Recall Deck 5 (2018) Flashcards
Parent divorced. What could be 5 negative outcomes for the child as an adult?
Many studies found that children of divorced families experienced lower levels of well-being regardless of scholastic achievement, conduct, psychological development, self-esteem, social competence, and relationships with other children (Gov’t Canada)
Loses time with each parent
Child may lose economic security
Child may lose emotional security
Child may have decreased social/psychological maturation
Child may change outlook on sexual behaviour
Child may lose cognitive/academic stimulation
May be less physically healthy
May have higher risk of emotional distress
Government of Canada:
https://www.justice.gc.ca/eng/rp-pr/fl-lf/divorce/2004_1/p2.html#:~:text=Many%20studies%20found%20that%20children,and%20relationships%20with%20other%20children.
Article (2014) )https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4240051/
Adolescent boy with autism, what are 2 risk factors for suicidal behaviour apart from depression?
-poor emotional regulation skills
- psychiatric comorbidities (intellectual disability – concreteness)
- bullying
-high functioning ASD
- deficits in expression of feelings/thoughts
-abuse
-prior suicide attempts – lethality
https://pubmed.ncbi.nlm.nih.gov/24713024/
Adolescent boy with autism, what are 2 risk factors for depression?
Higher cognitive functioning
Self-awareness of ASD deficit
Capacity of introspection
Stressful life events
Quality of social relationships and alexithymia
https://pubmed.ncbi.nlm.nih.gov/26413564/
Teen in rural community with only nurse practitioner. Psychosis. Delusions about mother. Younger sibling in house. Punched the wall. Delusions in the stomach and was going to cut something out of stomach. Dad and younger brother bring him in for assessment. List 5 things that indicated the need for acute inpatient admission/treatment?
- Safety concerns for self
-meets criteria for involuntary admission under the BC MHA? - Limited insight
- Safety for others – punching wall/delusions about mother – evidence of aggression
- Limited resources in community – limited access to provider
- limited access to mental health trained gatekeepers
- limited access to mental health specialist
Two medications with evidence for OCD?
- fluvoxamine
-sertraline-POTS study in pediatric OCD - clomipramine—first med to have evidence in pediatric OCD
- would we like to include SSRIs in here too? – i.e. fluoxetine
Name one treatment for mild/moderate OCD?
- CBT - ERP
What are 2 comorbidities with OCD that reduce the response to treatment: -
- OCPD
-ADHD? MDD?
especially MDD
Major Depressive Disorder (MDD):
Comorbid MDD in OCD patients is associated with:
Lower treatment response rates
Lower remission rates
Greater symptom severity and chronicity
Higher number of hospitalizations
More frequent aggressive obsessions
Higher number of suicide attempts
Post-Traumatic Stress Disorder (PTSD):
Having primary OCD with comorbid PTSD has been found to decrease treatment response rates.
Generalized Anxiety Disorder (GAD):
OCD with comorbid GAD was shown to increase dropout rates and decrease treatment response.
Bipolar Disorder (BD):
Comorbid BD in OCD patients is associated with:
More complex pharmacological interventions required
Higher rates of certain obsessions and compulsions
More frequent hospitalizations
Higher rates of suicidal thoughts and attempts
Attention-Deficit/Hyperactivity Disorder (ADHD):
The presence of ADHD was related to lower treatment response rates in children and adolescents with OCD.
Disruptive Behavior Disorders:
In children and adolescents with OCD, comorbid disruptive behavior disorders were associated with:
Lower treatment response rates
Lower remission rates
In general, patients with one or more comorbid diagnoses tend to have lower treatment response and remission rates compared to those without comorbidities.
The number of comorbid conditions is negatively related to treatment outcome, meaning that more comorbidities are associated with poorer response to treatment.
It’s important to note that the impact of comorbidities on OCD treatment can vary, and some studies have shown mixed results. Comprehensive clinical evaluation and tailored treatment approaches are crucial for managing OCD with comorbid conditions.
Haitian origin 14 year old, OCD, started on fluoxetine 30mg and added Risperidone 0.5mg BID added. Has Tremor and agitation etc. What are two pharmacodynamics/kinetic reasons for these effects.
- CYP 2D6 interaction – risperidone increased through the inhibition of CYP2D6 by fluoxetine.
- Could also be EPS from risperidone – rule out serotonin syndrome
Research on older tricyclic antidepressants found that African Americans were more likely to carry alleles that slow drug metabolism, potentially leading to higher blood levels and greater risk of side effects.
However, studies on SSRIs like paroxetine, sertraline, and fluoxetine found no racial or ethnic group differences in drug response related to these genetic variants.
Tardive Dyskinesia
There is some evidence that African Americans may be more susceptible to tardive dyskinesia (involuntary movements) from antipsychotics compared to white patients.
