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Flashcards in Pediatric Depression & Suicide Deck (35):
1

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)

2

Screening Tools for Depression

GAPS: Guidelines for Adolescent Preventative Services
Beck Depression Inventory
Kutcher Adolescent Depression Scale
SDQ: Strengths & Difficulties Questionnaire

3

Personal Interview Pneumonic to Screen for Depression

HEADSS

4

What does HEADSS stand for?

H: home
E: education, employment
A: activities
D: drugs
S: sexuality
S: suicide/depression

5

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

6

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

7

Define Psychomotor Agitation

Revved up
Pacing, hand wringing, mail biting, picking at skin, restlessness

8

Define Psychomotor Retardation

Move a little bit slower to provide answer
Deterioration of handwriting

9

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

10

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

11

Pneumonic for Signs/Symptoms of Depression

SIGECAPS

12

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

13

Medical Evaluation to Rule Out other Etiologies

Infection: EBV
Medication SE
Endocrine disorder: thyroid disorder
Tumor
Neurologic disorder
Misc: anemia

14

Which gender is more likely to attempt suicide?

Women

15

Which gender is more likely to succeed at a suicidal attempt?

Men

16

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

17

What is the pneumonic for teens at high risk of suicide?

SAD PERSONS

18

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

19

Treatment for Depression

Education
Develop treatment plan
Establish relevant links with resources in community
Safety plan

20

What should be included in depression education?

Recurrent & treatment options
Parental reactions
Confidentiality

21

Treatment Plan

Set specific goals in key areas of functioning
Determine treatment based on symptoms

22

Treatment Options for Suicidal Thoughts

CBT
Interpersonal psychotherapy
SSRIs

23

Treatment for Mild Depressive Symptoms

Active monitoring
Frequent visits
Regular exercise or leisure activities
Recommend peer support groups
Review self management goals
Provide education

24

What is cognitive behavior therapy based on?

Principle that one's thoughts, feelings, & behaviors affect one another

25

What is the goal of CBT?

Modify the negative thoughts & behaviors

26

What is interpersonal psychotherapy based on?

Principle that depression occurs in an interpersonal context

27

Goal of Interpersonal Psychotherapy

Address the interpersonal problems that may be contributing to or resulting from the depression

28

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

29

Fluoxetine (Prozac)

Approved for ages 8+ for depression & OCD
First line SSRI
Long half life

30

Escitalopram (Lexapro)

Approved for ages 12+ for depression
First line SSRI

31

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

32

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

33

Define Akathisia

Agitation
Feeling restless or in distress

34

Black Box warning for SSRI

Increased suicidal risk

35

Follow up for depression

Every week or 2
Once a month
Quarterly
Assess suicidal thoughts/activity
Track written goals
Instructions in writing, document education