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127 Cards in this Set
- Front
- Back
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What is adolescence? (2) |
10 - 19 years old (WHO definition) period between sexual maturation and attainment of adult roles |
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What effect does the imbalance between the limbic system and the underdeveloped prefrontal cortex have in adolescence? (4) |
- exploration - risk taking - plasticity - flexibility |
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According to Erikson's crises, what is the challenge faced by adolescents? |
increased involvement with peers --> identity vs confusion |
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What are 4 self-conscious emotions experienced by adolescents? What function do they serve? |
guilt - relationship repair shame - empathy for others' failings embarrassment - helps communication mistakes pride - self-esteem |
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How does emotional development change through adolescence ? (3) |
11-13 years: ME 14-15 years: WE >16 years: THEY (unique identity, concern for others) |
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What are 5 domains of primary care? |
health promotion!!! (esp important for adolescents) disease prevention curative care rehab supportive care |
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What is the difference between a high context & low context family structure? |
high context: hierarchical, family oriented low context: egalitarian, individual oriented |
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What are 5 areas that should be covered in an adolescent's psychosocial assessment? |
HEADS... home education activities drugs / depression sleep / sex / safety |
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What are 5 areas that adolescents have identified as health concerns? |
SIEVE... sexual issues image issues emancipation vocational / educational emotional issues |
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What are 4 stages of sexual identity in adolescence? |
1. feeling different 2. identity confusion 3. identity assumption 4. identity integration |
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What are 3 dimensions of sexuality? |
identity preferences behaviours |
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How does body fat change in adolescence? |
less body fat % in boys (11% --> 14%) more body fat % in girls (16% --> 27%) |
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What 3 things together cause acne? |
hormones sebum bacteria |
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How can you treat acne topically? |
benzoyl peroxide retinoic acid |
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What is the CRAFT questionnairre? |
to screen drug use level - ever been in a CAR with someone who was using - ever use to RELAX - ever use when you're ALONE - ever use to FORGET things - ever gotten into TROUBLE with it |
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What are 7 areas of disease prevention in adolescent primary care? |
- substance use (CRAFT) - injury prevention (MVAs, drowning, etc) - diet, exercise - immunizations - sunscreen - STI prevention - pregnancy prevention |
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What are 2 symptoms of Epstein Barr virus? |
rash enlarged liver & spleen (also: fatigue, fever, loss of appetite, sore throat, swollen lymph nodes) |
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How is infectious mononucleosis spread? (3) |
saliva blood semen |
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What is the definition of violence? |
unlawful use of force |
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What are 3 levels of sexual assault? |
level 1: sexual assault level 2: sexual assault w/ a weapon level 3: aggravated sexual assault |
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What is statutory rape? |
sexual intercourse with a minor <14 years old |
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T/F: in most cases of sexual assault, the perpetrator is convicted |
FALSE!!! Only 3 of 1000 are convicted! |
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Why is rape usually unreported? (5) |
fear shame guilt embarrassement usually by people you know |
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What are 6 behavioural indicators of sexual assault in teens? |
- antisocial behaviour - running away - promiscuity / prostitution - STIs, pregnancy - eating disorders - depression, self harm, suicide |
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T/F: You always notify police about incidences of sexual assault, for all ages of patients |
False! if >16 years old, can only notify police with patient's consent |
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What is a physician's approach to a survivor of sexual assault? (6) |
- introduction & regrets - safety issues? - offer support from a friend - empathic listening - explain choices & procedures - no why questions |
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What 4 areas should you ask about in a history for sexual assault? |
- ensure medical stability - previous pelvic exams - previous sexual hx - pregnancy hx |
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What are 2 other investigations you can do in an approach to sexual assault? (other than physical exam) |
drug & alcohol screen rohypnol |
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What are 2 phases of rape trauma syndrome? |
disorganisation reorganisation |
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What are 2 styles seen in the disorganisation phase of rape trauma syndrome? |
expressed style (fear, anger, anxiety) controlled style (outwardly composed) |
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What are 5 characteristics of the reorganisation phase of rape trauma syndrome? |
- difficulty with relationships - increased dependence - change in lifestyle - anger - sexual dysfunction |
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What are 5 criteria to dx PTSD? |
- recognisable stressor - re-experiencing of trauma - avoidance - persistent negative alteration in cognition and mood - change in arousal |
