Adolescent Mental Health

Question 1

how common are mental health disorders in ages 5-16

Answer 1

1 in 10

Question 2

what is anxiety

Answer 2

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

Question 3

how many people may ave an anxiety disorder severe enough to need treatment

Answer 3

up to 6%

many will have more than one type of anxiety disorder

Question 4

what can happen if adolescence anxiety isn’t treated

Answer 4

can persist into adulthood

Question 5

what are the genetic factors for anxiety disorders

Answer 5

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

Question 6

what behavioural factors can increase risk of an anxiety disorder

Answer 6

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

Question 7

what cognitive factors can increase risk of an anxiety disorder

Answer 7

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

Question 8

what are 6 types of anxiety disorders

Answer 8

social phobia
generalised anxiety disorder 
OCD
panic disorder 
phobias 
post traumatic stress disorder

Question 9

what are the biological symptoms of depression

Answer 9

changes in appetite and sleep, difficulty concentrating, fatigue and low energy, worthlessness, guilt, physical complaints that dont respond to treatment, reduced ability to function

Question 10

which young people are vulnerable to depression

Answer 10

young offenders 
looked after children 
LGBT
ethnic minority 
disability 
homeless 
gang members 
unemployed

Question 11

what causes depression in young people

Answer 11

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

Question 12

what is the management for emotional disorders (anxiety and depression) in young people

Answer 12

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)

Question 13

what is the most effective form of talking therapies

Answer 13

CBT

Question 14

what drugs are used in the treatment of many anxiety disorders and depression in youth

Answer 14

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

Question 15

what are the cautions in young people

Answer 15

Suicidal behaviour – thoughts more than actions
Increasing self-harm 
Agitation and hostility
Increase or decrease appetite
Hyponatraemia 
Early termination – think long term

Question 16

how common is self harm

Answer 16

Between 1 in every 12-15 children and young people deliberately self-harm

Question 17

what is the function of self harm

Answer 17

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

Question 18

what is the biology of self harm

Answer 18

promotes the release of endorphins

distress reduction- repeated as negative reinforcement

Question 19

what are features of non suicidal self injury

Answer 19

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’

Question 20

what are the features of suicidal self harm

Answer 20

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’

Question 21

what other problems can self harm be a ‘marker’ of

Answer 21

substance misuse
poor school attendance
low academic achievement
unprotected sex
bullying
domestic violence 
victimisation
child sexual and physical abuse

Question 22

what is the initial management for self harm

Answer 22

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