Transcript Conduct disorder

Child and Adolescent Mental Health
prof. Elham Aljammas
19/3/2014
Adolescence
Adolescence: transitional period
between childhood and
adulthood (11-22)
 Adolescents tend to develop
)
these skills in areas of
knowledge depth, but not in all
subject areas
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Common presentations to GPs
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Attention Deficit Hyperactivity Disorder
(ADHD)
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Autistic Spectrum Disorders
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Conduct disorders
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Depression
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Anxiety
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Obsessional-Compulsive Disorder (OCD)
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Eating Disorders
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Tic Disorders (inc Tourettes’s syndrome)
Predisposing risk factors
Family factors including
marital discord
substance misuse
criminal activities
abusive or injurious parenting practices
Individual factors including
‘difficult’ temperament
brain damage
epilepsy
chronic illness
cognitive deficits
Environmental factors including
social disadvantage
homelessness
low socioeconomic status
poverty
overcrowding
social isolation
Etiology
Attention Deficit Hyperactivity
Disorder (ADHD)
ADHD is a pervasive, heterogeneous behavioural
syndrome characterised by the core symptoms of
inattention,
hyperactivity
and impulsivity.
ADHD
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Methylphenidate,
atomoxetine and
dexamfetamine
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are recommended, within their licensed indications, as
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options for the management of ADHD.
Autistic Spectrum Disorder
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An intrinsic condition, ASD manifests core features
which are pervasive and include deficits in:
- Social communication
- Social interaction
- Social imagination
Current prevalence of all ASD diagnoses: 1.6%
Children with an ASD have a higher risk than peers of
developing other mental health problems.
CONDUCT DISORDERS
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Conduct disorders are the most common reason for
referral of children to mental health services
They have a significant impact on quality of life for those
involved, and, in the case of early onset (aggression at
three years of age) outcomes for children are poor
Many children do not receive support because of limited
resources, high prevalence and difficulty engaging some
families
Early effective intervention is particularly important:
recent research has established a neuro-developmental
basis for this finding
Conduct disorder and ODD
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Conduct disorder: repetitive and
persistent pattern of antisocial,
aggressive or defiant conduct and
violation of social norms
Oppositional defiant disorder:
persistently hostile or defiant behaviour
without aggressive or antisocial behaviour
Associated conditions
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Conduct disorders are often seen in
association with:
 attention deficit hyperactivity disorder
(ADHD)
 depression
 learning disabilities (particularly
dyslexia)
 substance misuse
 less frequently, psychosis and autism
Depression
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At any one time, the estimated number of children and young
people suffering from depression:
 1 in 100 children
 1 in 33 young people
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Prevalence figures exceed treatment numbers:
 about 25% of children and young people with depression
detected and treated
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Suicide is the:
 3rd leading cause of death in 15–24-year-olds
 6th leading cause of death in 5–14-year-olds
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Transition to Adult services, where appropriate, requires
careful planning
Depression
KEY SYMPTOMS
ASSOCIATED
SYMPTOMS
persistent
poor
sadness, or low or
irritable mood:
AND/OR
loss of interests
and/or pleasure
fatigue or low
energy
or increased
sleep
poor concentration
or indecisiveness
low self-confidence
poor or increased
appetite
suicidal thoughts or
acts
agitation or slowing
of movements
guilt or self-blame
Mild
Up to 4 symptoms
Moderate
5-6 symptoms
Severe
7-10 symptoms
Depression
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Anti-depressants should only be prescribed following
assessment by a psychiatrist and only be offered in
combination with psychological treatments
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First-line pharmacological treatment is fluoxetine*
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Do NOT use: tricyclic antidepressants, paroxetine, venlafaxine,
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Monitor for agitation, hostility, suicidal ideation and self-harm
and advise urgent contact with prescribing doctor if detected
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Sertraline or citalopram* as second-line treatment
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Consider adding atypical antipsychotic if psychotic depression
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Continue for 6 months following remission, then phase out over
6–12 weeks
Anxiety
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Type of anxiety experienced by the child (social,
generalised, panic, separation, specific phobia) and
degree of impairment to functioning is important to detail
in referral
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Cognitive Behavioural Therapy (CBT) and other
behavioural approaches indicated for most anxiety
disorders.
Obsessional-Compulsive disorder
(OCD)
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Obsessive-compulsive disorder (OCD): characterised
by the presence of either obsessions (repetitive,
distressing, unwanted thoughts) or compulsions
(repetitive, distressing, unproductive behaviours) –
commonly both. Symptoms cause significant functional
impairment/distress
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1% of young people are affected – adults often report
experiencing first symptoms in childhood
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Onset can be at any age. Mean age is late adolescence
for men, early twenties for women
Obsessional-Compulsive disorder
(OCD)
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All people with OCD should have access to evidencebased treatments: CBT including exposure and response
prevention (ERP) and/or pharmacology
If CBT ineffective or refused - review and consider adding
an SSRI
Sertraline and fluvoxamine are the only SSRIs licensed
for use in children and young people with OCD*
Monitor carefully and frequently
If successful, continue for 6 months post remission
Withdraw slowly with monitoring
Anorexia nervosa
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Severe dietary restriction despite very low weight (BMI <17.5
kg/m2)
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Morbid fear of fatness
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Distorted body image (that is, an unreasonable belief that one
is overweight)
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Amenorrhoea
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A proportion of patients binge and purge
Bulimia nervosa
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Characterised by an irresistible urge to overeat, followed by
self-induced vomiting or purging and accompanied by a morbid
fear of becoming fat.
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Patients with bulimia nervosa who are vomiting frequently or
taking large quantities of laxatives (especially if they are also
underweight) should have their fluid and electrolyte balance
assessed.
o
Selective serotonin reuptake inhibitors (SSRIs) and specifically
fluoxetine, are the drugs of first choice for the treatment of
bulimia nervosa.The effective dose of fluoxetine is higher than
for depression (60 mg daily).
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Tic Disorders
(including Tourettes’s Syndrome)
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Presentation:
Tics are involuntary, rapid, recurrent, non-rhythmic
motor movements.
Transient tic problems are very common in childhood,
more common in boys, and a family history of tics is
common..
Tourette’s syndrome is a constellation of multiple motor
and vocal tics originating in childhood/adolescence and
often persisting into adulthood.
Tic Disorders
(including Tourettes’s Syndrome)
Management:
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Psycho-social approaches
Pharmocological approaches:
- Haloperidol
- Risperidone
- Pimozide
- Clonidine
Thank you
ANY FURTHER
QUESTIONS?
ANY FURTHER
QUESTIONS?