Video Clip Adolescent Mental Health A brief overview of mental health issues facing many adolescents today „ Camp Erin

Depression and Social Depression Factors

• Depressed mood (irritability in teens) • Adolescents are especially vulnerable to social stressors. • Anhedonia • Chronic family discord • Weight loss/gains (not making # gains) • Academic failure, etc. • Insomnia/hypersomnia • Vast majority of clinically depressed teens have • Psychomotor retardation a history of abuse or neglect.

• Regular fatigue • Teens may have symptom remission with improvement in social environment. • Feelings of worthlessness or guilt

• Reduced concentration • One study showed 17% of MDD teens initially sought help with substance abuse issues • Thoughts of death

Bipolar Disorder (manic Dysthymic Disorder episode)

• Depressed or irritable mood • Abnormally elevated/expansive/irritable mood X1 week • Poor self esteem • Inflated self-esteem/grandiosity • Pessimism or hopelessness • Decreased need for sleep • Anhedonia • Pressured talk

• Social withdrawal • Flight of ideas or racing thoughts • Distractibility • Chronic fatigue • Increased goal directed behavior • Excessive anger • Excessive involvement in pleasurable activities that have painful consequences. • Appetite disturbance • Hallucinations/psychosis • Reduced concentration or memory Bipolar criteria sets Prevalence

• Single manic episode (1 week) „ 1% in adults

• MRE Hypomanic (4 days) „ Males and females equally afflicted • MRE Manic „ 14% met criteria for mania w/o duration • MRE Mixed „ 7.5% met criteria w/o severity • MRE Depressed „ .6% met criteria of both mania and severity • MRE Unspecified „ Study of 14-16 year olds Carlson and Kashani • Specifiers include: (1998) • Psychosis, seasonal pattern, severity, meloncholic, catatonic, postpartum, and rapid cycling

BP vs. ADHD Bereavement Mania Item Bipolar ADHD Irritable Mood 97% 72% „ State of grief related to the death of a loved one that may present with symptoms of MDD. Grandiosity 85% 7% Elevated Mood 87% 55% „ MDD generally not diagnosed within first two Daredevil Acts 70% 13% months after loss. Uninhibited People Seeking 68% 21% „ In some cases, MDD may be diagnosed in first Silliness/Laughing 65% 21% two months if symptoms are considered to be Flight of Ideas 6% 10% beyond the scope of “normal grieving’ (morbid Accelerated Speech 97% 78% preoccupation with worthlessness, prolonged Hypersexuality 45% 8% functional impairment, hallucinations outside of “grief psychosis”)

ADHD ADHD Inattentive

„ Subtypes „ 6 or more symptoms for at least 6 months „ Predominantly Inattentive Type „ Fails to give close attention to details/makes careless mistakes „ Predominantly Hyperactive-Impulsive Type „ Difficulty sustaining attention tasks/play „ Combined Type „ Does not listen when spoken to directly „ Not Otherwise Specified „ Poor follow through on chores, duties, etc. „ Has difficulty organizing „ Avoids tasks that require mental effort „ Frequently loses items „ Easily distracted „ Forgetful of daily activities ADHD Hyperactive/Impulsive ADHD

„ 6 or more for at least 6 months „ At least some of the symptoms were obvious before „ Fidgets with hands or squirms in seat the age of 7 „ Leaves activities when expected to stay „ Impairment is seeing in two or more settings „ excessively motor active when inappropriate „ Has difficulty with leisure activities/being quiet „ Impairment must be clinically significant in social, occupational or academic setting „ “driven by motor” or often “on the go” „ Talks excessively „ Blurts out answers „ Trouble waiting for turn „ Often interrupts or intrudes on others

ADHD Historical ADHD NOS Timeline

„ Symptoms of ADHD are prominent but do not meet the criteria for Combined type, Inattentive type Minimal Brain Damage 1920’s Minimal Brain Dysfunction 1930’s

Efficacy of Amphetamine 1937

Hyperactive Child Syndrome 1950

Hyperkinetic Reaction of Childhood (DSM-II) 1968

ADD or Hyperactivity (DSM-III) 1980

ADHD (DSM-III) 1987

ADHD (DSM-IV) 1994

Prevalence of Child AnxietyDisorders Anxiety Disorders Anxiety Disorder Children Adolescents ‰ Generalized Anxiety Disorder (overanxious d/o) Separation Anxiety Disorder 3.5 – 4.7% 0.7 – 2.0% ‰ Panic Disorder Generalized Anxiety Disorder 2.9 – 4.6% 5.9 – 7.3% • Specific Phobia Social Phobia/Avoidant 0.9 –1.6% 1.1% • Social Phobia Specific Phobia 2.4 – 9.2% 3.6 – 4.6% • Post Traumatic Stress Disorder Panic Disorder <1% 0.6 – 4.7% • Obsessive Compulsive Disorder

