PSYCHIATRIC

DISORDERS
in
ADOLESCENTS
Dr
Ramli Mohd Ali
Psychiatrist
PBKKR Hosp Permai JB

Some of the
disorders..
- Anxiety
- Depression
- Deliberate self-harm
- Suicide
- Substance Abuse
- Schizophrenia

Anxiety Disorders
1)

Separation Anxiety

2)

Social Phobias

3)

Generalised Anxiety
Disorder - GAD

Separation anxiety
Cardinal

features
- excessive anxiety engendered by
separation
- at least 4/52 duration
- significant distressful impairment in
* social
* academic
* or/and occupational functioning

Anxiety Disorder
Exhibit

excessive distress or
persistent worry about
- losing a parent or loved one
- possible harm befalling a loved
one
Suffer nightmares
- with themes of separation

Anxiety Disorder
Multiple

somatic complains
- headaches
- stomach ache
- nausea
School refusal

Social Phobia
Characterised

by
- marked & persistent fear of social
or performance situation
- in which individual is exposed to
unfamiliar people or possible
scrutiny
- frequently follows a traumatic event
- typically occurs in mid-teens
- f/h of anxiety disorders

Generalised Anxiety
Disorders
Characterised

by
- excessive worry about performance
& competence
* in the absence of scrutiny
- ruminates about past mistakes
- worry about future adversities
- may result in decline in academic
performance

Generalised Anxiety
Disorders

Cannot stop worrying

- appears to be
* restless
* tense
* fragile
* irritable
* unable to concentrate
* self-conscious

Depression
Characterised

by changes in

- behaviour

- biological activities

- cognition

Behaviour change
Withdrawn
Sad
Lack

interest
Outburst of aggression or
irritability

concentrating
Difficulty
Quiet

Biological change
Appetite

- increase or decrease

Weight

- increase or decrease

Sleep

- increase or decrease

Cognitive change
Worthless
Failure
Hopeless
Helpless
Suicidal

thoughts

Deliberate Self-harm
100x

more common than completed

suicide

- in adolescents
females
(?)

> males

failed suicides

risk

of repeating attempts

Deliberate self-harm
Risk

factors
* f/h psychiatric d/o

- e.g depression , alcohol

abuse
* underlying psychiatric d/o

- e.g ADHD , depression

* h/o abuse

- physical , sexual , emotional

Deliberate self-harm
Risk

factors
* problems in school
* poor impulse control
* have models for imitation
- e.g family members , pop
stars

Deliberate self-harm
Common

methods
- ingestion of non-edible
substance

* e.g shampoo , kerosene

- overdose of medication

* e.g paracetamol ,
hypnotics
- slashing wrists

Deliberate self-harm
Motivation

*
*
*
*
*
*

express anger
feeling lonely or unwanted
cry for help
teach a lesson
temporary respite from distress
make them change their minds

Suicide
(?)

accidental death from

DSH

males
ratio

> females

2-3 : 1

Suicide
Common

methods

- poisoning
- inhaling gas
- overdose
- hanging
- use of weapons

Suicide
Characteristics

*
*
*
*

suggesting serious intent

carried out in isolation

timed so that intervention is unlikely
precaution taken to avoid discovery
preparation made
- in anticipation of death

Suicide
Characteristics

intent

*
*
*
*

suggesting serious

suicide note left

other people informed of intention
extensive planning
failure to alert others
- following the episode

Schizophrenia
Usual

onset - late adolescence

Usually

insidious
- followed by a slow
deterioration
in functioning

Schizophrenia
Personality

*
*
*
*
*

traits at risk

loners
excessive shyness
suspicious
over-sensitive
withdrawn

Schizophrenia
Sy

& Sx
- auditory hallucinations
- delusions
- incoherent speech
- blunt expression
- inappropriate affect
-neglect personal hygiene
- inhibition / disinhibition

Substance Abuse
Commonly

*
*
*
*
*
*

NB

abused substance
tobacco
alcohol
stimulants
inhalants
ganja
morphine
: Progression of use

Substance Abuse
Risk

factors

* family
* school
* community

Substance Abuse
Family

*
*
*
*
*
*

risk factors
parents or siblings use
marital conflict
separation or divorce
absence of parents
low parental control
low warmth & parental
involvement

Substance Abuse
School

*
*
*

*
*
*

risk factors
high or low performance in school
little commitment to the school
ineffective / no policy in school
- regarding truancy & smoking
dropouts
friends that use
peer acceptance

Substance Abuse
Community

risk factors

* economically disadvantaged

or advantaged

* lack of social cohesion

* neighbourhood disorganisation

* desire for less boredom

* availability

* understanding that it is the

norm