Adolescent Mental Health

Question 1

what are the 4 tiers of adolescent mental health services?

Answer 1

1 = universal services (GP, school nurse, health visitors)
2 = combination of some CAHM services and some community services (primary mental health workers etc)
3 = specialist outpatient CAMH teams
4 = specialist inpatient CAMH units and intensive community treatment

Question 2

complex interactions of what lead to development of anxiety in adolescents?

Answer 2

psychological (emotions, learning, beliefs, stress etc)
social (family, relationships, socioeconomics)
biological (physiological, medications, genetics)

Question 3

what genetic factors can influence the development of anxiety?

Answer 3

biological vulnerability to inherit a fearful disposition
irritable, shy, cautious temperament
abnormal function of serotonin, norepinepherine, dopamine and GABA
overactive limbic system

Question 4

what behavioural factors can influence development of anxiety?

Answer 4

aquiring fear through classical conditioning (associated threatening stimulus with a non-threatening stimulus)
maintenance of fear through operant conditioning (negative reinforcement by avoidance and/or escape learning)
observational learning

Question 5

4 interrelated systems which act in an anxiety provoking situation?

Answer 5

physiological
cognitive
emotional
behavioural

Question 6

mean age of onset for any anxiety?

Answer 6

11

Question 7

mean age of onset for other anxieties (OCD, agorophobia, PTSD etc)?

Answer 7

20-25

Question 8

what causes depression in young people?

Answer 8

temperamental and psychological predisposing factors (negative perception of environment, future and self)
stressful environment (family relationships, home life, bullying, school etc)

Question 9

management of emotional disorders (anxiety and depression) in young people?

Answer 9

parenting training and guidance
talking therapy
medication (only used when other treatments don’t work or when presentation is so severe that other treatments aren’t possible

Question 10

when is talking therapy used and what types are possible?

Answer 10

if child is having significant school problems or having problems functioning socially
examples - CBT (mainly)

Question 11

how can emotional disorders be managed medically in young people?

Answer 11

SSRIs main choice (fluoxetine, sertraline)
can augment with low dose antipsychotic if poor response to at least 2 SSRIs
some tricyclics can be used but risks and side effects can be a problem
venlafaxine (SNRI) or mirtazapine (tetracyclic) in older adolescents can be used as alternative to SSRI
can use adult protocols in older groups

Question 12

reasons for self harm?

Answer 12

coping with intense emotions
communicating distress (cry for help)
re-connecting with self ("feel again") and others
attempt to end life
life saving act

Question 13

how does self harm have temporarily beneficial effects?

Answer 13

promotes release of endorphins bringing temporary reduction in distress

Question 14

non-suicidal self injury?

Answer 14

periods of optimism and some sense of control
successful decrease in discomfort after harming
usually chronic and repetitive
intend to relieve pain/emotions, not kill self

Question 15

features of suicidal behaviour?

Answer 15

hopelessness and helplessness
no release of discomfort after harming, persistent psychological pain
generally not chronic or repetitive
intend to escape pain/end life, tunnel vision - “only one way out”

Question 16

normal course of events if a child present to A and E after episode of self harm?

Answer 16

admission to a paediatric ward for time to cool off
undertake assessment of child and the family
address any child protection issues