Adolescent Psych/Youth at Risk


ADOLESCENT PSYCH/YOUTH AT RISK

Definition and introduction:
NRPA's definition: Youth at risk come from all backgrounds, races, and areas of the community. They are youth who are, or have the potential to be, influenced negatively by family, environment, or peers; social factors that deter positive mental and social growth. Also, those who do not have the financial resources or have the ability to affect a positive change within their environment, family or economic status.

Children and young adults who, through low self-esteem or poor social skills, are prone to become involved in crime, suicide, domestic abuse, drug and alcohol abuse, early pregnancy, and school absenteeism.

Facts about Adolescent Mental Health http://www.nccp.org/publications/pub_878.html
  • Approximately 20% of adolescents have a diagnosable mental health disorder.
  • Many mental health disorders first present during adolescence.
  • Between 20% and 30% of adolescents have one major depressive episode before they reach adulthood.
  • For a quarter of individuals with mood disorders like depression, these first emerge during adolescence.
  • Between 50% and 75% of adolescents with anxiety disorders and impulse control disorders (such as conduct disorder or attention-deficit/hyperactivity disorder) develop these during adolescence.
  • Suicide is the third leading cause of death in adolescents and young adults.
  • Suicide affects young people from all ages, races, genders, and socioeconomic groups, although some groups seem to have higher rates than others.
  • Older adolescents (aged 15-19) are at an increased risk for suicide (7.31/100,000).
  • Between 500,000 and one million young people aged 15 to 24 attempt suicide each year.
  • Existing mental health problems become increasingly complex and intense as children transition into adolescence.
  • Untreated mental health problems among adolescents often result in negative outcomes.
  • Mental health problems may lead to poor school performance, school dropout, strained family relationships, involvement with the child welfare or juvenile justice systems, substance abuse, and engaging in risky sexual behaviors.
  • An estimated 67% to 70% of youth in the juvenile justice system have a diagnosable mental health disorder.

Mental Disorders and At-Risk Behaviors:
  • suicidal thoughts
  • addictions—drugs, pornography, alcohol
  • Depression
  • Anxiety

  • Disruptive Disorders
  • Conduct Disorder
  • ODD

  • ADHD
  • Autism Spectrum Disorder
  • PTSD
  • Schizophrenia
  • Eating Disorders
  • Bipolar Disorder


SUICIDAL THOUGHTS

Warning signs/Symptoms
It is important to take the warning signs of teen suicide seriously and to seek help if you thing that you know a teenager who might be suicidal. Here are some of the things to look for:
  • Disinterest in favorite extracurricular activities
  • Problems at work and losing interest in a job
  • Substance abuse, including alcohol and drug (illegal and legal drugs) use
  • Behavioral problems
  • Withdrawing from family and friends
  • Sleep changes
  • Changes in eating habits
  • Begins to neglect hygiene and other matters of personal appearance
  • Emotional distress brings on physical complaints (aches, fatigues, migraines)
  • Hard time concentrating and paying attention
  • Declining grades in school
  • Loss of interest in schoolwork
  • Risk taking behaviors
  • Complains more frequently of boredom
  • Does not respond as before to praise

http://www.teensuicide.us/articles2.html
Treatment
One of the most important aspects of teen suicide prevention is support. The teenager needs to know that you support and love him or her, and that you are willing to help him or her find hope in life again. One of the most effective ways to prevent teen suicide is to recognize the signs of suicidal thoughts and feelings, and seek professional help. Some of the most effective teen suicide prevention programs consist of identifying and treating the following problems:
  • Mental and learning disorders
  • Substance abuse problems
  • Problems dealing with stress
  • Behavior Problems (such as controlling aggressive and impulsive behavior)

(prognosis, teensuicide.us)

ADDICTIONS
According to Medilexicon's medical dictionary:
Addiction is Habitual psychological or physiologic dependence on a substance or practice that is beyond voluntary control.
Withdrawal has many meanings, one of which is a psychological and/or physical syndrome caused by the abrupt cessation of the use of a drug in an habituated person.

According to the current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), published by the American Psychiatric Association:
Substance dependence: When an individual persists in use of alcohol or other drugs despite problems related to use of the substance, substance dependence may be diagnosed. Compulsive and repetitive use may result in tolerance to the effect of the drug and withdrawal symptoms when use is reduced or stopped. This, along with Substance Abuse are considered Substance Use Disorders.


  • The signs and symptoms of substance dependence vary according to the individual, the substance they are addicted to, their family history (genetics), and personal circumstances.
  • The person takes the substance and cannot stop - in many cases, such as nicotine, alcohol or drug dependence, at least one serious attempt was made to give up, but unsuccessfully.
  • Withdrawal symptoms - when body levels of that substance go below a certain level the patient has physical and mood-related symptoms. There are cravings, bouts of moodiness, bad temper, poor focus, a feeling of being depressed and empty, frustration, anger, bitterness and resentment.
  • There may suddenly be increased appetite. Insomnia is a common symptom of withdrawal. In some cases the individual may have constipation or diarrhea. With some substances, withdrawal can trigger violence, trembling, seizures, hallucinations, and sweats.
  • Addiction continues despite health problem awareness - the individual continues taking the substance regularly, even though they have developed illnesses linked to it. For example, a smoker may continue smoking even after a lung or heart condition develops.
  • Social and/or recreational sacrifices - some activities are given up because of an addiction to something. For example, an alcoholic may turn down an invitation to go camping or spend a day out on a boat if no alcohol is available, a smoker may decide not to meet up with friends in a smoke-free pub or restaurant.
  • Maintaining a good supply - people who are addicted to a substance will always make sure they have a good supply of it, even if they do not have much money. Sacrifices may be made in the house budget to make sure the substance is as plentiful as possible.
  • Taking risks (1) - in some cases the addicted individual make take risks to make sure he/she can obtain his/her substance, such as stealing or trading sex for money/drugs.
  • Taking risks (2) - while under the influence of some substances the addict may engage in risky activities, such as driving fast.