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How long do people have to show symptoms of PTSD to be dx with PTSD? |
≥1 month |
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What does PTSD therapy aim to do? (3) |
help patients to... - regain control - empower themselves - reconnect |
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What is anorexia nervosa? |
intense fear of weight gain, with restrictive eating & compensatory behaviours |
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What is bulimia nervosa? |
binge eating + compensatory behaviours |
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Which of the following has the highest mortality rate of mental disorders: - depression - eating disorders - anxiety disorders - personality disorders |
eating disorders |
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What is "drunkorexia" and what can it lead to? |
- compensating for calories that will be later consumed through alcohol (ie. subtracting those calories out of normal diet) - can lead to early cirrhosis |
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What are BMI thresholds for mild & extreme anorexia nervosa? |
mild: BMI <17 extreme: BMI <15 |
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What are 7 signs of anorexia nervosa? |
- emaciation, muscle wasting - lanugo - hypothermia - starvation edema - cardiac arrhythmias, bradycardia - osteoporosis - carotenemia |
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What are 5 signs of compensatory behaviours in anorexia nervosa? |
Russell's sign (callous on back of hand) dental enamel erosion parotid gland enlargement electrolyte abnormalities bloodshot eyes |
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What is the female athlete triad? (3) |
anorexia nervosa osteoporosis amenorrhea |
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What are 4 characteristics of bulimia nervosa? |
- intense preoccupation w/ body weight / shape - binge eating + compensatory behaviours at least once a week - sense of no control during episodes - normal or overweight |
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T/F: People with binge-eating disorders occasionally have compensatory behaviours |
False! Binge-eating disorder does not have compensatory behaviours |
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What motivates binge-eating disorder? |
desire to escape from self-awareness is accompanied by dopamine surge |
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What is the SCOFF questionnaire for eating disorders? |
to screen for eating disorder... ever feel SICK b/c uncomfortably full? ever lose CONTROL? lost OVER 15 lbs in 3 months? think you are FAT when others don't? does FOOD dominate your life? |
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T/F: Dieting is a common trigger for disordered eating |
True!!! Dieters are more likely to binge eat & vomit |
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T/F: Once weight loss is achieved, the body will reset its target weight to the new weight if it is maintained |
False!!! see: set-point theory |
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What are 6 predisposing factors for eating disorders? |
- peer pressure - genetics - biological (anxiety, OCD) - certain personality traits (perfectionist), low self-esteem - cultural expectations - media influence |
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What are 5 principles of treatment for eating disorders? |
- maintain therapeutic alliance - weight restoration (educate & improve environment) - restore healthy eating habits - work with family - deal with emotional issues |
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What are 4 manoeuvres that can be used during treatment of eating disorders? |
- separate illness from patient - empowerment - develop consensus - make written plan |
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What are 7 poor prognostic attributes in eating disorders? |
- denial - recent weight loss of ≥1kg/week - long duration of symptoms - no family support - severe emotional distress - cardiac arrhythmias - poor left ventricular function |
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What are 3 major red flags in eating disorders? |
- medical instability (bradycardia <50bpm, orthostatic hypotension) - electrolyte imbalances - severe malnutrition also: severe depression, pregnancy, loss of consciousness, hypothermia |
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What are 7 ways to assess hydration in children? |
- mucous membranes - skin turgor - cap refill - amount of vomit / diarrhea / urine - amount of intake - fever, weight loss, loss of consciousness? - sunken eyes, tearing |
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What is the first step in managing a child with possible dehydration? |
fluid rehydration |
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What are 7 red flags in a child with daily headaches? |
- fever, weight loss, failure to thrive - neurological symptoms - signs of increased ICP - affects sleep - positive FHx, PMHx - triggers - trauma |
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What are 3 ways a youth may end up on the street? |
- abuse / neglect @ home - thrown out of home - foster care |
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What are 7 ways that we can help youth access health care? |
- avoid stereotypical thought - listen - explain your role & scope of practice - explain confidentiality - develop youth-friendly sites - communication - anticipate the 'final question' |
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What is a mature minor? |
a patient under age of majority but sufficiently mature to consent to health care services |
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When are you ethically & legally obligated to report & break confidentiality? (3) |
- concern about suicide - concern about homicide - abuse of a child |
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What are the two most frequently used & abused substances in adolescence? |
alcohol cannabis (after that: opioids, cold medication, e-cigarettes) |
