Adolescent Mental Health

Question 1

what is the definition of anxiety?

Answer 1

mood state characterised by strong, negative emotion and bodily symptoms in which an individual apprehensively anticipate future danger or misfortune

Question 2

young people usually have more than one kind of anxiety disorder - true or false?

Answer 2

true

Question 3

is there a biological vulnerability to inherit a fearful disposition?

Answer 3

yes

Question 4

what kind of temperament can predispose to anxiety?

Answer 4

irritable
shy
cautious
quiet temperament

Question 5

what neurotransmitters are thought to be abnormal in anxiety?

Answer 5

serotonin
norepinephrine
dopamine
GABA

Question 6

what system in brain can be overactive in anxiety?

Answer 6

limbic system

Question 7

what 3 behavioural factors can contribute to anxiety?

Answer 7

acquisition of fear though classic condition
maintenance of fear though operant conditional
observational learning

Question 8

what cognitive factors can contribute to anxiety?

Answer 8

“what ifs”
worries about physiological symptoms
worries about anxiety-provoking situation

Question 9

what emotional factors contribute to anxiety?

Answer 9

fear, dread, panic

frustration, anger, disappointment, sadness

Question 10

what physiological factors contribute to anxiety?

Answer 10

increased HR
muscle tension 
sweating, blushing 
dizziness 
nausea or stomach ache

Question 11

how is mild anxiety treated in children?

Answer 11

CBT

Question 12

how is unresponsive or moderate/severe anxiety treated in children?

Answer 12

SSRIs

up to 12 week to effect, continue for 1 year

Question 13

can benzodiazepines be used for anxiety in children?

Answer 13

yes but there is paradoxical agitation so initial titration

Question 14

what medication has been proven to not be helpful in anxiety in children?

Answer 14

propranolol

Question 15

what groups are vulnerable to depression?

Answer 15

young offenders
looked after children 
LGBT
ethnic minorities 
disability 
homeless youth 
young people in gangs 
unemployed young people
those in stressful environment

Question 16

what is the temperamental and psychological predisposing factors that contribute to depression?

Answer 16

negative perception of environment, future and self

Question 17

does family history make you more likely to get depression?

Answer 17

yes

Question 18

what are three steps of management of emotional disorders?

Answer 18

parent training and guidance
talking therapy
medication (only when others dont work or severe presentation)

Question 19

what talking therapy offered for depression particularly when child having significant problems with school or other problems functioning socially?

Answer 19

CBT - helps to manage stress and think more positive

Question 20

what is first line medication for depression in children?

Answer 20

SSRIs - fluoxetine and sertraline

Question 21

what would you consider if poor response to at least 2 SSRIs?

Answer 21

augmentation with low dose antipsychotic (quetiapine, risperidone, aripirazole or olanzapine)

Question 22

some tricyclic can be used but risk and side effects can be problem - what are examples of these drugs?

Answer 22

clomipramine

amitriptyline

Question 23

what drugs can be considered alternatives to SSRIs in older groups?

Answer 23

venlafaxine (SSNRI)
mirtazapine (tetracyclic)

also adult like protocols may be appropriate (ie augmentation with bupropion, buspirone by inhibiting reuptake of NE or dopamine)

Question 24

are child mood disorders usually monitored in more than one setting?

Answer 24

yes

Question 25

should dose of medication be lower or higher in children?

Answer 25

lower - normally about half

Question 26

what should you be cautious of when prescribing medication for mood disorders in children?

Answer 26

suicidal behaviour - thoughts more than actions 
increasing self harm 
agitation and hostility 
increase or decrease appetite 
hyponatraemia 
early termination - think long term

Question 27

what is the definition of depressive illness?

Answer 27

persistent sadness, a feeling of hopelessness and mood changes, including irritability or anger

Question 28

what is the definition of self harm?

Answer 28

act of deliberately causing harm to oneself either by causing a physical injury or putting oneself in dangerous situations and/or self neglect

Question 29

what are thought to be the functions of self-harm?

Answer 29

coping with intense emotions 
communicating distress
reconnect with self (feel again)
suicide attempt
a life saving act

Question 30

what is the biological basis of self harm?

Answer 30

promotes release of endorphins

because it brings temporary stress reduction - these tend to be repeated

Question 31

what is the signs of non-suicidal self injury?

Answer 31

periods of optimism and control
decrease in discomfort
frequent chronic and repetitive
intent to relief from emotions 
choices available - temporary solution

Question 32

what is signs of suicidal self-injury?

Answer 32

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

Question 33

most acts of self harm in young people never come to attention of care services - true or false?

Answer 33

true

Question 34

what is the initial management of self harm?

Answer 34

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