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Childhood Severe Mental Illness
Introduction It is easy for parents to identify their child's physical needs: nutriticous food, warm clothes when it's cold, bedtime at a reasonable hour. However, a child's mental and emotional needs may not be as obvious. The basics for a child's good mental health include:
• unconditional love from a family Between 10 and 20% of children and young people have a mental health problem, and a small percentage will have a severe mental illness. The key to ideally handling these childhood disorders is for parents and carers to recognise the problem and seek appropriate treatment. The following signs may indicate the need for professional help or assessment:
• decline in school performance If you are worried about your child's mental health you should contact your GP or school nurse. Assessment is based on a collaborative process that should involve psychiatrists and doctors, the child, and the child,s family or carers, and school healthcare staff. Schizophrenia in Children Schizophrenia is an uncommon psychiatric illness in children, affecting only about 1 in 40,000, compared to 1 in 100 in adults. The illness is hard to recognise in its early phases. The behaviour of children and teens with schizophrenia may differ from that of adults with this illness. Causes of Schizophrenia in Children Damage to the nervous system during development seems to be of greater importance in childhood schizophrenia than in the adult-onset type. It is likely that genetic predisposition also plays a part. The risk of schizophrenia rises from 1% with no family history of the illness to 10% if a first degree relative has it, to 50% if an identical twin has it. Prenatal insults including viral infections, such as maternal influenza during the second trimester, starvation, lack of oxygen at birth, and untreated blood incompatibility may also contribute to the development of schizophrenia in childhood. Children unlike adults with adult-onset schizophrenia show evidence of progressively abnormal brain development. Symptoms of Childood Schizophrenia Most children with schizophrenia show delays in language and other functions long before their psychotic symptoms (hallucinations, delusions, and disordered thinking) appear, usually at age seven or later. In the first years of life, about 30% of these children have temporary symptoms of developmental disorder, such as rocking, posturing and arm flapping. Early warning signs of childhood schizophrenia include:
• trouble discerning dreams from reality The behaviour of children with this illness may change over time. The schizophrenic psychosis (hallucinations, delusions and sense of unreality) develops gradually in children, without the sudden psychotic break that sometimes occurs in adolescents and adults. Children may begin talking about strange fears and ideas. They may start to cling to parents or say things that do not make sense. Children who used to enjoy relationships with others may become more shy or withdrawn and seem to be in their own world. Children with schizophrenia experience difficulty in managing everyday life. In common with their adult counterparts, children with schizophrenia are at an increased risk of suicide. Misdiagnosis of Schizophrenia in Children Misdiagnosis of schizophrenia in children is all too common. Schizophrenia is often confused with autism but is distinguished from it by the persistence of hallucinations and delusions for at least 6 months, and a later age of onset - 7 years or older. Autism is usually diagnosed by age 3. Schizophrenia is also different to a brief psychosis which can be seen in people with depression, personality and dissociative disorders in children. Adolescents with bipolar disorder sometimes have acute onset of manic episodes that may be mistaken for schizophrenia. Children who have been victims of abuse may sometimes claim to hear voices of- or see visions of- the abuser. Treatment of Childhood Schizophrenia Early diagnosis and medical treatment are important. Children tend to be harder to treat and have worse prognosis than adult-onset schizophrenia patients. These children need individual care plans involving a combination of medication, individual therapy, family therapy and specialised programmes (for example, help at school or during activities). Standard antipsychotic drugs appear to be effective in treating hallucinations and delusions in children and adolescents with schizophrenia. The newer "atypical" antipsychotics may also help improve motivation and emotional expressiveness in some patients. However, children may be more susceptible to the side effects of medications. Bipolar Disorder in Children Many children and especially adolescents experience mood swings as a normal part of growing up, but when these feelings persist and begin to interfere with a child's ability to function in daily life, bipolar disorder, cometimes called manic depression, could be the cause. Bipolar disorder is a type of mood disorder marked by extreme changes in mood, energy levels and behaviour. Causes of bipolar disorder in children The illness tends to be highly genetic in origin, but there are clearly environmental factors that influence whether the illness will occur in a particular child. Bipolar disorder can skip generations and take different forms in different individuals. For the general population, there is a 1% risk of having bipolar disorder. When one parent has bipolar disorder, the risk to each child is 15-30%. When both parents have bipolar disorder, the risk increased to 50-75%. The risk of siblings and fraternal twins is 15-25%. The risk in identical twins is approximately 70%. Symptoms of bipolar disorder Symptoms can begin in early childhood but more typically emerge in adolescence or adulthood. Research by the American Academy of Child and Adolescent Psychiatry shows that up to 1/3 of 3.4 million children and adolescents with depression in the United States may actually be experiencing the early onset of bipolar disorder. Children with bipolar disorder usually alternate between extremely high moods (mania) and low moods (depression). These rapid mood shifts can produce irritability with periods of wellness between episodes, or the young person may feel both extremes at the same time. Parents who have children with the disorder often describe them as unpredictable, alternating between silly and withdrawn. Children with bipolar disorder are at a greater risk for anxiety disorders and attention-deficit hyperactivity disorder (ADHD). These "co-occurring" disorders complicate diagnosis of bipolar disorder and contribute to the lack of recognition of the illness in children. Below are a series of symptoms associated with the manic and depressive states of bipolar disorder. Not all children with bipolar disorder have all symptoms. If a child you know is struggling with any combination of these symptoms for more than two weeks, talk with a doctor or mental health professional. manic symptoms • Severe changes in mood - from unusually happy or silly or irritable, angry or aggressive. • Unrealistic highs in self-esteem. May feel indestructable or believe he or she can fly, for example. • Great increase in energy level. Sleeps little without being tired. • Excessive involvement in multiple projects and activities. May move from one thing to the next and become easily distracted. • Increase in talking. Talks much too fast, changes topics too quickly, and cannot be interrupted. This may be accompanied by racing thoughts or feeling pressure to keep talking. • Risk-taking behaviour such as abusing drugs and alcohol, attempting daredevil stunts, or being sexually active or having unprotected sex. depressive symptoms
