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DEPRESSION AND SELF HARM IN YOUNG PEOPLE

DEPRESSION AND SELF HARM IN YOUNG PEOPLE. Dr Cathy Symonds ST3 CAMHS Dr Katharina Junejo ST4 CAMHS. Depression Epidemiology Aetiology Symptoms Treatment Deliberate Self Harm Epidemiology Risk factors Assessment Prognosis. Overview . Case example.

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DEPRESSION AND SELF HARM IN YOUNG PEOPLE

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  1. DEPRESSION AND SELF HARM IN YOUNG PEOPLE Dr Cathy Symonds ST3 CAMHS Dr Katharina Junejo ST4 CAMHS

  2. Depression Epidemiology Aetiology Symptoms Treatment Deliberate Self Harm Epidemiology Risk factors Assessment Prognosis Overview

  3. Case example 14 year old girl is brought to her GP by her father who has concerns. The girl has been spending most of her time alone in her room, she does not have much motivation, and is not eating or sleeping well. • What additional information is required in the history? • What further questions are important? • How could you manage this girl?

  4. Symptoms – What is Depression? • Low Mood • Depressive Thinking • Pessimism • Suicidal ideas • Reduced self esteem • Ideas of guilt / worthlessness • Biological symptoms • Disturbed sleep (insomnia/hypersomnia/early morning wakening) • Disturbed appetite (more or less) • Diurnal variation in mood • Motor retardation/agitation • Poor concentration • Suicidal ideation /acts

  5. Symptoms • More common in prepubertal children • Somatic complaints • Psychomotor agitation • Separation anxiety • School refusal • Irritability • Less common in children • Expression of feelings, especially guilt or hopelessness • Sleep and appetite disturbance

  6. Symptoms • More common in adolescents • Hopelessness/helplessness • Anhedonia • Hypersomnia • Irritability • Use of alcohol and drugs • Reduced academic performance • Antisocial behaviour in males

  7. Depression - epidemiology • Isle of Wight Study ( Rutter et al 1970) • Miserable 10% of 10yr olds 40% of 14yr olds • Depression 0.2% of 10yr olds 2% of 14yr olds • Broader diagnostic criteria • Major depressive disorder: 1-2% prepubertal 2-5% adolescents • Sex ratio: 1:1 prepubertal F>M pubertal

  8. Aetiology

  9. Comorbidity • 50% have at least one other psychiatric diagnosis • Conduct disorder 40% • Anxiety disorder 34%

  10. Assessment • Full history and risk assessment • Alone and with family • Liaison with • School • Other professsionals involved

  11. Treatment • Outpatient, day patient, inpatient? • Mild • Supportive • Moderate • Supportive • CBT / Interpersonal therapy • Medication • Fluoxetine – if moderate/severe. To prevent relapse in moderate/severe – 6 months therapy.

  12. ‘It was like prescribing him a loaded gun’

  13. Suicide attempts and treatment Simon & Savarino 2007

  14. Suicide attempts and treatment related to age Simon et al 2006

  15. Case example 14 year old girl is brought to her GP by her father who has concerns. The girl has been spending most of her time alone in her room, she does not have much motivation, and is not eating or sleeping well. • What additional information is required in the history? • What further questions are important? • How could you manage this girl?

  16. SELF HARM IN YOUNG PEOPLE

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