Adolescent psychiatry

Adolescent psychiatry

1. Adolescent psychiatry and eating disorder Nur Fadzlina Zabri 082013100006

2. Introduction Adolescent is a transitional period out of relatively dependent to relatively independent adulthood Considered to occur between the ages of 10-19years. Begin with puberty, process that leads to sexual maturity or fertility

3. Offer opportunities for growth – physical dimension, cognitive and social competence, autonomy, self esteem and intimacy Time of increasing divergence between majority of young people who are headed to productive adulthood

4. Adolescent development period

5. Rebelliousness It is quite normal for normal parents and normal teenagers to clash and get into arguments. Adolescents are usually suspicious of and rebellious against convention and authority This attitude tends to fade after leaving school (at around 18 years of age ) Common signs are: criticising and questioning parents putting down family members or even friends unusual , maybe outrageous, fashions and hairstyles experimenting with drugs such as nicotine and alcohol bravado and posturing unusual , often stormy, love affairs Hallmarks of the adolescent • self-consciousness • self-awareness • self-centredness • lack of confi dence

6. Clinical approach

7. Common health problems in adolescent

8. Depression ‘ irritable , withdrawal from family & peers, deterioration in academic investment , devastating social isolation ’ 1-6% in community samples, rate of females double than male prevalence 14-25% in late adolescents 5:1,000 Body image and eating disturbances can aggravate depressive symptoms

9. Clinical features Negativistic Antisocial behaviour Use of alcohol/ illicit substances Restlessness, aggression, sulkiness, reluctant to cooperate in family venture Desire to leave home Inattentive to personal appearance Hallucination and delusion

10. Differential diagnosis attention-deficit/hyperactivity disorder (ADHD) substance-induced mood disorder anxiety symptoms & conduct disorder can coexist with depression

11. Course & prognosis depends on age of onset, episode severity and presence of comorbid disorders poorer prognosis: younger, recurrent & comorbid mean length of an episode is 9 months (cumulative recurrence 40% in 2 years & 70% in 5 years) 20-40% major depressive -> bipolar 1 in 5 yrs short/long-term relationship problems,poor academic achievement, persistently poor self-esteem

12. Treatment Hospitalization Psychotherapy, CBT Pharmacotherapy ( SSRI , close monitor for first 4 weeks (suicide) Duration of treatment : maintain antidepressant for 1 year in good response patient then can discontinue medication at a time of relatively low stress for a medication-free period

13. Resistance depression : no response up to 3 months, change to another SSRI, if not improving, combination antidepressants or augmentation strategies can be used, or antidepressant from different class Electroconvulsive therapy : persistent severe affective disorders + psychotic features, catatonic symptoms or persistent suicidality

14. Anxiety Characterized by state of apprehension or unease arising out of anticipation of danger Fear, worry, or dread that greatly impairs the ability to function normally and that is disproportionate to the circumstances at hand Teens  new experiences, school performance, social competence

15. Some anxiety is a normal aspect of development, as in the following : Fearful when separated from their mother, especially in unfamiliar surroundings. Shy teen may initially react to new situations with fear or withdrawal. Older children and adolescents often become anxious when giving a book report in front of their classmates Anxiety disorders often co-occur with depression , eating disorders , attention-deficit/hyperactivity disorder (ADHD) , Aspergers

16. Features Psychological symptoms Cognitive symptom: poor concentration, distractibility, negative thoughts Perceptual : derealisation , depersonalization Affective: diffuse, unpleasant, irritable Others : insomnia

17. Treatment Behavioral therapy (exposure-based cognitive- behavioral therapy) with or without drug therapy Parent-child and family interventions Drugs treatment SSRIs for long-term treatment for panic disorder Anti-anxiety ( buspirone ) : long-term management of anxiety benzodiazepines : relieve acute symptoms Beta blockers for anticipatory anxiety

18. Substance abuse Increase general trend use of MDMA (ecstasy) Hallucinatory ‘club drug’ at night-long raves  GHB, Rohypnol, Ketamine , MDMA (Ecstasy), Methamphetamine (Meth), and LSD (Acid. Anabolic steroid to enhance muscle strength