  • Dealing with problems - an addicted person commonly feels they need their drug to deal with their problems.
  • Obsession - an addicted person may spend more and more time and energy focusing on ways of getting hold of their substance, and in some cases how to use it.
  • Secrecy and solitude - in many cases the addict may take their substance alone, and even in secret.
  • Denial - a significant number of people who are addicted to a substance are in denial. They are not aware (or refuse to acknowledge) that they have a problem.
  • Excess consumption - in some addictions, such as alcohol, some drugs and even nicotine, the individual consumes it to excess. The consequence can be blackouts (cannot remember chunks of time) or physical symptoms, such as a sore throat and bad persistent cough (heavy smokers).
  • Dropping hobbies and activities - as the addiction progresses the individual may stop doing things he/she used to enjoy a lot. This may even be the case with smokers who find they cannot physically cope with taking part in their favorite sport.
  • Having stashes - the addicted individual may have small stocks of their substance hidden away in different parts of the house or car; often in unlikely places.
  • Taking an initial large dose - this is common with alcoholism. The individual may gulp drinks down in order to get drunk and then feel good.
  • Having problems with the law - this is more a characteristic of some drug and alcohol addictions (not nicotine, for example). This may be either because the substance impairs judgment and the individual takes risks they would not take if they were sober, or in order to get hold of the substance they break the law.
  • Financial difficulties - if the substance is expensive the addicted individual may sacrifice a lot to make sure its supply is secured. Even cigarettes, which in some countries, such as the UK, parts of Europe and the USA cost over $11 dollars for a packet of twenty - a 40-a-day smoker in such an area will need to put aside $660 per month, nearly $8,000 per year.
  • Relationship problems - these are more common in drug/alcohol addiction.

Treatment
These typically focus on getting sober and preventing relapses. Individual, group and/or family sessions may form part of the program. Depending on the level of addiction, patient behaviors, and type of substance this may be in outpatient or residential settings.
  • Psychotherapy - there may be one-to-one (one-on-one) or family sessions with a specialist.
  • Help with coping with cravings, avoiding the substance, and dealing with possible relapses are key to effective addiction programs. If the patient’s family can become involved there is a better probability of positive outcomes.
  • Self-help groups - these may help the patient meet other people with the same problem, which often boosts motivation. Self-help groups can be a useful source of education and information too. Examples include Alcoholics Anonymous and Narcotics Anonymous. For those dependent on nicotine, ask your doctor or nurse for information on local self-help groups.
  • Help with withdrawal symptoms – the main aim is usually to get the addictive substance out of the patient’s body as quickly as possible. Sometimes the addict is given gradually reduced dosages (tapering). In some cases a substitute substance is given. Depending on what the person is addicted to, as well as some other factors, the doctor may recommend treatment either as an outpatient or inpatient.



DEPRESSION
Symptoms
  • Persistent sad and irritable mood
  • Loss of interest or pleasure in activities once enjoyed
  • Significant change in appetite and body weight
  • Difficulty sleeping or oversleeping
  • Physical signs of agitation or excessive lethargy and loss of energy
  • Feelings of worthlessness or inappropriate guilt
  • Difficulty concentrating
  • Recurrent thoughts of death or suicide

Treatment
  • Develop a caring, supportive school environment for
children, parents, and faculty.
  • Ensure that every child and parent feels welcome in the school.
  • Prevent all forms of bullying as a vigorously enforced school policy.
  • Establish clear rules and publicize and enforce them fairly and consistently.
  • Have suicide and violence prevention plans in place and
implement them.
  • Have specific plans for dealing with the media, parents,
faculty, and students in the aftermath of suicide, school
violence, or natural disaster.
  • Break the conspiracy of silence (making it clear that it is
the duty of every student to report any threat of violence
or suicide to a responsible adult).
  • Ensure that at least one responsible adult in the school
takes a special interest in each student.
  • Emphasize and facilitate home–school collaboration.
  • Train faculty and parents to recognize the risk factors and
warning signs of depression.
  • Train faculty and parents in appropriate interventions for
students suspected of being depressed.
  • Utilize the expertise of mental health professionals in the
school (school psychologists, school social workers, and
school counselors) in planning prevention and
intervention, as well as in training others.


ANXIETY
  • Generalized anxiety disorder: This disorder involves excessive, unrealistic worry and tension, even if there is little or nothing to provoke the anxiety.



Symptoms vary depending on the type of anxiety disorder, but general symptoms include:
  • Feelings of panic, fear, and uneasiness
  • Uncontrollable, obsessive thoughts
  • Repeated thoughts or flashbacks of traumatic experiences

  • Nightmares

  • Ritualistic behaviors, such as repeated hand washing
  • Problems sleeping

  • Cold or sweaty hands and/or feet

  • Shortness of breath
  • Palpitations
  • An inability to be still and calm
  • Dry mouth
  • Numbness or tingling in the hands or feet
  • Nausea
  • Muscle tension
  • Dizziness

Treatment:
Fortunately, much progress has been made in the last two decades in the treatment of people with mental illnesses, including anxiety disorders. Although the exact treatment approach depends on the type of disorder, one or a combination of the following therapies may be used for most anxiety disorders:
  • Medication: Drugs used to reduce the symptoms of anxiety disorders include anti-depressants and anxiety-reducing drugs.
  • Psychotherapy: Psychotherapy (a type of counseling) addresses the emotional response to mental illness. It is a process in which trained mental health professionals help people by talking through strategies for understanding and dealing with their disorder.
  • Cognitive-behavioral therapy: People suffering from anxiety disorders often participate in this type of psychotherapy in which the person learns to recognize and change thought patterns and behaviors that lead to troublesome feelings.
  • Dietary and lifestyle changes
  • Relaxation therapy

http://www.medicalnewstoday.com/info/addiction/treatment-for-addiction.php

CONDUCT DISORDER

Children and adolescents with this disorder have great difficulty following rules and behaving in a socially acceptable way. They are often viewed by other children, adults and social agencies as "bad" or delinquent, rather than mentally ill. Many factors may contribute to a child developing conduct disorder, including brain damage, child abuse or neglect, genetic vulnerability, school failure, and traumatic life experiences.


