Mental Disorders in Adolescence Flashcards
How common are mental disorders in children and young people?
1 in 10 children and young people aged 5-16 diagnosed
1 in 3 child in every class
What is the aetiology of anxiety in young people?
Complex interactions of specific characteristics related to the young person and their environment
Which neurotransmitters are abnormal in anxiety?
Serotonin
NA
Dopamine
GABA
How does anxiety tend to present in children?
Irritable
Shy
Cautious
Quiet temperament
What behaviour factors can contribute to anxiety in children and young adults?
Acquisition of fear through classical conditioning
Maintenance of fear though operant conditioning
Observational learning
How is negative reinforcement manifested?
Avoidance and/or escape learning
What cognitive factors can contribute to anxiety in children and young adults?
Attentional biases Selective attention Distorted judgements of risk Neg spin on ambiguous/ non-threatening solutions Select avoidant solutions Selective memory processing Tendency to remember anxiety-provoking cues Perfectionistic beliefs Inflated sense of responsibility
What are the different types of anxiety disorders?
Social phobia GAD OCD Panic disorder Phobias PTSD
How is mild anxiety managed in young people?
CBT
How is moderate to severe anxiety managed in young people?
SSRI (sertraline, fluoxetine, fluvoxamine, citalopram)
Up to 12 weeks to effect
How long should ADs be continued in young people with anxiety?
1 year
Should you give propranolol to manage anxiety in young people?
NO
Who are vulnerable groups to depression?
Young offenders Looked after children LGBT; 44% have considered suicide Ethnic minorities Disability Homeless youth Young people in ganga Unemployed young people
What are common stressful triggers for depression in young adults?
Conflict between parents Depression in parents Separation or divorce of parents Conflicts with friends/ classmates Social disadvantage School stress Bullying Loss of someone important
Which form of psychotherapy is 1st line in mood disorders and anxiety?
CBT
What are the different forms of psychotherapy?
CBT Interpersonal Therapy EMDR (commonly used in PTSD) Solution focussed therapy CAT Psychodynamic psychotherapy
Commonly used medications in the treatment of depression in children and young adults?
SSRIs are 1st lie
Consider augmentation with low dose antipsychotic if poor response to 2 SSRIs; quetiapine, risperidone, aripiprazole or olanzapine
Venlafaxine or mirtazapine in older groups as alternative to SSRI¬
What parenting training and guidance can be given in the management of emotional disorders?
Young children are often treated with their family
Work with parents to help them help their child
Family therapy as a systemic approach if family relationships are considered precipitating or perpetuating factors
Should you prescribe medication alone in children?
No; prescribe in combination with psychotherapy
Cautions with SSRIs?
Suicidal behaviour Increasing self harm Agitation and hostility Increase or decrease appetite Hyponatraemia
How common is self harm in young people?
7% in 14-16 y/o at school
13% of 11-16 y/o in community
1 in every 12 children DSH
What are the functions of DSH?
Coping with intense emotions
Communicating distress
Re-connecting with self
Suidial lintent
What is the biological basis of self-harm?
Promotes the release of endorphins
Due to the temporary distress reduction; through negative reinforcement it tends to result in repeated behaviours
Characteristics of non-suicidal self-injury?
Periods of optimism and sense of control
Successful decrease in discomfort
Frequently chronic and repetitive
Intent to relief from unpleasant emotions
Uncomfortable but intermittent psychological pain
Choices available; temporary solution
Characteristic of suicidal self-injury?
Hopeless and helplessness
No release of discomfort
Generally not chronic or repetitive
Intent to escape pain or end consciousness
Unendurable, persistent psychological pain
Tunnel vision`
What is self harm often a marker for?
Substance misuse
Poor school attendance
Low academic achievement
Unprotected sex
Initial management of self harm?
Educate about signs of distress; use of positive coping skills
Try not to push
Refer to specialist mental health professional for assessment of risk and underlying cause
