are assessing for ADHD?
Speech, hearing and vision screening
BW: CBC, ferritin, B12, lead (if risk factors are present)0, thyroid
Psychometric testing (IQ) R/O learning disability
Sleep apnea
48
What is the SNAP-IV screening tool?
An ADHD screening tool given to teachers and caregivers.
49
Which ADHD screening tools are used for pediatric patients (not older teens)?
SNAP-IV 26 (caregiver and teacher)
Weiss Symptom record (caregiver and teacher)
Weiss Functional Impairment Rating Scale (WFIRS-S)
SCARED (Screen for child anxiety-related disorders)
50
Which Screening tools would you use if assessing an older teen for ADHD?
* SNAP-IV-26 (caregiver and teacher)
* Adult ADHD Self-Report Scale (ASRS)
* GAD 7 (<17 years)
* PHQ 9 modified for teens
* CRAFFT screening (adolescent substance use)
51
What are the 1st and 2nd line treatments for ADHD?
Pills (stimulants and non-stimulants) then skills.
52
Which physiological features do you want to pay special attention to when initiating pharm tx for ADHD? What to monitor as you move forward?
Pre-treatment
* Height, weight, BP, HR, cardiac exam
* *FMH of sudden cardiac death, PMH congenital heart defect (+/- repair), unexplained syncope, chest pain, SOB or activity intolerance
* ECG +/- cardiology evaluation
During Treatment
* Height, weight annually
* BP, HR twice annually and before/after dose increase
53
What are the 2 medication groups of stimulants that you can prescribe for ADHD?
Methylphenidate (Ritalin, Concerta, Biphentin)
Amphetamine (Dexedrine, Adderall, Vyvanse)
54
What are some non-stimulants that can be used to treat s/s assoc. with ADHD?
Atomoxetine (Strattera), an SNRI (2nd line)
3rd line:
Buproprion
MAOI
Clonidine
Guanfacine
55
What are some possible S/E to counsel about when starting a patient on stimulants for ADHD?
sleep problems
loss of appetite
GI sx
headache
nervousness
palpitations
Irritability
“revved up” feeling
hyper-focus or cognitive blunting
(dose too high or rebound)
56
How long should you wait if you are going to switch ADHD meds?
Other than clonidine and Strattera, you can switch the next day.
57
When prescribing ADHD meds, it is recommended you use generic or trade names?
Trade names as there are many formulations and you want to be sure your patient gets the medication as intended.
58
If you decide to co-prescribe an SSRI with Strattera (an SNRI) what do you need to be mindful of?
The combination may prolong QT.
59
Give some examples of skill-building strategies for people diagnosed with ADHD.
Social skills training
Organizational skills
Anger management
CBT/psychotherapy
Motivational interviewing
Mindfulness
Academic skills
Academic remediation and accomodations
Communication b/n home and school
60
Some parenting strategies to recommend when a child has been diagnosed with ADHD:
Take a disability perspective (child is not "bad")
Create a routine
Limit choices
Cue attention prior to short, clear instructions
Help the child plan and stay organized
Control distractions
Manage behaviour at the point of performance (addressing behaviour right away when it occurs)
Rewards and incentives
Maintain a sense of humour
Praise strengths and encourage the child
Get respite and attend to self-care
61
What is PTSD?
PTSD Post-traumatic stress disorder
-Set of symptoms that recurs after a person has experienced, witnessed, or was confronted with an event/ events that involved actual or threatened death or serious injury, or threat to physical integrity to self or others. Response involved intense fear, helplessness, or horror.
62
What is the clinical presentation of PTSD
-Intrusion symptoms associated with the traumatic event (distressing memories, dreams, dissociative reactions/ flashbacks where they feel like the traumatic event recurring, intense or prolonged distress, physiologic reaction to cues that resemble the traumatic event)
-Avoidance of stimuli associated with event (avoiding memories/ thoughts/ feelings associated with event, efforts to avoid external reminders like people, places, activities, objects, situations)
-Negative alterations in cognition and mood (inability to remember important aspects about event, negative beliefs about oneself, distorted cognitions about the cause/ consequence, blaming self or others, persistent feat, horror, anger, guilt, feelings of detachment from others, inability to experience positive emotions)
-Alterations in arousal and reactivity (irritable behaviour, angry outbursts, verbal or physical aggression, reckless or self destructive behaviour, hypervigilence, exaggerated startle response, problems with concentration, sleep disturbances)
63
What is the prevalence of PTSD in canada? What is the typical onset? More common in F or M?
9%
Onset mid to late 20s
F>M (2:1)
64
What are common forms of trauma that can initiate PTSD?
unexpected death of someone close, sexual assault, serious illness or injury to someone close, physical assault by partner or caregiver
65
What is a good screening question for PTSD?
Have there been distressing events in your life that have been difficult to get over?
Note: dont probe for details of trauma
66
Diagnosis of PTSD?
