Pediatric Depression and Suicide Flashcards
Risk factors for depression
6
- Personal or family history of depression
- Personal or family history of Bipolar disorder
- Suicide related behavior
- Substance abuse
- Other psychiatric illnesses
- Significant psychosocial stressors (family crisis, abuse, neglect, trauma)
Screen for depression if symptoms warrant it and yearly
- Screening tools? 4
- Personal interview? 1
- Screening tools
- GAPS (Guidelines for Adolescent Preventive Services)
- Beck Depression Inventory
- Kutcher Adolescent Depression Scale
- SDQ (Strengths and difficulties questionnaire) - Personal interview
HEADSS
HEADSS based interview questions
H (home)
E (education, employment)
A (activities)
D (drugs)
S (sexuality)
S (suicide/depression)
Criteria for diagnosis of depression
(DSM-IV-TR and DSM 5)
Absolute requirements? 2
Needs to include how many of the following symtpoms and what are they?
9
Symptoms cannot be due to what? 3
- A major depressive episode in children and adolescents typically includes at least 5 of the following symptoms during the same 2-week period
- At least one of the symptoms needs to be depressed mood or loss of interest or pleasure
- Depressed (or irritable) mood
- Diminished interest or loss of pleasure in almost all activities
- Sleep disturbance
- Weight change, appetite disturbance, or failure to achieve expected weight gain
- Decreased concentration or indecisiveness
- Suicidal ideation or thoughts of death
- Psychomotor agitation or retardation
8 . Fatigue or loss of energy - Feelings of worthlessness or inappropriate guilt
- Symptoms are not due to a medical condition or other psychiatric disorder (bipolar)
- Symptoms are not due to the direct physiological effects of a substance
- Symptoms are not better accounted for by bereavement beyond 2 months
Depressive symptoms in children and pre-pubertal youth
5
- Somatic complaints
- Psychomotor agitation
- Mood-congruent hallucinations
- School refusal
- Phobias/separation anxiety/increase in worrying
Depressive symptoms in adolescents and post-pubertal youth
6
- Low self esteem, apathy, boredom
- Substance use
- Change in weight, sleep or grades
- Psychomotor depression/hypersomnia
- Aggression/antisocial behavior
- Social withdrawal
Discuss the difference between depressive symptoms in younger children and in teens?
Younger children may present with more somatic symptoms and more likely to have psychomotor agitation
Teens may be more likely to present with social withdrawal, substance use and psychomotor depression
Signs and symptoms of major depression
SIGECAPS
S Sleep disturbance
I Interests (decreased for usual activities)
G Guilt (excessive or inappropriate)
E Energy (decreased)
C Concentration problems
A Appetite change
P Pleasure (decreased)
S Suicidal thoughts or actions
What is the goal of interviewing the caregivers of the pediatric depression pt as well?
Goal is to establish how much support the patient has and to assess for safety (suicidal behaviors)
Medical evaluation to rule out other etiologies
6
- Infection (Mononucleosis)
- Medication side effects
- Endocrine disorder (Thyroid disorder)
- Tumor
- Neurologic disorder
- Miscellaneous (anemia)
Differential diagnosis
9
- Normal moodiness of teens
- Major depressive disorder
- Substance induced mood disorder
- Adjustment disorder
- Anxiety disorder
- PTSD
- Bipolar disorder
- Eating disorder
- Conduct disorder
Suicidal behaviors in children and teens include:
9
- Expressing self destructive thoughts
- Drawing morbid or death-related pictures
- Using death as a theme during play in young children
- Listening to music that centers around death
- Playing video games that have a self-destructive theme
- Reading books or other publications that focus on death
- Watching TV programs that center around death
- Visiting internet sites that contain death related content
- Giving away possessions
Teens at high risk for suicide
2
- SAD PERSONS
2. + Family history of a first degree relative who committed suicide *
What does SAD PERSONS mean?
which ones are the critical high features 5
S (sex) females attempt more, males* complete more
A (age) over 16*
D (depression) and comorbid conduct disorder/impulsive/aggression/anxiety
P (previous attempts)*
E (ETOH) or other substance abuse (SA)
R (rational thinking lost) psychotic or SA
S (social supports lacking)*
O (organized plan) **
N (no significant other)
S (sickness or stressors)
Treatment for depression
4
- Initial management of depression includes patient and caregiver education
- Develop a treatment plan with patient and family
- Establish relevant links with mental health resources in the community
- Safety plan