DR.

WAN SALWINA WAN ISMAIL

LATIHAN KESIHATAN DAN KAUNSELING REMAJA
GRAND CONTINENTAL HOTEL
18th-22nd May 2009

Transition period from childhood to adulthood

Hormonal, physical and physiological changes
Prepares for tasks in adult life by achieving:
- the ability to produce
- emotional maturity to establish and nurture a
family and live in society
- physical strength, intelligence and judgment
to protect and provide for offspring

Power struggle
Personal space
Mood changes
Importance of peers
Risk taking
Self-esteem & self-concept
Sexual identity
Searching for self-identity

Problems or disorders?

Psychiatric disorders are COMMON in

adolescents - 20%
Consequences
- interfere with normal development
- school issues
- peers
- family relationship

Depressive illness
Suicide
Bipolar mood disorder
Anxiety disorders
School refusal
ADHD, Conduct Disorder, Oppositional defiant
Disorder
Substance related Disorder
Schizophrenia and related disorder
Eating disorders- AN, BN
Gender Identity Disorder
Developmental disorders Autism, Learning
difficulty, MR
Social problems teenage pregnancy, bullying,
abuse, mat rempit

Depressive symptoms ??
Differential diagnosis Major depressive
disorder, Dysthymia, Adjustment disorder
Management
- antidepressants
- psychotherapy supportive
psychotherapy, cognitive behaviour
therapy(CBT), interpersonal
psychotherapy(IPT)
- ECT

Assessment of suicide risk

- suicidal intent
- specific plan
- lethality of method
- precautions taken
- suicidal ideas
- previous attempt
- family history of suicide
- social support, involvement of substance

Depression

feeling low
insomnia
sleep
anhedonia
lethargy
hopeless/useless
loss of appetite/loss of weight
appetite/weight
suicidal thoughts

Mania
- feeling elated
- decreased need for
- flights of ideas
- energetic
- over confidence
- increased

Antidepressants
Antipsychotics
Mood stabiliser
Psychotherapy supportive
psychotherapy CBT, IPT
ECT

Anxiety symptoms ??
Differential diagnosis - Panic disorder,
Generalized anxiety disorder, Specific
phobia, Social phobia, Post Traumatic
Stress Disorder, Obsessive Compulsive
Disorder
Management:
- antidepressants
- anxiolytic(short-term use with
caution)
- psychotherapy

Differential diagnosis: IQ problem,

specific learning difficulty, ADHD,
school phobia & other anxiety
disorders, other psychiatric
disorders, problems relating to
peers & teachers

Treat the underlying cause

Negativistic,
hostile &
defiant
behaviour

ADHD

ODD

Violation of
major
norms &
rules

Conduct Disorder
Antisocial Personality
Disorder

ADHD
- Medications Methylphenidate,
Atomoxetine
- OT
Conduct and Oppositional Defiant Disorder
- individual counselling
- family involvement
- residential treatment
- foster family program
- PREVENTION

Commonly used substance Amphetamine, gum sniffing,

cigarette smoking, alcohol
Psychosis, depression,
mania,etc.
Management ??

Psychotic symptoms ??
Differential diagnosis:
Schizophrenia, delusional disorder,
schizoaffective disorder, bipolar mood
disorder, substance-related disorders,
organic causes
Management
- antipsychotics
- psychotherapy
- rehabilitation

Anorexia Nervosa(AN) - loss of

body weight, excessive diet
control, distorted body image,
amenorrhoea
Bulimia Nervosa(BN) rapid
consumption of large amount of
food, self-induced vomiting
Management:
- fluoxetine for BN
- psychotherapy- family therapy

Persistent cross-gender
identification
Persistent discomfort with his or
her sex or sense of
inappropriateness in the gender
role of that sex
Management?

Psychiatric problems and disorders among adolescents with

special needs
eg. Autism, MR,
Learning disability,
Downs syndrome, etc.

Other problems eg. bullying, teenage pregnancy, abuse, mat

rempit, etc.

Attachment
Parenting
Family relationship
Peers influence
Media
School
Community

Psychiatric disorders among

adolescents are common
Management
- Medicine
- psychotherapy - Individual
psychotherapy, Group
psychotherapy, Family therapy
Prevention

THANK YOU