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T/F: Males binge drink significantly more than females in adolescence |
False! males = females in binge drinking |
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What is the definition of binge drinking? |
≥5 drinks in one sitting (males) ≥4 drinks in one sitting (females) in past 4 weeks |
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T/F: amount of drug use does not correlate with age / grade in adolescence |
False! Use of alcohol, cannabis, and e-cigarettes increases with grade! |
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What are e-cigarettes? |
battery-operated device that vaporizes liquid in a chamber to be inhaled |
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T/F: Males are more likely to use e-cigarettes |
True |
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What are 8 risk factors for substance abuse in adolescence? |
- family hx - concurrent depression / anxiety / conduct disorder - peers who use - hx of abuse - LGBTQ - early use - chronic condition - learning disability |
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What are 5 levels in the substance use spectrum? |
abstinence experimentation (1-2 times) limited use problematic use / abuse use disorder (abuse + addiction) |
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What is tolerance? |
a need to increase the amount consumed for the same effect (ie. less effect with the same amount) |
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What is dependence? |
adverse effects felt when substance use is discontinued same / related substance is taken to relieve symptoms |
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What are 3 indicators of problematic substance use? |
- adverse consequences - hazardous situations - use despite problems |
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T/F: Concurrent mental disorders are only present in 10% adolescents that abuse substances |
False! 30-50% have concurrent mental health disorder! |
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What neurotransmitter does substance use affect? |
dopamine (@ reward pathway) |
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What are 6 regions of the brain affected by THC (cannabis)? |
- reward system - hypothalamus (appetite) - amygdala (anxiety) - cerebral cortex (memory, hallucinations, etc) - hippocampus (memory) - cerebellum (coordination) |
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What is different in the brain structure of an adolescent with an alcohol use disorder? |
smaller prefrontal gray & white matter volume |
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How would you approach treatment of substance use / abuse, depending on the stage of use? (4) |
abstinence = positive reinforcement experimentation / regular use = harm reduction problematic use / abuse = brief intervention dependence = motivational interviewing +/- referral |
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What are 5 classes of psychiatric medications? |
antidepressants mood stabilizers anxiolytics antipsychotics stimulants |
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Are males & females equally affected by adolescent depression? |
No! Higher prevalence in females |
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What are diagnostic dilemmas for physicians in adolescent depression? |
- lack of confidence in diagnosis - psychosocial stressors - fluctuating course - nature of adolescence |
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What are symptoms of depression? |
core: depressed mood, loss of interest daily: lack of concentration, low energy, insomnia physical: psychomotor agitation / retardation, weight change cognition: thoughts of death / suicide, guilt |
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What are 6 signs of depression? |
- change in behaviour - over-reactions - sustained anger / irritability - severe fatigue - change in appetite & weight - isolation |
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What are 6 risk factors for depression? |
low self-esteem witness / victim of violence PMHx (comorbidities, learning disabilities, chronic illness, physical disability) alcohol abuse LGBTQ w/o support family hx / dysfunction |
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What investigations should be done when suspecting depression? |
- rule out general medical conditions - substance use? - social functioning - family hx |
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Other than antidepressants, what else is included in the treatment of depression? (4) |
- engage & educate (eg. sleep hygiene, exercise) - assess hopelessness & suicide risk - psychotherapy - family intervention |
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What are two types of psychotherapy for depression? |
cognitive behavioural therapy interpersonal therapy |
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What are 4 classes of antidepressants for adolescents? |
SSRIs SNRIs tetracyclines bupropion (also: TCAs, but don't work in children / adolescents!) |
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What class of medication do these belong to: fluoxetine, sertraline? |
SSRI |
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What class of medication do these belong to: paroxetine, citalopram? |
SSRI |
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What class of medication do these belong to: venlafaxine, mirtazapine? |
SNRI |
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What class of medication do these belong to: nortriptyline, amitriptyline? |
TCA |
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What is the protocol for starting antidepressants in adolescents? (6) |
1. measure target symptom severity 2. educate 3. start test dose (increase over 2-4 weeks) 4. evaluate efficacy 5. side effects? 6. therapeutic support |
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Which class of antidepressants has the best evidence in adolescents? |
SSRIs (fluoxetine --> moderate-severe depression, +/- anxiety) |
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Why might adolescents not respond optimally to antidepressants? (3) |
