Mental Health Flashcards
Name the SSRIs.
Fluoxetine Sertraline Citalopram Escitalopram Fluvoxamine Paroxetine
Are SSRIs approved for Canada for use in kids and teens?
no
What is the mechanism of action of SSRIs?
- inhibit serotonin transporters, block reuptake and so increasing the concentration of the neurotransmitter serotonin within the synapse
- Speciifc SSRIs ma alos influence other neurotransmitter systems (e.g. dopamine, norepienphrine)
How are SSRIs metabolized?
the liver
- are rapidly absorbed
- absorption largely unaffected by ingestion of food
What is the halflife of fluoxetine?
96 hours (long-acting drug) Paroxetine is 21 h
What are the guidelines for initiating therapy with SSRIs?
- goal to achieve the minimum effective dose
- start low, often similar or slightly lower than for adults and titrate up
- do not need labs before starting
- usually do not interact with a lot of other meds
- weekly monitoring for the first 4 weeks
- then every 2 weeks
- then at 12 weeks and then as clinically indicated
- assess for SI, and adverse effects
-once achieve response should continue the med for at least 12 months to decrease chance of relapse
What is the reported effective of SSRIs for tens with depression?
40-70%
-most evidence is for fluoxetine
Can you use SSRIs for anxiety? Which one?
Yes they are effective. Can be considered early in the course if anxiety is severe or causing significant impairment.
No specific SSRI is superior to others for anxiety.
What are the side effects of SSRIS?
GI symptoms, sleep changes (either insomnia or somnolence or vivid dreams), restlessness, headache, appetite changes, sexual dysfunction
- may see agitation or impulsivity (make sure to RO bipolar)
- SE are dose dependent and decrease over time
-Risk of suicide is greater with untreated depression than that associated with appropriate SSRI use
Rare s/e: coagulopathy, SIADH, serotonin syndrome, QT prolongatino (esp with citalopram)
What is serotonin syndrome?
mental status change, myoclonus, ataxia, diaphoresis, fever, autonomic dysregulation
What is the concern with QT prolongation and SSRIs?
Most specific to citalopram at doses >40mg OD.
Do not exceed this dose.
Do not use citalopram in kids with congenital long QT.
Patients with underlying congenital heart disease or hepatic impairment (affecting citalpram metabolism) should be treated with caution if receiving citalopram and monitored closely for cardiac adverse effects, including torsades de pointes
How do you discontinue SSRI?
slow taper during a stress free time (e.g. the summer)
What are the emotions experienced by kids related to divorce?
- adjustment occurs in stages
- may experience loss, sadness, confusion, fear of abandonment, anger, guilt, grief, conflicts related to loyalty and misconceptions
- most feel worry about what the future holds
- overwhelming majority do not experience serious outcomes
What are some negative impacts that divorce can have for kids?
- score lower on measures of academic achievement, conduct, psychologic adjustment, self-concept and social relationships
- this can extend into adulthood with early marriage, divorce, risky sexual behaviour, etc
What are the 3 most significant factors that impact a child’s well-being during a divorce?
- quality of parenting
- quality of parent-child relationship
- degree, frequency, intensity and duration of hostile conflict
True or false. Most kids do not experience short and long term negative outcomes due to divorce.
True.
What are some family risk factors for difficulties with divorce?
ongoing conflict btwn parents (esp if abusive or focused on the kids) diminished capacity to parent/poor parenting lack of monitoring children' activities multiple family transitions parent mental health problems chaotic, unstable household impaired child-parer relationship economic decline
What are some family protective factors related to divorce?
- protection from conflict btwn parents
- cooperative parenting (except in cases of domestic violence)
- healthy relationship btwn child and parents
- parents’ psychological well-being
- quality, authoritative parenting
- household structure and stability
- supportive sibling relationships and extended family relationships
- economic stability
What is effective parenting?
- communicate well and frequently
- express love and devotion
- discipline with clear guidelines, limits and developmentally appropriate expectations
- -allow kids to feel a wide variety of emotions surrounding the divorce
What are characteristics of a positive parent-child relationship?
- warmth, supportiveness, effective problem-solving, positive communication
- low levels of conflict and negativity
- parents need to listen without judgment and be empathetic
What is the one of the most damaging aspects of divorce?
- ongoing parental conflict
- mediation is an effective way to resolve conflict
Which type of arrangement after divorce is the best for kids?
kids who parents have joint-custody are better adjusted
What are some considerations related to divorce for kids
- do better with routine and frequent access to both parents to develop memory of the other in their absence
- risk of losing attachment with one parent if they don’t see them often enough
What are some considerations related to divorce for kids 4-5 years old?
- often blame themselves, are clingy
- may take sides
- need to prevent this by involving both parents in day to day activities (e.g. parent-teacher interviews)
- keep conflict out of view of children
What are some considerations related to divorce for teens?
- peers become their reference group
- need access to both parents
What are the negative outcomes associated with ADHD in teens?
-higher risk for school failure, poor social relationships, MVCs, delinquency, poor vocational outcomes, more likely to experiment with substances