Mental Health + Psychopharm

Question 1

About half of psychiatric illness begins by age 14

Question 2

If you don’t have a lot of time with your peds/teens - at least ask about:

Answer 2

Anxiety, eating disorders, OCD, substance abuse.

Question 3

What are some examples of broad based scales to determine if there may be any mental health or social-emotional problem?

Answer 3

PSC-17/35 (brief)
ASQ-SE/BITSEA/ECSA (longer)

Question 4

Start PSC-17 at age ______

Answer 4

8 and up. It’s free - no fee.

Question 5

What does the PSC-17 investigate?

Answer 5

I (internalizing (depression/anxiety)
A (attention)
E (externalizing) - OCD, conduct

Question 6

AAP bright futures recommends depression screening for age _____.
Maternal depression

Answer 6

12 and up.
1,2,4 and 6 mo PP visits

Question 7

Vanderbilt or SNAP-IV evaluate _______

Answer 7

Inattention/hyperactivity.

Question 8

PHQ-9 administered to kids age _____

Answer 8

13 and up.

Question 9

MCPAP Depression Guidelines for PCPs - interpretation and guidance for PSC-17

Answer 9

Guides dx of sub-clinical to mild, moderate or severe depression, discuss medications and follow up protocol.

Question 10

Parts to assessing a suicidal plan

Answer 10

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!

Question 11

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.

Question 12

Use “unspecified disorder” or “adjustment disorder” if you’re not sure of the dx after the first appointment.

Question 13

T/F: you must always try CBT-based psychosocial treatment PRIOR to prescribing medication for preschoolers

Answer 13

True - except in mod-severe symptoms and functional impairment when there is a high risk of injury to self/others or worsening family dysfunction.

Question 14

AACAP.org guidelines

Question 15

MOA of ADHD stimulants (methylphenidate and amphetmine)

Answer 15

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.

Question 16

If you don’t have improvement or only partial improvement after _____ , then consider increased dose, or changing medication

Answer 16

3-7 days.

Question 17

T/F: ADHD stimulants need to stay on a consistent medication schedule - they should stay on their regimen over weekends and holidays.

Answer 17

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.

Question 18

Common SEs for stimulants?

Answer 18

nausea, upset stomach, decreased appetite, insomnia, HA, irritability,
Growth suppression?

Question 19

T/F: Strattera is a stimulant tx for ADHD
SE BBW?

Answer 19

FALSE. It is a non-stimulant.
BBW for suicidality.
Takes longer to start working (2-4 weeks)

Question 20

For Klonidine/guanfesine, it can affect BP. It could cause rebound HTN when they suddenly stop.

Answer 20

Maybe not take med holidays without weaning.

Question 21

Anxious youth are more at risk for ______

Answer 21

Developing all the other disorders - substance use disorder, mood, suicidal, psychosocial disorder.

Question 22

Sertraline/zoloft approved in kids ______
Prozac/Fluoxetine approved in ____

Answer 22

> = 6
= 7

Question 23

SSRI side effects are ______. They start working ______ and the combination of SSRI and _____ have the strongest impact.

Answer 23

GI, restlessness, insomnia, impulsivity, HA and fatigue
8 weeks and plateau at 24 weeks
CBT

Question 24

Why is paroxitine not the best choice for tx depression?

Answer 24

It’s a bit harder to monitor. Decreases appetite and if you miss a dose, then the SEs are more severe.

Question 25

Long term SEs for SSRIs and SNRIs?

Answer 25

Sexual dysfunction (33%)
Weight gain (5-10%)

Question 26

SLEEP! Do a sleep assessment as a FIRST STEP especially in anxiety, ADHD, irritability, etc.