Adolescent

1. Adolescent Depression

2. Depression… Is a condition of mental disturbance. Depression is one of the most frequent characteristic or adolescents referred for psychological treatment. Depression

3. Why do Adolescents get depressed? • Life changes • Mental illness • Acceptance • Appearance (low self esteem) • Lack of parental support • Being in a two parent family structure • School failure • Stressful peer relationship, conflict and rejection • Hormonal changes (Especially for girls)) Depression

4. Major Depressive Disorder • An individual experiences a major depressive episode and depressed characteristics • Felling lethargy meaning a lack of energy • Feeling hopelessness • Lasts two weeks or longer • Impairs daily function and activities Depression

5. 9 Symptoms to Determine Depressive Episodes • Feeling of depressed mood daily • Reduced interest of pleasure • Weight lose or gain • Increase or decrease in appetite • Troubles sleeping • Loss of energy • Feeling worthless or guilty • Problems thinking, concentrating, and decision making • Recurrent Depression

6. Pervasive depressive symptoms • Lack of interest in pleasant activities • Withdrawal from other (Family and friends) • Eating disorder • Drug abuse and conduct disorders Depression

7. Patros, G. Philip. Shamoo, K. Tonia. Depression and Suicide in Children and Adolescents: Prevention, Intervention, and Postvention. aren’t feeling sad or hopeless, they are irritable. Sleeping and eating patterns are drastically altered, and they will exhibit fidgety and restless behavior. Education, which is very important is affected also in adolescents who are depressed. It is difficult for them to focus, so their grades could very likely drop. Some, but not all my have thoughts of death or suicide. It is also documented that “4 of these symptoms must be present nearly every day for at least two week, and for those children under age six, at least 3 of the first four criteria will be exhibited”, for them to be considered “depressed.” Symptoms in adolescents • Lose interests in activities that they normally enjoy • Sad, lonely, irritable • Sleeping and eating patterns are drastically altered • Grades are very likely to drop • Some, but not all may have thoughts of suicide • 4 of these symptoms must be present nearly every day or for at least 2 weeks to be considered depressed Depression

8. Prevalence of Depression • Rates of depression is higher in girls than it is in boys • An episode of clinical depression during adolescence sets the ground for an increased risk for reoccurrence • “The prevalence rate of major depression changes with age from about 1% prepubertally to levels of between 5%-8% by age 19, with lower rates for boys compared to girls postpubertally. Depression

9. Family Factors • More criticizing than praising • Families have high levels of expressed emotion-hostility, conflict, and over involvement • Marital problems/sibling rivalry Depression

10. Family Factors (cont.) • Depressed mother often display inadequate parenting • Disengages from children • Depressed mothers may withdraw or ignore child-rearing situations • Depressed fathers are withdrawn, indecisive, cynical • High levels of expressed emotion, or hostility, conflict • Family members often fight but remain deeply involved in the details of one another’s lives??? • May cause adolescents to develop cognitive distortions and poor social skill, problem solving, and assertiveness Depression

11. Girls vs. Boys • Boys • Rarely discuss depression • Higher depression rates?? • Have the idea that real men don’t get depressed • Feelings of agitation • Crying spells Girls • Frequently discuss depression • Lower Depression Rates • Depression rates equalize • by late adolescence • Feelings of fatigue • Increased depression • Increased hormonal levels • Crying spells

12. Research on Depression • Scientists and research rely on family and twin studies to evaluate depression. • A family study assess family members of a person with a mood disorder and indicated if depression runs in family. • First degree relatives of people with family with depression often have depression 15 to 25% of the time Depression

13. Twin Studies • Twin Study in which identical twins and fraternal twins are compared • 1dentical(monozygotic) twins: Share 100% of genes • Fraternal(dizygotic) twins: Share 50% of genes • The twin study produces a concordance rates which is percentage of cases where each twin has the disorder • Depression is higher amongst identical twins than fraternal twins Depression

14. Biological Factors • Genetics account for 39 to 50 percent of depression symptoms • Help produce brain, neurochemical, and hormonal changes that lead to do depression • Environmental interaction can trigger depression • Genetic predisposition toward depression • Naturally predisposed to depression, born with low serotonin and norepinephrine Depression

