Adolescent mental health Flashcards
What is CAMHS
Child and Adolescent Mental Health Service
How many tiers of CAMHS are there?
4
What is CAMHS tier 1
Universal service consisting of all primary care agencies including GP, school nurses, health visitors and the schools themselves
What is CAMHS tier 2
A combination of some specialist CAMH services and some community-based services including primary mental health workers
What is CAMHS tier 3
Specialise MDT outpatient CAMHS team
What is CAMHS tier 4
High specialised inpatient CAMH units and intensive community treatment services
What are some genetic factors of anxiety disorders in children?
- Biological vulnerability to a fearful disposition
- Abnormal function of 5-HT, NA, dopamine and GABA
- Irritable, shy, cautious and quiet temperament
- Overactive limbic system
What are some behavioural factors of anxiety disorders in children?
- Acquisition of fear through classical conditioning
- Maintenance of fear through operant conditioning
- Negative reinforcement is manifested by avoidance and escape learning
- Observational learning
What are some cognitive factors for anxiety disorders in children?
- Attentional biases
- Selective attention
- Distortion of risk judgement
- Negative spin on non-threatening situations
- Select evoidant solutions
- Selective memory processing
- Tendency to remember anxiety-provoking cues
- Perfectionistic beliefs
- Inflated sense of responsibility
How is mild anxiety disorder treated in adolescence?
CBT
How is unresponsive or moderate-severe anxiety disorder managed in adolescence
- SSRIs
- Up to 12 weeks to affect
- Continue for 1 year
How common is depression in adolescents?
4-8 of 100 young people suffer from depression at any point in time
What are some vulnerable groups for depression in adolescence?
- Young offenders - 10%
- Looked after children - 23%
- LGBT - 44% have considered suicide
- Ethnic minorities
- Disabilities
- Homeless youth
- Young people in gangs
- Unemployed young people
What are some predisposing factors for depression in adolescence?
- Conflict between parents
- Depression or stress in parents
- Separation of parents
- Conflict with friends
- Social disadvantage
- School stress
- Bullying
- Loss of someone important
How is mild depression in adolescent managed?
- Watchful waiting for 2 weeks
- Group IPT/CBT, digital CBT for 2-3 months
How is unresponsive or moderate-severe depression managed in adolescence?
- Individual CBT, IPT, family therapy, psychodynamic therapry for 4-6 sessions
- Then Fluoxetine
- Then sertraline or citalopram
How common is self-harming behaviour in adolescence?
7% in 14-16 year olds at school
13% in 11-16 years old in the community
1 in every 12-15 young people deliberately self-harm
What are some functions of self-harm?
- Coping with intense emotions
- Communicating distress
- Re-connecting with self and others
- Suicidal attempt
What is the biological basis of self-harm?
Self harm promotes the release of endorphins, so brings temporary distress reduction and so through negative reinforcement (Removal of negative stimulus), it tends to be repeated
What are some features of non-suicidal self-injury in adolescence?
- Periods of optimism and some sense of control
- Successful decrease in discomfort
- Frequent chronic and repetetive
- Intent to relief from unpleasant emotions
- Uncomfortable but intermittent psychological pain
What are some features of suicidal self harm in adolescence?
- Hopeless and helplessness is central
- No release of discomfort after self-injury
- Generally not chronic or repetitive
- Intent to escape pain or end consciousness
- Unendurable, persistent psychological pain
- Tunnel vision (Only 1 way out)
How is self-harm in adolescence managed?
- Educate about signs of distress in themselves and others
- Use of positive coping skills
- Learn about the difference between self-inury and suicide and normalise the experience
- Some people will just want to be heard
- Refer to specialist mental health professional for risk assessment
