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Working with Children and Teenagers

Working with Children and Teenagers. Dr Kay Harvey Consultant Child and Adolescent Psychiatrist. Child and Adolescent Mental Health Service (CAMHS). Up to 18 years The team: psychiatrists, psychologists, mental health practitioners, art therapist. MOOD DISORDERS Depression

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Working with Children and Teenagers

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  1. Working with Children and Teenagers Dr Kay Harvey Consultant Child and Adolescent Psychiatrist

  2. Child and Adolescent Mental Health Service (CAMHS) • Up to 18 years • The team: psychiatrists, psychologists, mental health practitioners, art therapist.

  3. MOOD DISORDERS Depression Bipolar Affective Disorder Post natal depression PSYCHOTIC DISORDERS Schizophrenia SELF HARM CAMHS Child and Adolescent Mental Health Service ANXIETY DISORDERS Obsessive Compulsive Disorder Phobias Post Traumatic Stress Disorder Panic disorder DEVELOPMENTAL DISORDERS Autism ADHD OTHERS Tic disorders/Tourette’s Trichotillomania, conversion disorders

  4. Relevance to other specialties Presentations General Practice, A&E, Paediatrics Epidemiology Prevalence, childhood 1:10 (Meltzer) Adults 1:4 (Goldberg & Huxley)

  5. Attention Deficit Hyperactivity Disorder (ADHD) • 2-5% of population • 3-6x more common in boys. • Inattention • Hyperactivity • Impulsivity • Present from birth • Must be present in at least 2 settings and have been present most days for at least 6 months • Treatment: Stimulant medication

  6. ADHD Inattentive Hyperactive and Impulsive Fidgety, constantly leaving seat Runs or climbs excessively “on the go” as if “driven by a motor” Blurts things out Interrupts conversations • Difficulty sustaining attention • Misses fine detail • Fails to follow instructions • Fails to finish tasks • Forgetful, loses things easily

  7. Autistic Spectrum Disorder (ASD) • 1% of population • 3-4 x more common in boys • Spectrum: Asperger’s and Autism • Socialisation • Communication • Flexibility of thought (imagination)

  8. Socialisation • Difficulties with friendships and social situations • Preference for solitary activities • Difficulties with empathy • Communication • Language delay • Difficulty understanding jokes and sarcasm, literal language, body language, facial expressions and gestures. • Flexibility of thought (imagination) • Difficulty coping with changes in routine • Imaginative play

  9. Depression • Pervasive low mood for 2 weeks • Biological symptoms: appetite, weight loss/gain, sleep disturbance, poor conc, loss of sex drive. • 1% in children and 3% for adolescents • 95% of major depression occur in children with long-standing psychosocial difficulties • Treatments: Therapy and antidepressants. • Prognosis: 10% recover spontaneously within 3 months. At 12 months 50% remain depressed. • Mortality: 10%

  10. Aisha

  11. Depression and pregnancy • Post termination • Depression in pregnancy • Post partum depression • Risks???

  12. Bipolar Affective Disorder

  13. Manic Episodes • Increased activity or restlessness • Increased talkativeness and sociability • Poor concentration • Decreased sleep • Increased sexual energy • Overspending or other reckless behaviour • …..psychotic symptoms can also occur during depressive and manic episodes! • Mortality: 10-15%

  14. Callum

  15. Post Traumatic Stress Disorder Exposure to a traumatic event The traumatic event is persistently re-experienced Avoidance Symptoms of increased arousal

  16. Post Traumatic Stress Disorder • 10-100% of adolescents who have experienced a major trauma • Symptoms need to occur within 6 months of the trauma • Treatment • Prognosis: The majority of sufferers improve within 6 months.

  17. Sajad

  18. Issues in this case… • Domestic Violence • Vulnerability • Language barriers to treatment • Engaging with new surroundings.

  19. Deliberate Self Harm • Cutting, burning, taking overdoses. • Incidence: ??% • F:M 6:1 • Treatment • Mortality: 1:100 who end up in hospital after a suicide attempt will succeed within a year. Teenage boys are much more likely to die as a result of a suicide attempt.

  20. Lauren

  21. Anorexia Nervosa • Self induced low weight (BMI<17.5) combined with “a drive for thinness”. • 1:200 girls and 1:2000 boys at 16 years. Incidence is rising. • 90% of sufferers are female. • Social class bias and ethnic minorities • Treatment • Mortality rate of 15-20% - the highest mortality rate of any psychiatric disorder of adolescence

  22. Abbie

  23. The challenges of being a child psychiatrist… • Very stressful and distressing at times. • Police cells aren’t pleasant places to be at 3am on a Saturday morning! • Things don’t always work out well… • Unfortunately deaths do occur.

  24. The great bits about the job… • Allows you to be really nosey! • Build strong relationships with the families • You work as part of a multi disciplinary team • Very rewarding • 2 days are never the same!

  25. Any questions…

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