CHILD AND ADOLESCENT MENTAL HEALTH
MOOD DISORDERS
Depression Generalised Anxiety Disorder Obsessive Compulsive Disorder
Common in any age group XS and disproportionate anxiety and worry that Behaviour characterised by daily
negatively impacts ADL 1) Obsessions – unwanted and uncontrolled
Ø Can be a daily basis or months at a time thoughts and intrusive images difficult for pt to
PP
ignore
2) Compulsions - repetitive actions patients feel
urged to do to avoid being anxious
• Recent significant life events (e.g. death of loved FHx Ø A+D
one, new terminal diagnosis, family divorce etc.) Ø Eating disorders
RF
Ø ADHD
Ø Phobias
• Low mood Ø Irritable Vicious cycle
•
PLUS
Anhedonia Ø
Ø
Poor concentration
Anxious Ø Obsessions ® anxiety ®compulsive
Ø Nervousness behaviour (temporarly improves anxiety)
• Suicidal ideation
Sx • Insomnia Ø Time > 6/12
• Guilt Ø Restlessness
• Low energy Ø Reduced energy
• Poor concentration Ø Impaired sleep
Ø Tension in muscles
• LoA
Comp. Ø Suicide Suicide Suicide or harm to others
Ø HEADDSSS Ø HEADDSSS Ø HEADDSSS
Ix
Ø DASS-21 Ø GAD-7
Watchful waiting and advice: Watchful waiting and advice: Ø Patient and carer education
Mild or Mild
Ø Eat healthy, adequate sleep, Ø Eat healthy, adequate sleep, Ø self=help resources
low OCD
Ø Avoid alcohol and cannabis Ø Avoid alcohol, caffeine and drugs Ø Psychologist referral
mood
Ø F/U in 2 weeks Mild Ø Check environmental triggers Psychotherapy – CBT, family therapy
(e.g. bullies, peer pressure, drugs Mod-
Psychotherapy – CBT, family therapy Ø SSRI = 10mg fluoxetine (max =
usage) severe
Ø SSRI = 10mg fluoxetine (max = 20mg)
Ø F/U in 2 weeks OCD
Mx Mod- 20mg) Ø 2nd line - sertraline, citalopram
severe Ø 2nd line - sertraline, citalopram If Psychotherapy – CBT, family therapy
responsive to Rx Ø SSRI = 10mg fluoxetine (max =
Ø Continue for 6/12 after remission Mod- 20mg)
Suicidal Admit and observe overnight severe Ø 2nd line - sertraline, citalopram
risk Ø Mental health Act 2009 If responsive to Rx
Ø Ø Continue for 6/12 after remission
EATING DISORDERS
ANOREXIA NERVOSA Bullemia Nervosa Binge Eating General Mx
Feel overweight despite evidence Normal body weight that Patient excessively Patient and carer education (key)
indicating they are normal or low weight FLUCTUATES all the time overeats usu. due to Ø MDT: Psych, paediatrician, dietician, nurses,
Ø Underweight Ø Binging psychological distress
supporting family
PP Ø Nervousness to gain weight Ø Offsetting (purging, laxatives) Ø Overweight patients Ø Self-help resources
Ø Distorted perception about wt Ø Weekly for ≥3/12 (not restrictive) Ø Counselling
Ø Exercise, purging Ø Linked to self-esteem to weight Ø CBT
Ø Restricted intake (e..g overweight = rejection) Ø Address social issues (e.g. relationships, past
• Personality disorders • Personality disorders experiences)
• OCD • OCD
RF
• Anxiety • Anxiety Medical Mx (if conservative fails)
• Girls • Girls Ø SSRI (under specialist supervision)
• XS weight loss Ø Swollen salivary glands • Planned binge Ø Admit to observe for refeeding syndrome
• Amenorrhoea (parotid and submandibular) • Eating very quickly
Ø Mouth ulcers • Eating when not Refeeding syndrome
• Lanugo hair (fine soft hair)
Ø Teeth erosion hungry or satiety Ø Eating after severe nutritional deficit
Sx • Altered mood, anxiety and Ø Russell’s sign – Calluses on • Eating in dazed Ø Lower the BMI = lower period of malnutrition
depression knuckles which have scraped state = higher the risk
across teeth Ø Eating after prolonged starvation period
Ø GORD causes cells to finally process glucose,
Ø Cardiac ® arrythmias, cardiac Obesity – T2DM proteins and fats (consuming electrolytes)
Comp.
