Mental Health Flashcards
What are neuromotor disabilities
conditions of NS w/ motor deficit as main feature
T or F: children w/ neuromotor disability had same prevalence of mental health symptom as general population?
False
What are key determinants of mental health in kids w/ neuromotor disabilities?
- Their Dx/Health condition
(as certain mental health problems may be associated) - Body structure + function
(MSK pain associated w/ reduced participation, QOL, mental health) - Activities (motor, cognitive, LD)
(level of impairment) - Environment (family, school, community)
- Participation (WHO ICF framework* key determinant to mental health)
- Personal factors (i.e. temperament)
Point: by reviewing these factors you can address the mismatch (i.e. home does not fit motor ability) to improve participation
What categories does the WHO international classification of functioning framework use?
- Body structure
i. e. MSK disorder, constipation, GERD, feeding etc.) - Function
i. e. developmental age, therapist - Home environment
i. e. structura, physical parent-child interaction - School environment
i. e. function and participation, class placement, assistive device, relationships etc. - Individual factors
i. e. their favourite rec activities etc.
Please list examples of disruptive behaviour in preschool kid and indicators of problem behaviour
1- Noncompliance- misbehave in dangerous way (run into street)
2- Aggression- aggressive to get something they want
3- Temper Loss- daily tempers that last > 5 minutes
T or F: disruptive behaviours are RF for mental health disorders.
True
Examples of Q you can ask to get behavioural + emotional functioning info?
- difficulty encouraging child to do as asked?
- teacher mentioned concerns about readiness for school?
- concerns about ability to communicate or learn new skills?
- concerns about how they get along with kids at home or in the community?
- concerns about emotions, behave, or social functioning?
Three behaviours to identify when thinking of disruptive problem behaviours.
- Noncompliance
- Aggression
- Temper Loss
Provide examples of factors to evaluate for disruptive behaviour.
- Child factors:
- cognitive level
- lang and communication (Delay or atypical)
- social skills
- emotional regulation
- attention, overactivity, impulse regulation
- eating, sleeping - Family factors:
- parent child interaction
- prolonged separation from parent
- parental medical + mental health
- parent’s employment status
- neglect, domestic violence, food insecurity etc. - Environment factors:
- support from fam + social network
- quality of child care
- neighbourhood traits
- household composition
What do all kids w/ disruptive behav problems need to be screened for?
- Hearing
- Vision
- Irregularity in feeding + sleep
What standard screening record recommended for all kids < 5 y.o.?
Rourke Baby Record
List common parenting skills taught in parent training programs for kids w/ disruptive behaviour?
- (+) parent-chid relations
- developmentally appropriate expectations
- clear consistent expectations, routine, limits
- ID triggers for (+) and (-) behaviour
- (+) parenting skills (i.e. reward)
- reduce (-) or harsh parent-child interaction
- ignore minor behaviours (pick your battle)
- Time out selectively (specific behave like hitting) w/ clear rules
- Work as team
- Communicate w/ teachers
List features of EBM parent training programs focusing on disruptive behaviour.
- collaborative, interactive
- peer support
- describe key parenting principle
- discuss developmentally appropriate expectations
- observe parent-child interaction
- model parenting skills
- role play
- homework to practice w/ child
- reframe unhelpful concepts about child
Name one EBM parenting program available
Triple P Program
What is the 1st line intervention for disruptive behaviour problems in preschool kids?
EBM parent based training programs (i.e triple P program)
List two SSRI examples associated with less or highest incidence of withdrawal.
GOOD= Prozac/Fluoxetine associated w/ fewest episodes of withdrawal BAD= Paxil/Paroxetine= highest incidence of withdrawal symptoms on abrupt discontinuation
Which SSRI has most data supporting its use in treating depression in kids?
Fluoxetine
List common short term AE of SSRI.
- h/a
- appetite change
- GI (upset stomach)
- sleep change (insomnia, somnolence, dreams)
- restless
- +/- increased agitation or impulsivity
- sexual dysfunction
List rare or serious AE of SSRI.
- increased risk of bleeding
- SIADH
- prolonged QTC (risk of tornadoes de point)
- serotonin syn (mental status change, myoclonus, fever, diaphoresis, autonomic dysregulation)
- suicidality increased
What do you tell parents about increase thoughts of suicide while on SSRI?
- perhaps increased thoughts of SI; no increase completion
- risk of untreated depression > than associated with appropriate SSRI use
> 10 X more children w/ depression benefit from SSRI than report suicidality
Which specific SSRI should you not use for congenital long QT patients?