15. Structural Changes of Brain • The hippocampus, a small part of the brain that is vital to the storage of memories, appear to be smaller in people with a history of depression • A smaller hippocampus has fewer serotonin receptors • Decreased activity and size in the prefrontal area of the brain • Amygdala, caudate nucleus, and anterior cingulate cortex are damage as well • Reduced goal-directed behaviors and inhibition of negative mood • Reoccurring negative thoughts • Damage to white matter, basal ganglia and pons can impair the regulation of attention, motor behavior and emotions Depression

16. Neurotransmitters • Serotonin is a neurotransmitter that allows communication between nerves in the brain and body • Norepinephrine, serotonin, and dopamine influences motivation and emotional state • Antidepressant medication boost serotonin levels in the brain • Adolescents suffering from depression have memory problems and increased levels of cortisol Depression

17. Effects of Depression • Can Affect Growth and Development • Abstract thinking skills and concentration decrease • Depressed adolescents may have social skill deficits, communication problems, and relationship conflict

18. Depression Treatments

19. Assessment • The assessment is a very important step and it should be done before assigning any form of treatment to an adolescent. • The assessment is the way in which the healthcare provider determines why the adolescent feels depressed and the severity of their depression. treatments

20. Treatments Cognitive Behavioral Therapy • Used to determine the relationship between the adolescent’s emotion, behavior, and cognition. • This technique is based on the social learning theory. • This technique has been tested on many severally depressed adolescents and it has shown to have significant effects in the improvement of depression. treatments

21. Treatments • Family Therapy • This form of therapy is used to determine: • the adolescent’s relationship with their families • any problems that may be going on in the family • things that could be causing the depression of the adolescent • ways of improving family issues that could or have lead to depression • This technique has been shown as a great way to help prevent adolescent depression treatments

22. Treatments • Interpersonal Therapy • This therapy emphasis the effect of relationships and attachment on an adolescent’s mental health and ways of coping. • It concentrates on the 4 main categories of relationship difficulty: • Grief • Role disputes • Role transitions • Interpersonal deficits treatments

23. Treatments • Pharmacotherapy • This is the use of medications to treat depression in adolescence. • There are many different types of medications that can be used, some which have shown to be useful and some which have shown not to be useful. • The combination of pharmacotherapy and cognitive behavioral therapy have shown to have the greatest improvements in depressed adolescents. treatments

24. Treatments Other known forms of treatments include: • Electroconvulsive therapy • Repetitive Transcranial Magnetic Stimulation • Light Therapy • Behavioral Activation • Cognitive Therapy • Self-control Therapy • Social Skills Training treatments

25. Medication For Depression Antidepressants • used in the treatment of mood disorders • characterized by various manic or depressive affects. Medications

26. Selective serotonin reuptake inhibitors (SSRIs) • Are the most commonly prescribed antidepressants. They can ease symptoms of moderate to severe depression, are relatively safe and generally cause fewer side effects than other types. Medications

27. Types of (SSRIs) • fluoxetine (Prozac) • citalopram (Celexa) • escitalopram (Lexapro) . • fluvoxamine (Luvox) . Medications

28. Side Effects of (SSRIs) • Nausea • Dry mouth • Headache • Diarrhea • Nervousness, agitation or restlessness • Reduced sexual desire or difficulty reaching orgasm • Inability to maintain an erection (erectile dysfunction) • Rash • Increased sweating • Weight gain • Drowsiness • Insomnia Medications

29. suicide Prevalence

30. Prevalence • Approximately 5% of children at any one time may suffer from serious depression. • It is estimated that 4.7% of the teenage population suffers from depression. • There is no related difference in the prevalence of depression among pre-adolescent children, but it increases to a 2:1 female to male ratio in adolescents. prevalence

31. Prevalence • The prevalence of depression may be higher in children with other psychiatric disorders, those with general medical conditions, and children with developmental disorders and mental retardation. • Prevalence of depression appears to be increasing in successive generations of children, with onset at earlier ages. • Adolescents who develop depression often have recurrences in adulthood and a more severe case. prevalence