Signs and Symptoms:
  • Aggression to people and animals
    • bullies, threatens or intimidates others
    • often initiates physical fights
    • has used a weapon that could cause serious physical harm to others (e.g. a bat, brick, broken bottle, knife or gun)
    • is physically cruel to people or animals
    • steals from a victim while confronting them (e.g. assault)
    • forces someone into sexual activity
  • Destruction of Property
    • deliberately engaged in fire setting with the intention to cause damage
    • deliberately destroys other's property

  • Deceitfulness, lying, or stealing
    • has broken into someone else's building, house, or car
    • lies to obtain goods, or favors or to avoid obligations
    • steals items without confronting a victim (e.g. shoplifting, but without breaking and entering)
  • Serious violations of rules
    • often stays out at night despite parental objections
    • runs away from home
    • often truant from school

Treatment:
Treatment for conduct disorder is based on many factors, including the child's age, the severity of symptoms, as well as the child's ability to participate in and tolerate specific therapies. Treatment usually consists of a combination of the following:
  • Psychotherapy: is aimed at helping the child learn to express and control anger in more appropriate ways. A type of therapy called cognitive-behavioral therapy aims to reshape the child's thinking (cognition) to improve problem solving skills, anger management, moral reasoning skills, and impulse control. Family therapy may be used to help improve family interactions and communication among family members. A specialized therapy technique called parent management training (PMT) teaches parents ways to positively alter their child's behavior in the home.
  • Medication: Although there is no medication formally approved to treat conduct disorder, various drugs may be used to treat some of its distressing symptoms, as well as any other mental illnesses that may be present, such as ADHD or major depression.


http://www.webmd.com/mental-health/mental-health-conduct-disorder?page=2


ODD
In children with Oppositional Defiant Disorder (ODD), there is an ongoing pattern of uncooperative, defiant, and hostile behavior toward authority figures that seriously interferes with the youngster’s day to day functioning.
Symptoms:
  • Frequent temper tantrums
  • Excessive arguing with adults
  • Often questioning rules
  • Active defiance and refusal to comply with adult requests and rules
  • Deliberate attempts to annoy or upset people
  • Blaming others for his or her mistakes or misbehavior
  • Often being touchy or easily annoyed by others
  • Frequent anger and resentment
  • Mean and hateful talking when upset
  • Spiteful attitude and revenge seeking

Treatment:
  • parenting modification strategies
  • social and emotional skills training for children
  • in some cases, the addition of medication to the therapy plan
  • Working with your clinician, you can make a difference for your child by learning and using new:
  • communication skills
  • parenting skills
  • conflict resolution skills
  • anger management skills




ADHD
It is normal for children to have trouble focusing and behaving at one time or another. However, children with ADHD do not just grow out of these behaviors. The symptoms continue and can cause difficulty at school, at home, or with friends.


Symptoms:
  • have a hard time paying attention
  • daydream a lot
  • not seem to listen
  • be easily distracted from schoolwork or play
  • forget things
  • be in constant motion or unable to stay seated
  • squirm or fidget
  • talk too much
  • not be able to play quietly
  • act and speak without thinking
  • have trouble taking turns
  • interrupt others


Types

There are three different types of ADHD, depending on which symptoms are strongest in the individual:

  • Predominantly Inattentive Type: It is hard for the individual to organize or finish a task, to pay attention to details, or to follow instructions or conversations. The person is easily distracted or forgets details of daily routines.
  • Predominantly Hyperactive-Impulsive Type: The person fidgets and talks a lot. It is hard to sit still for long (e.g., for a meal or while doing homework). Smaller children may run, jump or climb constantly. The individual feels restless and has trouble with impulsivity. Someone who is impulsive may interrupt others a lot, grab things from people, or speak at inappropriate times. It is hard for the person to wait their turn or listen to directions. A person with impulsiveness may have more accidents and injuries than others.
  • Combined Type: Symptoms of the above two types are equally present in the person.


Treatment

  • Stimulant and Non-stimulant medications





AUTISM SPECTRUM DISORDER
Types:
  • Autistic Disorder (also called "classic" autism)
This is what most people think of when hearing the word "autism." People with autistic disorder usually have significant language delays, social and communication challenges, and unusual behaviors and interests. Many people with autistic disorder also have intellectual disability.
  • Asperger Syndrome
People with Asperger syndrome usually have some milder symptoms of autistic disorder. They might have social challenges and unusual behaviors and interests. However, they typically do not have problems with language or intellectual disability.
  • Pervasive Developmental Disorder – Not Otherwise Specified(PDD-NOS; also called "atypical autism")
People who meet some of the criteria for autistic disorder or Asperger syndrome, but not all, may be diagnosed with PDD-NOS. People with PDD-NOS usually have and milder symptoms than those with autistic disorder. The symptoms might cause only social and communication challenges.

Signs and Symptoms


  • ASDs begin before the age of 3 and last throughout a person's life, although symptoms may improve over time. Some children with an ASD show hints of future problems within the first few months of life. In others, symptoms might not show up until 24 months or later. Some children with an ASD seem to develop normally until around 18 to 24 months of age and then they stop gaining new skills, or they lose the skills they once had.
A person with an ASD might:
  • Not respond to their name by 12 months
  • Not point at objects to show interest (point at an airplane flying over) by 14 months

  • Not play "pretend" games (pretend to "feed" a doll) by 18 months
  • Avoid eye contact and want to be alone
  • Have trouble understanding other people's feelings or talking about their own feelings
  • Have delayed speech and language skills
  • Repeat words or phrases over and over (echolalia)
  • Give unrelated answers to questions
  • Get upset by minor changes
  • Have obsessive interests
  • Flap their hands, rock their body, or spin in circles
  • Have unusual reactions to the way things sound, smell, taste, look, or feel

Treatment:

