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RC: CPS Woo Hoo > Mental Health > Flashcards

Mental Health Flashcards

1
Q

What are neuromotor disabilities

A

conditions of NS w/ motor deficit as main feature

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2
Q

T or F: children w/ neuromotor disability had same prevalence of mental health symptom as general population?

A

False

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3
Q

What are key determinants of mental health in kids w/ neuromotor disabilities?

A
  1. Their Dx/Health condition
    (as certain mental health problems may be associated)
  2. Body structure + function
    (MSK pain associated w/ reduced participation, QOL, mental health)
  3. Activities (motor, cognitive, LD)
    (level of impairment)
  4. Environment (family, school, community)
  5. Participation (WHO ICF framework* key determinant to mental health)
  6. 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

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4
Q

What categories does the WHO international classification of functioning framework use?

A
  1. Body structure
    i. e. MSK disorder, constipation, GERD, feeding etc.)
  2. Function
    i. e. developmental age, therapist
  3. Home environment
    i. e. structura, physical parent-child interaction
  4. School environment
    i. e. function and participation, class placement, assistive device, relationships etc.
  5. Individual factors
    i. e. their favourite rec activities etc.
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5
Q

Please list examples of disruptive behaviour in preschool kid and indicators of problem behaviour

A

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

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6
Q

T or F: disruptive behaviours are RF for mental health disorders.

A

True

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7
Q

Examples of Q you can ask to get behavioural + emotional functioning info?

A
  • 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?
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8
Q

Three behaviours to identify when thinking of disruptive problem behaviours.

A
  1. Noncompliance
  2. Aggression
  3. Temper Loss
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9
Q

Provide examples of factors to evaluate for disruptive behaviour.

A
  1. Child factors:
    - cognitive level
    - lang and communication (Delay or atypical)
    - social skills
    - emotional regulation
    - attention, overactivity, impulse regulation
    - eating, sleeping
  2. Family factors:
    - parent child interaction
    - prolonged separation from parent
    - parental medical + mental health
    - parent’s employment status
    - neglect, domestic violence, food insecurity etc.
  3. Environment factors:
    - support from fam + social network
    - quality of child care
    - neighbourhood traits
    - household composition
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10
Q

What do all kids w/ disruptive behav problems need to be screened for?

A
  1. Hearing
  2. Vision
  3. Irregularity in feeding + sleep
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11
Q

What standard screening record recommended for all kids < 5 y.o.?

A

Rourke Baby Record

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12
Q

List common parenting skills taught in parent training programs for kids w/ disruptive behaviour?

A
  1. (+) parent-chid relations
  2. developmentally appropriate expectations
  3. clear consistent expectations, routine, limits
  4. ID triggers for (+) and (-) behaviour
  5. (+) parenting skills (i.e. reward)
  6. reduce (-) or harsh parent-child interaction
  7. ignore minor behaviours (pick your battle)
  8. Time out selectively (specific behave like hitting) w/ clear rules
  9. Work as team
  10. Communicate w/ teachers
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13
Q

List features of EBM parent training programs focusing on disruptive behaviour.

A
  • 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
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14
Q

Name one EBM parenting program available

A

Triple P Program

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15
Q

What is the 1st line intervention for disruptive behaviour problems in preschool kids?

A

EBM parent based training programs (i.e triple P program)

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16
Q

List two SSRI examples associated with less or highest incidence of withdrawal.

A 
GOOD= Prozac/Fluoxetine associated w/ fewest episodes of withdrawal
BAD=  Paxil/Paroxetine= highest incidence of withdrawal symptoms on abrupt discontinuation
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17
Q

Which SSRI has most data supporting its use in treating depression in kids?

A

Fluoxetine

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18
Q

List common short term AE of SSRI.

A
  • h/a
  • appetite change
  • GI (upset stomach)
  • sleep change (insomnia, somnolence, dreams)
  • restless
  • +/- increased agitation or impulsivity
  • sexual dysfunction
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19
Q

List rare or serious AE of SSRI.

