Pediatric Depression & Suicide Flashcards
Risk Factors for Depression
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)
Screening Tools for Depression
GAPS: Guidelines for Adolescent Preventative Services
Beck Depression Inventory
Kutcher Adolescent Depression Scale
SDQ: Strengths & Difficulties Questionnaire
Personal Interview Pneumonic to Screen for Depression
HEADSS
What does HEADSS stand for?
H: home E: education, employment A: activities D: drugs S: sexuality S: suicide/depression
Define Depression via DSM 5
Major depressive episode in children & adolescents typically includes at least 5 of the following symptoms during the same 2-week period
DSM-5 Criteria for Major Depressive Episode
Depressed/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
Fatigue or loss of energy
Feelings of worthlessness or inappropriate guilt
Symptoms not due to medical/other psychiatric disorder
Symptoms not due to substance abuse
Define Psychomotor Agitation
Revved up
Pacing, hand wringing, mail biting, picking at skin, restlessness
Define Psychomotor Retardation
Move a little bit slower to provide answer
Deterioration of handwriting
Depressive Symptoms in Children & Pre-pubertal Youth
Somatic complaints: abdominal pain, nausea, headache
Psychomotor agitation
Mood-congruent hallucinations
School refusal
Phobias/separation anxiety/increase in worrying
Depressive Symptoms in Adolescents & Post-pubertal Youth
Low self esteem Apathy Boredom Substance use Change in weight, sleep, or grades Psychomotor depression/hypersomnia Agression/antisocial behavior Social withdrawal
Pneumonic for Signs/Symptoms of Depression
SIGECAPS
What does SIGECAPS stand for?
S: sleep disturbance I: interests (decreased) G: guilt (excessive or inappropriate) E: energy (decreased) C: concentration problems A: appetite changes P: pleasure (decreased) S: suicidal though or actions
Medical Evaluation to Rule Out other Etiologies
Infection: EBV Medication SE Endocrine disorder: thyroid disorder Tumor Neurologic disorder Misc: anemia
Which gender is more likely to attempt suicide?
Women
Which gender is more likely to succeed at a suicidal attempt?
Men
Suicidal Behaviors in Children & Teens
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
What is the pneumonic for teens at high risk of suicide?
SAD PERSONS
What does SAD PERSONS stand for?
S: sex (gender) A: age over 16 D: depression & co-morbid conduct disorder/impulsive/ aggression/anxiety P: previous attempts E: ETOH or other substance abuse R: rational thinking lost S: social support lacking O: organized plan N: no significant other S: sickness or stressors
Treatment for Depression
Education
Develop treatment plan
Establish relevant links with resources in community
Safety plan
What should be included in depression education?
Recurrent & treatment options
Parental reactions
Confidentiality
Treatment Plan
Set specific goals in key areas of functioning
Determine treatment based on symptoms
Treatment Options for Suicidal Thoughts
CBT
Interpersonal psychotherapy
SSRIs
Treatment for Mild Depressive Symptoms
Active monitoring Frequent visits Regular exercise or leisure activities Recommend peer support groups Review self management goals Provide education
What is cognitive behavior therapy based on?
Principle that one’s thoughts, feelings, & behaviors affect one another
What is the goal of CBT?
Modify the negative thoughts & behaviors
What is interpersonal psychotherapy based on?
Principle that depression occurs in an interpersonal context
Goal of Interpersonal Psychotherapy
Address the interpersonal problems that may be contributing to or resulting from the depression
Where to start with pharmacotherapy for depression?
Assess prior treatment success Family history of successful antidepressant use Discussion of duration of treatment Review safety data of medication Reviewing SE
Fluoxetine (Prozac)
Approved for ages 8+ for depression & OCD
First line SSRI
Long half life
Escitalopram (Lexapro)
Approved for ages 12+ for depression
First line SSRI
Rules for SSRIs
Don’t abruptly stop
Increase dose 4-6 week increments
Wait out mild SE
Don’t stop med for SE- decrease dose
SSRI Side Effects
Headaches GI upset Insomnia Agitation Anxiety Dry mouth Constipation Sweating Sexual dysfunction Irritability Disinhibition Appetite changes Rash Serotonin syndrome Akathisia Hypomania Discontinuation syndrome Decreased sexual interest & ability to orgasm
Define Akathisia
Agitation
Feeling restless or in distress
Black Box warning for SSRI
Increased suicidal risk
Follow up for depression
Every week or 2 Once a month Quarterly Assess suicidal thoughts/activity Track written goals Instructions in writing, document education
