Adolescent Mental Health Flashcards
what is the definition of anxiety?
mood state characterised by strong, negative emotion and bodily symptoms in which an individual apprehensively anticipate future danger or misfortune
young people usually have more than one kind of anxiety disorder - true or false?
true
is there a biological vulnerability to inherit a fearful disposition?
yes
what kind of temperament can predispose to anxiety?
irritable
shy
cautious
quiet temperament
what neurotransmitters are thought to be abnormal in anxiety?
serotonin
norepinephrine
dopamine
GABA
what system in brain can be overactive in anxiety?
limbic system
what 3 behavioural factors can contribute to anxiety?
acquisition of fear though classic condition
maintenance of fear though operant conditional
observational learning
what cognitive factors can contribute to anxiety?
“what ifs”
worries about physiological symptoms
worries about anxiety-provoking situation
what emotional factors contribute to anxiety?
fear, dread, panic
frustration, anger, disappointment, sadness
what physiological factors contribute to anxiety?
increased HR muscle tension sweating, blushing dizziness nausea or stomach ache
how is mild anxiety treated in children?
CBT
how is unresponsive or moderate/severe anxiety treated in children?
SSRIs
up to 12 week to effect, continue for 1 year
can benzodiazepines be used for anxiety in children?
yes but there is paradoxical agitation so initial titration
what medication has been proven to not be helpful in anxiety in children?
propranolol
what groups are vulnerable to depression?
young offenders looked after children LGBT ethnic minorities disability homeless youth young people in gangs unemployed young people those in stressful environment
what is the temperamental and psychological predisposing factors that contribute to depression?
negative perception of environment, future and self
does family history make you more likely to get depression?
yes
what are three steps of management of emotional disorders?
parent training and guidance
talking therapy
medication (only when others dont work or severe presentation)
what talking therapy offered for depression particularly when child having significant problems with school or other problems functioning socially?
CBT - helps to manage stress and think more positive
what is first line medication for depression in children?
SSRIs - fluoxetine and sertraline
what would you consider if poor response to at least 2 SSRIs?
augmentation with low dose antipsychotic (quetiapine, risperidone, aripirazole or olanzapine)
some tricyclic can be used but risk and side effects can be problem - what are examples of these drugs?
clomipramine
amitriptyline
what drugs can be considered alternatives to SSRIs in older groups?
venlafaxine (SSNRI)
mirtazapine (tetracyclic)
also adult like protocols may be appropriate (ie augmentation with bupropion, buspirone by inhibiting reuptake of NE or dopamine)
are child mood disorders usually monitored in more than one setting?
yes
should dose of medication be lower or higher in children?
lower - normally about half
what should you be cautious of when prescribing medication for mood disorders in children?
suicidal behaviour - thoughts more than actions increasing self harm agitation and hostility increase or decrease appetite hyponatraemia early termination - think long term
what is the definition of depressive illness?
persistent sadness, a feeling of hopelessness and mood changes, including irritability or anger
what is the definition of self harm?
act of deliberately causing harm to oneself either by causing a physical injury or putting oneself in dangerous situations and/or self neglect
what are thought to be the functions of self-harm?
coping with intense emotions communicating distress reconnect with self (feel again) suicide attempt a life saving act
what is the biological basis of self harm?
promotes release of endorphins
because it brings temporary stress reduction - these tend to be repeated
what is the signs of non-suicidal self injury?
periods of optimism and control decrease in discomfort frequent chronic and repetitive intent to relief from emotions choices available - temporary solution
what is signs of suicidal self-injury?
hopelessness and helplessness
no release of discomfort
generally not chronic or repetitive
intent to escape pain or end consciousness
unendurable, persistent psychological pain
tunnel vision - one way out
most acts of self harm in young people never come to attention of care services - true or false?
true
what is the initial management of self harm?
engaging young people in therapeutic alliance and promoting joint clinical decision-making on basis of understanding and compassion
educate about use of positive coping skills
refer to specialist mental health professional for assessment of risk and underlying causes
