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
List consequences of maternal depression on the infant, toddler, school-aged child and adolescent
- infant: anger and protective style of coping vs. passivity with withdrawal, lower cognitive performance
- toddler: passive noncompliance, less mature expression of autonomy, internalizing and externalizing problems, less creative play, lower cognitive performance
- school-age: impaired adaptive functioning, affective disorders, anxiety and conduct disorders, ADHD, lower IQ
- adolescents: mental health, substance abuse, alcohol dependence, ADHD, LD
List sources of resilience in children with respect to the effect of maternal depression
- temperament (more robust, easy-going is protective)
- strong social and cognitive skills
- understanding of parent’s illness
- recognition by child that he/she is not to blame for illness-related behaviour
List ways to support a mother with depression
- Encourage her own mental health care, (i.e. psychotherapy, SSRI for mother)
- Interaction coaching techniques
- Bolster social support
- Provide home visiting interventions
- Family-centered intervention
- Interpersonal therapy
Should St. John’s Wort be used to treat maternal depression
- can be effective for mild to moderate depression
- may have many drug interactions
- not safe during pregnancy or breastfeeding
List possible reactions that children demonstrate in response to divorce
- Sadness
- Confusion
- Fear of abandonment
- Anger
- Guilt
- Grief
- Conflicts related to loyalty and misconceptions
- Relief (if domestic violence or abuse stops)
How does divorce impact children?
- Most cases, no serious outcomes
- Can have lower academic achievement, conduct, psychological adjustment, self-concept and social relations
- Increase in poverty, educational failure, risky sexual behaviour, unplanned pregnancies, earlier marriage or cohabitation, marital discord and divorce
List protective factors that can reduce risk of negative outcomes for children experiencing divorce (opposites are risk factors)
- Protection from conflict between parents
- Cooperative parenting
- Healthy relationships between child and parents
- Parents’ psychological well being (need to look after themselves, introduce new relationships slowly)
- Quality, authoritative parenting
- Household structure and stability
- Supportive sibling and extended family relationships
- Economic stability
What are the three most significant factors that impact a child’s well-being during the process of divorce?
- Quality of parenting (warmth, nurturance, effective discipline and limit-setting)
- Quality of parent-child interaction (warmth, supportiveness, positive and frequent communication)
- Degree, frequency, intensity and duration of hostile conflict
List risk factors for suicide
- depression
- previous suicide attempt
- maybe self-hamr behaviours
- impulsivity
- presence of precipitating factors (divorce, break-up, bullying, academic disappointment, homosexuality, legal proceedings)
- ## poor child-parent communication and relationships
How to assess suicidality
- ask about frequency, intensity and quality of suicidal thoughts
- passive vs. active suicidal thoughts
- future orientation vs. hopelessness
- intent
- ## plan
Determine that a teen who recently attempted suicide is safe for discharge for ED. List discharge plan
- clear instructions regarding importance of communicating suicidal thoughts to trusted adults
- need for mental health follow-up
- list of local crisis services
- use of ED if actively suicidal