Other Side Effects
African Americans may be more likely than whites to gain weight while taking atypical antipsychotics.
One study found that African Americans had a higher rate of discontinuation of antipsychotic medication, possibly due to side effects.
Some researchers have suggested there may be ethnic differences in the pharmacodynamics or pharmacokinetics of antipsychotics that could explain the higher incidence of certain adverse events in Afro-Caribbean populations.
Same stem…mom says that meds won’t work and symptoms are because of passion/spiritual. What are some cultural reasons for refusing treatment? What could you explore with her?
Cultural Stigma and Beliefs
Perception of Mental Illness
In many Afro-Caribbean cultures, there is significant stigma surrounding mental health issues. Mental illness is often viewed as:
A sign of personal weakness
A moral failing
Something to be ashamed of and hidden from others
This stigma can prevent individuals from acknowledging mental health problems and seeking help.
Spiritual and Religious Interpretations
Mental health issues are frequently attributed to:
Evil spirits or demonic possession
Punishment for sins or moral transgressions
A lack of faith or commitment to God
These beliefs can lead people to seek help from religious leaders or folk practitioners rather than mental health professionals.
Distrust of Medical Systems
Historical Context
There is often a deep-seated mistrust of medical and mental health systems among Afro-Caribbean communities, stemming from:
A history of unethical medical experimentation on Black populations
Experiences of racism and discrimination in healthcare settings
This mistrust can make individuals reluctant to engage with formal mental health services.
Cultural Competence Concerns
Many Afro-Caribbean individuals worry that mental health professionals may:
Lack understanding of their cultural background and experiences
Misinterpret normal cultural behaviors as symptoms of mental illness
Provide treatment that is not culturally appropriate or effective
Community and Family Dynamics
Collectivist Culture
Afro-Caribbean cultures tend to be collectivist, emphasizing:
Family honor and reputation
The impact of individual actions on the entire community
A mental health diagnosis may be seen as “contaminating” not just the individual, but the extended family and community.
Privacy and Self-Reliance
There is often a strong emphasis on:
Keeping family matters private
Solving problems within the family or community
Self-reliance and “toughing it out”
These values can discourage seeking outside help for mental health issues.
Alternative Help-Seeking Behaviors
Instead of formal psychiatric treatment, Afro-Caribbean individuals may prefer to:
Seek guidance from religious leaders or community elders
Use traditional healing practices or folk remedies
Rely on family support and prayer
These alternatives are often seen as more culturally acceptable and less stigmatizing than psychiatric treatment.
By understanding these cultural factors, mental health professionals and policymakers can work towards developing more culturally competent and accessible mental health services for Afro-Caribbean communities.
role of voudu:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6880247/
Ethnic minority experience barriers to treatment. List reasons that limit access. Name 2 reasons MH treatment might be less effective with an ethnic minority youth (reduced response)
-poverty – access to ethnically based care/cost
- racism – barrier to youth interacting with care as well as receiving care
. List 5 pharmacokinetic or pharmacodynamics differences between MPH and dextroAmphetamine?
MPH increases clonidine levels
Amphetamine interacts with fluoxetine/paroxetine -2D6
Dopamine reuptake inhibitor
Amphetamine – more stimulant; vesicles add more into the cleft
- amphetamines have: (a) MAO inhibition, (b) are CYP 2D6 substrates, and (c) inhibit VMAT-2–> increase levels of dopamine and NE in synaptic cleft through both reuptake inhibition AND vesicle release
- methylphenidate–> (a) serotonin receptor 1A agonist, (b) inhibitor of 1A2, (c) redistribution of VMAT-2
MPH and cocaine – differentiate:
Methylphenidate does not have the same abuse liability as cocaine due to slower dissociation from the site of action, slower uptake into the striatum, and slower binding and dissociation with the dopamine transporter protein relative to cocaine [144]. However, it is important to remember that the route of administration may alter the abuse liability of a substance. The oral administration of psychostimulants has been shown to decrease the likability of a substance while parenteral usage (injected, snorted) has been shown to be associated with euphoria [144]. Individuals with ADHD and either SUD or CD are at highest risk for diversion and misuse and are more likely to both misuse and divert their stimulant medication [145]. Both immediate-release and, to a lesser degree, extended-release preparations of stimulant medications can be diverted or misused, with extended release preparations having less potential for parenteral usage [55, 145]. Nonstimulants such as atomoxetine and guanfacine XR do not have abuse potential.
Kid with anxiety and side effects and you switch to another SSRI. What are some ways to switch between two SSRI/meds of the same class? What are some possible consequences of the stopping (or switching we can’t remember)
Titration down and then start new med with titration up
- Cross-titration of medications
- consequences of switching – could improve! Could deteriorate with new medication; could deteriorate if no treatment (stop and switch method); could have adverse reactions (allergic reaction, side effects of medication)
Conduct disorder, no ADHD. List the components of the lacking prosocial emotion specifier?