Clinical, DSM-5 criteria.
Can be remembered by TRAUMA +
-Traumatic event
-Re-experiences event
-Avoidance of stimuli associated with event
-Unable to function
-More than 1 month
-Arousal increased
+ negative alterations in cognition, mood
67
Ddx of PTSD?
Acute stress disorder (<1 month of symptoms)
Bipolar
Borderline personality disorder
ADHD
68
Non pharm treatment of PTSD?
Psychotherapy
CBT:
* Stage 1: Safety and stabilization: emotionl regulation to build coping skills, meds for PTSD, managing substance use
* Stage 2: Remembrance and mourning: exposure to traumatic memories, work through distorted thoughts, relational patterns, and grief
* Stage 3: Reconnection and integration: exposure therapy, etc to create a new future, new relationships, strengthen identity
Also EMDR (eye movement desensitization and reprocessing)
69
Pharmacological options for PTSD?
* SSRI, SNRI first line (fluoxetine, paroexetine, sertraline, venlafaxine)
* Prasozin for disturbing dreams and nightmares
* Mirtazepine second line
* TCA, atypical antipsychotics third line (risperidone, olanzepine)
70
What is the most prevalent psychiatric condition in children and adolescents?
Anxiety
71
What proportion of youth does anxiety affect?
15-20%
72
What is anxiety?
Fear without definable source
Physiological response, may be perceived as vague feeling of uneasiness, apprehension, foreboding
73
What is generalized anxiety disorder?
* Excessive anxiety and worry for 6+ months in a number of events/ activities
* Difficult to control worries
* And 3+ (only 1+ required in kids) of restless/ keyed up/ on edge, easily fatigued, poor concentration, irritability, muscle tension, sleep disturbance.
74
What are panic attacks?
* Discrete period of intense fear or discomfort, with 4+ symptoms developed abruptly and peaked in 10 min
* Palpitations, sweating, shaking, SOB, choking, CP, nausea/ abdo distress
* Catastrophic interpretation of benign physical sensations/ cognitions
75
What is social anxiety disorder?
Social anxiety
* Marked and persistent fear of social or performance situations in which person is exposed to unfamiliar people or scrutiny by others
* Fear of being humiliated, embarrassed
* Exposure provokes anxiety, panic attacks
* Recognizes fear is excessive/ unreasonable
* Avoids social or performance situations
* Interferes with function
76
What assessment tool do we used for anxiety in pediatric populations
* SCARED (Screen for child related anxiety disorders)
* Suggested by Berkowitz: Multidimensional anxiety scale for children, Spence children’s anxiety scale, SCARED
77
Some differentials to consider for anxiety?
* School phobia
* Depression
* ADHD
78
What are some things parents can do to support children with anxiety?
-Parental support/ education
-Not minimizing children fears,
-helping empower children to overcome fears,
-reading books about over coming fears (i.e., The Bernstein Bears in the Dark),
-provision of physical comfort,
-telling kids fictional characters (i.e., monsters, witches) do no exist,
-limit exposure to feat provoking situations (movies/ programs/ disastrous events)
79
What is the first line treatment for pediatric patients with mild to moderate anxiety disorder?
CBT!
Programs to focus on
* Psychoeducation
* Somatic management (relaxation techniques)
* Exposure methods (desensitization)
80
What medication is approved by Health Canada for anxiety in patients <18 years?
None (RxFiles)
81
What medications do we use for management of moderate to severe anxiety in pediatric populations
SSRIs first line
Fluoxetine
Sertraline, escitalopram, citalopram also good options
82
T/F When treating anxiety in pediatric populations, you may need a higher dose of SSRs compared to when treating for depression?
True
83
Within the pediatric population, is depression more common in males or females?
Trick question
-More common in males pre-puberty
-More common in females following puberty
84
Prevalence of depression in adolescents?
8-11%
85
Risk factors for depression in pediatric populations?
Low birth weight, fhx depression and anxiety in FDR (including PPD), family dysfunction, exposure to early adversity, psychosocial stressors (peer problems, bullying, academic difficulties), gender dysphoria, homosexuality, negative style of interpreting events and coping with stress, hx of anxiety disorder, SUD, learning disability, ADHD, TBI, chronic illness, fhx psychiatric illness, medications (propranolol, phenobarbital, prednisone)
86
Describe the pathophysiology of depression briefly.
Exact pathophysiology unknown, likely multifactorial (genetic, psychosocial, environmental)
-Genetic influences
-Changes in neurotransmitters (serotonin, NE)
87
What are the symptoms of depression?
-Low mood
SIGECAPS
* Sleep disturbances
* Interest decreased
* Guilt
* Energy low
* Concentration poor
* Appetite changes
* Psychomotor agitation or retardation
* Suicidal ideation
Other symptoms in kids include
-irritability
-anger
88
T/F most adolescents diagnosed with depression have comorbid psychiatric disorders.
