Adolescent Mental Health Flashcards
What are the first two tiers of CAMHS?
Tier 1 = universal services consisting of all primary care agencies
Tier 2 = combination of some specialist CAMH services and some community based services
What are tiers 3 and 4 of CAMHS?
Tier 3 = specialist multidisciplinary outpatient CAMH teams
Tier 4 = highly specialised inpatient CAMH units and intensive community treatment services
How common are mental health issues in children and young people?
1 in 10 children and young people aged 5-16 suffer from a diagnosable mental health disorder
How many adults with mental health problems are diagnosed in childhood?
Over 50% = less than half were treated appropriately at the time
What do mental health problems in children have an impact on?
Educational attainment and social relationships
What does mental health problems in children have strong links with?
Social disadvantage
What is parental mental illness associated with?
Increased rates of mental health problems in young people
What are some features of anxiety?
One of most common mental health disorders = incidence increasing, likely to persist into adulthood if untreated
How does anxiety affect children and young people?
Young people usually have more than one type of anxiety
Up to 6% of young people may have a disorder severe enough to need treatment
What are the genetic factors that influence anxiety?
Biological vulnerability to fearful disposition
Abnormal function of 5-HT, NA, dopamine and GABA
Overactive limbic system
Irritable, shy, cautious and quiet temperament
What behavioural factors influence anxiety?
Acquisition of fear through classical conditioning
Maintenance of fear through operant conditioning
Observational learning
How does classical conditioning cause acquisition of fear?
Individual associates threatening stimulus with non-threatening stimulus
How does operant thinking allow fear to be maintained?
Negative conditioning is manifested by avoidance and/or escape learning
What cognitive factors influence anxiety?
Attentional biases, selective attention, distorted judgement, negative spin on non-threatening situations, select avoidant situations, selective memory processing, tendency to remember anxiety-provoking experiences, perfectionistic beliefs, inflated sense of responsibility
How is mild anxiety treated?
Cognitive based therapy
How is unresponsive or moderate-severe anxiety treated?
SSRIs for 1 year = up to 12 weeks to take effect
Benzodiazepines may be used = need initial titration, cause paradoxical agitation
What are some features of depression?
More common than reported and symptoms can be easily misunderstood
Estimated 4-8 of 100 young people suffer from depression
What are some groups of young people particularly vulnerable to depression?
Young offenders and young people in gangs
Looked after children and homeless youths
LGBT, unemployed young people and disability
Ethnic minorities = Asian women, Pakistani, Bangladeshi
What are some predisposing factors for depression?
Family history, conflict with family and divorce
Negative perception of environment and self
Conflict with friends, school stress and bullying
Social disadvantage and loss of someone important
How is mild depression treated?
Watchful waiting for 2 weeks then CBT for 2-3 months
How is unresponsive or moderate-severe depression treated?
Start with individual CBT, family therapy or psychodynamic psychotherapy for 4-6 weeks
Trial fluoxetine and then give sertraline/citalopram
What is the most effective psychotherapy for mood disorders?
Cognitive based therapy
What are some features of cognitive based therapy?
May be individual or in groups
Learn ways to manage stress and to think more positively about the future
Do things to improve mood
What are some other psychological therapies used to treat depression?
IPT, EMDR, solution focused therapy, CAT, psychodynamic psychotherapy
What is pharmacological therapy useful for in treating depression?
Effective in improving clinical symptoms especially in combination with psychotherapy
What are some features of pharmacological therapy for depression?
Response takes several weeks
Neuronal plasticity may aid recovery
SSRIs are first line
Venlafaxine/mirtazapine in older group may be alternative to SSRI
When should you consider augmentation with an antipsychotic to treat depression?
If there has been poor response to at least 2 SSRIs
What are the rues for pharmacological management of depression?
Start low and go slow Polypharmacy often needed if severe Allow time for adequate trial Change one drug at a time Always combine with psychosocial interventions
What are some cautions for depression?
Suicidal thoughts and increasing self harm
Agitation and hostility
Increase or decrease in appetite
How common is self harming behaviour?
Prevalence = 7% of 14-16 year olds at school, 13% of 11-16 year olds in community
1 in 12-15 young people deliberately self harm
40% of A and E attendances
Why do people self harm?
To cope with intense emotions
To communicate distress
To re-connect with self and others
In an attempt to end their life
What effect does self harm have on the brain?
Promotes release in endorphins = brings temporary distress reduction so tends to be repeated due to negative reinforcement
What are some predisposing factors to self harm?
High emotional reactivity, emotional numbing, poor distress tolerance, thought suppression, early abuse, family hostility, poor communication and problem solving skills
What are some features of non-suicidal self injury?
Periods of optimism and some sense of control
Successful decrease in discomfort
Frequently chronic and repetitive
Intent to relieve unpleasant emotions
Uncomfortable but intermittent psychological pain
Choices available = “temporary solution”
What are some features of suicidal self injury?
Hopeless and helpless 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 is the link between self harm and suicide?
Rate of suicide increases to between 50-100 times
Men who self harm are more than 2x likely to die by suicide
25% who die by suicide would have attended general hospital following self harm the previous year
How common is recurrence of self harm?
1 in 6 people who attend A and E following self harm will self harm again in the following year
What is the initial management for self harm?
Educate about signs of distress in themselves and others
Use of positive coping skills
Refer to specialist mental health professional for assessment of risk and underlying causes