Generalized Anxiety Symptoms of Anxiety Disorder

• Cardiovascular • Palpitation, ^bp

• Respiratory • SOB, ^ respiration • Excessive anxiety (X 6 months)

• Skin • Flushing, sweaty • Restlessness or feeling keyed up

• Musculoskeletal • Temors, cramps • Easily fatigued

• Gastrointestinal • Diarrhea, nausea • Trouble concentrating

• Other physical • HA, chest pain • Irritability

• Psychological • Fears, stress • Muscle tension

• Social/Behavioral • Clingy, • Sleep disturbance

Panic Disorder Panic Disorder

• Palpitations, pounding heart „ Followed by 1 month of • Sweating „ Persistent concern about having additional attacks • Trembling, shaking „ Worry about the implications of the attack or its • Shortness of breath consequences • Feeling of choking „ Significant change in behavior related to attack

• Chest pain or discomfort

• Dizziness

• Derealization or depersonalization

• Fear of losing control/dying

• Paresthesias (numbness or tingling sensations)

• Chills or hot flashes

Common Phobias In Specific Phobia Children

„ Persistent fear that is excessive or unreasonable • Animals • Zoophobia

• Blood • Hematophobia „ Cued by specific object or situation • Thunder • Brontophobia „ Results in anxiety response • Dark • Nyctophobia

„ Avoidance leads to impairment of routine • Strangers • Xenophobia

„ > than 6 months in duration for minors • Fire • Pyrophobia

• Germs/dirt • Mysophobia

• Heights • Acrophobia

• Spiders • Arachnophobia Post Traumatic Stress Social Phobia/Anxiety Disorder (1)

• Fear of performance „ Re-experiencing the traumatic event • Fear of unfamiliar people/situations „ Nightmares/flashbacks/distressing memories „ • Afraid of scrutiny Repetitive play with event related themes „ Sudden “catastrophic” anxiety with cues • Forecasts embarrassment „ Sense of reliving event (trauma re-enactment)

• Situations are avoided „ Intense physiological/psychological distress with similar events • Children will express with tantrums/tearfulness, freezing or shrinking

Post Traumatic Stress Post Traumatic Stress Disorder (2) Disorder (3)

„ Avoidance or emotional numbness „ Increased symptoms of arousal „ Efforts to avoid thoughts/feelings „ Difficulty with sleep „ Irritability/anger outburst „ Efforts to avoid activities/places „ Poor concentration „ Limited recall of aspects of trauma „ Hypervigilance „ Diminished interest in activities „ Exaggerated startle response „ Feelings of estrangement/detachment „ Restricted affect „ Sense of foreshortened future

Post Traumatic Stress Disorder (4) PTSD in minors

„ Symptoms present for more than one month „ 14-43% of boys/girls have experienced at least one traumatic event in their life „ Symptoms cause impairment of functioning „ 3 to 15% of girls and 1 to 6% of boys could be diagnosed with PTSD. Obsessive Compulsive Obsessive Compulsive Disorder Disorder

• Obsessions „ Compulsions • Recurrent and persistent thoughts, impulses or images „ Repetitive behaviors in response to an obsession • Thoughts, images not simply excessive worries about „ Behaviors or mental acts are aimed at preventing or real life problems reducing distress • Person attempts to ignore or suppress thoughts or impulses with other thoughts • Person recognizes that the thought, impulses are product of own mind (not thought insertion)

Obsessive Compulsive Five common categories of Disorder OCD

• Washers „ Other required Criteria for Diagnosis • Fear of contamination/cleaning compulsions „ Person recognizes this is excessive or unreasonable (not • “If I don’t clean this, something bad will happen.” necessary in children) • Checkers • Repeatedly checks things „ Causes marked distress, time consuming, or • “If I left the oven on, the house will burn down.” significantly interfere with the person’s normal routine • Doubters and sinners • Fears terrible things will happen • “Am I a good Catholic? Did I do this job right?”

• Counter and arrangers • Ruled by magical thinking and superstition • Asymmetry will lead to catastrophe i.e. pencils must face north

• Hoarders • Cannot throw anything away • “Something horrible will happen if I throw this away.”

