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
Early adolescent
(puberty: 10-
14years)
• Adjustment of physical and psychosexual changes (girls advance this stage)
• Beginnings of psychological independence from parents
Middle adolescent
(14-17 years)
• Boys started to caught up with adjustment - group sexual attractions and
relationships are common at this stage
• Intellectual knowledge and cognitive processes become quite sophisticated.
Experimentation and risk-taking behaviour is a feature.
Late adolescent
(maturity: 17–19
years)
• Stage of reaching maturity and leads to more self-confidence with relationships
and successful rapport with parents.
• Thought is more abstract and reality-based.

6. 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

7. Clinical approach

9. Common health problems in adolescent
Psychological
health
problem
Depression,
anxiety, self
harm
Death
motor vehicle
accident, fire
arm use, and
suicide
Substance
abuse and
dependent
marijuana,
alcohol,
tobacco
Body image
concern and
eating disorder
Bulimia,
anorexia,
obesity
Risk taking
behavior
Sexual
adjustment,
teenage
pregnancy

10. 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

11. 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

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

13. 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

14. 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

15. • 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

16. 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

17. 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

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

22. 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

24. 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

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

27. 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

28. 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)

29. 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

30. 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).

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

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

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

34. 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

35. 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)

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

37. 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

38. 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

39. 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

40. Treatment
• Hospitalization
• Psychotherapy : CBT, Dialectical behavioural
therapy
• Pharmacotherapy

42. 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

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

44. References
• Human Development, 9th Edition by Tata Mcgraw Hill edition
• Kaplan & Sadock’s concise Textbook of Clinical Psychiatry
• 7th 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