Mood and psychotic disorders Flashcards
Prevalence of depression pre puberty
1%
Prevalence of depression post puberty
3%
Sex pattern of depression in children and adolescents
Male and female equally affected pre puberty
More common in females after puberty
Percentage of young people with depression who remain depressed after 12 months
50%
Clinical features of depression in young children
Poor feeding
Failure to thrive
Tantrums
Separation anxiety
Regressed behaviours
Clinical features of depression in older children
Somatisation e.g. headache, stomach ache
School refusal
Poor school achievement
Sleep issues
Antisocial behaviour
Percentage of young people with depression who also have anxiety
50-80%
Percentage of young people with depression who also have conduct disorder
25%
Percentage of young people with depression who also have OCD
15%
Percentage of young people with depression who also have an eating disorder
5%
Treatment options for mild depression in young people
Watchful waiting
After 4 weeks - supportive therapy, self help, or group CBT
Treatment options for moderate to severe depression in young people
CAMHS review
3 months of individual CBT, IPT or family therapy
Pharmacology once psychotherapy considered/tried
First line antidepressant for young people
Fluoxetine
Second line antidepressants for young people
Sertraline
Citalopram
SSRI most likely to cause increased suicidal behaviour in young people
Paroxetine
Results of Treatment of Adolescents with Depression Study
CBT not superior to placebo
Fluoxetine superior to placebo
CBT and fluoxetine combination superior to placebo and had fastest effect
CBT and fluoxetine combination best at preventing relapse
Three leading causes of death in adolescents
Accidents
Homicides
Suicides
Percentage of adolescent deaths due to suicide
12%
Percentage of adolescent boys with suicidal ideation
14%
Percentage of adolescent girls with suicidal ideation
25%
Sex patterns of suicide in teenagers
Suicide attempts more common in females
Completed suicides more common in males
Most common method by teenage boys with completed suicide
Hanging
Most common methods by teenage girls with completed suicide
OD
Jumping from heights
Percentage of adolescents who attempt suicide that repeat within a year
10%
Prevalence of bipolar affective disorder in adolescents
1%
Percentage of adults with bipolar affective disorder who had their first symptoms aged <20
60%
Most common comorbidity with adolescent bipolar affective disorder
ADHD
Percentage of adolescents who have an episode of major depression who go on to have a manic episode by adulthood
20%
Features which increase the likelihood of a subsequent manic episode in adolescents with depression
Rapid onset
Psychomotor symptoms
Psychotic features
Family history of mania/other mood disorder
Mania/hypomania following treatment with antidepressants
Percentage of teenagers with bipolar affective disorder who complete suicide
10%
Age at which childhood onset schizophrenia develops by
12
Age at which early onset schizophrenia develops by
18
Age at which very early onset schizophrenia develops by
13
Prevalence of schizophrenia among adolescents
1-2 per 1000
Male:female ratio of very early onset schizophrenia
2:1
Premorbid features associated with early onset schizophrenia
Language delays
Delays in reading
Delays in bladder control
Delays in social functioning
Prognosis of early onset schizophrenia compared to adult onset
Worse prognosis in early onset schizophrenia
Risk of EPSEs in children/adolescents compared to adults
Higher risk overall
Higher risk of acute dystonia
Lower risk of akathisia
First line treatment for early onset schizophrenia
Oral, atypical antipsychotic
Common clinical features of children presenting with a manic episode
Atypical or mixed features
Irritability
Labile mood
Behavioural problems
Periods of depression
Sex predominance of bipolar affective disorder in children and young people
Male>female in children
Male = female in adolescents
Typical first mood disorder seen in bipolar affective disorder in young people
Depression
First line treatment for mania in young people
Second generation antipsychotic
Prevalence of adolescent suicidal ideation in the past year in the UK
15%
Most common psychiatric emergency seen in children and adolescents
Suicidal behaviour
Overall prevalence of psychiatric problems in adolescence
16-20%
Most common mental health problems in adolescents
Depression
Anxiety
Most common comorbidity in children and adolescents with bipolar disorder
ADHD
Percentage of children and adolescents with bipolar disorder who also have ADHD
53%
Percentage of children and adolescents with bipolar disorder who also have ODD
43%
Percentage of children and adolescents with bipolar disorder who also have conduct disorder
27%
Most common positive symptom among young people with schizophrenia
Delusions
Percentage of adolescents who experience an episode of depression by the age of 19
20%
Percentage of 15-16 year olds who admit to deliberate self harm
6.9%
Treatment options for manic episodes in adolescents
Aripiprazole
Consider the adult recommendations
Age at which fluoxetine may be considered for depression in young people
12
Starting dose of fluoxetine to treat depression in children and young people
10mg daily
Usual maximum dose of fluoxetine to treat depression in children and young people
20mg daily
Antidepressants which should not be used to treat depression in children and young people
Paroxetine
Venlafaxine
TCAs
St John’s wort
Proportion of children aged 5-19 with a mental disorder
1 in 8
Three most common types of mental disorder among children aged 5-19
Emotional e.g. anxiety, depression
Behavioural e.g. conduct disorder
Hyperactivity
Type of mental disorder which has become more common in children over the last 15-20 years
Emotional
Percentage of girls aged 17-19 with a mental disorder
23.9%
Proportion of preschool children with a mental disorder
1 in 18
Proportion of primary school aged children with a mental disorder
1 in 10
Proportion of secondary school aged children/young people with a mental disorder
1 in 7
Proportion of people aged 17-19 with a mental disorder
1 in 6
Most common type of mental disorder among young people aged 11-19
Emotional disorders
Most common type of mental disorder among children aged 5-10
Behavioural disorders
Prevalence of schizophrenia in children aged <15
1 in 2000
Type of psychosis which has the worse prognosis when it begins in childhood
Schizophrenia
Advice on admission for children who self harm
All children who self harm should be admitted to a paediatric ward for an overnight stay
