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CPS Statement > Mental Health & Developmental Disabilities > Flashcards

Mental Health & Developmental Disabilities Flashcards

1
Q

Describe the drug characteristics of SSRIs

A
  • rapidly absorbed
  • hepatically metabolized
  • absorption unaffected by ingestion of food
  • long-acting
  • propensity for discontinuation syndrome
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2
Q

Which SSRI has the most evidence with respect to the treatment of depression in children and adolescents?

A

Fluoxetine (Prozac)

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3
Q

Which SSRI has evidence of negative impact on the treatment of depression in children and adolescents?

A

Paroxetine (Paxil)

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4
Q

List some short-term side effects of SSRIs

A
  • GI symptoms
  • sleep changes (insomnia, somnolence, vivid dreams)
  • restlessness
  • headaches
  • appetite changes
  • sexual dysfunction
  • increased agitation or impulsivity (behavioural activation)
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5
Q

What are more rare adverse effects of SSRIs?

A
  • increased bleeding risk
  • SIADH
  • serotonin syndrome
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6
Q

List the features of serotonin syndrome

A
  • mental status changes
  • myoclonus
  • ataxia
  • diaphoresis
  • fever
  • autonomic dysregulation
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7
Q

What warnings exist for the use of Citalopram?

A
  • use only in doses
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8
Q

What differentials should be excluded when assessing a patient with anxiety?

A
  • ADHD
  • depression
  • bipolar disorder
  • autism spectrum disorder
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9
Q

To increase tolerability of medication for anxious patients, what approach should be taken?

A
  • start at lower doses
  • titration upwards gradually
  • provide psychoeducation regarding potential side effects and their usually transient nature
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10
Q

How should you manage a patient with symptoms or family history of bipolar disorder when considering SSRI initiation?

A

Refer to psychiatrist for further assessment, management, given risk for hypo mania with SSRI

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11
Q

List, in order of increasing half life, four SSRIs

A
  • Fluvoxamine
  • paroxetine
  • Sertraline
  • Escitalopram
  • Citalopram
  • Fluoxetine
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12
Q

What challenges do children with ADHD face, compared with children without ADHD?

A
  • school difficulties
  • lower self-esteem
  • family stress
  • psychiatric comorbidities
  • poor social skills
  • social isolation
  • poor sibling relationships
  • poor peer relationships
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13
Q

What are adolescents with ADHD at higher risk for, compared with children without ADHD?

A
  • school failure
  • poor social relationships
  • motor vehicle collisions
  • delinquency
  • poor vocational outcomes
  • experimentation with tobacco, alcohol, drugs, sex
  • being cited for speeding or other traffic violations
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14
Q

What are some types of arrhythmic heart disease in children?

A
  • long and short QT syndrome
  • arrhythmogenic right ventricular cardiomyopathy
  • Brugada syndrome
  • WPW
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15
Q

Compared to the general population, what is the risk of sudden unexpected death in children on ADHD stimulant medications?

A

Same

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16
Q

What features on personal history would necessitate further assessment by a cardiologist?

A
  • SOB with exercise without another explanation (i.e. asthma, obesity)
  • Poor exercise intolerance without another explanation
  • Fainting or seizures with exercise/startle/fright
  • Palpitations brought on by exercise
17
Q

What features on family history are concerning for increased cardiac risk?

A
  • Family hx (in 1st or 2nd degree relative) of sudden or unexplained death, including sudden infant death syndrome, unexplained drowning or unexplained motor vehicle accidents
  • Family hx of arrhythmia, cardiomyopathy, heart transplant, pulmonary hypertension, implantable defibrillator
18
Q

What features on physical examination may be concerning for increased cardiac risk?

A
  • hypertension
  • pathological-sounding murmur
  • sternotomy incision
  • absent/delayed femoral pulses
19
Q

In a patient with ADHD with no personal history, family history or physical exam findings concerning for underlying cardiac disease, who should initiate ADHD medications?

A
  • Primary care physician, ADHD specialist
20
Q

Should routine ECGs be performed on patients with ADHD before starting medications?

A

No

21
Q

List alternative therapies that MAY be useful for ADHD

A
  • Dietary management for children with allergic symptoms or migraine headaches
  • Trace element supplementation for patients with documented deficiencies
  • Herbs may play a role in memory and cognition and have sedative and anxiolytic properties
  • Biofeedback may be offered in cases where medication is not suitable
  • Hypnotherapy may be helpful in controlling secondary symptoms of ADHD
22
Q

Which alternative therapies have NO scientific evidence to support them?

