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Primary care management of depression in children and adolescents

doi: 10.1097/01.NPR.0000484416.19871.fc
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INSTRUCTIONS Primary care management of depression in children and adolescents


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Lippincott Williams & Wilkins, publisher of The Nurse Practitioner journal, will award 2.0 contact hours for this continuing nursing education activity.

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Primary care management of depression in children and adolescents

General Purpose: To assist clinicians with identifying and treating children and adolescents presenting with depression in the primary care setting. Learning Objectives: After completing this continuing-education activity, you should be able to: 1. Discuss risk factors and diagnostic criteria for depression in children and adolescents. 2. Explain medication and nonpharmacologic treatments for depression.

  1. Which is a symptom of depression reported in preschoolers?
    1. irritability
    2. anhedonia
    3. mood swings
  2. Which statement concerning depression and suicide is accurate?
    1. Adolescent boys report more symptoms of depression than girls.
    2. More adolescent boys than girls die from suicide.
    3. According to a nationwide survey, 3% of students reported that they had a suicide plan.
  3. Irritability and anger
    1. are rarely linked to suicidal ideation.
    2. are not generally associated with depression in older youths.
    3. often compound depression due to negative reactions from adults.
  4. Which symptom is least common in adolescents with depression?
    1. self-mutilation and personality changes
    2. sadness
    3. risk taking and acting out
  5. Which of the following statements is accurate?
    1. Children of parents who committed suicide have a lower risk of suicide.
    2. Asking about thoughts of suicide may trigger self-harm.
    3. Depression has strong genetic components.
  6. Which statement is accurate concerning the TADS clinical trial?
    1. CBT was the most effective treatment.
    2. Fluoxetine was less effective than CBT for MDD.
    3. Fluoxetine with CBT was the most effective treatment.
  7. Which of the following statements is correct?
    1. The USPSTF recommends screening adolescents ages 15 to 18 for MDD.
    2. In a study conducted by Curry and colleagues, almost half of the participants had a recurrence of MDD.
    3. In the TADS follow-up, 34% of the adolescents recovered from their episode of MDD.
  8. Which outcome of the TORDIA study is especially relevant to treatment providers?
    1. Approximately 40% of adolescents do not adequately respond to the first course of antidepressant therapy.
    2. Adolescents with MDD do not respond to SSRI medications.
    3. Venlafaxine was superior to SSRI with fewer adverse reactions.
  9. Predictors of suicidal ideation identified by the TASA study did not include
    1. higher income.
    2. poor academic performance.
    3. White race.
  10. Which antidepressant is FDA approved for MDD in children age 8 and older?
    1. paroxetine
    2. escitalopram
    3. fluoxetine
  11. Parents need help in recognizing that
    1. parenting practices and family dynamics can improve treatment response.
    2. family history of MDD is the source of the child's pathology.
    3. it is ultimately the child's choice that directs the course of treatment.
  12. A primary reason for providing parents with materials explaining depression symptoms is to
    1. promote interaction with the child regarding his or her experiences.
    2. encourage observation for symptoms in other family members.
    3. help to build an alliance with treatment providers.
  13. Which statement reflects the 2004 Black Box Warning about antidepressants?
    1. A depression tool must be completed before starting antidepressant therapy.
    2. Children and teens taking an SSRI must be closely monitored for suicidal ideation.
    3. Monitor patients taking SSRIs for abnormal bleeding.
  14. A mood diary is suggested as a way to
    1. demonstrate the developmental level of the child.
    2. promote coping skills for managing anger.
    3. help the child or adolescent name his or her feelings.
  15. Which is not a common component of CBT?
    1. social skills training
    2. identifying the unconscious meaning behind behavior
    3. restructuring the interpretation of events
  16. Which is the ultimate lesson behind cognitive restructuring?
    1. The feelings and beliefs around negative events can be changed.
    2. All actions have consequences.
    3. Unsafe decisions are a result of negative emotions.
  17. Which statement about family therapy is accurate?
    1. It focuses on the family as the source of the pathology.
    2. It attempts to change the role of the patient in family dynamics.
    3. It supports the depressed child in setting treatment goals for the family.
  18. Which statement is accurate regarding screening for depression?
    1. Urgent care visits are one ideal opportunity to screen for depression.
    2. The USPSTF recommends screening all children ages 7 to 11 for depression.
    3. Primary care clinicians are encouraged to screen as part of the annual physical.


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