NR 606 Week 3 Questions and Answers

NR 606 Week 3 Questions and Answers Discontinuing antidepressants in children and adolscents Taper off medications, can cause withdrawal symptoms if abruptly d/c Symptoms: nausea, body aches, nervousness, insomnia, "electrical shock", body aches, and increase in suicidality. Severe withdrawal: Paxil and Effexor Generalized Anxiety Disorder (GAD) excessive anxiety and worry, occurring more days than not for 6 months. Symptoms of anxiety and worry associated with: -Restlessness -Easily fatigue - Diff. concentrating -Irritability -Muscle tension -Sleep disturbance Separation anxiety by history and observation of separation scenes must be present greater than 4 wks and cause significant distress of impair functioning. Intense worry or fear of being separated occurs at 10mo-3 yrs Selective Mutism Ages 2-4 years old, females Commonly comorbid with social anxiety d/o Diagnosis: based on clients medical, developmental, and family hx. Collaboration with speech-language pathologist Therapy for OCD Mild-Mod OCD CBT w. exposure and response prevention SSRI, clomipramine-- if symptoms persist after 2 or more medication trials of treatment, start atypical antipsychotics. Bipolar affective disorder in children Diagnosis of children before puberty is controversial. Comorbidities : ADHD, ODD, anxiety, learning disorders, substance abuse. Experiences rapid cycling moods and mixed episodes Body Dysmorphic Disorder (BDD) begins in adolescence associated with obsessive-compulsive disorder Being preoccupied with one or more perceived flaws in physical appearance which is not visible to others. Repetitive behavior: checking mirrors, excessive grooming, picking or seeking reassurance. Screening body dysmorphic disorder BDDQ BDD-YBOCS-A: Severity 0-48. Increased score of 20 the presence of BDD. The higher the score the more severe Treatment of BDD CBT, SSRI, Hospitalization Depressive symptoms in adolescents and children Sadness/irritability Academic decline Withdrawal from friends and family Loss of interest in things of past enjoyment Problems w. sleep Appetite or weight changes Feelings of guilt Clinging to parent Unexplained crying Actions of self harm SCARED Screen for Child Anxiety Related Disorders screening for GAD, panic, separation and social anxiety. Score higher than 30 indicates a specific diagnosis. Score greater than 23: Presence of anxiety d/o Score 8: social anxiety d/o Score of 7: panic disorder or somatic symptoms Score 5: Separation anxiety d/o Score 3: School avoidance social phobia anxiety must persist for greater than 6 months and be consistently present in a similar setting. Must occur in peer setting Symptoms: tantrums, crying, clinging, freezing up or with drawling. PANS and PANDAS Pediatric autoimmune neuropsychiatric d/o associated with strep sudden onset of OCD severe symptoms. Cunningham Panel lab test-- treat with antibiotics sensitive to SSRIs, start w low dose, increase slowly. Agoraphobia children avoiding bday parties, movies theater, play grounds, or other crowded areas. Panic disorder childhood onset is rare, for those who have panic attacks, or panic like symptoms may indicate sexual abuse, DV, and medical issue. DSM GAD Adult: Three physical or cognitive symptoms Children: one physical or cognitive symptoms DSM Social phobia Adult: intense fear of social situations. Physical symptoms: blushing, stammering, nausea, diff. speaking, racing heart. Children: tantrums, crying, clinging, freezing up, or withdrawal. Anxiety Comorbidity Bipolar disorder, depression, ADHD OCD diagnostic obsessions and compulsions must be time-consuming ( greater than one hour day), disrupts normal routines, functioning or relationships. Symptoms: persistent, intrusive thoughts, repetitive behaviors-- washing, checking, ordering, and fear of catastrophe Diagnostic criteria MDD greater than one symptom for most of the day all day for 2 weeks-- feeling sad, loss of interest/pleasure. In addition of greater than 4 symptoms must be present: decrease wt, increase or increase in appetite, insomnia/hypersomnia, psychomotor agitation, fatigue, thoughts of death, feelings of worthlessness, decrease ability to think. Treatment of MDD Develop safety treatment plan SSRIs Start at low doses, slowly increase dose, or change within 4 wks. Phases: Acute: Decrease in symptoms 8-12 wks Continuation: Prevent relapse 6-12 months, Consolidate treatment gains. Maintenance: Aim to prevent relapse by continuing treatment SSRIs adverse effects impulsivity, irritability, agitation _________ associated with increase of suicidal thinking and actions Paroxetine Bipolar treatment Pharmacological: Lithium, Depakote, Latuda. Therapy: Motivational Interviewing, Family- Focused therapy, Interpersonal & Social Rhythm Therapy bipolar reaction to SSRIs worsening symptoms, rapid cycling and mania, serotonin syndrome GAD-PC Guidelines for Adolescents Depression in Primary Care Endorses combo therapy consisting of psychotherapy and meds. Creating a safety plan PHQ-9A Patient Health Questionnaire 9 Modified for Adolescents. 20-27 severe depression Less than 4 no depression KSADS-PL Kiddie Schedule for Affective D/O and Schizophrenia for School diagnosing bipolar disorder.