Mental Health Flashcards
what are 3 postpartum psychiatric conditions
- postpartum blues
- postpartum depression (symptoms for at least 1 month)
- postpartum psychosis (begins within 4 weeks)
are antidepressants teratogenic?
No!!
what are some consequences of maternal depression infant toddler school aged adolescent
infant- anger
lower cognitive performance
toddler- Less creative play and lower cognitive performance
poor self control, lower interaction, passive noncompliance
school aged- Internalizing and externalizing problems, impaired adaptive functioning, anxiety, conduct disorders
ADHD, lower IQ
adolescent- depression, anxiety, panic disorders, conduct disorders, substance use
ADHD, learning disabilities
what screening questions would you ask to assess for cardiac risk factors for sudden death among children starting stimulant medication
Personal History:
SOB with exercise without explanation (asthma)
Poor exercise tolerance without other explanation
Fainting/Seizures with exercise, or fright
Palpitations with exercise
Personal or Fam Hx of: sudden death FamHx non-ischemic heart disease FamHx/Personal Hx Long QT or arrythmia WPW Cardiomyopathy Heart transplant Pulm HTN Defibrillator
Exam:
Hypertension
Murmur
Sternotomy incision
what is one of the strongest predictors of suicide during adolescence, and lifelong
A previous suicide attempt is one of the strongest predictors of suicide during adolescence, and lifelong
what risk factors are associated with increased risk of suicide?
Mental illness Prior self-harm or suicide attempt Impulsivity Precipitating factors Family factors (family conflict) Lack of psychosocial support
what should you ask on history to screen for risk of sudden cardiac death prior to starting stimulant medication
SOB on exercise without explanation
exercise intolerance
palpitations brought on by exercise
fainting/seizures with exercise
FHx of personal hx of: long QT, arrhythmias nonischemic heart disease WPW Cardiomyopathy Pulmonary HTN Heart transplant sudden unexplained death unexplained MVAs or drownings Defibillator
what should you look for on physical exam to screen for risk of sudden cardiac death prior to starting stimulant medication (3)
sternotomy scar
HTN
organic murmur
other abnormal cardiac findings
effects of divorce for age:
<3
4-5
school age
less than 3: may reflect a caregiver’s distress and grief
age 4-5: blame themselves and become clingy with separation anxiety
School age: may take sides and have loyalty conflicts
family protective factors for divorce (8)
Protection from conflict between parents Cooperative parenting Healthy relationships between child and parents Parents’ psychological well being Quality, authoritative parenting Household structure and stability Supportive sibling relationships and extended family relationships Economic stability
family risk factors for divorce (8)
Ongoing conflict between parents Poor parenting Lack of monitoring children’s activities Multiple family transitions Parent mental health problems Chaotic, unstable household Impaired parent-child relationships Economic decline
what are the 3 main processes that have a positive mediating effect on child well-being after parental divorce
improving the quality of parenting
improving the quality of parent–child relationships controlling hostile conflict
are routine labs required before starting an SSRI?
No routine Labs needed prior to starting (unless screening for thyroid as cause of sx, liver disease if concerning symptoms, or monitoring other drug levels that may interact, like valproic acid
After starting an SSRI in a child what monitoring is required?
1) weekly for the first four weeks after initiation of SSRI
2) every two weeks for the next four weeks;
3) at 12 weeks;
4) as clinically indicated beyond the 12-week point
Once a complete response has been achieved with SSRI, how long should the medication be continued?
should be continued for a minimum of six to 12 months to decrease the risk of depressive relapse
Which SSRI medication has the most data supporting its use for treating depression in children and adolescents?
Fluoxetine
What is the max dose for citalopram
Citalopram should not be used in dosages >40 mg/day.
what children should not be prescribed citalopram
should not be prescribed for children and adolescents with congenital long QT syndrome.
what could you tell parents about the risk of SI with starting an SSRI
The risk of suicidality associated with untreated depression is likely greater than that associated with appropriate SSRI use.
To improve tolerability of medication for anxious patients, clinicians should include the following in their overall approach: (3)
To improve tolerability of medication for anxious patients, clinicians should include the following in their overall approach:
Psychoeducation
Lower starting dosages
Gradual titration to therapeutic dosages.
