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
• 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
– 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
• Depression
– Anergy – loss of vitality, Gives up easily
– Somatic complaints, Sleep and appetite
disturbance
– Feeling unloved, Suicidal ideation
• Management
– Anti-depressants
• 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
a) Recurrent episodes of binging
• “ox hunger”
b) Recurrent purging and excessive exercises
• To prevent weight gain
c) Binging and purging
• Occurring at least 2X per week for 3 months
d) 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