3 years ago

Child & Youth Mental Health Algorithm - GPSC

Child & Youth Mental Health Algorithm - GPSC

Initiating and

Initiating and Monitoring Sertraline for Anxiety Disorders in Children / YouthClick here forFluoxetine pageAnxiety Diagnosis(DSM‐IV criteria)‐ Children (6‐12)‐ Adolescent >12)Use PST/PO andWRP throughoutthe treatmentprocess.Initiate PST/PO for at least 3 visits.SCARED > 25, symptoms continue causingdistress and CFA /TeFA shows decrease orno change in function.Time to start medication!Measurefunctioning usingCFA / TeFA andside effects usingsCKS in every visitBegin Sertraline at 25 mg daily for 2 weeks.(If poorly tolerated, start with 12.5 mg for 2weeks and continue increasing as indicated)Increase Sertraline to 50 mg daily for aminimum of 6 – 8 weeks.If Sertraline has been well tolerated andsignificant anxiety symptoms are still present,increase dosage to 75 mg daily for 6 ‐ 8weeks.If symptoms have not improved after 8 weeksof treatment, increase the dosage by 25 mgevery 2 weeks to a maximum of 75 – 100 mg.OCD treatment oftenrequires higher doses.If a child or youth is notresponding to 100 mgafter 12 week s oftreatment, werecommend a referralto specialized mentalhealth care.If you have reached the maximum dose andanxiety symptoms continue to cause distressand dysfunction or there is suicidal risk, REFERTO A MENTAL HEALTH SPECIALISTAtypical antipsychoticsare not meant to beused to treatdepression in primaryhealth care.29_CYMH_PSP_Medication_Algorithm_Sertraline_2011_11_23 1 of 1

Referral FlagsReferral of the teen with an anxiety disorder to specialty mental health services can occur atthree different points. The following referral points are suggestions only. Each first contact careprovider must identify their own comfort level with treatment and management of adolescentanxiety disorders and act accordingly. These suggestions are:Emergency Referral (prior to treatment initiation by first contact care provider): Suicidal ideation with intent or suicide plan Major depressive episode with psychosis (presence of delusions and/or hallucinations)Urgent Referral (treatment may be initiated but referral should be made concurrently): Symptoms severe and function significantly deteriorated (e.g. severe OCD, severe panic) Relapse from previous positive treatment response Persistent suicidal ideation with no intent or suicide plan Comorbid major depressive episode and family history of Bipolar Disorder History of suicide attempts HypomaniaUsual Referral: Referral for Cognitive Behavioural Therapy if available Persistent school avoidance Anxiety disorder not responding to adequate first contact treatment trial

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