Mental Health Flashcards
Broad screening tools available for mental health in children
KSADs,
Child Behavior Checklist (birth to 8, developmental and behavioral)
Pediatric Symptom checklis (IDs early difficulties, potential psychosocial probs)
How does the DSM distinguish subtypes of Mood Disorders?
Polarity, severity, chronicity, recurrences, etc.
How common is depression in children and adolescents
Children: 2% (M=F)
Ados: 4-8% (1:2 M-F ratio)
DSM 5 criteria for depression
depressed mood anhedonia appetite and weight changes sleep pattern changes psychomotor retardation or agitation fatigue or loss of energy feelings of worthlessness or excessive/inappropriate guilt Indecisiveness and diminished ability to concentrate Recurrent thoughts of death, SI
Caveats to DSM5 criteria for depression
not mixed, must cause impairment, not due directly to substance, not d/t bereavement
ABCs mnemonic for depression
A=anhedonia B=bad mood C=concentration problems D= death thoughts E= energy deficits F= food intake changes G= Guilt/self esteem H= hyper/hypoactive motor behavior I= Insomnia
How does depression look different in kids?
irritability may be most notable
Mood may be more reactive, esp in a dos
Somatic complaints and social isolation
Screening tool for depression
DISC
for age 13+
No popular screening tool for younger kids
Treatment for Depression: Mild, Moderate, Severe
Mild: CBT (fx well in 3 realms, no SI)
Moderate: CBT, possible meds
Severe: CBT & meds
10 principles of CBT
- Based on therapeutic relationship
- Develop cognitive (re)formulation
- Requires planning treatment and structuring sessions (make goals)
- Therapist guides, pt is active participant
- Collaborative decision making
- Focused on problem solving
- Focused on here and now
- Seeks to identify “automatic thoughts”
- Involves identifying emotions
- Includes homework for the pt and family with self help assignments
Pharm therapy used for depression
SSRIs
start low, go slow
No polypharmacy in primary care!
Usual duration of pharm Tx for depression
6-12mo after remission
as long as Sx present
Longer if psychotic features, severe SI
Side effects SSRIs
mainly sleep, GI, HA, libido
Which SSRIs in kids for depression?
1st line: fluoxetine
2nd: sertraline (zoloft), citalopram (Celexa), escitalopram (Lexapro); maybe venlafaxin (effexor)
3rd line: consult pedi psych
SS of serotonin syndrome
tachycardia, tremors, restlessness, confusion, fever, HTN, hemodynamic instability, salivation, muscle twitches, incoordination, ataxia, N/V/D, can look flu-like
Drugs that may potentiate – Serotonin syndrome
Triptans, opioids, St John’s wort, macrolides
Serotonin Withdrawal Syndrome
N/V, dizziness, vertigo, sleep disruption, flu-like sx, sensory disturbances
Not universal
Types of anxiety
GAD, Social anxiety, panic DO w/or w/o agoraphobia, agoraphobia w/o hx panic do, specific phobia, separation anxiety do, selective mutism
Clues to anxiety
Avoidance, somatic symptoms, sleep problems, excessive need for reassurance, poor school performance and/or avoidance, explosiveness esp when confronted by anxiety- provoking stimulus, eating problems
Diagnosis of anxiety
Excessive anxiety and worry occur more days than not for >6mo
Associated w/at least 3 of following: restless, easily fatigued, difficulty concentrating/goes blank, irritability, muscle tension, sleep disturbance
Screening tool for anxiety
SCARED
for parents and children
6-17yo
What is Conduct DO?
persistent and repetitive
violate rights of others / societal rules
Marked by lack of empathy
What criteria must be met to Dx Conduct DO?
3 of following: Agression to people and animals Destruction of property Deceitfulness or theft Serious violation of rules
What is ODD?
pattern of negativistic, hostile, defiant behavior
What criteria must be met to x ODD?
4/8:
often loses temper, often argues w/adults, defiant, annoys others on purpose, blames others for own mistakes, easily annoyed by others, often angry and resentful, often spiteful or vindictive
*significant impairment in family, social, academic, occupational settings
Tx for Conduct DO and ODD
no medical tx, though comorbidities must be IDs and treated (ADD common)
Tx for anxiety
CBT and pharmacotherapy (SSRIs)
