Depression and self harm in young people
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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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Depression and self harm in young people

DEPRESSION AND SELF HARM IN YOUNG PEOPLE

Dr Cathy Symonds ST3 CAMHS

Dr Katharina Junejo ST4 CAMHS


Overview

Depression

Epidemiology

Aetiology

Symptoms

Treatment

Deliberate Self Harm

Epidemiology

Risk factors

Assessment

Prognosis

Overview


Case example

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?


Symptoms what is depression

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


Symptoms

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


Symptoms1

Symptoms

  • More common in adolescents

    • Hopelessness/helplessness

    • Anhedonia

    • Hypersomnia

    • Irritability

    • Use of alcohol and drugs

    • Reduced academic performance

    • Antisocial behaviour in males


Depression epidemiology

Depression - epidemiology

  • Isle of Wight Study ( Rutter et al 1970)

    • Miserable 10% of 10yr olds40% of 14yr olds

    • Depression0.2% of 10yr olds2% of 14yr olds

  • Broader diagnostic criteria

    • Major depressive disorder: 1-2% prepubertal

      2-5% adolescents

  • Sex ratio: 1:1 prepubertal

    F>M pubertal


Aetiology

Aetiology


Comorbidity

Comorbidity

  • 50% have at least one other psychiatric diagnosis

    • Conduct disorder40%

    • Anxiety disorder34%


Assessment

Assessment

  • Full history and risk assessment

    • Alone and with family

  • Liaison with

    • School

    • Other professsionals involved


Treatment

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.


Depression and self harm in young people

‘It was like prescribing

him a loaded gun’


Suicide attempts and treatment

Suicide attempts and treatment

Simon & Savarino 2007


Suicide attempts and treatment related to age

Suicide attempts and treatment related to age

Simon et al 2006


Case example1

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?


Self harm in young people

SELF HARM IN YOUNG PEOPLE


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