1. Management of Mental Disorder in Adolescent
Ronny T Wirasto
Program Studi Pendidikan Dokter
FMIPA
Universitas Tadulako
2011

2. Topik
Definisi
Gangguan
Diagnosis
Terapi

3. Background
World Health Organization evidence indicates that internationally:
by 2020 childhood neuropsychiatric disorders will rise proportionately by over 50%
neuropsychiatric disorders will become one of the five most common causes of morbidity, mortality and disability among children

4. Developmental theory :
Psychosexual
Psycho-cognitive
Psychosocial

5. Adolescence represents a “station”
on the human development
between childhood and adulthood
Biological changes are pre-set
by hormonal changes
Most obvious effects being on
growth
body shape
secondary sexual characteristics

6. Females aged 12-17 more likely than male peers:
Youth ages 14 through 17 are significantly more likely to have had a Major Depressive Episode accompanied by thoughts of better off dead or thoughts of committing suicide than ages 12-13
MDE with suicidal thoughts – not varied by urbanicity – (large, small and non-metro similar)
Females aged more likely than male peers:
Major Depressive Episode in lifetime
Thought about killing themselves at worst or most recent MDE

7. Reasons for Mental Health Treatment in Past Year for Youth Ages 12-17 (non drug-related):
Felt depressed (52%)
Breaking Rules / Acting Out (28%)
Felt Very Afraid or Tense (21%)
Thought about or Tried Killing Self (19%)
Family or Home Problems (13%)
School-Related Issues (11%)
Social / Friend Problems (8%)

8. Common disorders Conduct disorders Substance abuse Emotional disorders
Eating disorders
Psychosis

9. Conduct disorder Commonest disorder in adolescence
Affects 4-10% adolescent population
Usually associated with
parental psychopathology
alienation from parents
Presenting features
Socially disapprove behaviours
At home or/and in the community
Common presentation
Defiance, Destructive, Vandalism, Delinquent,Stealing, Violent crimes

10. Factors Management Boredom Keeping up with peers
Relieving frustrations
Expressing a point
Management
Family therapy
Anger management
Group work
Community programes

11. Emotional Includes Depression Anxiety Deliberate self harm
Obsessive compulsive disorders
Anergy – loss of vitality, Gives up easily
Somatic complaints, Sleep and appetite disturbance
Feeling unloved, Suicidal ideation

12. Management Anti-depressants Supportive psychotherapy
SSRI (selective serotonin re-uptake inhibitor)
Fluoxetine
Fluvoxamine
Setraline
Supportive psychotherapy
Family psycho-education

13. Anxiety Affects more females than males
Differentiate between normal shyness and anxiety disorder
Clinical features :
Anxious/conscious of
appearance
school performance
personal relationship
gender identity
school refusal
Physical symptoms
headaches
abdominal pains
hyperventilation

14. Management Exposure with relaxation Social skills training Anxiolytics
Alprazolam
Diazepams
Anti-depressants
Fluvoxamine
Fluoxetine

15. Eating disorder Anorexia nervosa Diagnostic criteria Underweight
<85% of expected weight for age and height
Intense fear for fatness
feels and believes to be fat
eventhough underweight
Amenorrhoea
for 3 consecutive months
Excessive diet restriction
voluntary starvation
increase activity level
use of laxative and purgative

16. Bulimia Diagnostic criteria Recurrent episodes of binging
“ox hunger”
Recurrent purging and excessive exercises
To prevent weight gain
Binging and purging
Occurring at least 2X per week for 3 months
Self worth that is overly influenced by body shape and weight

17. “Binge”
Consuming large amounts of food in a discrete period
Has no control over the eating
In Bulimia
Patient feels remorse after binging
Binging usually done alone

18. Bulimics resort to drastic measures to prevent
weight gain after a binge
Self-induce vomiting
Compulsive & excessive exercise
Abuse laxatives & diuretics
Because of the disgust & shame : binging
Behaviour
Bulimics may be more willing to enter Rx than anorexic

19. Factors Social emphasis on slimness Fear of growing up
Childhood psychopathology
Suppression of emotional expression

20. Psychosis
Similar with adult
Social/environment
Individual