Page 1200 - TNFlipTest

PS36 Psychiatry
Child Psychiatry
Toronto Notes 2019
HEADSSS Interview Home environment Education/Employment Activities
Drugs/Diet
Sex
Safety Suicide/depression
Mood Disorders
MAJOR DEPRESSIVE DISORDER Epidemiology
• lifetimeprevalenceforpre-pubertal1-2%(F:M=1:1);adolescents8-18%(F:M=2:1)
Clinical Presentation
• onlydifferenceindiagnosticcriteriaisthatirritablemoodmayreplacedepressedmood
• physicalfeatures:insomnia(children),hypersomnia(adolescents),somaticcomplaints,substance
abuse, decreased hygiene
• psychologicalfeatures:irritability,boredom,anhedonia,lowself-esteem,deteriorationinacademic
performance, social withdrawal, lack of motivation, listlessness
• commoncomorbiddiagnoses:anxiety,ADHD,ODD,conductdisorder,andeatingdisorders
Treatment
• majorityneverseektreatment
• individual(CBT,IPT),familytherapyandeducation,modifiedschoolprogram
• SSRIs:1stlinefluoxetine;2ndlineescitalopram,sertraline
• closefollow-upforadolescentsstartingSSRIstomonitorforincreasedsuicidalideationorbehaviour
• inseveredepression,bestevidenceforcombinedpharmacotherapyandpsychotherapy
• ECT:onlyinadolescentswhohavesevereillness,psychoticfeatures,catatonicfeatures,persistentlysuicidal • internetbasedpsychotherapy,lighttherapy,self-helpbooks
Prognosis
• prolongedepisodes,upto1-2yr=poorprognosis
• adolescentonsetpredictschronicmooddisorder;upto2/3willhaveanotherdepressiveepisodewithin
5yr
• complications:negativeimpactonfamilyandpeerrelationships,schoolfailure,significantlyincreased
risk of suicide attempt (10%) or completion (however, suicide risk low for pre-pubertal children), substance abuse
DISRUPTIVE MOOD DYSREGULATION DISORDER
Clinical Presentation
• severe,developmentallyinappropriate,recurrentverbalorbehaviouraltemperoutburstsatleast3x/wk
• symptomonsetbeforeage10,occurringfor12mo,withnomorethan3consecutivemofreefrom
symptoms
• criterianotmetforintermittentexplosivedisorder,bipolardisorder(nomania/hypomania)
• supersedesdiagnosisofODDifcriteriaforbotharemet
• commoncomorbidities:ADHD,anxietydisorders,depressivedisorders
BIPOLAR DISORDER
Clinical Presentation
• mixedpresentationandpsychoticsymptoms(hallucinationsanddelusions)morecommonin adolescent population than adult population
• unipolardepressionmaybeanearlysignofadultbipolardisorder
• ~30%ofpsychoticdepressedadolescentsreceiveabipolardiagnosiswithin2yrofpresentation
• associatedwithrapidonsetofdepression,psychomotorretardation,mood-congruentpsychosis,
affective illness in family, pharmacologically-induced mania
Treatment
• pharmacotherapy:moodstabilizers(lithium,anticonvulsants)and/orantipsychotics(risperidone, olanzapine, quetiapine, aripiprazole)
• psychotherapy:CBT,FamilyFocusedTherapy
Anxiety Disorders
• lifetimeprevalence10-20%;F:M=2:1
Clinical Presentation
• childrenandadolescentsrarelyvocalizetheiranxietybutinsteadexhibitbehaviouralmanifestations • schoolproblems,recurrentphysicalsymptoms(abdominalpain,headaches)especiallyinmornings,
social and relationship problems, social withdrawal and isolation, family conflict, difficulty with sleep initiation, temper tantrums, irritability and mood symptoms, alcohol and drug use in adolescent
Differential Diagnosis
• depressivedisorders,ODD,truancy
• persistenceandimpairmenttodailyfunctioningdifferentiatesanxietydisorderfromnormalanxiety
• forschoolavoidance,differentiatefearofgeneralperformanceandhumiliation.Consideranxietyabout
separation, and rule out bullying and school refusal due to learning disorder