There is no cure for ASDs. Therapies and behavioral interventions are designed to remedy specific symptoms and can bring about substantial improvement. The ideal treatment plan coordinates therapies and interventions that meet the specific needs of individual children. Most health care professionals agree that the earlier the intervention, the better.
  • Educational/behavioral interventions: Therapists use highly structured and intensive skill-oriented training sessions to help children develop social and language skills, such as Applied Behavioral Analysis. Family counseling for the parents and siblings of children with an ASD often helps families cope with the particular challenges of living with a child with an ASD.
  • Medications: Doctors may prescribe medications for treatment of specific autism-related symptoms, such as anxiety, depression, or obsessive-compulsive disorder. Antipsychotic medications are used to treat severe behavioral problems. Seizures can be treated with one or more anticonvulsant drugs. Medication used to treat people with attention deficit disorder can be used effectively to help decrease impulsivity and hyperactivity.
  • Other therapies: There are a number of controversial therapies or interventions available, but few, if any, are supported by scientific studies. Parents should use caution before adopting any unproven treatments. Although dietary interventions have been helpful in some children, parents should be careful that their child’s nutritional status is carefully followed.




POST TRAUMATIC STRESS DISORDER
Post-traumatic stress disorder symptoms typically start within three months of a traumatic event. In a small number of cases, though, PTSD symptoms may not appear until years after the event.
Post-traumatic stress disorder symptoms are generally grouped into three types: intrusive memories, avoidance and numbing, and increased anxiety or emotional arousal (hyperarousal).
Symptoms:
  • Flashbacks, or reliving the traumatic event for minutes or even days at a time
  • Upsetting dreams about the traumatic event
  • Symptoms of avoidance and emotional numbing may include:
  • Trying to avoid thinking or talking about the traumatic event
  • Feeling emotionally numb
  • Avoiding activities you once enjoyed
  • Hopelessness about the future
  • Memory problems
  • Trouble concentrating
  • Difficulty maintaining close relationships
  • Symptoms of anxiety and increased emotional arousal may include:
  • Irritability or anger
  • Overwhelming guilt or shame
  • Self-destructive behavior, such as drinking too much
  • Trouble sleeping
  • Being easily startled or frightened
  • Hearing or seeing things that aren't there
Post-traumatic stress disorder symptoms can come and go. You may have more post-traumatic stress disorder symptoms when things are stressful in general, or when you run into reminders of what you went through. You may hear a car backfire and relive combat experiences, for instance. Or you may see a report on the news about a rape and feel overcome by memories of your own assault.


Treatment:
Post-traumatic stress disorder treatment often includes both medication and psychotherapy. Combining these treatments can help improve your symptoms and teach you skills to cope better with the traumatic event — and life beyond it.
  • Medications
  • Several types of medications can help symptoms of post-traumatic stress disorder improve.
  • Antipsychotics.In some cases, you may be prescribed a short course of antipsychotics to relieve severe anxiety and related problems, such as difficulty sleeping or emotional outbursts.
  • Antidepressants. These medications can help symptoms of both depression and anxiety. They can also help improve sleep problems and improve your concentration. The selective serotonin reuptake inhibitor (SSRI) medications sertraline (Zoloft) and paroxetine (Paxil) are FDA-approved for the treatment of PTSD.
  • Anti-anxiety medications. These drugs also can improve feelings of anxiety and stress.
  • Psychotherapy
  • Cognitive therapy. This type of talk therapy helps you recognize the ways of thinking (cognitive patterns) that are keeping you stuck — for example, negative or inaccurate ways of perceiving normal situations.
  • In PTSD treatment, cognitive therapy often is used along with a behavioral therapy called exposure therapy.
  • Exposure therapy. This behavioral therapy technique helps you safely face the very thing that you find frightening, so that you can learn to cope with it effectively. A new approach to exposure therapy uses "virtual reality" programs that allow you to re-enter the setting in which you experienced trauma — for example, a "Virtual Iraq" program.
  • Eye movement desensitization and reprocessing (EMDR). This type of therapy combines exposure therapy with a series of guided eye movements that help you process traumatic memories.
  • All these approaches can help you gain control of lasting fear after a traumatic event. The type of therapy that may be best for you depends on a number of factors that you and your health care professional can discuss.
  • Medications and psychotherapy also can help you if you've developed other problems related to your traumatic experience, such as depression, anxiety, or alcohol or substance abuse. You don't have to try to handle the burden of PTSD on your own.
SCHIZOPHRENIA

Symptoms:

There are five types of symptoms characteristic of schizophrenia: delusions, hallucinations, disorganized speech, disorganized behavior, and the so-called “negative” symptoms. However, the signs and symptoms of schizophrenia vary dramatically from person to person, both in pattern and severity. Not every person with schizophrenia will have all symptoms, and the symptoms of schizophrenia may also change over time.

Delusions

  • A delusion is a firmly-held idea that a person has despite clear and obvious evidence that it isn’t true. Delusions are extremely common in schizophrenia, occurring in more than 90% of those who have the disorder. Often, these delusions involve illogical or bizarre ideas or fantasies. Common schizophrenic delusions include:
  • Delusions of persecution – Belief that others, often a vague “they,” are out to get him or her. These persecutory delusions often involve bizarre ideas and plots (e.g. “Martians are trying to poison me with radioactive particles delivered through my tap water”).

  • Delusions of reference – A neutral environmental event is believed to have a special and personal meaning. For example, a person with schizophrenia might believe a billboard or a person on TV is sending a message meant specifically for them.
  • Delusions of grandeur – Belief that one is a famous or important figure, such as Jesus Christ or Napolean. Alternately, delusions of grandeur may involve the belief that one has unusual powers that no one else has (e.g. the ability to fly).
  • Delusions of control – Belief that one’s thoughts or actions are being controlled by outside, alien forces. Common delusions of control include thought broadcasting (“My private thoughts are being transmitted to others”), thought insertion (“Someone is planting thoughts in my head”), and thought withdrawal (“The CIA is robbing me of my thoughts”).

