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44 Cards in this Set
- Front
- Back
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What does failure to thrive in adolescence generally refer to?
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Emotional, behavioral, and mental health concerns
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When we do appropriate anticipatory guidance and screening of adolescents, how much time will it take to make sure that we cover every topic?
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45 minutes
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What changes in brain neurochemistry dictate to you if you are going to use a prescription medication to help treat your adolescent's emotional or mental health disorders and which classes of drugs are going to be the most effective?
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Hormonal changes of puberty
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As kids start going through puberty, what is there a change in?
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Change in prevalence of mental health disorders, in particular, depression.
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What sex is more affected by depression and more difficult to treat?
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Females
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What disorders to males often have?
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Compounding presence or presentation with ADHD or a conduct disorder
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Are there enough psychiatrist and mental health workers to take care of all the adolescents that require mental health counseling?
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NO
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As a primary care physician counseling an adolescent for depression, what guideline should be followed?
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Have enough training to do approximately 4 meetings in your office that will take about a half hour or longer.
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Who is the first person to diagnose an adolescent with a mental health problem?
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Primary care physician
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What is a PCP responsible for when it comes to children with a mental health problem?
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You are responsible for either maintaining them in your office or referring them.
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What are the classic symptoms for kids with depression?
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HA, abdominal pain, fatigue
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When a kid presents with more than one somatic symptom, what should a physician do?
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Red flag goes up and you have to be more sensitive to the emotional aspects of what they are going through.
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What are 97-98% of headaches?
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Tension headahces
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When asking a teenager the following question, what are we looking for: Have you lost interest in things you used to enjoy?
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We are looking at time frame of the past ~3-6 mos. and not just last 5 min
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What should one be looking for with the following question: Have you had any thoughts of hurting yourself?
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BIG RED FLAG! Send immediately to social worker's office, sign a contract, or tell parents b/c they have to observed 24 hours a day until they can be seen by a skilled counselor.
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How should all depressed patients be diagnosed?
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Differential diagnosis.
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All of following could cause what?
-ADHD like symptoms -Thyroid problems -Anemia -Brain tumor -Mononucleosis -Substance abuse |
Depression
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Who should try to work on such a patient case:
-Simple, straight forward case, hasn't been going on for very long -Does the patient have good parents, good relationships, and show motivation to change? |
You may want to try your hand at working with this patient in your practice
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Is a referral needed for an adjustment disorder? What about psychotherapy meds?
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NO
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Is a referral needed for mild depression? psychotherapy meds?
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Referral needed, no psychotherapy meds
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Is a referral needed for moderate depression? psychotherapy meds?
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Referral needed, consider antidepressants-->work with your pt. to see how they feel about it, meds are not needed for more than 6 mos.
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Is a referral needed for severe depression? psychotherapy meds?
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Referral needed, strongly encourage medication and meds may be needed for life
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Who should someone with psychotic symptoms be referred to?
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Psychiatrist
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If you want to send a kid out, what type of referral should be given? How long should one wait before giving a referral?
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Relatively current referral. Don't wait 6-9 mos. It is too long for a kid with a problem to wait.
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In therapy, an adolescent should be worked to develop what?
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Coping skills
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What can be the difference b/w a viable adulthood and a totally destroyed life?
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Meds/psychotherapy can make a significant difference in kids life
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What drugs have no demonstrated efficacy b/c of the development of the noradrenergic system during the adolescent years and they are potentially cardiotoxic?
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Tricyclic Antidepressants
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What drugs are good drugs to treat an adolescent with depression?
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SSRI-->b/c serotonergic system is relatively stable within adolescence
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To use SSRI's what dosage should be given?
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Start at half the recommended adult dose and titrate upward at one week intervals.
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What is the general rule of thumb when giving an adolescent SSRI's?
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Try kids on 2 SSRIs
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Once on stable SSRI drug, how long should it be continued?
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6-9 months
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How should SSRI's be withdrawn?
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Slowly, but don't start withdrawal right before going back to school. Summer is a good time to withdrawal to see how they do off their drugs but recheck when school starts
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What consists of a basic workup for somatization?
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-CBC
-Sed rates (if the Sed rates are 0 or 2 there is NOT something nasty going on) -Urines -Biochem profile -Occult stool for blood if the pt. has abdominal pain |
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What do the following indicate?
-Vomiting -Loss of consciousness -Weight loss |
Indicate something more than depression or stress
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With teens and stress management, what is important?
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That the teen is theone coming up with 75% of suggestions.
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What is one essential thing that must be done with teens and stress management in the office?
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Duplicate what happens to the world at large.
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What are the variables that make up the 4 different types of stress?
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Foreseeable/unforseeable, Avoidable/Unavoidable
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What variables does Type A stress consist of?
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Foreseeable & avoidable
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What variables does Type B stress consist of?
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Unforeseeable & unavoidable
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How can one manage something that is unforseeable and unavoidable?
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Go with the flow
Learn to vent and then move on AA, serenity prayer |
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What is type C stress?
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Forseeable and unavoidable
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How should type C stress (forseeable and unavoidable) be dealt with?
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Develop a leap of faith, have an understanding of that which goes beyond self and society, also a lot of trust
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What is type D stress?
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Unforseeable and avoidable
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How can we avoid something that is unforseeable?
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-Develop a leap of faith
-Have an understanding of that which goes beyond self and society -Also a lot of trust |
