SSRIs
The SSRI that has the most evidence supporting its use for managing depression in children and teens.
* Bonus Question - The indication(s) for starting SSRIs in children/teens
Fluoxetine
* Severe / significantly impairing symptoms; if unable to partake in psychotherapy
The sub-group that are at greatest risk of suicide in the adolescent population
First Nations / Métis, and Inuit
The gender of the military parent associated with worse child/youth mental health outcomes, when the parent is deployed
Mother : Father
Maternal SSRI use is compatible with breastfeeding
Yes.
The mental health condition that you should screen for on history prior to starting an SSRI
Bipolar Disorder
2 risk factors associated with adolescent suicide
A previous suicide attempt
A history of mental illness
Impulsivity
Family conflict
Parental mental illness
Family history of suicide
Exposure to suicide via the media or people known to the adolescent
The absence of a solid follow-up plan
2 risk factors that put children with neuromuscular disabilities at risk of mental health disorders.
1. Body Structures / Function
2. Communication Skills
3. Environmental Factors
2 consequences of maternal depression on the fetus
Inadequate prenatal care
Poor nutrition
Higher preterm birth
Low birth weight
Pre-eclampsia
Spontaneous abortion
The clinical monitoring schedule following the start of an SSRI
1) Weekly for the first four weeks following initiation of SSRI medication;
2) Every two weeks for the next four weeks;
3) At 12 weeks;
4) Then as clinically indicated beyond the 12 week point.
3 protective factors when it comes to suicidality
Sense of family responsibility
Life satisfaction
Future orientation
Social support
Coping and problem-solving skills
Religious faith
Intact reality testing
Solid therapeutic relationships (e.g., pediatrician, teacher, therapist)
Define “weight bias” as it pertains to overweight/obese children.
The tendency to make unfair judgments based on a person’s weight.
The 3 post-partum psychiatric disorders (as per the CPS...)
Post-partum blues
Post-partum psychosis
Post-partum depression
5 possible side effects of SSRIs
Gastrointestinal symptoms
Sleep changes (either insomnia or somnolence, and sleep disturbances, including vivid dreams)
Restlessness
Headaches
Appetite changes
Sexual dysfunction
Bleeding (rare...)
SiADH (rare...)
Serotonin Syndrome
Outline the components of a suicidality assessment.
* Bonus 100 pts – Name a Validated Suicide Severity Rating Scale
Assess:
1 - Ideation
2 - Intent
3 - Plan
Do NOT assess while the patient is intoxicated
* The Columbia Suicide Severity Rating Scale
List the components of the WHO’s International Classification of Functioning "Review of Systems" framework for the complex child.
1. Body Structures
2. Body Functions
3. Home Environment
4. School Environment
5. Participation
4 features of SSRI Neonatal Behavioural Syndrome.
A syndrome of respiratory, motor, CNS and gastrointestinal symptoms, including tachypnea, cyanosis, jitteriness/tremors, increased muscle tone, and feeding disturbance.
10-30% of exposed babies.
Onset with hours. Resolution typically within 2 weeks.