Hallucinations

  • Hallucinations are sounds or other sensations experienced as real when they exist only in the person's mind. While hallucinations can involve any of the five senses, auditory hallucinations (e.g. hearing voices or some other sound) are most common in schizophrenia. Visual hallucinations are also relatively common. Research suggests that auditory hallucinations occur when people misinterpret their own inner self-talk as coming from an outside source.
  • Schizophrenic hallucinations are usually meaningful to the person experiencing them. Many times, the voices are those of someone they know. Most commonly, the voices are critical, vulgar, or abusive. Hallucinations also tend to be worse when the person is alone.

Disorganized speech

  • Fragmented thinking is characteristic of schizophrenia. Externally, it can be observed in the way a person speaks. People with schizophrenia tend to have trouble concentrating and maintaining a train of thought. They may respond to queries with an unrelated answer, start sentences with one topic and end somewhere completely different, speak incoherently, or say illogical things.
Common signs of disorganized speech in schizophrenia include:
  • Loose associations – Rapidly shifting from topic to topic, with no connection between one thought and the next.
  • Neologisms – Made-up words or phrases that only have meaning to the patient.
  • Perseveration – Repetition of words and statements; saying the same thing over and over.
  • Clang – Meaningless use of rhyming words (“I said the bread and read the shed and fed Ned at the head").

Disorganized behavior

  • Schizophrenia disrupts goal-directed activity, causing impairments in a person’s ability to take care of him or herself, work, and interact with others. Disorganized behavior appears as:
  • A decline in overall daily functioning
  • Unpredictable or inappropriate emotional responses
  • Behaviors that appear bizarre and have no purpose
  • Lack of inhibition and impulse control

Negative symptoms (absence of normal behaviors)

  • The so-called “negative” symptoms of schizophrenia refer to the absence of normal behaviors found in healthy individuals. Common negative symptoms of schizophrenia include:
  • Lack of emotional expression –Inexpressive face, including a flat voice, lack of eye contact, and blank or restricted facial expressions.
  • Lack of interest or enthusiasm – Problems with motivation; lack of self-care.
  • Seeming lack of interest in the world – Apparent unawareness of the environment; social withdrawal.
  • Speech difficulties and abnormalities – Inability to carry a conversation; short and sometimes disconnected replies to questions; speaking in monotone.

Types of schizophrenia

There are three major subtypes of schizophrenia, each classified by their most prominent symptom:
  • paranoid schizophrenia
  • disorganized schizophrenia
  • catatonic schizophrenia

Signs and symptoms of paranoid schizophrenia

The defining feature of paranoid schizophrenia is absurd or suspicious ideas and beliefs. These ideas typically revolve around a coherent, organized theme or “story” that remains consistent over time. Delusions of persecution are the most frequent theme, however delusions of grandeur are also common.

People with paranoid schizophrenia show a history of increasing paranoia and difficulties in their relationships. They tend to function better than individuals with other schizophrenic subtypes. In contrast, their thinking and behavior is less disordered and their long-term prognosis is better.

Signs and symptoms of disorganized schizophrenia

  • Disorganized schizophrenia generally appears at an earlier age than other types of schizophrenia. Its onset is gradual, rather than abrupt, with the person gradually retreating into his or her fantasies.
  • The distinguishing characteristics of this subtype are disorganized speech, disorganized behavior, and blunted or inappropriate emotions. People with disorganized schizophrenia also have trouble taking care of themselves, and may be unable to perform simple tasks such as bathing or feeding themselves.
  • The symptoms of disorganized schizophrenia include:
Impaired communication skills
Incomprehensible or illogical speech
Inappropriate reactions (e.g. laughing at a funeral)
Emotional indifference
Infantile behavior (baby talk, giggling)
Peculiar facial expressions and mannerisms


People with disorganized schizophrenia sometimes suffer from hallucinations and delusions, but unlike the paranoid subtype, their fantasies aren’t consistent or organized.

Signs and symptoms of catatonic schizophrenia

  • The hallmark of catanoic schizophrenia is a disturbance in movement: either a decrease in motor activity, reflecting a stuporous state, or an increase in motor activity, reflecting an excited state.
Stuporous motor signs. The stuporous state reflects a dramatic reduction in activity. The person often ceases all voluntary movement and speech, and may be extremely resistant to any change in his or her position, even to the point of holding an awkward, uncomfortable position for hours.
Excited motor signs. Sometimes, people with catatonic schizophrenia pass suddenly from a state of stupor to a state of extreme excitement. During this frenzied episode, they may shout, talk rapidly, pace back and forth, or act out in violence—either toward themselves or others.

  • People with catatonic schizophrenia can be highly suggestible. They may automatically obey commands, imitate the actions of others, or mimic what others say.

Treatment
Antipsychotic drugs aren’t the only treatment people with schizophrenia need. Psychotherapy and support are also key.
With proper treatment, some individuals with schizophrenia can recover.
About a quarter of young people with schizophrenia who get treatment get better within six months to two years, research has found.
Another 35 to 40 percent see significant improvements in their symptoms after longer-term treatment—enough to let them live relatively normal lives outside hospitals with only minor symptoms.
Antipsychotic drugs play a crucial role in treatment. These drugs don’t cure schizophrenia. Instead, they reduce symptoms such as delusions and hallucinations.
The drugs can have side effects, such as physical agitation and muscle spasms. In addition, their long-term use causes permanent neurological damage.
Reduced symptoms don’t necessarily mean individuals are able to function effectively outside a hospital, however.
Psychosocial support can help make that possible.
Psychotherapy can help individuals learn how to function in appropriate, effective and satisfying ways. By teaching individuals how to cope, psychotherapy can help people overcome dysfunction and regain their lives.
Individuals may also need training in social skills or vocational counseling and job training.

Family education, family psychotherapy and self-help groups are also beneficial.


EATING DISORDERS

Eating disorders -- such as anorexia, bulimia, and binge eating disorder – include extreme emotions, attitudes, and behaviors surrounding weight and food issues. Eating disorders are serious emotional and physical problems that can have life-threatening consequences for females and males. Click on the links below to learn more about the different types of eating disorders and their symptoms.

