Adolescent Psychiatry
Dr Brendan Doody
Adolescence









The changes of adolescence
Start from about 11 years – Girls, 13 years – Boys
Start to think and feel differently
Concern about appearance
Make close relationships outside the family
Develop views not shared by parents – arguments
Parents feel rejected
Striving for independence – Trying out new things
Learn about the would in earnest
Suicide in Adolescents




Each day in Republic of Ireland at least one person ends his/her life by suicide
Most who attempt self-harm are more intent on changing their life
circumstances than ending their lifes
Many parasuicidal patient repeat their behaviours subsequently
Among young men second only to accidents as a cause of death
Emotional Problems





Research – At some time 4 out of 10 adolescents have felt so miserable that
they have cried and have wanted to get away from everyone and everything
In the course of adolescence, more than 1 in 5 think so little of themselves that
life is not worth living
These common feeling can lead to depression
Other signs of emotional distress, e.g. over eating
Emotional disorders often not recognised
Developmental Factors




Rates of suicidal behaviour rise sharply in adolescence
Adolescents worry that their intention, motives, behaviour are being examined
by the people around them
Change from concrete to hypothetical thinking
Adolescence a time fro risk-taking behaviour
Sexual Problems







Dramatic physical changes – may be very worrying (shyness…excessive
bragging)
Early onset of sexual activity
Concerns about sexuality
Need for sensitive support, clear guidance and accurate information
Most adolescents careful in choice of partner
Promiscuity, repeated unprotected intercourse often signs of underlying
emotional problem
Also signs of risk taking behaviour
Behaviour Problems






Teenagers and parents complain about each other’s behaviour
Parents fear a loss of control or influence
While wanting some structure and boundaries, resent restriction on their
growing freedom and ability to decide for themselves
Disagreements common, part of the young person’s struggle to establish a
separate identity
May get to point where parents have lost control
Do parents know where their children are?
School Problems





Refusal to go to school – difficulties separating
Children who truant from school
Emotional problems often affect school work
Pressure to do well may come from parents or teache5rs, but usually
adolescent themselves want to do well and push themselves
Excessive nagging can be counter-productive
Eating Problems






Being fat is a common cause of unhappiness
Often made fun of, become depressed and grow to dislike themselves
Many adolescents diet, particularly girls
Very few develop serious eating disorders
Anorexia or Bulimia
More likely in those who take up serious dieting, have low self-esteem, are
under stress and have been over-weight as a child
Drugs, Solvents and Alcohol




Most teenagers never use drugs or inhale solvents
Most that do never go beyond experimenting
Alcohol that drug that causes the most problems
When serious, sudden changes in behaviour ?possibility of drug use
How to Cope








Anxiety experienced by parents is more than matched by the periods of
uncertainty, turmoil and unhappiness experienced by the adolescent
Most difficulties not serious or long-term
Parents continue to play a crucial role
Provide a Secure Base
The need for rules
Adults – a source of advice, sympathy and comfort
Don’t expect gratitude
Sources of help
Suicide and Metal Illness


90% of those who end their lives by suicide are suffering from mental illness,
most commonly depression
Alcohol is an increasingly important factor
Precipitating Factors




Inter-personal argument in preceding 72 hours
Bereavement, Break-up or relationship etc
Cultural issues
Suicide and education
Recognising and Responding to Suicidal Behaviour





The expression of suicidal thoughts or intentions should never be ignored
Most people have given warning signs
Temporary nature of suicidal ideation, especially in the young
Impulsivity is a central feature of adolescent suicidal behaviour – Access to
methods
Commonest way of recognising – the individual disclosing his distress or
intention
How to enquire about suicide






Ability to listen, and elicit such thoughts
Time and sympathy are essential
Questions about the future can elicit hidden self-destructive impulses
Expressions of failure or hopelessness
Person says there is no future, death the only solution
If person has considered methods or made plans, a serious situation
Depression in Childhood and Adolescence

Uses of the term “Depression”
o A mood – Sad and miserable
o Syndrome – clustering of moods and types of behaviour (6-8% of 12 to
16 year olds
o Disorder – Handicapping, particular symptoms, characteristic course
an response to treatment (1-2% of 12 to 16 year olds)
Definition


Individual suffers from depressed mood, loss of interest and enjoyment,
reduced energy (duration of 2 weeks)
Other common symptoms include
o Reduced concentration and attention
o Reduced self-esteem and self-confidence
o Ideas of guild and unworthiness
o Bleak and pessimistic view of the future
o Ideas or acts of elf-harm or suicide
o Disturbed sleep
o Weight loss or gain
Causation-risk factors


Personal factors in the child
Temperament, educational difficulties, chronic physical condition, genetic
Family factors
Parental mental illness, marital disharmony, tense atmosphere in the
home,


child-rearing practices, abuse, social circumstances
Outside the family
E.g. bullying at school
TRIGGERING FACTOR
Treatment


Psychological
Supportive therapy
Cognitive-behavioural therapy
Family therapy
Biological
Anti-depressants