Flashcards in Disorders of Childhood and Adolescence Deck (96):
What percent of adolescents consider suicide?
Does depression self resolve?
True or false: brain structures can change with prolonged depression
Do most schools have suicide prevention programs?
Not most, but getting better
True or false: irritability as a symptom of depression is much more common in children
True or false: inattentiveness is not a common manifestation of depression in children
False--must r/o depression prior to diagnosing ADHD
What must always be r/o with suspected depression in children?
Substance abuse or medical condition
Can schizophrenia appear similar to depression or bipolar mania?
What are the criteria for MDD in children? (9)
-Recurrent thoughts of death
How many criteria are needed to diagnose MDD in children? How long must s/sx last?
Five symptoms for 2 weeks
Which is more common in MDD: weight loss or gain?
Which is more common in MDD: hypersomnia or hyposomnia
True or false: to meet the criteria for MDD, children can have irritability instead of depressed mood
What are the mood differences from adult MDD?
More irritable and labile
True or false: anhedonia is not a key marker in childhood MDD
Do children often verbalize feelings of sadness?
True or false: somatic complaints are common in childhood MDD
True or false: kids with MDD have an increased sensitivity to criticism, and poor focus
Why can a learning disability cause MDD?
Major part of self-worth at this age
What is the average length of depression?
What percent of childhood MDD remit by 2 years?
What is the chance of recurrence of MDD in children at 2 and 5 years?
40% by 2 years
60-70% by 5 years
True or false: depression caught early is usually more treatable
False--usually more of a chronic, recurrent issue
What percent of children with MDD have one or more comorbid psychiatric conditions?
Substance abuse is preceded by MDD by how many years on average?
What are the major mental health issues with marijuana use?
More anhedonia, apathy
What is double depression?
Dysthymia + MDD
What is the comorbidity of MDD + dysthymia?
Worse social impact
PTSD in the pediatric population often mimics what other psychiatric condition
What is the common manifestation of trauma in kids?
Reenact the trauma
What is the key distinguishing factor for deciding therapy vs medical treatment for MDD?
Severity--psychotherapy first, add drugs if severe
What is the MOA of bupropion?
Increased NE and dopamine
What are the two SSRIs that are FDA approved in children, and are first line?
Lexapro (escitalopram) and prozac (fluoxetine)
Why is it that bupropion is useful for the treatment of ADHD and depression?
Increased NE and dopamine which is similar to amphetamine
What doses of SSRIs must be prescribed for OCD (high or lower than for MDD)? How long does this take to take effect for OCD?
Takes months to take full effect
Neurovegetative s/sx benefit from what particular SSRI?
What antidepressant has an increased risk of seizures?
What is the major adverse effects of SSRIs?
Disinhibition with SSRI use is suspicious for what?
Which antidepressant has an increase in DBP?
Which antidepressant has an increased risk of GI bleeding? MAO?
Cymbalta (duloxetine) (SNRI)
What are the s/sx of serotonin syndrome? (5)
What are the s/sx of discontinuation of antidepressants?
-Electric shock sensations
What percent of MDD in children has severe suicidal ideation?
What is the leading cause of disability in the world?
A child with one depressed parent is how many times more likely to have depression?
A child with two depressed parent is how many times more likely to have depression?
Why must you disclose the black box warning for SSRIs?
What is the issue with the black box warning? What were the results of the study that led to this conclusion?
Correlation vs causation
(2% with placebo suicide vs 4% with)
What is the probability of having increased suicidal ideation with meds vs without?
Without = 15%
When in the course of the depression is the risk of suicidal ideation greatest post antidepressant prescription?
First four weeks
The black box warning goes up to what age?
What has happened to rates of suicide since the black box warning? What about the number of prescriptions?
Suicides have Gone up 20%
Number of prescriptions down 20%
What are the five questions that should be asked with suicidal ideation?
2. Means / access
5. Previous attempts
What is the issue with contracts for safety?
Still liable for anything that happens
What is the role of family history of suicide in determining the risk for suicide?
What is a major warning sign for suicidality?
Getting significantly better in a short period of time--may point to suicidal ideation
True or false: childhood bipolar disorders tend to be less severe than adult onset
What are the characteristics of childhood bipolar disorders as compared to adults? (2)
-Mixed with *rapid* cycling
What is the usual initial episode of bipolar disorder in children: depression or mania?
What is the prevalence of bipolar disorder in adolescents?
What is a rapid cycler for bipolar adults vs kids?
Adults = 4 times / year
Children = 4 times / day
What is the MOA of aripiprazole?
Atypical antipsychotic and mood stabilizer
What is the treatment for bipolar disorder?
antipsychotics (mood stabilizers)
What are the common side effects with antipsychotics? (3)
What are the two antipsychotics that cause weight gain? Are these typical or atypical antipsychotics?
(both atypical antipsychotics)
Where is the weight gain located with antipsychotics?
What is the major side effect of risperidone? MOA?
What is akathisia? What is this commonly caused by?
Need to move
What is the major benefit of quetiapine over other psychotics?
What are the two antipsychotics that cause less weight gain?
What is the MOA of antipsychotics?
Reduce the dopamine in mesolimbic area of the brain
What are the typical antipsychotics? (4)
What are the atypical antipsychotics? (6)
("Old Quietly Risper from A to Z")
What are the major side effects of antipsychotics? (4)
What is the treatment for dystonia use with antipsychotics?
What is neuroleptics malignant syndrome? S/sx? Lab change?
-Adverse reaction to antipsychotics, and dopamine blockade
-presenting with fever, autonomic instability, and delirium.
What is the treatment for neuroleptic malignant syndrome?
-Dantrolene for muscle rigidity, and bromocriptine
What labs must be monitored with Li use? (3)
What must be monitored with Depakote (valproic acid) use? (3)
What is the major side effect of lamotrigine?
What are the major side effect of tegretol (carbamazepine)?
What is the major issue with Li?
Chronic renal insufficiency, and narrow therapeutic index
What are the only two drugs that have been proven to decrease suicidality?
What are the skin side effects of Li?
What are the endocrine problems with Li?
What happens to the tremor with Li?
Increase from fine to coarse as increased dose
What is the major cardiac issue with Li?
What is the only OTC analgesic that is appropriate with Li intake?
What is the major adverse reaction to (clozapine)?
What is the major issue in benzos with children?
What is the reversal agent for benzos?
Is separation anxiety a symptom of depression in kids?
What type of hallucinations are seen with serotonin syndrome: visual or auditory?
What happens to bipolar kids or other psychotic kids when you put them on a stimulant for suspected ADHD?
-Worsens symptoms, and may cause hallucinations