19. Gateway of drug Alcohol , marijuana, tobacco Lead to use more addictive substances ( cocaine,heroin )

20. Risk factors for drug abuse Poor impulse control and tendency to seek out sensation Family influences ‘difficult’ temperament Early and persistent behavior problem Academic failure and lack of commitment to education Peer rejection Early initiation into drug use Alienation and rebelliousness

21. signs of substance abuse Red eyes and health complains- being overly tired Less interest in school, drop in grades, skipping classes New friends who have little interest in their families or school activities Chemical-soaked rags or papers, clothing stains (inhaling vapors)

22. Effects of drug abuse in teens Emotional problem : anxiety, depression, schizophrenia Behavioural problem : violence Addiction and dependence Risky sex Learning problems : short term and long term memory Diseases : HIV , AIDS, Hepatitis B

23. Alcohol, drug and sexual risk taking in teen Sexual exploration and Risk taking is common and expected in adolescence However, certain behaviors increase the likelihood of unwanted outcomes such as pregnancy or sexually transmitted disease (STD) Among the 34% of high school students who are sexually active, 22% reported drinking or using drugs the last time they had sexual intercourse. White males combined sex and drugs/drinking at the highest rates (CDC, 2012).

24. What’s the connection? intoxication: by impairing judgment, suppressing inhibition, reducing perception of risk, and/or heightening desire

25. Prevention Cognitive behavioural therapy, family therapy Psychoeducation Social National Institute of Drug Abuse for Teens (NIDA) Multisystemic therapy

26. Death in adolescent Among teenagers, non Hispanic black males have the highest death rate

27. Vehicle accidents In 2014, 2,270 teens in the United States ages 16–19 were killed Six teens ages 16–19 died every day from motor vehicle High risk in: - Males - Teens driving with teen passengers: increases the crash risk of unsupervised teen drivers - Newly licensed teens: during the first months

28. Prevention Psychoeducation Advise regarding seat belts safety and to stay away from drinking and driving Skill-building and driving with supervision for new drivers Social Enforcing minimum legal drinking age laws and zero blood-alcohol tolerance laws for drivers under age 21 are recommended. Graduated Driver Licensing Programs (GDL)

29. Firearms Firearm-related death (homicide, suicide, accidental death) are far more common in U.S Guns are number one killer of African American youth

30. Prevention Psychoeducation : Parents should keep the guns locked and unloaded, with the ammunition locked in a separate location When handling or cleaning a gun, never leave it unattended, not even for a moment Teach your children never to touch guns. Make sure they know that guns can be dangerous. Talk with your kids about the risk of firearm injury outside the home, in places they may visit or play Social : Confiscating guns from the street Restriction of guns availability AAP urges the development of quality, violence-free programming and constructive dialogue among child health and education advocates

31. Suicide Risk factor : History of emotional illness : stress , depression, and suicidal behavior , substance abuse, unstable personality Ready availability of gun in the house They tend to think poorly of themselves , feeling hopeless, often isolate themselves from family, history of being abused or neglected, school problem - academic or behavioural

32. Warning signs of potential suicide in adolescents Change in behavior (risk taking, isolation, anhedonia ) Change in mood (hopelessness) Change in thinking (guilt, bizarre thoughts) Preoccupation in death Talk of suicide Perceived intolerable stress or loss

33. Treatment Hospitalization Psychotherapy : CBT, Dialectical behavioural therapy Pharmacotherapy

34. Prevention Open communication between the teen and parents or other persons of trust is very important for preventing teen suicide Socials Hotlines – effort is minimal Program to reduce substance abuse, self-esteem, build problem-solving and coping abilities

35. Questions what are common health adolescent problem? How do you differentiate anxiety and depression? What are comorbidities seen in anxiety? What is gateway drug ?

36. References Human Development, 9 th Edition by Tata Mcgraw Hill edition Kaplan & Sadock’s concise Textbook of Clinical Psychiatry 7 th Edition, A Short Textbook of Psychiatry by Niraj Ahuja Internet http://www.med.umich.edu/yourchild/topics/guns.htm https://www.cdc.gov/nchs/data/databriefs/db37.pdf http://www.msdmanuals.com/professional/pediatrics/mental-disorders-in-children-and-adolescents/overview-of-anxiety-disorders-in-children-and-adolescents http://www.actforyouth.net/resources/rf/rf_substance_0712.pdf