Mental health

Question 1

what are the differences between post partum blues, psychosis and depression

Answer 1

BLUES:
during 1st week, last hours to days
crying, confusion, anxiety, depressed mood

PSYCHOSIS:
within 4 weeks
delusion, hallucinations, gross impairment in functioning

DEPRESSION:week one to 6 mo
dysphoric mood, fatigue, anorexia, sleep issues, anxiety, guilt, suicidal thoughts
Al least one month
causing impairment
Edinburgh Postnatal Depression Scale

Question 2

risk factors for postnatal depression

Answer 2

previous post partum depression - 50% risk
Hx of mood disorder
depression symptoms during pregnancy
family Hx of psychiatric disorders

Question 3

what are infants of depressed mothers at risk of?

Answer 3

insecure attachment
negative affect
dysregulated attention and arousal

Question 4

What are toddlers and preschoolers of depressed mom at risk of?

Answer 4

poor self control
internalizing or externalizing issues
issues with social interaction and cognitive difficulties

Question 5

what are school age and teens of depressed mom at risk of

Answer 5

poor adaptive abilities
learning disabilities
ADHD
psychopathology

Question 6

which SSRI has the shortest half life

Answer 6

fluvoxemine+++

Question 7

are SSRI approved in kids

Answer 7

no, off label use

Question 8

long QT should not receive what SSRI

Answer 8

cetilopram

Question 9

what the FU for SSRI start

Answer 9

weekly for 1month
q 2 week for 1 mon
at 3 mo
and PRN

Question 10

which is SSRI best for anxiety

Answer 10

very little benefit, fluox, sertraline

Question 11

which 2 conditions are associated with sudden death and should be very careful if starting stimulant

Answer 11

TGA

TOF

Question 12

elimination diet and ADHD

Answer 12

could have some role in kids with Hx atopy

Question 13

what are the benefits of family based treatment of AN?

Answer 13

1. remain connected to friends and family
2. stay in their own environment
3. empowers the family
4. Ensures the inpatient service is only for children who have failed outpt

Question 14

what are important counselling points when meeting a family about to start treatment for AN?

Answer 14

• Need an MDT approach
• clarify that this is not their fault
• teach parents that their child is unable to care for themselves and that parents need to take charge
• need to stop abnormal behaviours - exercise related behaviours …
• denial a strong feature and will be challenging
• try to find the few unpleasant things to help build rapport
• impose behaviour consequences
• parents may need to decrease working hours or take time off to deal

Question 15

what are the medical goals of treatment?

Answer 15

1. wgt gain - 0.2 to 0.5 kg perweek
2. needs 3 meals and 2 snacks
3. could offer dietician support

Question 16

what SSRI has highest withdrawal effects

Answer 16

paradoxine

Question 17

SSRI with longest half life?

Answer 17

Fluoxetine

Question 18

what are SSRI side effects

Answer 18

GI sumptoms
sleep changes
restlessness
HA
sexual dysfunction
*** dose dep and decrease over time

Rare: Inc bleeding, SIADH, serotonin syndrome
QTc for citalopram

Question 19

how long should a child be on SSRI?

Answer 19

once complete response - stay on for 6-12 mon
slow taper
during NON stressful time
if more complicated - refer

Question 20

what kids with anxiety should start SSRI?

Answer 20

if severe
if causing significant functional impairment
if unable to benefit from psychotherapy

Question 21

what are treatment points for a child with svere anxiety?

Answer 21

psychoeducation
start low dose SSRI
gradual titration up

Question 22

Important cardiac Hx pre ADHD stimulant use

Answer 22

lower exercise tolerance
extreme SOB with exercise
Fainting/palpitations with exercise or startle
FHx - sudden death, < 35