A
  • increased risk of bleeding
  • SIADH
  • prolonged QTC (risk of tornadoes de point)
  • serotonin syn (mental status change, myoclonus, fever, diaphoresis, autonomic dysregulation)
  • suicidality increased
20
Q

What do you tell parents about increase thoughts of suicide while on SSRI?

A
  • 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
21
Q

Which specific SSRI should you not use for congenital long QT patients?

A

Citalopram (Celexa)

Citalopram doses should not be used in doses > 40 mg/day (as QTC more likely prolonged here)

22
Q

T or F: you can safely use SSRI if long-QT syn?

A

True.

23
Q

How long do you continue SSRI once complete response achieved?

A

min. 6-12 months to reduce risk of relapse

24
Q

T or F: you need to taper SSRI reduction

A

True; avoid withdrawal syndrome

25
Q

When do you consider SSRI use in anxiety?

A

If severe or causing significant functional impairment OR if unable to benefit from psychotherapy.

26
Q

How can you improve tolerability to an SSRI in pt with anxiety?

A
  1. psychoeducation always offered first
  2. start at lower dose
  3. gradual titration
27
Q

Name the 3 most significant factors that impact resiliency in kids of separating parents.

A
  1. quality of parenting
  2. quality of parent-child interaction
  3. degree, f, duration of hostile conflict
28
Q

List some family risk factors in exacerbating mental health issues in kids w/ separating parents.

A
  • 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
29
Q

List some protective family factors to avoid mental health issues in kids w/ separating parents.

A
  • 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
30
Q

What are some practical CPS recommendations:

A
  • maintain (+) supportive relationships between parent + child
  • encourage (+) parenting and effective discipline
  • recommend mediation in complex cases
  • encourage parent to look after own health
31
Q

Name some complications if untreated ADHD:

A
  • 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
32
Q

T or F: children with unprepared CHD frequently have ADHD

A

True

33
Q

T or F: all kids with ADHD should get routine ECG

A

False

  • no current indication before or during ADHD dx when hx, fhx and P/E normal
34
Q

T or F: all kids should get routine cardio consult before starting ADHD med

A

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
35
Q

Describe post part blues, psychosis and post part depression.

A

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

36
Q

How many F in Canada experience postpartum depression?

A

13%

37
Q

What are RF for postpartum depression?

A
  • hx of mood disorders
  • depressive symptoms during pregnancy
  • fhx of psychiatric disorders
38
Q 
List affects of maternal depression in the:
(A) prenatal
(B) infant
(C) Toddler
(D) School age
(E) Teen
A

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

39
Q

Which factors exacerbate effects of depressed caregiver?

A
  • male (more vulnerable than F)
  • marital conflict
  • conflict/stressful events
  • poverty
40
Q

Which factors protect BB from effects of depressed caregiver?

A
  • easy going temperament
  • good social cognitive skills
  • non depressed father can buffer mom’s depression
  • understanding’s parent’s illness
41
Q

Treatment for maternal depression.

A
  1. social support + psychoeducational intervention
  2. Med
    - reassure mother neurodevelopment okay as no long term AE
42
Q

T or F: TCA and SSRi have risk of increased fetal anomalie

A

False.

- yes do cross placenta though

43
Q

T or F: St. John’s wart may interact w/ drugs

A

True

  • mother should be told that data on St. John’s wart limited and herbal remedies should not be taken during preg and lactation
44
Q

List example questions to ask about postpartum depression?

A
  • 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?
45
Q

What is the second most common cause of death in Canadian teens?

A

Suicide

46
Q

List an approach to SI:

A
  • mental illness
  • prior attempt
  • impulsivity
  • stressors
  • family factors
  • lack of support
47
Q

How do you assess a recent suicide attempt?

A
  1. Ideation
    - frequency, intensity, passive or active
  2. Intention
    - presence of intent, reasons for living
  3. Plan
    - plan and detail
    - method
    - impulsive vs. planned
    - lethality of method used
    - steps to reduce chance of discovering

RC: CPS Woo Hoo (9 decks)

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