Suicide Suicide Facts

„ Ideation-thoughts of death and dying that includes • Completed suicide occurs five times more often in males strategies to takes one’s life. • Suicide attempts occur three times more often in females „ Gestures-sometimes referred to as “parasuicide” which means an attempt that is not • Most common method of completed suicide is firearm meant to take one’s life. (66% of male suicides and 50% of female suicides) • American males ages 15-19 -13.6 per 100k „ Attempts- actions taken with intention of ending a life. • American females ages 15-19 -3.6 per 100k

• 3rd leading cause of death in adolescent population (accidents, homicide, suicide) Possible Warning Signs of Suicide Factors Suicide

• Genetic Factors • Suicidal threats • Writing about suicide • Risk of suicide is highest for those with relatives who have a history of mood disorders • Direct threats • Indirect threats • Social Factors • Preoccupation with death • Exposure to chaotic, abusive and neglectful • Giving away items environments increase risk of aggressive, self- • Reading or writing about death destructive and suicidal behaviors • Repetitive thoughts about a dead person • Biological Factors • Changes in behavior • Alcohol may increase vulnerability to suicidal • Social withdrawal, isolation behavior • Increased risk taking • Emotional lability • Some correlation between aggressive and impulsive behaviors and suicide attempts • Unexplained absences

Possible Warning Signs of Suicide Self-Injury: Definition

• Changes in physical condition „ By definition, self-harm refers to hurting oneself to • Recent weight loss or gain relieve emotional pain or distress. The most common • Lethargy, exhaustion forms of this behavior are cutting and burning. The • Changes in thoughts least common forms of self-harm include pulling out • Reduced concentration or rational thought bodily hairs, punching walls, and ingesting toxic • Low self esteem substances or sharp objects.

• Changes in feelings • Hopelessness, anger, anxiety and moodiness • Less communicative

• Stress • Intolerable loss or change (trauma)

AAMFT

Self-Injury: Behaviors Self-Injury: Behaviors

• carving

• scratching • biting • branding • head banging • marking • bruising • picking, and pulling skin and hair • hitting • burning/abrasions • tattooing • Ingestion of sharps/toxins • excessive body piercing • cutting Self-Injury: Reasons Self-Injury: Diagnosis

• Take risks • Attention • Bipolar Disorder

• Rebel • Anger • Depression

• Reject parental values • Hopelessness • Borderline Personality Disorder (as adult)

• Express individuality • Worthlessness • PTSD

• Acceptance • Traumatic event • Psychosis

• Desperation • Suicidal intentions • Mental Retardation

• Autism

Self-Injury: Clinical Features Self-Injury: Interventions

• Release of tension/stress • accept reality and find ways to make the present moment more tolerable. • “Feel alive” with sight of blood • identify feelings and talk them out rather than acting on them.

• Dissociates from overwhelming feelings • distract themselves from feelings of self-harm (for example, counting to ten, waiting 15 minutes, saying "NO!" or "STOP!," • Punishes body for behaviors practicing breathing exercises, journaling, drawing, thinking about positive images, using ice and rubber bands) • External expression of internalized rage • stop, think, and evaluate the pros and cons of self-injury. • Replicates earlier abuse • soothe themselves in a positive, non-injurious, way.

• Make internal wounds external (visible) • practice positive stress management.

• Event markers (memorial for traumatic events) • develop better social skills.

• Creates euphoria • Hospitalization

AACAP-Facts for Families

Internet Addiction: Internet Addiction Clinical Features

• Social networking ‰ Preoccupation • Facebook ‰ Downplaying Use • MySpace • Twitter ‰ Lack of Control

• Cybersex/Cyperporn ‰ Loss of Time

• Compulsive Surfing ‰ Negative Impact on Other Areas of Life ‰ Hiding From Negative or Uncomfortable Feelings or Situations • Online Gaming • Massive Multiplayer Online Role-Playing Games ‰ Defensiveness (MMORPGs) • World of Warcraft (Warcrack) ‰ Misuse of Money/relationships • 10 million registered users ‰ • Everquest (Evercrack) Mixed Feelings • Halo 3 (Halodiction) Internet Addiction: Addictive Features Video Clip

• Multiplayer „ http://www.pbs.org/wgbh/pages/frontline/parents / • Single player

• Graphics

• Fantasy

• Fighting

• Higher levels with more playing time

• Relationships

• Discovery