This specifier is labeled “with Limited Prosocial Emotions” (LPE) and is used when children exhibit at least 2 out of 4 criteria over at least 12 months, and in multiple relationships and settings: (1) lack of remorse or guilt; (2) callous- lack of empathy; (3) unconcerned about performance; and (4) shallow or deficient affect.
https://www.sciencedirect.com/science/article/pii/S0890856720319857#:~:text=This%20specifier%20is%20labeled%20%E2%80%9Cwith,%3B%20and%20(4)%20shallow%20or
Child born in shelter, parents in shelter, mom partied during pregnancy. Child has facial FAS features, behavioural issues, conduct type symptoms. List 5 possible diagnosis. List perinatal/environmental risk factors for ADHD
o ASD
-ADHD
-Reactive Attachment Disorder
-Parent/child relational issue
-PTSD
- Not sure of age but: MDD, ODD, Conduct, Substance Use
Perinatal risk factors:
Low birth weight
Smoking in pregnancy
Advanced parental age
Prematurity
ACE Family history
Prenatal – very low BW (<1.5kg) 2-3X ↑, ↑ maternal stress, tobacco/EtOH/drugs/toxin exposure.
Postnatal – neonatal anoxia, CNS infxn, severe head injury, exposure to lead/toxins.
Psychosocial – ACEs, early severe deprivation, parenting influences outcome (may ∆ threshold to bring pt to Rx).
Personal – ↓ behavioural inhibition/effortful control/constraint, -ve emotionality, ↑ novelty seeking.
Kids in therapy. List 5 ways that kids express resistance in therapy.
- Not showing up
- Shows up late
- Not doing homework
- Not making eye contact
- Not talking
- Tantrums
- Agreement with everything
Kid does not have mental illness. But has mild delay, failed grade 8, repeat offences. Lawyer asks you for assessment. What are 5 things you would assess to determine competency to stand trial?
Can the kid state what the charge is? They don’t have to understand
Does the kid understand people think they did the crime?
Does the child understand the consequences of being found guilty/not guilty (is this true or is it more for the effects of the crime?)
Do they understand the roles of each person?
Child needs to be able to communicate with their counsel
Girl doing therapy, cluster b, doing well. On weekend she had broken up with boyfriend, drank, cut and skipped school. She’s late and mom fills you on all this. She shows up and wants to talk about her emotions. List 5 components that you could address to make this session effective today.
- Check if suicidal currently/current plan
- Discuss safety concerns – cutting
- Discuss safety concerns – drinking
- Identify coping skills used prior to cutting/drinking – commend
- Review safety plan
- Validate emotional distress over difficult feelings
- Address that she is late
*Need to review how to do DBT with patients
Kid with head injury. Had 2 head injuries in the past 3 years. Also had a past depressive episode and treated with meds. Not on meds now. Hospitalized for 24 hours. What 3 things would you monitor in post concussive disorder or what are the psych symptoms to monitor for post concussion? What are the risk factors for developing another depressive episode
- headache, vision changes, nausea
- sleep (MDD), eating (post-concussive/MDD), concentration (post-concussive, MDD), mood, aggression
Risk factors: Neuroticism, previous MDD, severity of previous episodes/current, family history, head injuries, comorbid psychiatric illnesses, ACEs, comorbid medical conditions, substance use
(GO LOOK AT CANMAT)
Eating disorder. What are 3 differences between AN and ARFID. List 3 etiologies of ARFID.
ARFID does not have distortion of body image
ARFID does not restrict with intent of losing weight
ARFID may have a normal BMI
Etiologies of ARFID:
Neurodevelopmental disorder – ASD
Trauma/neglect
OCD
Depression. List factors of an episode that increase risk of recurrence.
- Severity
- Previous episodes
- Neuroticism
- Comorbid Psychiatric illness
- Family history
- Substance use
- Comorbid medical conditions
- Previous head injuries
School refusal. 21a. What is your treatment approach (nonpharm) for school refusal
History, collateral from parents and school
Screen for precipitating factors - bullying, abuse, safety and substance use
- Screen for perpetuating factors – learning disorders, adhd, asd, anxiety, depression
- Motivational interviewing/involve the child in the plan to return; focus on return to school either immediate or gradual – need a team meeting with school, family and child with clear communication of plan plus timely follow-up
How can a teacher help a child with test anxiety?
- More time; separate room
- See where ethe struggles are (teacher meets with them)
- see what the student thinks would be helpful
- breaks in the test itself
- do you need headphones/fidget gadget
- do on a computer/verbally etc.
How can a teacher help a kid with anxiety about doing large projects?
IEP with focus on breaking down large problems into smaller problems. Mentorship on doing this with a large project; could also include connection to a team (group project) with individually assigned tasks
- involvement of parents/EA
- regular check-ins
