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1
Adolescent
Depression
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Depression…
Is a condition of mental disturbance. Depression is one of the most frequent characteristic or adolescents referred for psychological treatment.
Depression
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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
Why do Adolescents get depressed?
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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
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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 making1. Recurrent
Depression
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Pervasive depressive symptoms
Lack of interest in pleasant activities Withdrawal from other (Family and
friends) Eating disorder Drug abuse and conduct disorders
Depression
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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
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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
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Family Factors More criticizing than praising Families have high levels of expressed
emotion-hostility, conflict, and over involvement
Marital problems/sibling rivalry
Depression
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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
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Girls Frequently discuss
depression Lower Depression Rates
Depression rates
equalize
by late adolescence
Feelings of fatigue
Increased depression
Increased hormonal levels
Crying spells
Girls vs. BoysBoys
Rarely discuss depression
Higher depression rates??
Have the idea that real men don’t get depressed
Feelings of agitation
Crying spells
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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
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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
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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
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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
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
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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
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Depression
Treatments
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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
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TreatmentsCognitive 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
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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
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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
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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
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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
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Medication For Depression
Antidepressants used in the treatment of mood
disorders characterized by various manic or
depressive affects.
Medications
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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
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Types of (SSRIs)
fluoxetine (Prozac) citalopram (Celexa) escitalopram (Lexapro) . fluvoxamine (Luvox) .
Medications
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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
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Prevalence
suicide
30
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
Prevalence
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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
Prevalence
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Self-injury
Adolescent
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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
Self-Injury…
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Signs of self injuryBecause 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
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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.
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Types of self injuryDirect Direct
Direct Embodied through the
phenomenon of self injury”
Ex: Cutting Scratching Burning skin Picking wounds Inserting objects into
the body Banging ones head
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”Self-injury
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Target areas for self injury
Arms and wrists (74%) Legs (44%) Abdomen (25%) Head (23%) Chest (18%) Genital area (8%)
Self-injury
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Biological and Physical Causes
Biological “ 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”
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
Self-injury
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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
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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
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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
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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
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suicide
Adolescent
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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 Methods
FirearmsSuffocationPoisioning
suicide
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Suicide Rate
suicide
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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
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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
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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
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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
51
Percentage of U.S. adolescents that seriously consider attempting suicide….
suicide
52
Suicide attempt by U.S. adolescents from different
races…. Cultural contexts also are related to suicide
attempts, and adolescents suicide attempts vary across ethnics groups in the United States. More than 20 percent of Native American/Alaska native adolescents reported that they had attempted suicide, and suicide accounts for 20 percent of deaths in 15-19 year olds.
Both early and late experiences may be involved in suicide attempts. The adolescent might have a long-standing history of family instability and unhappiness.
suicide
53
Suicide attempt by U.S. adolescents from different
races….
suicide
54
Psychological profile of a suicidal adolescent….
Suicidal adolescents often have depressive symptoms. Although not all depressed adolescents are suicidal, depression is the most frequently cited factor associated with adolescent suicide.
A sense of hopelessness, low self-esteem, and high self-blame also are associated with adolescent suicide.
A recent study found that a perception of being a burden on others and thwarted belongingness were linked to suicidal thoughts.
suicide
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What to do and what not to do when you suspect someone is
considering suicide…What to do:
Ask direct, straightforward questions in a calm manner: “Are you thinking about hurting yourself?”
Asses the seriousness of the suicidal intent by asking questions about feelings, important relationships, who else the person has talked with, and the amount of thought given to the means to be used. If a gun, pills, a rope, or other means have been obtained and a precise plan has been developed, clearly the situation is dangerous. Stay with the person until help arrives.
Be a good listener and be very supportive without being falsely reassuring.
Try to persuade the person to obtain professional help and assist him or her in getting this help.
suicide
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What to do and what not to do when you suspect someone is
considering suicide…cont.
• What not to do: Do not ignore the warnings signs. Do not refuse to talk about suicide if a person
approaches you about it. Do not react with humor, disapproval, or
repulsion. Do not give false reassurances by saying such
things as “Everything is going to be ok.’ Also do not give out simple answers or platitudes, such as “you have everything to be thankful for.”
Do not abandon the individual after the crisis has passed or after professional help has commenced
suicide
57
Questions? suicide
Self-injury
Depression
treatments
prevalence