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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

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 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



Comorbidity
Comorbidity

  • 50% have at least one other psychiatric diagnosis

    • Conduct disorder 40%

    • Anxiety disorder 34%


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.


‘It was like prescribing

him a loaded gun’


Suicide attempts and treatment
Suicide attempts and treatment

Simon & Savarino 2007



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?



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