Adolescent Mental Health

Question 1

How is CAMHS organised

Answer 1

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

Question 2

How common are mental health problems in adolescents

Answer 2

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

Question 3

Which disorders are common in children and adolescents

Answer 3

Emotional disorders - anxiety, phobias, OCD etc.
Conduct disorders
Disruptive behaviors - ADHD
Developmental Disorders

Question 4

Does parental mental health affect adolescents

Answer 4

Yes
Associated with increased rates of mental health problems in young people
1/3 more likely

Question 5

Mental health problems in children/young people are linked to social disadvantage - true or false

Answer 5

True

Impacts educational attainment, relationships and life chances

Question 6

If anxiety is untreated in childhood what is likely to happen

Answer 6

It will persist into adulthood

Question 7

What genetic factors can lead to anxiety in children

Answer 7

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

Question 8

What behavioural factors can lead to anxiety in children

Answer 8

Acquisition of fear through classical conditioning - associate a non threatening stimulus as threatening
Negative reinforcement – certain negative stimuli reinforce behaviours
Observational learning

Question 9

What are the main types of anxiety disorders

Answer 9

Social phobia
Generalized anxiety disorder
Obsessive Compulsive Disorder
Panic Disorder
Phobias
Post Traumatic Stress Disorder

Question 10

How do you manage anxiety disorders

Answer 10

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

Question 11

which types of anxiety present the earliest

Answer 11

Separation anxiety and phobias

Question 12

List some common biological symptoms of depression

Answer 12

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

Question 13

Which groups are vulnerable to depression

Answer 13

Young offenders 
Looked after children 
LGBT 
Ethnic minorities 
Disabilities 
Homeless youth

Question 14

What can cause depression in children and young people

Answer 14

Family history - genetics
Temperamental and psychological predisposing factors
Stressful environment - family conflict, school stress, loss, bullying etc

Question 15

How do you manage depression in children and young people

Answer 15

Parenting training and guidance - young children can be helped by parents
Talking therapies
Medication - only used if everything else doesn’t work

Question 16

What type of therapy is most effective for emotional disorders

Answer 16

CBT - cognitive behavioural therapy

Therefore first line

Question 17

Which medications can be used in children and young people

Answer 17

SSRIs - safe and effective
Fluoxetine and sertraline 
Should see effects within a few weeks 
Use alongside psychotherapy
Only used if therapy isn't working

Question 18

If SSRIs don’t work what do you use

Answer 18

If you’ve tried 2 SSRIs and they haven’t worked

Consider adding a low dose anti psychotic - risperidone etc

Question 19

What is the definition of self-harm

Answer 19

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.

Question 20

How common is self harm in children

Answer 20

Between 1 in every 12-15 children and young people deliberately self-harm
The numbers are increasing

Question 21

Why do people self harm

Answer 21

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

Question 22

Describe the biological basis of self harm

Answer 22

It promotes the release of endorphins
Therefore gives temporary distress reduction
Negative reinforcement leads to repetition of these behaviours

Question 23

What is the difference between non-suicidal and suicidal self injury

Answer 23

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

Question 24

Does self-harm lead to suicide

Answer 24

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

Question 25

What should you do if a child presents to A&E with self harm

Answer 25

Admit to a paediatric ward for time to ‘cool off’
Assessment of child and family
Address any child protection issues
Treat underlying issues

Question 26

Abnormal attachment styles in childhood can predispose to and predict later difficulties with adult personality. - true or false

Answer 26

True

Question 27

What are the 4 main attachment styles

Answer 27

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