Pediatric Depression & Suicide

Question 1

Risk Factors for Depression

Answer 1

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)

Question 2

Screening Tools for Depression

Answer 2

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

Question 3

Personal Interview Pneumonic to Screen for Depression

Answer 3

HEADSS

Question 4

What does HEADSS stand for?

Answer 4

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

Question 5

Define Depression via DSM 5

Answer 5

Major depressive episode in children & adolescents typically includes at least 5 of the following symptoms during the same 2-week period

Question 6

DSM-5 Criteria for Major Depressive Episode

Answer 6

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

Question 7

Define Psychomotor Agitation

Answer 7

Revved up

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

Question 8

Define Psychomotor Retardation

Answer 8

Move a little bit slower to provide answer

Deterioration of handwriting

Question 9

Depressive Symptoms in Children & Pre-pubertal Youth

Answer 9

Somatic complaints: abdominal pain, nausea, headache
Psychomotor agitation
Mood-congruent hallucinations
School refusal
Phobias/separation anxiety/increase in worrying

Question 10

Depressive Symptoms in Adolescents & Post-pubertal Youth

Answer 10

Low self esteem
Apathy
Boredom
Substance use
Change in weight, sleep, or grades
Psychomotor depression/hypersomnia
Agression/antisocial behavior
Social withdrawal

Question 11

Pneumonic for Signs/Symptoms of Depression

Answer 11

SIGECAPS

Question 12

What does SIGECAPS stand for?

Answer 12

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

Question 13

Medical Evaluation to Rule Out other Etiologies

Answer 13

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

Question 14

Which gender is more likely to attempt suicide?

Answer 14

Women

Question 15

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

Answer 15

Men

Question 16

Suicidal Behaviors in Children & Teens

Answer 16

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

Question 17

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

Answer 17

SAD PERSONS

Question 18

What does SAD PERSONS stand for?

Answer 18

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

Question 19

Treatment for Depression

Answer 19

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

Question 20

What should be included in depression education?

Answer 20

Recurrent & treatment options
Parental reactions
Confidentiality

Question 21

Treatment Plan

Answer 21

Set specific goals in key areas of functioning

Determine treatment based on symptoms

Question 22

Treatment Options for Suicidal Thoughts

Answer 22

CBT
Interpersonal psychotherapy
SSRIs

Question 23

Treatment for Mild Depressive Symptoms

Answer 23

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

Question 24

What is cognitive behavior therapy based on?

Answer 24

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

Question 25

What is the goal of CBT?

Answer 25

Modify the negative thoughts & behaviors

Question 26

What is interpersonal psychotherapy based on?

Answer 26

Principle that depression occurs in an interpersonal context

Question 27

Goal of Interpersonal Psychotherapy

Answer 27

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

Question 28

Where to start with pharmacotherapy for depression?

Answer 28

``` Assess prior treatment success Family history of successful antidepressant use Discussion of duration of treatment Review safety data of medication Reviewing SE ```

Question 29

Fluoxetine (Prozac)

Answer 29

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

Question 30

Escitalopram (Lexapro)

Answer 30

Approved for ages 12+ for depression | First line SSRI

Question 31

Rules for SSRIs

Answer 31

Don't abruptly stop Increase dose 4-6 week increments Wait out mild SE Don't stop med for SE- decrease dose

Question 32

SSRI Side Effects

Answer 32

``` 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 ```

Question 33

Define Akathisia

Answer 33

Agitation | Feeling restless or in distress

Question 34

Black Box warning for SSRI

Answer 34

Increased suicidal risk

Question 35

Follow up for depression

Answer 35

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