Mental Health & Developmental Disabilities Flashcards
Describe the drug characteristics of SSRIs
- rapidly absorbed
- hepatically metabolized
- absorption unaffected by ingestion of food
- long-acting
- propensity for discontinuation syndrome
Which SSRI has the most evidence with respect to the treatment of depression in children and adolescents?
Fluoxetine (Prozac)
Which SSRI has evidence of negative impact on the treatment of depression in children and adolescents?
Paroxetine (Paxil)
List some short-term side effects of SSRIs
- GI symptoms
- sleep changes (insomnia, somnolence, vivid dreams)
- restlessness
- headaches
- appetite changes
- sexual dysfunction
- increased agitation or impulsivity (behavioural activation)
What are more rare adverse effects of SSRIs?
- increased bleeding risk
- SIADH
- serotonin syndrome
List the features of serotonin syndrome
- mental status changes
- myoclonus
- ataxia
- diaphoresis
- fever
- autonomic dysregulation
What warnings exist for the use of Citalopram?
- use only in doses
What differentials should be excluded when assessing a patient with anxiety?
- ADHD
- depression
- bipolar disorder
- autism spectrum disorder
To increase tolerability of medication for anxious patients, what approach should be taken?
- start at lower doses
- titration upwards gradually
- provide psychoeducation regarding potential side effects and their usually transient nature
How should you manage a patient with symptoms or family history of bipolar disorder when considering SSRI initiation?
Refer to psychiatrist for further assessment, management, given risk for hypo mania with SSRI
List, in order of increasing half life, four SSRIs
- Fluvoxamine
- paroxetine
- Sertraline
- Escitalopram
- Citalopram
- Fluoxetine
What challenges do children with ADHD face, compared with children without ADHD?
- school difficulties
- lower self-esteem
- family stress
- psychiatric comorbidities
- poor social skills
- social isolation
- poor sibling relationships
- poor peer relationships
What are adolescents with ADHD at higher risk for, compared with children without ADHD?
- school failure
- poor social relationships
- motor vehicle collisions
- delinquency
- poor vocational outcomes
- experimentation with tobacco, alcohol, drugs, sex
- being cited for speeding or other traffic violations
What are some types of arrhythmic heart disease in children?
- long and short QT syndrome
- arrhythmogenic right ventricular cardiomyopathy
- Brugada syndrome
- WPW
Compared to the general population, what is the risk of sudden unexpected death in children on ADHD stimulant medications?
Same
What features on personal history would necessitate further assessment by a cardiologist?
- SOB with exercise without another explanation (i.e. asthma, obesity)
- Poor exercise intolerance without another explanation
- Fainting or seizures with exercise/startle/fright
- Palpitations brought on by exercise
What features on family history are concerning for increased cardiac risk?
- Family hx (in 1st or 2nd degree relative) of sudden or unexplained death, including sudden infant death syndrome, unexplained drowning or unexplained motor vehicle accidents
- Family hx of arrhythmia, cardiomyopathy, heart transplant, pulmonary hypertension, implantable defibrillator
What features on physical examination may be concerning for increased cardiac risk?
- hypertension
- pathological-sounding murmur
- sternotomy incision
- absent/delayed femoral pulses
In a patient with ADHD with no personal history, family history or physical exam findings concerning for underlying cardiac disease, who should initiate ADHD medications?
- Primary care physician, ADHD specialist
Should routine ECGs be performed on patients with ADHD before starting medications?
No
List alternative therapies that MAY be useful for ADHD
- Dietary management for children with allergic symptoms or migraine headaches
- Trace element supplementation for patients with documented deficiencies
- Herbs may play a role in memory and cognition and have sedative and anxiolytic properties
- Biofeedback may be offered in cases where medication is not suitable
- Hypnotherapy may be helpful in controlling secondary symptoms of ADHD
Which alternative therapies have NO scientific evidence to support them?
- Vision therapy
- Oculovestibular treatment
- Sound training
Define postpartum blues, postpartum depression and postpartum psychosis
- Blues: emotional disturbance with crying, confusion, mood lability, anxiety and depressed mood appearing within first week postpartum, lasting for few hours to few days.
- Depression: begins in or extends into postpartum period with symptoms including dysphoric mood, fatigue, anorexia, sleep disturbances, anxiety, excessive guilt, suicidal thoughts
- Psychosis: severe disorder beginning within 4 weeks postpartum with delusions, hallucinations, gross impairment of functioning
List risk factors for postpartum depression
- history of mood disorders
- depression symptoms during pregnancy
- family history of psychiatric disorders
- negative life events
- poor marital relationships
- having an infant with special needs/medically fragile
- lack of social support
