Mental Health Issues in Adolescents

Overview & Risk Factors - Teen Mind Maze

• Adolescence: Critical period for mental health; peak onset for many disorders; significant morbidity.
• Common Spectrum: Mood (depression, bipolar), anxiety disorders, behavioral (ADHD, conduct), substance use, early psychosis.
• Impact: Impaired development, academic failure, social dysfunction, ↑suicide risk.
• Risk Factors - Bio-Psycho-Social Model:
  • Biological: Genetics (family history), neurodevelopmental vulnerabilities, hormonal shifts (puberty), chronic illness.
  • Psychological: Low self-esteem, history of trauma/abuse (ACEs), poor coping skills, cognitive distortions.
  • Social/Environmental: Family discord/neglect, peer issues (bullying, rejection), high academic stress, socioeconomic adversity, substance availability, social media pressures.

⭐ Suicide is a leading cause of death in 15-19 year-olds; addressing mental health is crucial for prevention (WHO data often cited in exams).

Mood & Anxiety Woes - Emotional Rollercoaster

• Major Depressive Disorder (MDD):
  • Persistent sadness/irritability, anhedonia. SIGECAPS symptoms. Duration ≥ 2 weeks.
  • Screen: Patient Health Questionnaire-Adolescent (PHQ-A).
  • Rx: Psychotherapy (CBT, IPT); SSRIs (Fluoxetine, Escitalopram) for mod-severe.
  • ⚠️ SSRIs: Black box warning for ↑suicidal ideation (<25 yrs). Monitor.
• Bipolar Disorder:
  • Episodic mania/hypomania (elevated mood, ↓sleep, impulsivity) & depression. Often misdiagnosed.
  • Rx: Mood stabilizers (Lithium, Valproate), atypical antipsychotics. Avoid antidepressant monotherapy (risk of switch).
• Anxiety Disorders:
  • Types: GAD, Social Anxiety, Panic, Separation Anxiety.
  • Core: Excessive worry/fear, avoidance, impairment.
  • Screen: SCARED (Screen for Child Anxiety Related Emotional Disorders).
  • Rx: CBT first-line. SSRIs (Sertraline, Fluoxetine) for mod-severe or if CBT fails.

⭐ In adolescents, irritability can be a more prominent mood symptom than sadness in Major Depressive Disorder.

Behavioral & Eating Issues - Rebel Yells & Food Fights

• Attention-Deficit/Hyperactivity Disorder (ADHD)
  • Inattention, Hyperactivity, Impulsivity.
  • Symptoms <12 yrs, in ≥2 settings. Vanderbilt/Conners scales.
  • Management: Behavior therapy (1st line preschool), Stimulants (Methylphenidate), Atomoxetine.
• Oppositional Defiant Disorder (ODD)
  • Angry/irritable mood, argumentative/defiant behavior, vindictiveness.
  • No serious violation of others' rights.
• Conduct Disorder (CD)
  • Violates rights/norms: aggression, destruction, deceit, serious rule-breaking.
  • Can progress to Antisocial Personality Disorder.
• Eating Disorders
  • Anorexia Nervosa (AN)
    • Low weight (BMI <17.5), intense fear of gain, body image distortion.
    • Complications: Bradycardia, hypotension, lanugo, amenorrhea, osteoporosis.

    ⭐ Anorexia Nervosa has the highest mortality rate of any psychiatric disorder.

  • Bulimia Nervosa (BN)
    • Binge eating + compensatory behaviors (purging, fasting, excessive exercise).
    • Russell’s sign. Usually normal/overweight.
  • Binge Eating Disorder (BED)
    • Recurrent binge eating. Marked distress. No compensatory behaviors.

Assessment & Management - Doc's Detective Toolkit

• Assessment:
  • HEADSSS: Home, Education/Employment, Eating, Activities, Drugs, Sexuality, Suicide/Depression, Safety.
  • Screening tools: PHQ-A (Depression), GAD-7 (Anxiety), CRAFFT (Substance abuse).
  • Collateral history: Parents, teachers.
• Management Principles:
  • Biopsychosocial model.
  • Multidisciplinary team: Pediatrician, psychiatrist, psychologist, social worker.
  • Psychoeducation for patient & family.
  • Pharmacotherapy (judicious use) & psychotherapy (CBT, IPT).

⭐ Confidentiality is key in adolescent mental health, but safety (suicidal/homicidal ideation, abuse) overrides it, mandating disclosure to guardians/authorities if risk is imminent (⚠️ Exception to confidentiality).

High‑Yield Points - ⚡ Biggest Takeaways

• Depression and Anxiety disorders are the most common mental health issues in adolescents.
• Suicide is a leading cause of mortality; always assess for suicidal ideation and risk factors.
• ADHD often persists, impacting academics; Conduct Disorder involves rule violation.
• Substance use disorders frequently co-occur with other mental health conditions.
• Early identification using tools like HEEADSSS and multimodal intervention are crucial.
• Eating disorders (Anorexia, Bulimia Nervosa) have high morbidity; screen at-risk youth.
• Confidentiality is key, but safety concerns (suicidality, homicidality, abuse) override it.