Mental Health + Psychopharm Flashcards
About half of psychiatric illness begins by age 14
If you don’t have a lot of time with your peds/teens - at least ask about:
Anxiety, eating disorders, OCD, substance abuse.
What are some examples of broad based scales to determine if there may be any mental health or social-emotional problem?
PSC-17/35 (brief)
ASQ-SE/BITSEA/ECSA (longer)
Start PSC-17 at age ______
8 and up. It’s free - no fee.
What does the PSC-17 investigate?
I (internalizing (depression/anxiety)
A (attention)
E (externalizing) - OCD, conduct
AAP bright futures recommends depression screening for age _____.
Maternal depression
12 and up.
1,2,4 and 6 mo PP visits
Vanderbilt or SNAP-IV evaluate _______
Inattention/hyperactivity.
PHQ-9 administered to kids age _____
13 and up.
MCPAP Depression Guidelines for PCPs - interpretation and guidance for PSC-17
Guides dx of sub-clinical to mild, moderate or severe depression, discuss medications and follow up protocol.
Parts to assessing a suicidal plan
Straightforward/frank
Connect the Q with depressive or dysphoric symptom
Separate plans, urges, behavior
Acts?
Anything stops them from acting?
Could be a time where these feelings get worse - what would it take to keep you safe in that situation ?
Safety plans.
Anticipate and emphasize the need for relationships!
During assessment of MH disorders in children, make sure to provide impression, remind of strength, convey hope and review the treatment plan to encourage patient and parents.
Use “unspecified disorder” or “adjustment disorder” if you’re not sure of the dx after the first appointment.
T/F: you must always try CBT-based psychosocial treatment PRIOR to prescribing medication for preschoolers
True - except in mod-severe symptoms and functional impairment when there is a high risk of injury to self/others or worsening family dysfunction.
AACAP.org guidelines
MOA of ADHD stimulants (methylphenidate and amphetmine)
MPD: Blocks reuptake of DA and NE but little effect on presynaptic release of DA.
Amphetamine: DA and NE reuptake inhibitor and increases release of DA and NE.
If you don’t have improvement or only partial improvement after _____ , then consider increased dose, or changing medication
3-7 days.
T/F: ADHD stimulants need to stay on a consistent medication schedule - they should stay on their regimen over weekends and holidays.
False. They can take medication holidays (over summer) or over weekends. They can give only during instances where the child needs to be more attentive and composed.
Common SEs for stimulants?
nausea, upset stomach, decreased appetite, insomnia, HA, irritability,
Growth suppression?
T/F: Strattera is a stimulant tx for ADHD
SE BBW?
FALSE. It is a non-stimulant.
BBW for suicidality.
Takes longer to start working (2-4 weeks)
For Klonidine/guanfesine, it can affect BP. It could cause rebound HTN when they suddenly stop.
Maybe not take med holidays without weaning.
Anxious youth are more at risk for ______
Developing all the other disorders - substance use disorder, mood, suicidal, psychosocial disorder.
Sertraline/zoloft approved in kids ______
Prozac/Fluoxetine approved in ____
> = 6
= 7
SSRI side effects are ______. They start working ______ and the combination of SSRI and _____ have the strongest impact.
GI, restlessness, insomnia, impulsivity, HA and fatigue
8 weeks and plateau at 24 weeks
CBT
Why is paroxitine not the best choice for tx depression?
It’s a bit harder to monitor. Decreases appetite and if you miss a dose, then the SEs are more severe.
Long term SEs for SSRIs and SNRIs?
Sexual dysfunction (33%)
Weight gain (5-10%)
SLEEP! Do a sleep assessment as a FIRST STEP especially in anxiety, ADHD, irritability, etc.
