Adolescent Mental Health Flashcards
how common are mental health disorders in ages 5-16
1 in 10
what is anxiety
mood state characterised by strong, negative emotion and bodily symptoms in which an individual apprehensively anticipates future danger or misfortune
how many people may ave an anxiety disorder severe enough to need treatment
up to 6%
many will have more than one type of anxiety disorder
what can happen if adolescence anxiety isn’t treated
can persist into adulthood
what are the genetic factors for anxiety disorders
biological vulnerability to inherit a fearful disposition
irritable, shy, cautious, quiet temperament
abnormal function of serotonin, norepinephrine, dopamine and GABA
limbic system can be overactive
what behavioural factors can increase risk of an anxiety disorder
acquisition of fear through classical conditioning - an individual associated a threatening stimulus with a non threatening stimulus
maintenance of fear through operant conditioning- negative reinforcement is manifested by avoidance and / or escape learning
observational learning
what cognitive factors can increase risk of an anxiety disorder
Attentional biases Selective attention Distorted judgments of risk Negative spin on ambiguous/non-threatening situations Select avoidant solutions Selective memory processing Tendency to remember anxiety-provoking cues/experiences Perfectionistic beliefs Inflated sense of responsibility
what are 6 types of anxiety disorders
social phobia generalised anxiety disorder OCD panic disorder phobias post traumatic stress disorder
what are the biological symptoms of depression
changes in appetite and sleep, difficulty concentrating, fatigue and low energy, worthlessness, guilt, physical complaints that dont respond to treatment, reduced ability to function
which young people are vulnerable to depression
young offenders looked after children LGBT ethnic minority disability homeless gang members unemployed
what causes depression in young people
Family history (genetics)
Temperamental and psychological predisposing factors
(Negative perception of environment, future and self (negatively biased construal of own personal world))
Stressful environment: Conflict between parents, or with parents or siblings Depression or too much stress in parents Separation or divorce of parents Conflicts with friends or classmates Social disadvantage School stress – not doing well, or too much pressure Bullying Loss of someone important
what is the management for emotional disorders (anxiety and depression) in young people
parenting training and guidance
family therapy
talking therapy (by a psychotherapist, nurse, social worker, counsellor, psychologist, psychiatrist)
medication (only when other treatments don’t work/ arent possible)
what is the most effective form of talking therapies
CBT
what drugs are used in the treatment of many anxiety disorders and depression in youth
SSRIs first line- fluoxetine and sertraline
Consider augmentation with low dose antipsychotic medication if poor response to at least 2 SSRIs– (Quetiapine, Risperidone, Aripiprazole or Olanzapine)
Some tricyclic can be used (clomipramine, amitriptyline) but risks and side effects can be a problem
Venlafaxine (SSNRI), Mirtazapine (tetracyclic) in older group can be considered as alternatives to SSRIs
what are the cautions in young people
Suicidal behaviour – thoughts more than actions Increasing self-harm Agitation and hostility Increase or decrease appetite Hyponatraemia Early termination – think long term
how common is self harm
Between 1 in every 12-15 children and young people deliberately self-harm
what is the function of self harm
Coping with intense emotions
Communicating distress
Re-connecting with self (feel again) and others
An attempt to end one’s life (i.e. suicide intent)
A life saving act
what is the biology of self harm
promotes the release of endorphins
distress reduction- repeated as negative reinforcement
what are features of non suicidal self injury
Periods of optimism and some sense of control
Successful decrease in discomfort – Successful ‘alteration of consciousness’
Frequently chronic and repetitive
Intent to relief from unpleasant emotions
Uncomfortable but intermittent psychological pain
Choices available – ‘temporary solution’
what are the features of suicidal self harm
Hopeless and helplessness 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 – ‘one way out’
what other problems can self harm be a ‘marker’ of
substance misuse poor school attendance low academic achievement unprotected sex bullying domestic violence victimisation child sexual and physical abuse
what is the initial management for self harm
Engaging young people in a therapeutic alliance and promoting joint clinical decision-making on the basis of understanding and compassion is essential
You can’t just tell someone who self-injures to stop - it is not that easy
Educate about signs of distress in themselves and others, as well as the use of positive coping skills
Respond to common self-injury is with a “low-key, dispassionate and respectful curiosity
Learn about the difference between self-injury and suicide and normalise the experiences
Some people will just want to be heard and empathised with
Try not to push them by asking questions that may overwhelm them
Refer to specialist mental health professional for assessment of risk and underlying causes
