Management of Mental Disorder in Adolescent Ronny T Wirasto Program Studi Pendidikan Dokter FMIPA Universitas Tadulako 2011

Topik Definisi Gangguan Diagnosis Terapi

Background World Health Organization evidence indicates that internationally: by 2020 childhood neuropsychiatric disorders will rise proportionately by over 50% neuropsychiatric disorders will become one of the five most common causes of morbidity, mortality and disability among children

Developmental theory : Psychosexual Psycho-cognitive Psychosocial

Adolescence represents a “station” on the human development between childhood and adulthood Biological changes are pre-set by hormonal changes Most obvious effects being on growth body shape secondary sexual characteristics

Females aged 12-17 more likely than male peers: Youth ages 14 through 17 are significantly more likely to have had a Major Depressive Episode accompanied by thoughts of better off dead or thoughts of committing suicide than ages 12-13 MDE with suicidal thoughts – not varied by urbanicity – (large, small and non-metro similar) Females aged 12-17 more likely than male peers: Major Depressive Episode in lifetime Thought about killing themselves at worst or most recent MDE

Reasons for Mental Health Treatment in Past Year for Youth Ages 12-17 (non drug-related): Felt depressed (52%) Breaking Rules / Acting Out (28%) Felt Very Afraid or Tense (21%) Thought about or Tried Killing Self (19%) Family or Home Problems (13%) School-Related Issues (11%) Social / Friend Problems (8%)

Common disorders Conduct disorders Substance abuse Emotional disorders Eating disorders Psychosis

Conduct disorder Commonest disorder in adolescence Affects 4-10% adolescent population Usually associated with parental psychopathology alienation from parents Presenting features Socially disapprove behaviours At home or/and in the community Common presentation Defiance, Destructive, Vandalism, Delinquent,Stealing, Violent crimes

Factors Management Boredom Keeping up with peers Relieving frustrations Expressing a point Management Family therapy Anger management Group work Community programes

Emotional Includes Depression Anxiety Deliberate self harm Obsessive compulsive disorders Anergy – loss of vitality, Gives up easily Somatic complaints, Sleep and appetite disturbance Feeling unloved, Suicidal ideation

Management Anti-depressants Supportive psychotherapy SSRI (selective serotonin re-uptake inhibitor) Fluoxetine Fluvoxamine Setraline Supportive psychotherapy Family psycho-education

Anxiety Affects more females than males Differentiate between normal shyness and anxiety disorder Clinical features : Anxious/conscious of appearance school performance personal relationship gender identity school refusal Physical symptoms headaches abdominal pains hyperventilation

Management Exposure with relaxation Social skills training Anxiolytics Alprazolam Diazepams Anti-depressants Fluvoxamine Fluoxetine

Eating disorder Anorexia nervosa Diagnostic criteria Underweight <85% of expected weight for age and height Intense fear for fatness feels and believes to be fat eventhough underweight Amenorrhoea for 3 consecutive months Excessive diet restriction voluntary starvation increase activity level use of laxative and purgative

Bulimia Diagnostic criteria Recurrent episodes of binging “ox hunger” Recurrent purging and excessive exercises To prevent weight gain Binging and purging Occurring at least 2X per week for 3 months Self worth that is overly influenced by body shape and weight

“Binge” Consuming large amounts of food in a discrete period Has no control over the eating In Bulimia Patient feels remorse after binging Binging usually done alone

Bulimics resort to drastic measures to prevent weight gain after a binge Self-induce vomiting Compulsive & excessive exercise Abuse laxatives & diuretics Because of the disgust & shame : binging Behaviour Bulimics may be more willing to enter Rx than anorexic

Factors Social emphasis on slimness Fear of growing up Childhood psychopathology Suppression of emotional expression

Psychosis Similar with adult Social/environment Individual