True! 60%+! Screen for other disorders (anxiety, ADHD, ODD, conduct disorder, SUD, bipolar)
89
What assessments would you do on a child who is presenting with symptoms suggestive of depression?
-HEADS (home, education/ employment, activities, drugs/ alcohol, depression/ suicide, sex, safety)
-PHQ-9, SCARED (screening, NOT diagnosis). Moods and feelings questionnaire
-Always screen for SI (SADPERSONS), risk of harm to self or others, psychotic features or manic features
-MSE
90
How is depression diagnosed?
Clinical diagnosis
* DSM-5 criteria (5/9 symptoms for at least 2 weeks)
(low mood, SIGECAPS)
91
What labs might you consider when working a child up for depression?
CBC, lytes, Cr, eGFR, ferritin, TSH, FPG, serum tox, urine tox
* Prior to starting meds, also helpful to have LFTs, ECG, b-hcg, so I would also include these
92
Should you do imaging for a child diagnosed for depression?
No, unless you are concerned about an intercranial abnormality ie brain tumour
93
Ddx for depression?
* Other MH disorders: Anxiety, bipolar, substance use disorder, eating disorders, ADHD
* Anemia, hypothyroidism, DM, cancer, TB, Addisons, post concussion syndromes, SLE, HIV
* Medication causes (propranolol, phenobarb, prednisone)
94
Non pharm management for depression?
-NESTSSS: Nutrition, exercise (cardiovascular) sleep, time for self, social support, social media (reduce), substances
-CBT (60-70% of youth respond to psych treatments per Rx Files).
-RxFiles suggests that if depression less severe, consider active monitoring (lifestyle/ non pharm) for 6-8 weeks, then psychological treatments (CBT) for 6-8 weeks, then pharmacotherapy if needed.
Consider going directly to medication if moderate severe depression/ anxiety.
-Safety plan always
-To ED if suicidal/ homicidal intent or psychosis
95
What medication is approved by health canada for depression in pediatric patients?
None
96
What medication is considered first line (has best supporting evidence) for depression in pediatric populations? Be specific.
Fluoxetine.
97
What are other good options for depression in pediatric populations?
* Sertraline, escitalopram, citalopram
98
What must we be cautious of when using escitalopram and citalopram (compared to sertraline)
NB that escitalopram and citalopram can prolong QT and cannabis can increase levels of both.
99
T/F We tend to avoid SNRIs and TCAs in peds
True
* Rx files states we tend to avoid SNRIs/ TCA in peds (more activating, AE’s more common)
100
Common AE we counsel patients starting SSRIs on?
HANDSSS
-headache or dizziness
-anxiety/ agitation, anticholinergic
-nausea
-diarrhea/ GI upset
-sleep disturbance,
-sexual dysfunction,
-suicidality
Most are transient (first 1-2 weeks) and dose related.
101
What is very important to education pediatric patients/ their families on when starting them on an SSRI?
increased risk for suicide at start of antidepressant therapy- seek care immediately
102
You start Jim, age 14, on an SSRI for moderately severe depression. When will you check in on him next?
* RxFiles suggest checking in weekly x4 weeks after SSRI initiation, then q2 weeks x 4 weeks, then monthly ongoing.
103
When might you see early effects of an SSRI?
2-3 weeks
104
At what does do you initiate an SSRI? Should you titrate this? How often?
Start low, titrate up q1-2 weeks until happy with effects/ suggested therapeutic dose is reached
105
What is considered an "adequate trial" for medications for antidepressants?
4-6 weeks (though may require up to 12 weeks for full clinical effects).
106
Jim has been on his SSRI antidepressant for 6 months and decided to quit it all of a sudden. What might he experience?
Withdrawal syndrome- FINISH
-Flu like symptoms (HA, arthralgia, malaise)
-Insomnia
-Nausea
-Imbalance (dizziness)
-Sensory disturbances
-Hyperactivity (agitation, anxiety)
107
How long would you expect to treat a patient with an SSRI for their first episode of depression?
6-12 months after remission is achieved.
108
What is the second most common cause of death for those aged 15-24
Suicide
109
What is suicidal ideation?
thoughts of engaging in suicide related behavior
110
What is suicidal intent?
having a plan for suicide and the aim/ resolve to follow through with it
111
What are suicidal behaviours?
Behaviours related to suicide, including preparatory acts, suicide attempts, death
112
What is a suicide attempt?
Non-fatal, self-directed, potentially injurious behaviour with any intent to die as result of behaviour.
113
What are risk factors for suicide?
SADPERSONS
-Sex- male (females more likely to attempt, males more likely to succeed)
-Age (<20, >44)
-Depression
-Previous attempt
-Etoh use
-Rationale thinking loss
-Suicide in close friends or family members
-Organized plan
-No social support systems
-Sickness (chronic illness)
114
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115