32. Adolescent Self-injury

33. Self-Injury… • The intentional cutting, burning, or otherwise wounding without the intent to die. • Direct, deliberate destruction of one’s own body tissue in the absence of suicidal intent. Self-injury

34. Signs of self injury Because self injury is often kept a secret it is hard to spot signs and symptoms: • Scratches (whether they may be from cuts or burns) • Fresh wounds such as cuts, scrapes, or bruises • Claims of frequent accidents or mishaps (which may explain the marks) • Broken bones • Low self esteem (just because someone has low self esteem does not necessarily mean they self injure, however research shows that low self esteem is a factor related self injury) Self-injury

35. Common methods of self injury • Cuts- often made with a blade or glass shard; a cut is usually classed as an incision if its length is greater than its depth. Cuts are often described incorrectly as lacerations, which strictly speaking, are tears arising from blunt force injury • Puncture injuries- made by a pointed object inserted at right angles to the surface and then withdrawn, or inserted at an angle and then left under the skin. An injury is usually classified as puncture if its depth is greater than its length. • Dry burns- by contact with a flame or hot object includes electrical burns • Scalds- by contact with hot liquid or steam; external or internal (e.g. over-hot drinks) • Chemical burns- by contact with caustic substances • Other presentations- re-opened injuries; bruising (potential for fractures) following wall punching, head banging or self hitting; tissue damage arising from ligature an appendage; injuries caused by abrading or scouring the skin; internal damage for reversible insertions ; injecting contaminants into the skin or deliberately contaminating wounds.

36. Types of self injury Direct Direct Direct Indirect “normal” ways adolescents struggle to find their place in the world” Ex: Excessive drinking Substance abuse Acting out sexually Developing eating disorders Or engaging in other high risk behaviors” • Embodied through the phenomenon of self injury” • Ex: Cutting • Scratching • Burning skin • Picking wounds • Inserting objects into the body • Banging ones head Self-injury

37. Target areas for self injury • Arms and wrists (74%) • Legs (44%) • Abdomen (25%) • Head (23%) • Chest (18%) • Genital area (8%) Self-injury

38. Biological and Physical Causes Biological Physical Physical Stressful event in an adolescents life Feeling like they have lost control of a situation or situations Having no where else to turn • “ Dysregulation of serotonergic neurotransmission has been proposed to play a role in the expression of self injury” • “ Biological studies implicate reduced serotonergic neurotransmission in both inwardly and outwardly directed aggressive behaviors, especially impulsive ones pertains to patients with a history of attempted suicide. Individuals with personality disorders who cut or burn themselves” Self-injury

39. Statistics • It has been estimated that as many one teenager in ten self harm. • A revealing study 6020 adolescents found that 6.9 % had harmed themselves in the previous year and 13.2% reported at least once. • People who injure themselves are more likely to have an eating disorder and vice versa, self cutting has been reported in 40% of bulimics and 35% of anorexics • A study of the 2828 individuals who sought hospital treatment in Oxford for self harm between 1988 and 1996 found rates much higher in those from lower social groups. • In Arnold’s (1995) survey or 76 UK women , 30% reported they began self injuring around the age of 12. Similarly, Favazza and Conterio (1989) found 14 years old to be the most common age of onset in a study of 240 U.S. residents Self-injury

40. Other disorders associated with self injury: • Myths and facts about cutting and • Borderline personality disorder • Mood disorders • Obsessive Compulsive disorder • Post traumatic stress disorder (PTSD) • Dissociative disorders • ting and other means of self-harm tend to be taboo subjects, the people Self-injury

41. Possible maintenance factors for self injury • Persistence of original circumstances that led to initiation of self injury- such as an abusive relationship , social isolation, or repeated rejection • Conviction about self injury- believing that survival is impossible unless one remains in a injured state, that one deserves punishment, that cutting is the only way to reduce unpleasant feelings and that overt action is always necessary to communicate feelings to others • Emotional response from others- such as concern about injuries expressed by friends and family. Reinforcement is external and positive when self injury becomes associated with some welcome response. • Social aspects- as with “secondary gain” from having friends who cut or from acquisition of social status Self-injury

