CARE OF THE ADOLESCENT

1. CARE OF THE ADOLESCENT Chapter 22 Michael Cooper, Alan Glasper and Chris Taylor

2. Introduction This presentation will help you to examine the problem of anorexia poses for adolescents. Part 1 – Anorexia: Depression & Suicide Part 2 – Therapeutic Approaches to Treatment Part 3 – Useful Resources

3. PART 1: Anorexia: Depression & Suicide

4. Depression and Suicide in Anorexia Up to 3% of patients with anorexia successfully commit suicide. Anorexia has been construed by some experts as self destructive and a “compromise with suicide”. A longitudinal study conducted by Crisp, A., (2006) indicated from follow ups of patients with anorexia over 35 years that they are significantly more at risk of premature death than the general population, mostly from suicide or the consequences of malnutrition Crisp A 2006 Death, Survival And Recovery in Anorexia Nervosa: A Thirty Five Year Study European Eating Disorders Review 14, 168–175

5. Suicide: Questions to Ask Do you feel that no-one cares about you? Do you feel that life is not worth living? Do you feel like ending your life? Have you made plans to end your life? Do you have tablets or a weapon to use to end your life? When do you plan to end your life? Where will you do it? You may not be directly involved in such an assessment but you can see from the style of the questions that a direct approach is considered essential when assessing risk.

6. General Risk Factors for Suicide Low Risk: The person has thoughts such as “I can’t go on” “I wish I were dead”, “I just wish I wouldn’t wake up”, but has not thought about ending their life. Medium Risk: the person has thought about ending their life but has no active plans to do so. High Risk: the person has a definite plan to end their life.

7. PART 2: Therapeutic Approaches to Treatment

8. 1. Cognitive Behavioural Therapy (CBT) This increasingly popular method of therapy aims to help the patient to become aware of thought distortions which cause psychological distress, and behaviour patterns to be reinforced, in order to correct them. The patient and therapist work together to identify problems in the relationship between thoughts, feelings and behaviour. This leads to a personalised, time limited therapy with goals and strategies that are continually monitored and evaluated. FIND OUT MORE AT: http://www.rcpsych.ac.uk/mentalhealthinformation/therapies/cognitivebehaviouraltherapy.aspx

9. 2. Cognitive Analytical Therapy (CAT) CAT looks at both conscious thoughts and feelings as well as unconscious factors to explore a patient’s habitual coping mechanisms and to consider whether these may be exacerbating the problems. The focus is on problem solving and the development of skills with the active use of education strategies. CAT is time-limited, with a course of treatment lasting between 6 and 24 sessions. FIND OUT MORE AT: http://www.acat.me.uk/

10. 3. Interpersonal Psychotherapy (ITP) IPT aims to work specifically with relationship issues. The therapy would focus on one or two agreed areas of relationships or resolving interpersonal problems. IPT is a time limited therapy with a standard period of 16 weekly sessions. The therapy progresses through three stages: assessment, problem focus and conclusion FIND OUT MORE AT: http://www.interpersonalpsychotherapy.org/

11. 4. Dialectical Behaviour Therapy (DBT) DBT is a development of cognitive behavioural therapy (CBT), that specifically addresses self defeating behaviour and emotional instability. The focus is on developing skills to manage emotional life, communicating needs more effectively and improving relationships. DBT can involve both individual and group therapy. FIND OUT MORE AT: http://www.palace.net/~llama/psych/dbt.html

12. 5. Art Therapy The overall aim of art therapy is to enable the patient to change and grow on a personal level through the use of artistic materials. It differs from other psychological therapies in that it is a three way process between the therapist the patient and the artwork. FIND OUT MORE AT: http://www.baat.org/art_therapy.html

13. Dilemmas of Care In your learning groups, read this newspaper report: http://edinburghnews.scotsman.com/index.cfm?id=939112006. Now discuss the following questions: Q. The implication was that the care path produced care that was too complex. Given that anorexia has the highest mortality of all mental health problems, is the criticism of the authority fair? Q. How might scarce resources have contributed to this sad situation? Q. How has communication or a breakdown of communication affected this situation?

14. PART 3: Useful Resources

15. Useful Resources • Patient Self Help Telephone Resources • Eating Disorders Youth Helpline EDA 0845634 7650 • Anorexia and Bulimia Care ABC 01462 423 351 • National Centre for Eating Disorders 01372 469 351

16. 2. Useful books: Buckroyd 1966 2nd. Ed. Eating Your Heart Out: Understanding and Overcoming Eating Disorders Vermilion Press This is considered an excellent book on the subject that sensitively explores the many underlying causes of anorexia and bulimia nervosa that uses sufferer’s personal accounts Christine Fenn Dr. 1998 Forget the Fear of Food Need to know Written by a leading nutritionist considered a hard hitting summary on the perils of dieting with guidance towards healthy eating. Rowe D 1993 The Successful Self: freeing our hidden inner strengths Harper Collins Crisp, A.H., Joughin, N., Halek, C. and Bowyer, C. (1996). Anorexia Nervosa. The Wish to Change. Psychology Press. Hove, East Sussex. Treasure, J. (1997). Anorexia Nervosa. A Survival Guide for Sufferers and Those Caring for Someone with an Eating Disorder. Psychology Press, Hove, Sussex. Schmidt U, Treasure J.(1993) Getting Better Bit(e) by Bit(e). A survival kit for sufferers of bulimia nervosa and binge eating disorder Brunner-Routledge.