Anorexia Nervosa

Anorexia nervosa is a serious, potentially life-threatening eating disorder characterized by self-starvation and excessive weight loss.
Symptoms

  • Resistance to maintaining body weight at or above a minimally normal weight for age and height.
  • Intense fear of weight gain or being “fat,” even though underweight.
  • Disturbance in the experience of body weight or shape, undue influence of weight or shape on self-evaluation, or denial of the seriousness of low body weight.
  • Loss of menstrual periods in girls and women post-puberty.
Eating disorders experts have found that prompt intensive treatment significantly improves the chances of recovery.  Therefore, it is important to be aware of some of the warning signs of anorexia nervosa.
Warning Signs
  • Dramatic weight loss.
  • Preoccupation with weight, food, calories, fat grams, and dieting.
  • Refusal to eat certain foods, progressing to restrictions against whole categories of food (e.g. no carbohydrates, etc.).
  • Frequent comments about feeling “fat” or overweight despite weight loss.
  • Anxiety about gaining weight or being “fat.”
  • Denial of hunger.
  • Development of food rituals (e.g. eating foods in certain orders, excessive chewing, rearranging food on a plate).

  • Consistent excuses to avoid mealtimes or situations involving food.

  • Excessive, rigid exercise regimen--despite weather, fatigue, illness, or injury, the need to “burn off” calories taken in.

  • Withdrawal from usual friends and activities.

  • In general, behaviors and attitudes indicating that weight loss, dieting, and control of food are becoming primary concerns.
Health Consequences of Anorexia Nervosa
Anorexia nervosa involves self-starvation.; The body is denied the essential nutrients it needs to function normally, so it is forced to slow down all of its processes to conserve energy. This “slowing down” can have serious medical consequences:

  • Abnormally slow heart rate and low blood pressure, which mean that the heart muscle is changing.  The risk for heart failure rises as heart rate and blood pressure levels sink lower and lower.

  • Reduction of bone density (osteoporosis), which results in dry, brittle bones.

  • Muscle loss and weakness.

  • Severe dehydration, which can result in kidney failure.

  • Fainting, fatigue, and overall weakness.
  • Dry hair and skin, hair loss is common.
  • Growth of a downy layer of hair called lanugo all over the body, including the face, in an effort to keep the body warm.
About Anorexia Nervosa
Approximately 90-95% of anorexia nervosa sufferers are girls and women.
Between 0.5–1% of American women suffer from anorexia nervosa.
Anorexia nervosa is one of the most common psychiatric diagnoses in young women.
Between 5-20% of individuals struggling with anorexia nervosa will die.  The probabilities of death increases within that range depending on the length of the condition.
Anorexia nervosa has one of the highest death rates of any mental health condition.
Anorexia nervosa typically appears in early to mid-adolescence.

Binge Eating Disorder

Binge Eating Disorder (BED) is a type of eating disorder not otherwise specified and is characterized by recurrent binge eating without the regular use of compensatory measures to counter the binge eating.
Symptoms
  • Frequent episodes of eating large quantities of food in short periods of time.
  • Feeling out of control over eating behavior during the episode.

  • Feeling depressed, guilty, or disgusted by the behavior.

There are also several behavioral indicators of BED including eating when not hungry, eating alone because of embarrassment over quantities consumed, eating until uncomfortably full.
Health Consequences of Binge Eating Disorder
The health risks of BED are most commonly those associated with clinical obesity.  Some of the potential health consequences of binge eating disorder include:
  • High blood pressure
  • High cholesterol levels
  • Heart disease
  • Diabetes mellitus
  • Gallbladder disease
  • Musculoskeletal problems

About Binge Eating Disorder

  • The prevalence of BED is estimated to be approximately 1-5% of the general population.
  • Binge eating disorder affects women slightly more often than men--estimates indicate that about 60% of people struggling with binge eating disorder are female, 40% are male
  • People who struggle with binge eating disorder can be of normal or heavier than average weight.
  • BED is often associated with symptoms of depression.
  • People struggling with binge eating disorder often express distress, shame, and guilt over their eating behaviors.
  • People with binge eating disorder report a lower quality of life than non-binge eating disorder.

Bulimia Nervosa

Bulimia nervosa is a serious, potentially life-threatening eating disorder characterized by a cycle of bingeing and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of binge eating.
Symptoms
  • Regular intake of large amounts of food accompanied by a sense of loss of control over eating behavior.
  • Regular use of inappropriate compensatory behaviors such as self-induced vomiting, laxative or diuretic abuse, fasting, and/or obsessive or compulsive exercise.
  • Extreme concern with body weight and shape.
The chance for recovery increases the earlier bulimia nervosa is detected. Therefore, it is important to be aware of some of the warning signs of bulimia nervosa.
Warning Signs of Bulimia Nervosa
  • Evidence of binge eating, including disappearance of large amounts of food in short periods of time or finding wrappers and containers indicating the consumption of large amounts of food.
  • Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics.
  • Excessive, rigid exercise regimen--despite weather, fatigue, illness, or injury, the compulsive need to “burn off” calories taken in.
  • Unusual swelling of the cheeks or jaw area.
  • Calluses on the back of the hands and knuckles from self-induced vomiting.
  • Discoloration or staining of the teeth.
  • Creation of lifestyle schedules or rituals to make time for binge-and-purge sessions.
  • Withdrawal from usual friends and activities.
  • In general, behaviors and attitudes indicating that weight loss, dieting, and control of food are becoming primary concerns.
  • Continued exercise despite injury; overuse injuries.
Health Consequences of Bulimia Nervosa
Bulimia nervosa can be extremely harmful to the body.  The recurrent binge-and-purge cycles can damage the entire digestive system and purging behaviors can lead to electrolyte and chemical imbalances in the body that affect the heart and other major organ functions.  Some of the health consequences of bulimia nervosa include:
  • Electrolyte imbalances that can lead to irregular heartbeats and possibly heart failure and death.  Electrolyte imbalance is caused by dehydration and loss of potassium and sodium from the body as a result of purging behaviors.
  • Inflammation and possible rupture of the esophagus from frequent vomiting.
  • Tooth decay and staining from stomach acids released during frequent vomiting.
  • Chronic irregular bowel movements and constipation as a result of laxative abuse.
- Gastric rupture is an uncommon but possible side effect of binge eating.
About Bulimia Nervosa
  • Bulimia nervosa affects 1-2% of adolescent and young adult women.
  • Approximately 80% of bulimia nervosa patients are female.
  • People struggling with bulimia nervosa usually appear to be of average body weight.
  • Many people struggling with bulimia nervosa recognize that their behaviors are unusual and perhaps dangerous to their health.
  • Bulimia nervosa is frequently associated with symptoms of depression and changes in social adjustment.
  • Risk of death from suicide or medical complications is markedly increased for eating disorders