42. Treatment and Prevention Treatment options: Self injury of any type needs to be treated whether that is through counseling and medication or a combination of both. It needs to be treated. Prevention: • Identify those who are the most at risk: help to teach them resilience and healthy coping skills that they can call in a time of distress • Expand the social network: People who self injure often feel lonely if someone who does self injure can form a relationship with someone who doesn’t it can improve the self injurers relationship and communication skills • Raise awareness: Parents, Adults, and even other adolescents should be educated about the warning signs of self injury and know what to do should the situation arise. • Promote programs that will encourage peers to seek help: Peers tend to be loyal to a friend when they know that friend is in crisis. Programs that encourage youth to reach out to adults • Offer education on the media influences of the world: The media has a huge impact on adolescence encouraging them to experiment. Teach critical thinking skills about these influences and this may help reduce the impact. Self-injury

43. Adolescent suicide

44. The cause of suicide… • Studies show that suicide attempts among young people may be based on long-standing problems triggered by a specific event. Suicidal adolescents may view a temporary situation as a permanent condition. Feelings of anger and resentment combined with exaggerated guilt can lead to impulsive, self-destructive acts. • Untreated depression is the number one cause for suicide • Depression is triggered by several negative life experience and can harm the person if they do not get it treated • Some examples of how suicide can be triggered: • Relationship problems • Not feeling loved or wanted • Moving to a new environment and not being accepted • Loss of a loved one, or someone close to them • Also a mental disorder can trigger suicide, such as bipolar and Schizophrenia suicide

45. Top Three Methods of Suicide • Firearms-50% • Suffocation-24% • Poisoning-18% suicide

46. Suicide Rate suicide

47. How can adolescent suicide be treated/prevented? Prevention Methods • Prevention Programs such as therapy • Cognitive therapy is basically talk therapy where you talk out why you would want to commit suicide. What exactly can fix your problem? • Cognitive therapy reduced the rate of repeated suicide attempts by 50%. • Dialectical behavior therapy-helps with borderline personality disorder. • Medication: Clozapine-approved by Food and Drug Administration for suicide prevention in people with Schizophrenia • Schools can come up with prevention programs which some researchers suggest start in the 7th grade. Suicide.org • Some may check in to a psychiatric hospital • When adolescents are depressed, they have a tough time believing that their outlook can improve. But professional treatment can have a dramatic impact on their lives. It can put them back on track and bring them hope for the future. suicide

48. Signs of suicide,thoughts,feelings,and attempts… Many factors are associated with suicidal attempts: • Parent absence, bullying, rejection, alcohol abuse, drug abuse, depression, sexual abuse, rape, physical abuse, unhappiness, parents pushing adolescents to overachieve, having friends who engage in suicidal behavior, and a family history of suicidal behavior just to name a few of many factors. • After some of these factors come into play, Suicidal thoughts begin to arise. • As research shows, some actual attempts include self injury, poisoning, drug overdose, knife marks, bruises, and overdose of pills. • Since 1991, attempts have declined. • In emerging adulthood, males are 6 times more likely to commit suicide than females. Males use more lethal ways of attempting suicide such as using guns, but females take less lethal ways such as overdosing on sleeping pills and cutting their wrist. • 15 – 19 year old Females were more likely to attempt suicide than males but males were more likely to succeed in suicide. suicide

49. Signs of suicide,thoughts,feelings,and attempts…cont. • Four out of five teens who attempt suicide have given clear warnings. Pay attention to these warning signs: • Suicide threats, direct and indirect • Obsession with death • Poems, essays and drawings that refer to death • Giving away belongings • Dramatic change in personality or appearance • Irrational, bizarre behavior • Overwhelming sense of guilt, shame or rejection • Changed eating or sleeping patterns • Severe drop in school performance • Giving away belongings suicide

50. Percentage of U.S. adolescents that seriously consider attempting suicide…. • Sometimes teens feel so depressed that they consider ending their lives. Each year, almost 5,000 young people, ages 15 to 24, kill themselves. • The rate of suicide for this age group has nearly tripled since 1960, making it the third leading cause of death in adolescents and the second leading cause of death among college-age youth. suicide