Core Exam #3: Pediatric Psychopharmacology: Depression (Goren)

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Lack of interest in most activites

What is anhedonia?

Irritable
Hypersensitive
Crying

DSM-IV Depressive Episode Characteristics: Rather than being depressed children are?

Socially withdrawn

DSM-IV Depressive Episode Characteristic: Rather than loss of interest children are?

Not gaining weight at the rate they should be

DSM-IV Depressive Episode Characteristic: Rather than weight loss children are?

Describe themselves negatively "I'm Dumb" or "I'm Stupid"

DSM-IV Depressive Episode Characteristic: Rather than worthlessness children do what?

Change in appetite
Weight loss
Insomnia
Slowing
Fatigue
Feeling of worthlessness/guilt
Poor concentration
Thoughts of death

In order to be considered having a depressive episode children must go through a period of depressed mood and lack of interest in most activities for 2 weeks. They must also present with 4 other symptoms. What are some of these symptoms?

Girls

In preadolescents boys and girls equally display depression. In adolescent years which gender displays cases of depression?

Preadolescent

Increased comorbid conduct disorder, increased genetic loading, and less response to AD therapy is an indicator of what age group of depression onset?

Yes (2.3 X greater)

Most people recover from depression in 1 year. Is the risk of recurrence increased without treatment?

1. Serotonin
2. NE
3. Cortisol

There is no solid genetic marker of depression, but what are the 3 genetic factors of depression?

Family and Relationship Factors

How do depressed parent, hostily family environment, poor social skills, and parental criticism related to pediatric depression?

Symptoms occur less than 2 months after recovery

What is the definition of relapse?

Recurrence

What is it called when symptoms return 2 months after recovery?

1. Acute (1-12 wks)
2. Consolidation (12-24 weeks)
3. Continuation (6-12 months)

What are the 3 treatment phases of depression? What is the time frame for each phase?

absence of symptoms for 2-8 weeks

In the consolidation phase remission is achieved? How can remission be defined?

1. Focus on symptom improvement
2. Achieve clinical response (50% improvement in symptoms for 2 wks)

What 2 things happen during the acute phase?

Continuation Phase

When a patient has sustain remission and achieved recovery by showing an absence of symptoms for more than 2 months, what treatment phase are they in?

Bupropion

What anti-depressant can't be used in patient with seizures because it induces seizures?

Educate!

What is the number one focus of non-pharmacologic treatment of depression?

If the patient has a Vitamin D deficiency

When is light therapy beneficial?

Supportive Therapy for 4-6 weeks

What type of therapy should be used first? How long should it be used before starting medication?

Cognitive Behavioral Therapy

What does CBT stand for?

1. Paroxetine
2. Citalopram
3. Sertraline

What 3 SSRIs are NOT approved for pediatric depression?

OCD

What is Sertraline FDA approved for in children ages 6-17 years old?

1. Escitalopram
2. Fluoxetine

What 2 SSRIs are approved for pediatric depression?

Fluoxetine

Which SSRI has a long 1/2 life so it is not as big of a deal to miss a dose?

Bupropion

What is a good anti-depressant for concurrent ADHD?

Suicidal thoughts and suicide

What is a very serious side effect of TCAs?

Fluoxetine

What SSRI has the most consistent positive data for treatment of pediatric depression?

False (SNRI)

True or False: Venlafaxine is a SSRI.

1. Acute Phase (6-12 wks)
2. Continuation Phase (4-12 months)
3. Maintenance Phase (1 or more years)

What are the 3 phases of pharmacologic treatment? What is the time frame for each phase?

Maintenance Phase

In which pharmacologic treatment phase is the goal to prevent depression recurrence?

Relapse

What is the goal to prevent in the continuation phase?

Increase suicidality in youth

As of October 2005 a Black Box Warning has been applied to all anti-depressants. What was the warning based on?

True

True or False: One issue with anti-depressants is that children can actually become manic at times.

Suicide is more likely when patients do not take their medication. SSRIs can actually decrease the suicide risk

What is the relationship between SSRIs and suicide?

ADHD

Behavioral disorders are common. They are often co-morbid with what other disorder?

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