Eating Disorder Not Otherwise Specified (EDNOS)

Eating disorders such as anorexia and bulimia include extreme emotions, attitudes, and behaviors surrounding weight and food issues.  They are serious disorders and can have life-threatening consequences. The same is true for a category of eating disorders known as eating disorders not otherwise specified or EDNOS. These serious eating disorders can include any combination of signs and symptoms typical of anorexia and bulimia, so it may be helpful to first look at anorexia and bulimia.
Symptoms associated with anorexia nervosa include:
  • Refusal to maintain body weight at or above a minimally normal weight for  height, body type, age, and activity level
  • Intense fear of weight gain or being “fat”
  • Feeling “fat” or overweight despite dramatic weight loss
  • Loss of menstrual periods
  • Extreme concern with body weight and shape
Symptoms associated with bulimia nervosa include:
  • Repeated episodes of bingeing and purging
  • Feeling out of control during a binge and eating beyond the point of comfortable fullness
  • Purging after a binge, (typically by self-induced vomiting, abuse of laxatives, diet pills and/or diuretics, excessive exercise, or fasting)
  • Frequent dieting
  • Extreme concern with body weight and shape
The following are some common examples of eating disorders not otherwise specified, but your experience may be different. If you are concerned about your eating and exercise habits and your thoughts and emotions concerning food, activity and body image, we urge you to consult an ED expert.
Examples of EDNOS
  • Menstruation is still occurring despite meeting all other criteria for anorexia nervosa.
  • All conditions are present to qualify for anorexia nervosa except the individual's current weight is in the normal range or above.
  • Purging or other compensatory behaviors are not occurring at a frequency less than the strict criteria for bulimia nervosa
  • Purging without Binging—sometimes known as purging disorder
  • Chewing and spitting out large amounts of food but not swallowing
The commonality in all of these conditions is the serious emotional and psychological suffering and/or serious problems in areas of work, school or relationships. If something does not seem right, but your experience does not fall into a clear category, you still deserve attention.

Treating an Eating Disorder

Treatment is available. Recovery is possible.
  • Eating disorders are serious health conditions that can be both physically and emotionally destructive.
  • People with eating disorders need to seek professional help.
  • Early diagnosis and intervention significantly enhance recovery.
  • Eating disorders can become chronic, debilitating, and even life-threatening conditions.
What Does Treatment Involve?
The most effective and long-lasting treatment for an eating disorder is some form of psychotherapy or counseling, coupled with careful attention to medical and nutritional needs.  Some medications have been shown to be helpful.  Ideally, whatever treatment is offered should be tailored to the individual; this will vary according to both the severity of the disorder and the patient’s individual problems, needs and strengths.
Recommended care is provided by multidisciplinary team including but not limited to a psychologist, psychiatrist, social worker, nutritionist, and/or primary care physician.
Care should be coordinated and provided by a health professional with expertise and experience in dealing with eating disorders.
Treatment must address the eating disorder symptoms and medical consequences, as well as psychological, biological, interpersonal and cultural forces that contribute to or maintain the eating disorder.  Nutritional counseling is also necessary and should incorporate education about nutritional needs, as well as planning for and monitoring rational choices by the individual patient.
Many people with eating disorders respond to outpatient therapy, including individual, group or family therapy and medical management by their primary care provider.  Support groups, nutrition counseling, and psychiatric medications administered under careful medical supervision have also proven helpful for some individuals. Family Based Treatment is a well-established method for families with minors.
Inpatient care (including hospitalization and/or residential care in an eating disorders specialty unit or facility) is necessary when an eating disorder has led to physical problems that may be life threatening, or when an eating disorder is causing severe psychological or behavioral problems.  Inpatient stays typically require a period of outpatient follow-up and aftercare to address underlying issues in the individual’s eating disorder.
The exact treatment needs of each individual will vary.  It is important for individuals struggling with an eating disorder to find a health professional they trust to help coordinate and oversee their care.




BIPOLAR DISORDER

Bipolar disorder is a serious mental illness in which common emotions become intensely and often unpredictably magnified. Individuals with bipolar disorder can quickly swing from extremes of happiness, energy and clarity to sadness, fatigue and confusion. These shifts can be so devastating that individuals may choose suicide.
All people with bipolar disorder have manic episodes — abnormally elevated or irritable moods that last at least a week and impair functioning. But not all become depressed.


Bipolar disorder

Manic depression; Bipolar affective disorder
Bipolar disorder is a condition in which people go back and forth between periods of a very good or irritable mood and depression. The "mood swings" between mania and depression can be very quick.

