Mental Health

Question 1

Broad screening tools available for mental health in children

Answer 1

KSADs,
Child Behavior Checklist (birth to 8, developmental and behavioral)
Pediatric Symptom checklis (IDs early difficulties, potential psychosocial probs)

Question 2

How does the DSM distinguish subtypes of Mood Disorders?

Answer 2

Polarity, severity, chronicity, recurrences, etc.

Question 3

How common is depression in children and adolescents

Answer 3

Children: 2% (M=F)
Ados: 4-8% (1:2 M-F ratio)

Question 4

DSM 5 criteria for depression

Answer 4

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

Question 5

Caveats to DSM5 criteria for depression

Answer 5

not mixed, must cause impairment, not due directly to substance, not d/t bereavement

Question 6

ABCs mnemonic for depression

Answer 6

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

Question 7

How does depression look different in kids?

Answer 7

irritability may be most notable
Mood may be more reactive, esp in a dos
Somatic complaints and social isolation

Question 8

Screening tool for depression

Answer 8

DISC
for age 13+
No popular screening tool for younger kids

Question 9

Treatment for Depression: Mild, Moderate, Severe

Answer 9

Mild: CBT (fx well in 3 realms, no SI)
Moderate: CBT, possible meds
Severe: CBT & meds

Question 10

10 principles of CBT

Answer 10

• 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

Question 11

Pharm therapy used for depression

Answer 11

SSRIs
start low, go slow
No polypharmacy in primary care!

Question 12

Usual duration of pharm Tx for depression

Answer 12

6-12mo after remission
as long as Sx present
Longer if psychotic features, severe SI

Question 13

Side effects SSRIs

Answer 13

mainly sleep, GI, HA, libido

Question 14

Which SSRIs in kids for depression?

Answer 14

1st line: fluoxetine
2nd: sertraline (zoloft), citalopram (Celexa), escitalopram (Lexapro); maybe venlafaxin (effexor)
3rd line: consult pedi psych

Question 15

SS of serotonin syndrome

Answer 15

tachycardia, tremors, restlessness, confusion, fever, HTN, hemodynamic instability, salivation, muscle twitches, incoordination, ataxia, N/V/D, can look flu-like

Question 16

Drugs that may potentiate – Serotonin syndrome

Answer 16

Triptans, opioids, St John’s wort, macrolides

Question 17

Serotonin Withdrawal Syndrome

Answer 17

N/V, dizziness, vertigo, sleep disruption, flu-like sx, sensory disturbances
Not universal

Question 18

Types of anxiety

Answer 18

GAD, Social anxiety, panic DO w/or w/o agoraphobia, agoraphobia w/o hx panic do, specific phobia, separation anxiety do, selective mutism

Question 19

Clues to anxiety

Answer 19

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

Question 20

Diagnosis of anxiety

Answer 20

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

Question 21

Screening tool for anxiety

Answer 21

SCARED
for parents and children
6-17yo

Question 22

What is Conduct DO?

Answer 22

persistent and repetitive
violate rights of others / societal rules
Marked by lack of empathy

Question 23

What criteria must be met to Dx Conduct DO?

Answer 23

3 of following:
Agression to people and animals
Destruction of property
Deceitfulness or theft
Serious violation of rules

Question 24

What is ODD?

Answer 24

pattern of negativistic, hostile, defiant behavior

Question 25

What criteria must be met to x ODD?

Answer 25

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

Question 26

Tx for Conduct DO and ODD

Answer 26

no medical tx, though comorbidities must be IDs and treated (ADD common)

Question 27

Tx for anxiety

Answer 27

CBT and pharmacotherapy (SSRIs)