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Exam 4-DWB > childhood depression > Flashcards

childhood depression Flashcards

1
Q

what is a significant risk factor for childhood depression

A

family history

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2
Q

Biochemical factors for childhood depression

A

neurotransmitter systems {dopamine, serotonin}

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3
Q

what are some core symptoms of depression related to hypothalmic functions

A
  1. appetite changes
  2. sleep pattern changes
    * * are tied to the pituitary gland
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4
Q

Is there a relationship between a particular mindset or approach to perceiving external events and a predisposition to depression

A
  1. assumption of personal blame
  2. expectation that one negative experience is part of a pattern of negative events
  3. general pessimism
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5
Q

Childhood depression range

A

from mild to severe and can lead to significant dysfunction

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6
Q

Childhood depression is associated with

A

increased risk of suicide and risk-taking behavior

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7
Q

Childhood depression is often recognized when

A

only after noticing difficulty in school and social functioning

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8
Q

Clinical presentation of depression in children

A

varies with developmental level;

must look at child/adolescent from developmental perspective

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9
Q

Infants and young children presentation of depression

A
  1. pattern of depressed affect, lack of pleasure;
  2. patterns should be noted across settings, activities, and relationships
  3. failure to thrive
  4. developmental delays such as speech and motor
  5. repetitive self-soothing behaviors such as rocking
  6. poor attachment behaviors
  7. loss of developmental skills
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10
Q

Toddlers and preschoolers and presentation of depression

A
  1. lack of energy
  2. eagerness to please, tendency to cling
  3. separation problems that are persistent and intense
  4. sadness, irritability, lack of pleasure
  5. poor appetite and weight loss
  6. sleep issues
  7. loss of developmental milestones or regression of behavior
  8. increased physical complaints
  9. overall behavior problems
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11
Q

school-age children presentation of depression

A
  1. irritability, anger, hostility
  2. hyperactivity, reckless behavior
  3. difficulty handling feelings
  4. frequent absences, school phobia
  5. feelings of anger, upset, sadness
  6. loss of interest and pleasure in usual activities
  7. describe themselves negatively
  8. feeling guilty about behaviors
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12
Q

Adolescents and depression

A
  1. stress about separation from family, college decisions, school pressure, behavior choices;
  2. mood shifts are common
  3. capable of abstract thinking and recognizing feelings {piaget}+
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13
Q

Adolescents and presentation of depression

A
  1. despair
  2. blame
  3. guilt
  4. self-hate
  5. decreased interest or pleasure
  6. withdrawal
  7. hopelessness
  8. changes in weight or appetite
  9. changes in sleep patterns
    10 substance abuse or slef-medication
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14
Q

What is the most important part of diagnosing depression in children and adolescents

A

history

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15
Q

Standardized screening tools for depression in childhood

A
  1. Child behavior checklist for age 4-18 yesars
  2. Children’s depression rating scale-revised for age 6-12 years
  3. Beck depression inventory for adolescents and adults
  4. PHQ-9 {PHQ-2}
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16
Q

HEADSS Assessment

A
  1. can serve as guide to address important areas
  2. relies on effective, nonjudgmental interviewing
  3. must preserve confidentiality when possible
  4. can serve as framework for history taking
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17
Q

what does HEADSS stand for

A 
Home
Education, employment
Activities
Drugs/alcohol
Sexuality
Suicide
18
Q

What should be included with the history

A
  1. current problems
  2. family hx of medical/pshyciatric illnesses
  3. pharmacologic or psychologic treatment
  4. prior psychologic functioning
  5. peer/family relationships
  6. suicide ideations or attempts
  7. substance abuse
  8. developmental level and functioning
  9. recent stressors or losses
  10. sexual and reproductive history
  11. abuse
19
Q

What is the strongest predictor of suicide

A

previous attempt

20
Q

Physical assessment for depression

A
  1. hx is important for diagnosis

2. must perform a physical assessment

21
Q

Differential diagnosis for depression

A
  1. anemia
  2. chronic fatigue
  3. eating disorder
  4. endocrine disorder
  5. hypothyroidism
  6. chronic infection
  7. substance abuse: alcohol, marijuana, cocaine
  8. medications: antihypertensives, clonidine, phenobarb
22
Q

Management of depression in children

A
  1. on first visit, assess for suicide risk

2. difficult in referrals d/t lack of specialists and insurance restraints

23
Q

Treatment of depression in children

A
  1. psychotherapy
  2. cognitive behavior therapy
  3. social skills training
  4. medication
24
Q

Antidepressants in children

A

black box warning for those under the age of 25

25
Q

Treatment for adolescents with depression {TADS}

A
  1. NIMH multicenter clinical trial
  2. best response was combination of medication and CBT
  3. rate of suicidal thought decreased in all groups
26
Q

Pharmacologic therapy for depression in children is most often used for children when

A

they experience significant impairment in day-to-day functioning

27
Q

Factors to consider when prescribing medication for depression

A
  1. safety
  2. abuse
  3. selling
  4. comorbidities
  5. side-effect profiles
  6. concurrent medical issues
28
Q

What is first line for treatment of depression

A

SSRIs

  1. effective
  2. well tolerated
  3. few side effects
29
Q

Guidelines for treatment with antidepressant

A
  1. if no benefit after 4 weeks consider different med
  2. mild response - continue for 10 weeks to optimize response
  3. monitor closely d/t 40-50% relapse within 2 years
30
Q

duration for treatment with antidepressants in children/adolescents

A

up to 1 year

31
Q

When do you consider decreasing dose of antidepressant

A

if symptom free for 3 months

32
Q

how long do you treat depression in child/adult

A
  1. usually 6-9 months but up to 12 months until child demonstrates a normal mood level
  2. taper antidepressants slowly
33
Q

What are complicating factors for treating adolescent depression

A

comorbidities

34
Q

common comorbidites in many adolescents

A
  1. conduct and behavior disorders
  2. anxiety
  3. ADHD
  4. ADD
35
Q

2/3 of child/adolescents with MDD have what

A

another mental disorders

36
Q

Comorbidities with depression in adolescents can

A
  1. affect progonsis
  2. has negative ramifications
  3. increases recurrence
  4. increases suicide attempts
  5. affects outcome
  6. affects response to treatment
37
Q

Early-onset depression in the young is associated with

A

a protracted course, poorer outcome, and probability of functional impairment

38
Q

What is the first-line treatment for mild to moderate depression

A

Psychotherapy

39
Q

What is the only FDA-approved medication for depression in children and adolescents

A

Prozac

40
Q

In children with depression you should educate family to watch for and report

A

increases in agitation, behavior changes, suicidal thoughts or behaviors

Exam 4-DWB (20 decks)

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