atrophy and sudden cardiac death ®
Ø HypoTN Ø HypoK Ø o hypoMg, HypoK, hypoPO4
Ø Hypothermia (red flag) o arrythmias, HF and fluid
Ø HypoK overload
Ø Slow re-introduction (restricted calories) ®
Admit to hospital if haem unstable: via NGT, PEG or Oral
Ix Ø Postural hypoTN, bradycardia, Aim for 3-4000 calorie intake/day (1-2kg wt
hypothermia, hypoglycaemia, QT gain/week)
prolonged (low Ca, Mg, K) Ø EUC and fluid balance monitor
Ø Rapid severe wt loss Ø ECG monitor (Arrhythmias)
Ø Vit suppl. (e.g. B1, B9 and B12)
Ø Unsafe behaviour
MOOD DISORDERS
Depression Generalised Anxiety Disorder Obsessive Compulsive Disorder
Common in any age group XS and disproportionate anxiety and worry that Behaviour characterised by daily
negatively impacts ADL 1) Obsessions – unwanted and uncontrolled
Ø Can be a daily basis or months at a time thoughts and intrusive images difficult for pt to
PP
ignore
2) Compulsions - repetitive actions patients feel
urged to do to avoid being anxious
• Recent significant life events (e.g. death of loved FHx Ø A+D
one, new terminal diagnosis, family divorce etc.) Ø Eating disorders
RF
Ø ADHD
Ø Phobias
• Low mood Ø Irritable Vicious cycle
•
PLUS
Anhedonia Ø
Ø
Poor concentration
Anxious Ø Obsessions ® anxiety ®compulsive
Ø Nervousness behaviour (temporarly improves anxiety)
• Suicidal ideation
Sx • Insomnia Ø Time > 6/12
• Guilt Ø Restlessness
• Low energy Ø Reduced energy
• Poor concentration Ø Impaired sleep
Ø Tension in muscles
• LoA
Comp. Ø Suicide Suicide Suicide or harm to others
Ø HEADDSSS Ø HEADDSSS Ø HEADDSSS
Ix
Ø DASS-21 Ø GAD-7
Watchful waiting and advice: Watchful waiting and advice: Ø Patient and carer education
Mild or Mild
Ø Eat healthy, adequate sleep, Ø Eat healthy, adequate sleep, Ø self=help resources
low OCD
Ø Avoid alcohol and cannabis Ø Avoid alcohol, caffeine and drugs Ø Psychologist referral
mood
Ø F/U in 2 weeks Mild Ø Check environmental triggers Psychotherapy – CBT, family therapy
(e.g. bullies, peer pressure, drugs Mod-
Psychotherapy – CBT, family therapy Ø SSRI = 10mg fluoxetine (max =
usage) severe
Ø SSRI = 10mg fluoxetine (max = 20mg)
Ø F/U in 2 weeks OCD
Mx Mod- 20mg) Ø 2nd line - sertraline, citalopram
severe Ø 2nd line - sertraline, citalopram If Psychotherapy – CBT, family therapy
responsive to Rx Ø SSRI = 10mg fluoxetine (max =
Ø Continue for 6/12 after remission Mod- 20mg)
Suicidal Admit and observe overnight severe Ø 2nd line - sertraline, citalopram
risk Ø Mental health Act 2009 If responsive to Rx
Ø Ø Continue for 6/12 after remission
EATING DISORDERS
ANOREXIA NERVOSA Bullemia Nervosa Binge Eating General Mx
Feel overweight despite evidence Normal body weight that Patient excessively Patient and carer education (key)
indicating they are normal or low weight FLUCTUATES all the time overeats usu. due to Ø MDT: Psych, paediatrician, dietician, nurses,
Ø Underweight Ø Binging psychological distress
supporting family
PP Ø Nervousness to gain weight Ø Offsetting (purging, laxatives) Ø Overweight patients Ø Self-help resources
Ø Distorted perception about wt Ø Weekly for ≥3/12 (not restrictive) Ø Counselling
Ø Exercise, purging Ø Linked to self-esteem to weight Ø CBT
Ø Restricted intake (e..g overweight = rejection) Ø Address social issues (e.g. relationships, past
• Personality disorders • Personality disorders experiences)
• OCD • OCD
RF
• Anxiety • Anxiety Medical Mx (if conservative fails)
• Girls • Girls Ø SSRI (under specialist supervision)
• XS weight loss Ø Swollen salivary glands • Planned binge Ø Admit to observe for refeeding syndrome
• Amenorrhoea (parotid and submandibular) • Eating very quickly
Ø Mouth ulcers • Eating when not Refeeding syndrome
• Lanugo hair (fine soft hair)
Ø Teeth erosion hungry or satiety Ø Eating after severe nutritional deficit
Sx • Altered mood, anxiety and Ø Russell’s sign – Calluses on • Eating in dazed Ø Lower the BMI = lower period of malnutrition
depression knuckles which have scraped state = higher the risk
across teeth Ø Eating after prolonged starvation period
Ø GORD causes cells to finally process glucose,
Ø Cardiac ® arrythmias, cardiac Obesity – T2DM proteins and fats (consuming electrolytes)
Comp.
atrophy and sudden cardiac death ®
Ø HypoTN Ø HypoK Ø o hypoMg, HypoK, hypoPO4
Ø Hypothermia (red flag) o arrythmias, HF and fluid
Ø HypoK overload
Ø Slow re-introduction (restricted calories) ®
Admit to hospital if haem unstable: via NGT, PEG or Oral
Ix Ø Postural hypoTN, bradycardia, Aim for 3-4000 calorie intake/day (1-2kg wt
hypothermia, hypoglycaemia, QT gain/week)
prolonged (low Ca, Mg, K) Ø EUC and fluid balance monitor
Ø Rapid severe wt loss Ø ECG monitor (Arrhythmias)
Ø Vit suppl. (e.g. B1, B9 and B12)
Ø Unsafe behaviour
