CAMH

Question 1

Typical symptoms of depression if children / adolescents?

Answer 1

• Low mood
• Anhedonia, a lack of pleasure in activities
• Low energy
• Anxiety and worry
• Clinginess
• Irritability
• Avoiding social situations (e.g. school)
• Hopelessness about the future
• Poor sleep, particularly early morning waking
• Poor appetite or over eating
• Poor concentration
• Physical symptoms such as abdominal pain

It is often triggered by life events, although it can happen without any apparent triggers.

Psychosocial contributors:

• Potential triggers (e.g. loss of a family member)
• Home environment
• Family relationships
• Relationship with friends
• Sexual relationships
• School situations and pressures
• Bullying
• Drugs and alcohol
• History of self harm
• Thoughts of self harm or suicide
• Family history
• Parental depression
• Parental drug and alcohol use
• History of abuse or neglect

Question 2

Management of depression in children / adolescents?

Answer 2

MILD depression or single negative event (e.g. loss of a family member) –> watchful waiting and advice about (healthy diet, exercise and avoiding alcohol and cannabis). Follow up within 2 weeks is advised.

MODERATE to SEVERE:

• full assessment
• therapy: CBT, interpersonal, family, non-directive supportive
• FLUOXETINE 1st line, 10mg rising to 2omg
• SERTRALINE and CITALOPRAM 2nd line
• continue meds for 6 months after remission
• intensive psych therapy
• monitor in 2ndary care with the Mood and Feelings Questionnaire (MFQ)
• admission if risk of self harm, suicide, self neglect or self guarding.

Question 3

What is generalised anxiety disorder and how to you assess it?

Answer 3

Excessive and disproportional anxiety and worry that negatively impacts the persons everyday activity. Sx present on a daily basis for months at a time.

Assessment:

• The GAD-7 anxiety questionnaire for severity
• Assess for co-morbid mental health problems, such as depression and OCDr
• Assess for environmental triggers and contributors, such as family relationships, friendships, bullies, school pressures, alcohol and drug use

Question 4

Management of generalised anxiety disorder?

Answer 4

MILD anxiety: watchful waiting, advice strategies (meditation, diet, exercise, avoid alcohol, caffeine, drugs)

MODERATE / SEVERE; refer to CAMHS for:

• counselling
• CBT
• medical: usually SSRIs eg sertraline