Adolescent Mental Health Flashcards
How is CAMHS organised
Tier 1 = all services for all young people (school, nurses, GP etc)
Tier 2 = some community based services and some specialist services
Tier 3 = specialist outpatient services
Tier 4 = inpatient services and specialist units
How common are mental health problems in adolescents
1 in 10 children and young people aged 5–16 suffer from a diagnosable mental health disorder so relatively rare
Most common presentations are ADHD, conduct disorder and anxiety/depression
Which disorders are common in children and adolescents
Emotional disorders - anxiety, phobias, OCD etc.
Conduct disorders
Disruptive behaviors - ADHD
Developmental Disorders
Does parental mental health affect adolescents
Yes
Associated with increased rates of mental health problems in young people
1/3 more likely
Mental health problems in children/young people are linked to social disadvantage - true or false
True
Impacts educational attainment, relationships and life chances
If anxiety is untreated in childhood what is likely to happen
It will persist into adulthood
What genetic factors can lead to anxiety in children
Biological vulnerability to inherit a fearful disposition
Irritable, shy, cautious, and quiet temperament
Abnormal function of serotonin, norepinephrine, dopamine, and GABA
The limbic system can be overactive
What behavioural factors can lead to anxiety in children
Acquisition of fear through classical conditioning - associate a non threatening stimulus as threatening
Negative reinforcement – certain negative stimuli reinforce behaviours
Observational learning
What are the main types of anxiety disorders
Social phobia Generalized anxiety disorder Obsessive Compulsive Disorder Panic Disorder Phobias Post Traumatic Stress Disorder
How do you manage anxiety disorders
Mild anxiety – CBT
Unresponsive or moderate-severe – SSRIs (up to 12 weeks for effect, continue for 1 year)
Benzodiazepines – risk of paradoxal agitation, used for initial titration of SSRIs
which types of anxiety present the earliest
Separation anxiety and phobias
List some common biological symptoms of depression
changes in appetite, changes in sleep, difficulty concentrating, fatigue and low energy, feelings of worthlessness or guilt, physical complaints that do not respond to treatment and reduced ability to function
Which groups are vulnerable to depression
Young offenders Looked after children LGBT Ethnic minorities Disabilities Homeless youth
What can cause depression in children and young people
Family history - genetics
Temperamental and psychological predisposing factors
Stressful environment - family conflict, school stress, loss, bullying etc
How do you manage depression in children and young people
Parenting training and guidance - young children can be helped by parents
Talking therapies
Medication - only used if everything else doesn’t work
What type of therapy is most effective for emotional disorders
CBT - cognitive behavioural therapy
Therefore first line
Which medications can be used in children and young people
SSRIs - safe and effective Fluoxetine and sertraline Should see effects within a few weeks Use alongside psychotherapy Only used if therapy isn't working
If SSRIs don’t work what do you use
If you’ve tried 2 SSRIs and they haven’t worked
Consider adding a low dose anti psychotic - risperidone etc
What is the definition of self-harm
Self harm is the act of deliberately causing harm to oneself either by causing a physical injury, by putting oneself in dangerous situations and/or self neglect.
How common is self harm in children
Between 1 in every 12-15 children and young people deliberately self-harm
The numbers are increasing
Why do people self harm
Coping with intense emotions
Communicating distress
Re-connecting with self (feel again) and others
An attempt to end one’s life
To release suicidal feelings without ending their life
Describe the biological basis of self harm
It promotes the release of endorphins
Therefore gives temporary distress reduction
Negative reinforcement leads to repetition of these behaviours
What is the difference between non-suicidal and suicidal self injury
Non-suicidal will have some sense of control and the act will give some release of emotion and distress
It is often chronic and repetitive
Suicidal self-harm will have feelings of hopelessness and there is no release of discomfort after harming
Generally not repetitive and intent tis to end suffering
Does self-harm lead to suicide
It can do
Rate of suicide increases to between 50 and 100 times
¼ of all people who die by suicide have attended hospital following self-harm in the previous year
What should you do if a child presents to A&E with self harm
Admit to a paediatric ward for time to ‘cool off’
Assessment of child and family
Address any child protection issues
Treat underlying issues
Abnormal attachment styles in childhood can predispose to and predict later difficulties with adult personality. - true or false
True
What are the 4 main attachment styles
Secure- healthy and satisfied in relationships. Trusting and deep emotional connection.
Dismissive/Avoidant - will keep distance and remain independent and isolated. May shut down emotionally in potentially hurtful situations like conflict
Anxious-Resistant - desperate for love/affection but may push partners away through behaviour like jealousy, clingyness etc.
Fearful/Avoidant - ambivalence rather than isolation. The person will avoid their emotions as they become overwhelmed or fear hurt so don’t get close