Citalopram (Celexa)
Citalopram doses should not be used in doses > 40 mg/day (as QTC more likely prolonged here)
T or F: you can safely use SSRI if long-QT syn?
True.
How long do you continue SSRI once complete response achieved?
min. 6-12 months to reduce risk of relapse
T or F: you need to taper SSRI reduction
True; avoid withdrawal syndrome
When do you consider SSRI use in anxiety?
If severe or causing significant functional impairment OR if unable to benefit from psychotherapy.
How can you improve tolerability to an SSRI in pt with anxiety?
- psychoeducation always offered first
- start at lower dose
- gradual titration
Name the 3 most significant factors that impact resiliency in kids of separating parents.
- quality of parenting
- quality of parent-child interaction
- degree, f, duration of hostile conflict
List some family risk factors in exacerbating mental health issues in kids w/ separating parents.
- poor parenting
- impaired parent-child relationships
- ongoing conflict (esp if abusive)
- lack of monitoring kid’s activities
- multiple family transitions
- chaotic unstable household
- economic decline
List some protective family factors to avoid mental health issues in kids w/ separating parents.
- quality authoritative parenting
- cooperative parenting (unless domestic violence)
- healthy parent-child relations
- protection from conflict btw parents
- parents’ psychological parenting
- household stability
- supportive siblings
- economic stability
What are some practical CPS recommendations:
- maintain (+) supportive relationships between parent + child
- encourage (+) parenting and effective discipline
- recommend mediation in complex cases
- encourage parent to look after own health
Name some complications if untreated ADHD:
- higher risk of school failure
- poor social relationships
- motor vehicle collisions
- delinquency
- poor vocational outcomes
- more likely to experiment with smoking, drugs, sex, speeding and traffic violations
T or F: children with unprepared CHD frequently have ADHD
True
T or F: all kids with ADHD should get routine ECG
False
- no current indication before or during ADHD dx when hx, fhx and P/E normal
T or F: all kids should get routine cardio consult before starting ADHD med
False
- if newly identified RF for co-existent cardiac dx you can decide on risk and benefit of me
- if known congenital heart dx or arrhythmia -> individualize the approach via cardio and you
Describe post part blues, psychosis and post part depression.
Post partum blues= common, crying, emotional, in 1st week and last hour-day; no (-) sequelae
Psychosis= severe, rare, start within 4 wk
Depression= symptom present min. 1 month, can last several months
How many F in Canada experience postpartum depression?
13%
What are RF for postpartum depression?
- hx of mood disorders
- depressive symptoms during pregnancy
- fhx of psychiatric disorders
List affects of maternal depression in the: (A) prenatal (B) infant (C) Toddler (D) School age (E) Teen
Prenatal= inadequate care/nutrition, prem, SGA, pre-eclampsia, spontaneous abortion
Infant= insecure attachment, (-) affect, dysregulated
= anger coping, passive, withdrawal, lower cognition
Toddler= poor self control, social interaction
= passive, less autonomous, lower interaction, less creative and lower cognitive
School age= impaired adaptive functioning, affective disorder, anxiety, CD, ADHD, lower IQ
Teen= depression, anxiety, panic, CD, phobia, substance abuse, ADHD, LD
Which factors exacerbate effects of depressed caregiver?
- male (more vulnerable than F)
- marital conflict
- conflict/stressful events
- poverty
Which factors protect BB from effects of depressed caregiver?
- easy going temperament
- good social cognitive skills
- non depressed father can buffer mom’s depression
- understanding’s parent’s illness
Treatment for maternal depression.
- social support + psychoeducational intervention
- Med
- reassure mother neurodevelopment okay as no long term AE
T or F: TCA and SSRi have risk of increased fetal anomalie
False.
- yes do cross placenta though
T or F: St. John’s wart may interact w/ drugs
True
- mother should be told that data on St. John’s wart limited and herbal remedies should not be taken during preg and lactation
List example questions to ask about postpartum depression?
- how are you feeling about being a new mother?
- are you enjoying your baby?
- do you find your baby easy or difficult to care for?
- how are things going in your family?
- are you getting enough rest?
- how is your appetite?
- during the last month, have you been bothered by feeling down, depressed, hopeless or have little interest in activities?
What is the second most common cause of death in Canadian teens?
Suicide
List an approach to SI:
- mental illness
- prior attempt
- impulsivity
- stressors
- family factors
- lack of support
How do you assess a recent suicide attempt?
- Ideation
- frequency, intensity, passive or active - Intention
- presence of intent, reasons for living - Plan
- plan and detail
- method
- impulsive vs. planned
- lethality of method used
- steps to reduce chance of discovering
