Paeds Cases · mental-behavioural-and-psychosomatic
Psychopharmacology and psychotropic medicines in children and adolescents — OSCE communication station
Observed structured encounter testing shared decision-making to start an SSRI in an adolescent with depression, including counselling on the suicidality warning, expected timeline, side effects and review schedule; and a deterioration requiring recognition of SSRI activation and a safety response.
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Target exams
RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
Station A is a shared decision-making conversation with a 15-year-old and her mother about starting fluoxetine for moderate depression. Station B is a phone review two weeks later in which she reports new agitation and intrusive thoughts, requiring recognition of SSRI activation and a safety response.
Station objectives
- Conduct a shared decision-making conversation with an adolescent and parent about starting an SSRI, including the indication, the combination with therapy, and the expected timeline. [1]
- Counsel honestly and accurately on the FDA black-box suicidality warning, common side effects, and the review schedule. [8]
- Recognise SSRI activation or suicidality at early review and respond with a safe plan. [9]
References5ShowHide
- [1]March J Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents with Depression Study (TADS) randomized controlled trial. JAMA, 2004.PMID 15315995
- [2]March JS The Treatment for Adolescents With Depression Study (TADS): long-term effectiveness and safety outcomes. Archives of General Psychiatry, 2007.PMID 17909125
- [8]Bridge JA Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment: a meta-analysis of randomized controlled trials. JAMA, 2007.PMID 17440145
- [9]Gibbons RD Suicidal thoughts and behavior with antidepressant treatment: reanalysis of the randomized placebo-controlled studies of fluoxetine and venlafaxine. Archives of General Psychiatry, 2012.PMID 22309973
- [10]Le Noury J Restoring Study 329: efficacy and harms of paroxetine and imipramine in treatment of major depression in adolescence. BMJ, 2015.PMID 26376805