CME : Your SA Journal of CPD - Volume 25, Issue 5, 2007
Volume 25, Issue 5, 2007
Author Sean HatherillSource: CME : Your SA Journal of CPD 25, pp 212 –214 (2007)More Less
More and more children with chronic diseases are surviving into adolescence and adulthood.
Adolescence represents a period of increased risk for a number of psychiatric disorders.
There is an increased prevalence of psychiatric disorder in youth with chronic physical illnesses.
Emotional and behavioural problems can have a significant impact on the morbidity and mortality associated with chronic physical illness.
The rate of treatment non-adherence in this population is approximately 50%.
Adolescents with chronic physical illness are less likely to display antisocial behaviour and substance abuse, but are more likely to have experienced sexual abuse.
Author Anthony L. PillaySource: CME : Your SA Journal of CPD 25, pp 216 –218 (2007)More Less
Suicidal adolescents can evoke anxiety and even hostility in clinicians, and a calm approach will benefit the clinician, the patient and her / his family.
Depressive symptoms must be assessed early on as this helps to establish the course of the problem and its management.
Assessing suicide risk is a significant component of the initial consultation.
Levels of hopelessness and availability of support from significant others are among the useful indicators of suicide risk.
The first stage of dealing with a suicidal adolescent is crisis intervention, which involves supporting, containing and ensuring she / he knows that someone cares.
Once the crisis dissipates, intervention must be aimed at the underlying issues, which are often interpersonal conflicts.
Individual consultations with the adolescent must focus on helping her / him learn problem-solving skills.
Family sessions are also important, since they have a role to play in helping the young person.
Source: CME : Your SA Journal of CPD 25, pp 220 –223 (2007)More Less
Children and adolescents are more vulnerable to the effects of traumatic experiences than adults and are thus at an increased risk of developing adverse psychological reactions to such events.
Adolescents experience a range of traumatic situations and employ a variety of coping strategies in their attempts to manage stress.
Health care providers can play a vital role in assisting adolescents to cope with traumatic situations by assessing how adolescents deal with stressful situations and by providing them and their parents with information about coping with trauma.
Be aware that adolescents, particularly older males, have a tendency to deny general thoughts, emotions, and behaviours and tend to underreport symptoms.
An adolescent who shows signs of re-experiencing the trauma, has nightmares or flashbacks, or shows signs of anxiety or hyperarousal, should be referred to a local mental health care professional urgently.
The main features of PTSD are painful reliving of the event, avoidance, emotional numbing, and hyperarousal.
Management of adolescents with PTSD should include education about the disorder and its treatment (pharmacological and psychotherapeutic) and providing assistance with acquiring additional support from local support groups and / or social services.
Controlled treatment research with traumatised children and adolescents has lagged behind other treatment research on child psychopathology.
Ideally, all traumatised adolescents should have access to primary health care facilities where their physical and psychological needs can be addressed in the early aftermath of a traumatic experience.
Author Marian Elizabeth CampbellSource: CME : Your SA Journal of CPD 25, pp 224 –227 (2007)More Less
A non-pathologising psychodynamic understanding of adolescence can assist health professionals to communicate more effectively with teenage patients.
Adolescence is a distinct developmental period characterised by enormous physical, emotional and psychological shifts that can manifest in dramatic behavioural changes.
A hallmark of adolescence is an extreme tension of opposites in the psyche that tugs and pulls the adolescent between the safety of childhood and the developmental urges toward separation and individuality.
This tension causes psychic conflict and concomitant anxiety that the psyche deals with through defence mechanisms.
Two pertinent defence mechanisms that explain many of the overt behaviours typically seen in adolescence are 'acting out' and 'projection'.
These defences are normal and functional except when, taken to the extreme, they can cause developmental arrest.
In aid of normal human development, healthy psyches are unconsciously predisposed toward recognising authentic adults who can both 'hold' their anxieties and limit their destructive potential.
Communication always occurs on both conscious and unconscious levels simultaneously, thus health professionals need to become aware of unconscious prejudices and attitudes toward adolescents that can severely hinder effective communication.
Author Rita ThomSource: CME : Your SA Journal of CPD 25, pp 228 –230 (2007)More Less
Psychiatric disorders are common in adolescents. HIV infection and its psychiatric consequences are also common in adolescents. It is important to identify psychiatric disorders both in terms of HIV prevention and treatment.
The primary developmental task of adolescence is to establish one's identity. This results in an increasing need for independence and may result in denial of serious illness, rebellion against authority figures and questioning of facts about HIV infection and treatment.
Psychiatric disorders associated with HIV infection in adolescents include neurocognitive disorders, psychosis and depression. All these disorders may require treatment with ART as well as psychotropic medication. It is important to be aware of drug interactions and side-effects of both ART and psychotropic medications.
Common psychosocial issues in adolescents with HIV infection include adherence, disclosure, bereavement and sexuality.
Effective management of these psychosocial issues requires a collaborative approach with both the adolescent patient and his or her caregiver.
Adherence in adolescents is influenced by the extent of disclosure and acceptance of the illness, the health status of caregivers, the family environment in which the adolescent lives, and the adolescent's need for independence.
Disclosure is a process in adolescents that is dependent on the individual's developmental phase as well as family and caregiver concerns and needs in this regard.
HIV-positive adolescents may experience multiple bereavements, and these bereavements may result in significant disruption and other losses at the same time (such as loss of home, financial security and schooling).
Sexuality develops during childhood and adolescence. Caregivers are the most appropriate people to discuss sexuality with their children and adolescents but seldom feel comfortable doing so. Health care workers need to assist them in undertaking this task.
Sex education and discussions around sexuality should occur over time in the context of a trusted relationship and in the context of other developmental issues.
Author Rosanna StraussSource: CME : Your SA Journal of CPD 25, pp 232 –235 (2007)More Less
Positive psychology is a new focus in the field of mental health.
The model shifts the emphasis from merely recovering from mental illness to preventing mental illness and developing good mental health.
The theory presents a reframing of human motivation.
Adolescents can be understood differently in this framework.
They can be seen as resilient and as a resource rather than as a problem.
Interventions for adolescents can be aimed at developing specific competencies and enhancing existing abilities.
Author Lynda A . AlbertynSource: CME : Your SA Journal of CPD 25, pp 239 –240 (2007)More Less
Source: CME : Your SA Journal of CPD 25, pp 245 –247 (2007)More Less
With the exception of clozapine, 'atypical' antipsychotics have not been shown to represent major gains in effectiveness.
There are growing concerns about potential adverse long-term health consequences of the atypical antipsychotics, notably weight gain, diabetes, hyperlipidaemia and hyperprolactinaemia.
Children and adolescents may be particularly vulnerable to antipsychotic adverse effects.
It is rational to consider both older and 'atypical' antipsychotics for clinical use, based on the risk profile of each patient.
Regardless which antipsychotic is selected, it is important to inform patients (and their caregivers) of the relative risks and benefits, and to monitor treatment effectiveness, tolerability and adherence.