Mental Health Test 3 Flashcards
Barriers to mental health services
Stigma among families to bring up mental health concerns with doctor
Inadequate identification of youth with mental illness
Mental health provider shortage
Inadequate coverage of mental health services by both public and private health insurance companies
Complex and fragmented service delivery systems
Predisposing characteristics that may suggest mental illness
School failure Suicide Substance abuse Violence Homelessness Incarceration
SCHIP children’s Mental health parity act (State)
A bill to ensure the parity of mental and medical care in programs operated under the state children’s health insurance program
The bill requires the states offering both medical and mental health coverage that is not more restrictive than medical coverage in terms of financial requirements and treatment limitations. S.1337
Implications for sleep hygiene
Change in sleep pattern may be an early sign of mental illness Sleep debt destabilizes frontal lobe Lack of sleep worsens all mood disorders Parents with sleep debt is more irritable Sleep diary Consider role of media and phone Consider OSA Work on sleep first or simultaneously
Psycho-social emergencies
Suicidal or homicidal intent Psychosis Drug overdose Dangerous or destructive out of control behavior Panic attack Abuse neglect
Characteristics of social phobia vs anxiety disorder
Social phobia marked and persistent fear of one or more social or performance situations in which child is exposed to unfamiliar people or possibly squinty by others
The child fears they will act in a way that will be humiliating or embarrassing ,exposure to situation provokes considerable anxiety,feared situation are avoided or else endured with intense anxiety and distress
Anxiety is excessive unrealistic worries and fearfulness NOT related to a specific object or situation.
Characteristics of separation anxiety
Excessive
distress when separating from attachment figure is anticipated
worrying about losing or possible harm to figure
Worrying that an event will lead to separation
Refusing to go to school or be because of separation
Refusing to sleep , nightmares involving theme of separation
Complains of physical symptoms when separation occurs
Clinical characteristics of GAD
EXCESSIVE ANXIETY ,UNREALISTIC WORRIES and FEARFULNESS
Perfectionist
Excessive approval from other
Seen in adolescents
•Excessive anxiety, unrealistic worries, and fearfulness, not related to a specific object or situation
•Child finds it difficult to control worry
•Plus one of the following symptoms
•Restlessness or feeling keyed up/on edge
•Being easily fatigued
•Difficulty concentrating or mind going blank
•Irritability
•Muscle tension
•Sleep disturbance
Clinical characteristics of bipolar disorders
Chapter 18
Early childhood
Mania
Clinical characteristics of OCD
Obsessions as defined by:
•Recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress
•The thoughts, impulses, or images are not simply excessive worries about real-life problems
•The person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action
Compulsions
•Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly
•The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive
Clinical characteristics of PTSD
A. Exposure
•Person exposed to a event that involved threat of harm/death to self or other
•Person’s response involved intense fear, helplessness, or horror
•B. Traumatic event is re-experienced Recurrent and intrusive recollections (play)
•Recurrent and distressing dreams
•Acting or feeling as if event were recurring (reenactment)
•Intense distress at exposure to internal or external cues that resemble an aspect of the event
•Physiological reactivity on exposure to cues
Common obsessions
- Contamination
- Harm to self or others
- Need for symmetry/order
- Religious or moral concer
- Sexual or aggressive
- Lucky or unlucky numbers
- Contamination
- Harm to self or others
- Need for symmetry/order
- Religious or moral concerns
- Sexual or aggressive
- Lucky or unlucky numbers
Manifestations of depression and using a differential diagnosis
- Anxiety
- Psychosis
- Conduct disorders
- Incipient bipolar disorder
- Learning/school problems
- Exposure to adverse childhood events
Interventions for depression including first line medications
•First line treatment is with the serotonin reuptake inhibitors
- FDA approval for pediatric depression is with:
- Fluoxetine (7 to 17 years of age)
- Escitalopram (12 to 17 years of age)
Side effects of pharmacology management
- The most common side effects:
- Gastrointestinal, insomnia or somnolence, vivid dreams, nightmares, restlessness, diaphoresis, headaches, akathisia, changes in appetite, and sexual dysfunction
- 3% - 8% of youths (especially children) may show increased impulsivity, agitation, irritability, silliness, and “behavioral activation”
- Rare side effects:
- Serotonin syndrome and increased suicidality are side effects of antidepressants