Causes, incidence, and risk factors

Bipolar disorder affects men and women equally. It usually starts between ages 15 - 25. The exact cause is unknown, but it occurs more often in relatives of people with bipolar disorder.
Types of bipolar disorder:
  • People with bipolar disorder type I have had at least one manic episode and periods of major depression. In the past, bipolar disorder type I was called manic depression.
  • People with bipolar disorder type II have never had full mania. Instead they experience periods of high energy levels and impulsiveness that are not as extreme as mania (called hypomania). These periods alternate with episodes of depression.
  • A mild form of bipolar disorder called cyclothymia involves less severe mood swings. People with this form alternate between hypomania and mild depression. People with bipolar disorder type II or cyclothymia may be wrongly diagnosed as having depression.
In most people with bipolar disorder, there is no clear cause for the manic or depressive episodes. The following may trigger a manic episode in people with bipolar disorder:
  • Life changes such as childbirth
  • Medications such as antidepressants or steroids
Periods of sleeplessness
  • Recreational drug use

Symptoms

The manic phase may last from days to months. It can include the following symptoms:
  • Easily distracted

  • Little need for sleep
  • Poor judgment
  • Poor temper control

  • Reckless behavior and lack of self control
    • Poor judgment
    • Sex with many partners (promiscuity)
    • Spending sprees

  • Very elevated mood

    • Excess activity (hyperactivity)
    • Increased energy
    • Racing thoughts
    • Talking a lot
    • Very high self-esteem (false beliefs about self or abilities)

  • Very involved in activities

  • Very upset (agitated or irritated)
These symptoms of mania occur with bipolar disorder I. In people with bipolar disorder II, the symptoms of mania are similar but less intense.
The depressed phase of both types of bipolar disorder includes the following symptoms:

  • Daily low mood or sadness

  • Difficulty concentrating, remembering, or making decisions

  • Eating problems

    • Loss of appetite and weight loss
    • Overeating and weight gain

  • Fatigue or lack of energy

  • Feeling worthless, hopeless, or guilty

  • Loss of pleasure in activities once enjoyed
  • Loss of self-esteem

  • Thoughts of death and suicide

  • Trouble getting to sleep or sleeping too much

  • Pulling away from friends or activities that were once enjoyed
There is a high risk of suicide with bipolar disorder. Patients may abuse alcohol or other substances, which can make the symptoms and suicide risk worse.
Sometimes the two phases overlap. Manic and depressive symptoms may occur together or quickly one after the other in what is called a mixed state.

Signs and tests

Many factors are involved in diagnosing bipolar disorder. The health care provider may do some or all of the following:
  • Ask about your family medical history, such as whether anyone has or had bipolar disorder
  • Ask about your recent mood swings and for how long you've had them
  • Perform a thorough examination to look for illnesses that may be causing the symptoms
  • Run laboratory tests to check for thyroid problems or drug levels
  • Talk to your family members about your behavior
  • Take a medical history, including any medical problems you have and any medications you take
  • Watch your behavior and mood
Note: Drug use may cause some symptoms. However, it does not rule out bipolar affective disorder. Drug abuse may be a symptom of bipolar disorder.

Treatment

Periods of depression or mania return in most patients, even with treatment. The main goals of treatment are to:
  • Avoid moving from one phase to another
  • Avoid the need for a hospital stay
  • Help the patient function as well as possible between episodes
  • Prevent self-injury and suicide
  • Make the episodes less frequent and severe
The health care provider will first try to find out what may have triggered the mood episode. The provider may also look for any medical or emotional problems that might affect treatment.
The following drugs, called mood stabilizers, are usually used first:
  • Carbamazepine
  • Lamotrigine
  • Lithium
  • Valproate (valproic acid)
Other antiseizure drugs may also be tried.
Other drugs used to treat bipolar disorder include:
  • Antipsychotic drugs and anti-anxiety drugs (benzodiazepines) for mood problems
Antidepressant medications can be added to treat depression. People with bipolar disorder are more likely to have manic or hypomanic episodes if they are put on antidepressants. Because of this, antidepressants are only used in people who also take a mood stabilizer.
Electroconvulsive therapy (ECT) may be used to treat the manic or depressive phase of bipolar disorder if it does not respond to medication. ECT uses an electrical current to cause a brief seizure while the patient is under anesthesia. ECT is the most effective treatment for depression that is not relieved with medications.
Transcranial magnetic stimulation (TMS) uses high-frequency magnetic pulses to target affected areas of the brain. It is most often used after ECT.
Patients who are in the middle of manic or depressive episodes may need to stay in a hospital until their mood is stable and their behavior is under control.
Doctors are still trying to decide the best way to treat bipolar disorder in children and adolescents. Parents should consider the possible risks and benefits of treatment for their children.
SUPPORT PROGRAMS AND THERAPIES
Family treatments that combine support and education about bipolar disorder (psychoeducation) may help families cope and reduce the odds of symptoms returning. Programs that offer outreach and community support services can help people who do not have family and social support.
Important skills include:
  • Coping with symptoms that are present even while taking medications
  • Learning a healthy lifestyle, including getting enough sleep and staying away from recreational drugs
  • Learning to take medications correctly and how to manage side effects
  • Learning to watch for the return of symptoms, and knowing what to do when they return
Family members and caregivers are very important in the treatment of bipolar disorder. They can help patients find the right support services, and make sure the patient takes medication correctly.
Getting enough sleep is very important in bipolar disorder. A lack of sleep can trigger a manic episode. Therapy may be helpful during the depressive phase. Joining a support group may help bipolar disorder patients and their loved ones.
  • A patient with bipolar disorder cannot always tell the doctor about the state of the illness. Patients often have trouble recognizing their own manic symptoms.
  • Changes in mood with bipolar disorder are not predictable. It it is sometimes hard to tell whether a patient is responding to treatment or naturally coming out of a bipolar phase.
  • Treatments for children and the elderly are not well-studied.




TR FACILITIES FOR AT RISK YOUTH
Recreational Therapists work in a variety of community and clinical settings for people of all ages with physical and/or psychological disabitiies including but not limited to:
  • Psychiatric Hospitals
  • Rehabilitation Hospitals
  • Substance Abuse and Addiction Treatment Facilities
  • Skilled Nursing Facilities
  • Residential and Day treatment programs for children, adolescents, and seniors
  • School
  • Camps
  • Community Senior Centers
  • Community Recreation Centers
  • Medical Hospitals
  • Forensic Facilities (prisions, juvenile hall)
  • Private Practice
  • Wilderness Programs

No comments:

Post a Comment