Adolescent Depression & Suicide - Allen

Question 1

By what percent have suicide rates risen over the last 50 years?

Answer 1

60%

(most strikingly in the developing world)

Question 2

World Health Organization projects that depression will be the second most prevalent medical condition in the world by what year?

Answer 2

2020

(that’s only 5 years away, yikes!)

Question 3

The Centers for Disease Control and Prevention reported that the rate of antidepressant use in the United States rose between 1988 and 2008 by what percent?

Answer 3

400%

Question 4

For Americans ages 12 and over, how many are on antidepressant medication?

Answer 4

1 in 10

Question 5

Women are how many times more likely to use an antidepressant than men?

Answer 5

2.5x

Question 6

What percent of females and males with severe depressive symptoms take antidepressant medication.

Answer 6

40% of females

20% of males

Question 7

What is the prevalence of mental health disorder diagnoses in Minnesota?

Answer 7

• 1 in 10 people on MN health plans have been diagnosed with a mental health disorder
  
  • including 1 in 10 children/adolescents

Question 8

In MN, what percent —of psychiatric medications are prescribed by primary care?

Answer 8

>80%

Question 9

What is the rate of suicide in the US?

Answer 9

12 per 100,000

—Suicide is the 2nd leading cause of death under age 18.

Question 10

What group is most at risk of suicide in the US?

Answer 10

white male over age 85

Question 11

What group of adolescent/youth is at most risk of suicide?

Answer 11

American Indian youth ages 15-24

Question 12

What four major mood disorders have increased risk of suicide?

Answer 12

• Major Depressive Disorder
• —Persistent Depressive Disorder
• —Bipolar 1 & 2 Disorder
• —Disruptive Mood Deregulation Disorder

Question 13

What are two key features of Major Depressive Disorder required for diagnosis?

Answer 13

• Persistent sadness (depressed mood)–in children or adolescents=irritable mood
• Loss of interest in activities once enjoyed

Question 14

What is the main feature of Persistent Depressive Disorder required for diagnosis?

Answer 14

• Dysthymia
  
  • Depressed mood for at least 2 years
  • 1 year in children and adolescents

Question 15

What are the main features of Bipolar Disorder required for diagnosis?

Answer 15

• Major depressive episode plus severe changes in mood to either extreme irritability, or overly silly and elated
• 1 → mania 7 days
• 2 → hypomania 4 days

Question 16

What are the critera for Disruptive mood dysregulation disorder?

Answer 16

• Onset must be before 10
  
  • —A. Severe recurrent temper outbursts-verbal or physical–out of proportion to situation
  • —B. Temper outbursts inconsistent with developmental age
  • —C. Temper outbursts on average 3+ times week
  • —D. Mood between outbursts persistently irritable or angry
• —Criteria A-D present 12+ months
• —Criteria A & D present in 2 settings of 3: home, school, peers
• —Restricted to age 6-18

Question 17

Why did DSM-5 add Disruptive mood dysregulation disorder?

Answer 17

• Distinguishes children with milder mood dysregulation from childhood-onset bipolar disorder
• Intent is to reduce number of prescriptions such as lithium
• Less than 1% of diagnosed bipolar children develop bipolar disorder in adulthood
  
  • more likely to develop unipolar depression or anxiety disorders as adults

Question 18

Which is a core symptom of major depression necessary for the diagnosis?

a. Loss of interest in activities once enjoyed
b. Significant change in appetite or body weight
c. Difficulty sleeping or oversleeping
d. Psychomotor agitation or retardation

Answer 18

A

Question 19

Hormonal changes around age 14 cause increase the chance of developing depression in girls by how much?

Answer 19

2x

Question 20

What percent of adolescents —ages 9-17 meet criteria for major depression?

Answer 20

5%

Question 21

What comorbidities does depression often co-occur with?

Answer 21

—ADHD
—Conduct disorder
—Delinquency
—Drug/alcohol
—Anxiety
—Eating disorder

Question 22

What three screening tools are helpful in the assessment of adolescent depression?

Answer 22

• —PHQ-9
• Beck Depression Inventory
• Children’s Depression Inventory

Question 23

What is the overall trend for depression in MN over the last 10 years?

Answer 23

Rates have decreased

Question 24

What are key clinical decision points for depression in adolescents?

Answer 24

Is this depression:

• —Caused by a medical condition or a medication?
• —A reaction to a stressful life event?
• —A depressive variant (e.g., bipolar, SAD, atypical)?
• —Co-occurring with another mental disorder?
• —Co-occurring with drug and alcohol use?
• —Accompanied by suicide risk?

Question 25

What are the key pharmacology practice recommendations for depression in adolescents?

Answer 25

* SSRIs should be reserved for moderate to severe depression * —fluoxetine (Prozac), citalopram (Celexa), and sertraline (Zoloft) * —Tricyclic antidepressants are contraindicated * —lack of proven efficacy * —potential risk of cardiac arrhythmia * Antidepressant treatment should be maintained for 1 year * —Adolescents on ADD/ADHD medications should be monitored closely

Question 26

What are the three goals of cognitive behavioral therapy that have been proven effective in the treatment of depression in adolescents?

Answer 26

—Challenge maladaptive beliefs —Enhance problem-solving abilities —Increase social competence

Question 27

Which of the following is a research based conclusion about treatment for adolescents with depression? ## Footnote A. Combined treatment accelerates benefits of treatment B. Treating patients longer makes only modest differences in overall benefit. C. Adding CBT to medication has little benefit D. SSRIs should never be prescribed given their potential to elevate suicide risk

Answer 27

A

Question 28

What are some predisposing factors of adolescent suicide?

Answer 28

—Previous suicide attempt —Psychiatric disorder —Sexual/physical abuse —Exposure to violent behavior —Family history of suicide or mood disorder —Gender male —Gay or Lesbian sexual orientation

Question 29

What are four precipitating factors of adolescent suicide?

Answer 29

—Substance abuse —Prior suicide attempt —Access to firearms —Social/Emotional Stress (eg., conflict with friends/family/law, despair, hopelessness)

Question 30

You are treating a 17-year-old boy. Which of the following combinations of factors should immediately raise a red flag for both the potential to commit suicide and access to means? ## Footnote A. The boy had a previous suicide attempt and has a family history of mood disorders B. The boy has a history of physical abuse, a family history of suicide, and his father is a gun collector C. The boy admits to smoking marijuana and likes to drive fast D. The boy exhibits anxiety and talks about feeling hopeless and purposeless

Answer 30

A?

Question 31

How should clinicians conduct themselves when interviewing suicidal adolescants?

Answer 31

* Ask about suicidal thoughts; be direct * —Be available & interested * —Listen * —Be non-judgmental; don’t argue * —Don’t act shocked * —Don’t offer glib reassurances, e.g. “Things will work out fine”, “You have your whole life ahead of you” * —Don’t be sworn to secrecy * —Take action; remove means, establish a safety contract * —Barrier between firearms and alcohol * —Enlist help

Question 32

What are ten behavior patterns that clinicians should closely monitor for when there is concern for suicidality?

Answer 32

1. Talking or in any other way communicating about a willingness to die or kill oneself; 2. Increased substance abuse; 3. Expressing a sense of purposelessness; 4. Showing signs of anxiety, including agitation and changes in sleep patterns; 5. Expressing feelings of being trapped in various personal situations; 6. Expressing feelings of hopelessness; 7. Withdrawing from social activities with friends and family; 8. Showing unusual signs of anger; 9. Engaging in reckless behavior; 10. Exhibiting signs of mood changes