A
  • Vision therapy
  • Oculovestibular treatment
  • Sound training
23
Q

Define postpartum blues, postpartum depression and postpartum psychosis

A
  • Blues: emotional disturbance with crying, confusion, mood lability, anxiety and depressed mood appearing within first week postpartum, lasting for few hours to few days.
  • Depression: begins in or extends into postpartum period with symptoms including dysphoric mood, fatigue, anorexia, sleep disturbances, anxiety, excessive guilt, suicidal thoughts
  • Psychosis: severe disorder beginning within 4 weeks postpartum with delusions, hallucinations, gross impairment of functioning
24
Q

List risk factors for postpartum depression

A
  • history of mood disorders
  • depression symptoms during pregnancy
  • family history of psychiatric disorders
  • negative life events
  • poor marital relationships
  • having an infant with special needs/medically fragile
  • lack of social support
25
Q

List consequences of maternal depression on the infant, toddler, school-aged child and adolescent

A
  • infant: anger and protective style of coping vs. passivity with withdrawal, lower cognitive performance
  • toddler: passive noncompliance, less mature expression of autonomy, internalizing and externalizing problems, less creative play, lower cognitive performance
  • school-age: impaired adaptive functioning, affective disorders, anxiety and conduct disorders, ADHD, lower IQ
  • adolescents: mental health, substance abuse, alcohol dependence, ADHD, LD
26
Q

List sources of resilience in children with respect to the effect of maternal depression

A
  • temperament (more robust, easy-going is protective)
  • strong social and cognitive skills
  • understanding of parent’s illness
  • recognition by child that he/she is not to blame for illness-related behaviour
27
Q

List ways to support a mother with depression

A
  • Encourage her own mental health care, (i.e. psychotherapy, SSRI for mother)
  • Interaction coaching techniques
  • Bolster social support
  • Provide home visiting interventions
  • Family-centered intervention
  • Interpersonal therapy
28
Q

Should St. John’s Wort be used to treat maternal depression

A
  • can be effective for mild to moderate depression
  • may have many drug interactions
  • not safe during pregnancy or breastfeeding
29
Q

List possible reactions that children demonstrate in response to divorce

A
  • Sadness
  • Confusion
  • Fear of abandonment
  • Anger
  • Guilt
  • Grief
  • Conflicts related to loyalty and misconceptions
  • Relief (if domestic violence or abuse stops)
30
Q

How does divorce impact children?

A
  • Most cases, no serious outcomes
  • Can have lower academic achievement, conduct, psychological adjustment, self-concept and social relations
  • Increase in poverty, educational failure, risky sexual behaviour, unplanned pregnancies, earlier marriage or cohabitation, marital discord and divorce
31
Q

List protective factors that can reduce risk of negative outcomes for children experiencing divorce (opposites are risk factors)

A
  • Protection from conflict between parents
  • Cooperative parenting
  • Healthy relationships between child and parents
  • Parents’ psychological well being (need to look after themselves, introduce new relationships slowly)
  • Quality, authoritative parenting
  • Household structure and stability
  • Supportive sibling and extended family relationships
  • Economic stability
32
Q

What are the three most significant factors that impact a child’s well-being during the process of divorce?

A
  • Quality of parenting (warmth, nurturance, effective discipline and limit-setting)
  • Quality of parent-child interaction (warmth, supportiveness, positive and frequent communication)
  • Degree, frequency, intensity and duration of hostile conflict
33
Q

List risk factors for suicide

A
  • depression
  • previous suicide attempt
  • maybe self-hamr behaviours
  • impulsivity
  • presence of precipitating factors (divorce, break-up, bullying, academic disappointment, homosexuality, legal proceedings)
  • ## poor child-parent communication and relationships
34
Q

How to assess suicidality

A
  • ask about frequency, intensity and quality of suicidal thoughts
  • passive vs. active suicidal thoughts
  • future orientation vs. hopelessness
  • intent
  • ## plan
35
Q

Determine that a teen who recently attempted suicide is safe for discharge for ED. List discharge plan

A
  • clear instructions regarding importance of communicating suicidal thoughts to trusted adults
  • need for mental health follow-up
  • list of local crisis services
  • use of ED if actively suicidal

CPS Statement (19 decks)

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