- studies only include adolescents with mild depression for a short time - developmental differences in drug response - differences in depression in adolescents (vs adults) |
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What is the main symptom of anxiety disorder? |
excessive anxiety & worry for ≥6 months that is difficult to control |
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What is the treatment approach for anxiety disorder in adolescents? (3) |
1. individual psychotherapy 2. family psychotherapy 3. pharmacotherapy (2nd line) |
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What are 2 options for pharmacotherapy for anxiety disorder in adolescents? |
SSRIs SNRIs |
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T/F: benzodiazepines are commonly indicated as long-term treatment for anxiety disorder in adolescents |
FALSE! Shouldn't use benzodiazepines b/c of tolerance |
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Compare bipolar disorder type I vs type II |
BP type I: requires 1 manic episode BP type II: requires hypomanic episode + depressive episode (no mania) |
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What is the peak age of onset for bipolar disorder? |
15-19 years old |
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What is a manic episode? |
abnormal and persistent elevated / expansive / irritable mood lasting ≥1 week |
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What is a hypomanic episode? |
abnormal and persistent elevated / expansive / irritable mood lasting ≥4 days not severe enough to cause impairment |
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What are 3 signs of bipolar disorder? |
- increased activity - decreased need for sleep - inappropriate sexual behaviour |
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What is severe mood dysregulation? Does it increase risk for bipolar disorder? |
severe non-episodic irritability and hyperarousal does not increase risk of bipolar disorder |
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What is the best treatment for bipolar disorder? |
lithium |
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What lab test should be done before starting lithium? |
pregnancy test |
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What is the main side effect of lithium? |
GI effects |
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What are 3 types of symptoms in schizophrenia? |
positive negative disorganized |
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How long do you need to have symptoms to be diagnosed with schizophrenia? |
≥6 months |
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What are 3 examples of thought patterns in schizophrenia? |
thought withdrawal thought blocking neologisms |
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What are 7 features of schizophrenia prodrome? |
- illusions - thoughts of reference / grandeur - magical thinking - distractibility - poor concentration - social withdrawal - obsessions |
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What is brief psychotic disorder vs. schizophreniform disorder? |
brief psychotic disorder: 1-30 days schizophreniform disorder: 30 days - 6 months |
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What is delusional disorder? |
presence of ≥1 delusions for ≥1 month no change in functioning! |
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What is schizoaffective disorder? |
have concurrent depressive & manic disorder |
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What are 3 general medical conditions (other than schizophrenia) that can cause psychosis? |
major depressive episode cognitive disorder (eg. delirium, dementia) personality disorder |
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What are 5 areas / investigations to inquire about when assessing schizophrenia in adolescence? |
- medical & psychiatric history - prenatal history - mental status exam - urine toxicology - basic blood work |
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What are the 2 categories of antipsychotics? |
typical (eg haloperidol, chlorpromazine) atypical (eg. risperidone, olanzapine, quetiapine) |
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What is the mechanism of action for risperidone? |
dopamine & serotonin antagonist |
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T/F: risperidone has significant extrapyramidal side effects |
True! |
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What is the mechanism of action for olanzapine? |
serotoning & dopamine antagonist |
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T/F: olanzapine has more extrapyramidal side effects than risperidone |
False! Olanzapine has fewer EPS than risperidone |
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What is the mechanism of action for clozapine? |
dopamine antagonist |
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T/F: clozapine has more extrapyramidal side effects than risperidone |
False! It has no extrapyramidal side effects or tardive dyskinesia (but does cause drowsiness & agranulocytosis) |
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T/F: Health Canada recommends atypical antipsychotics as first line treatment for adolescents with schizophrenia |
False!! There are no Health Canada approved indications for atypical antipsychotics in children / adolescents |
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What are 6 side effects from antipsychotics? |
neurologic (eg. TD, akathisia, neuroleptic malignant syndrome) weight gain lipid abnormalities low glucose metabolism hyperprolactinemia sedation |
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T/F: highly educated and intelligent youth are at significantly lower risk for suicide |
False! They are at higher risk of suicide! |
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What are 7 risk factors for suicide in adolescents? |
- depression - males: conduct disorder, substance use - females: previous attempt - isolation - ethanol use - friend of a suicide completer - family history |
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When would you use a Form 1? (3) |
concerned about... - risk of harm to themself - risk of harm to others - lack of ability to care for self |