• Frequent sadness or crying. When manic, children and adolescents, in contrast to adults, are more likely to be irritable and prone to destructive outbursts than to be elated or euphoric. When depressed, there may be many physical complaints such as headaches, muscle aches, stomachaches or tiredness, frequent absences from school, poor performance in school, talk of or efforts to run away from home, irritability, complaining, unexplained crying, social isolation, poor communication, and extreme sensitivity to rejection and failure. Many teens with bipolar disorder abuse alcohol and drugs as a way to feel better and escape. Children with bipolar disorder may also have difficulty with relationships. Misdiagnosis of bipolar disorder in childhood Bipolar disorder is difficult to recognise and diagnose in children because it does not have exactly the same symptoms established for adults, and because its symptoms can resemble of co-occur with those of other common childhood-onset mental disorders. In addition, symptoms of bipolar disorder may be initially mistaken for normal emotions and behaviours of children and adolescents. In adolescents, bipolar disorder can be misdiagnosed as borderline personality disorder, post-traumatic stress disorder and schizophrenia. Treatment of bipolar disorder in children Early intervention and treatment offer the best chance for children with emerging bipolar disorder. Once the diagnosis of bipolar disorder is made, the treatment of children and adolescents is based mainly on experience with adults, since there is very limited data on the effectiveness and safety of mood stabilising medications in youth. The essential treatment for this disorder in adults involves the use of appropriate doses of mood stabilisers. It is important to note that children may experience side effects to an increased degree compared with adults. In addition to medication, a good treatment plan should include close monitoring of symptoms, education about the illness, counselling or psychotherapy for the individual and family, stress reduction, good nutrition, regular sleep and exercise, and participation in a network of support. Depression in Children All children "feel blue", from time to time, have a bad day, or are sad. However, when these feelings persist and begin to interfere with a child's ability to function in daily life, clinical depression could be the cause. Depression is a serious mental health problem that affects people of all ages, including children. In fact, depression affects as many as one in every 33 children and one in eight adolescents. Depression can lead to academic underachievement, social isolation, and create difficult relationships with family and friends. Depression in children is also associated with an increased risk for suicide. It has been estimated that more than 90% of children and adolescents who take their lives have a mental health disorder such as depression. The risk is particularly greatest among adolescent boys if aaccompanied by conduct disorder and alcohol or other substance abuse. In addition to this, depressive disorders confer an increased risk of illness and relationship and social difficulties that persist long after the depressive episode. Depression in young people often occurs with other mental disorders, most commonly anxiety, disruptive behaviour or substance abuse disorders, and with physical illnesses, such as diabetes. Once a young person has experienced an episode of depression, s/he is at an increased risk for having another episode of depression within the next five years. Children who experience a depressive episode are five times more likely to have depression as an adult. Causes of depression in children No one thing causes depression. Children who develop depression may have a family history of the disorder. Family history, stressful life events such as losing a parent, divorce, or discrimination, and other physical or psychological problems are all factors that contribute to the onset of the disorder. Children who experience abuse, neglect,or other trauma or who have a chronic illness areat a higher risk for depression. Depression in children often occurs along with other mental health problems such as anxiety, bipolar disorder or disruptive behaviour disorders. Adolescents who become clinically depressed are also at a higher risk for substance abuse. Other risk factors in the development of depression include:
• Stress symptoms of depression in children The symptoms of depression in children and adolescents are the same as they are for adults. However, recognition and diagnosis may be more difficult in youth for several reasons. The way the symptoms are expressed varies with the developmental stage of the child. In addition, children and young adolescents with depression may have difficulty in properly identifying their emotions and moods. For example, instead of communicating how bad they feel, they may act out and be irritable toward others, which may be interpreted simply as misbehaviour or disobedience. Research has shown that parents are even less likely to identify major depression in their adolescents than are the adolescents themselves. Some of the symptoms of major depressive disorder include:
• Persistent sad or irritable mood Five or more of these symptoms must persist for two or more weeks before a diagnosis of major depression is given. Symptoms that may be associated with depression in children include:
• Frequent vague, non-specific physical complaints such as headaches, muscle aches, stomachaches or tiredness Many teens with depression abuse alcohol and drugs as a way to numb or manage their pain. Any child or adolescent who abuses substances should be evaluated for depression. If an addiction develops, it is essential to treat both the mental disorder and the substance abuse problem at the same time. treatment of depression in childhood Depression is treateable. Early identification, and treatment helps children reach thier full potential. Children who show signs of depression should be referred to and evaluated by a doctor and preferrably referred to a child psychiatrist. The assessment may include psychological tests and medical test to rule out any underlying conditions that might explain the child's symptoms. Treatment for depressive disorders in children and adolescents often involves short-term psychotherapy, medication, or the combination, and targeted interventions involving the home or school environment. psychotherapy Recent reserch shows that cognitive behaviour therapy (CBT) can help relieve depression in children and adolescents leading to remission in 65% of cases. Interpersonal therapy has also been shown to be effective in the treatment of depression. Continuing psychotherapy for several months after remission of symptoms may help patients and families pull together the skills jthey have learned during the acute phase of depression to cope with the after-effects of depression, recognise environmental stressors and understand behavioural and thoughts that could contribute to a relapse. medication Research clearly demonstrates that antidepressant medications, especially when combined with psychotherapy, can be very effective treatments for depression in adults. However recently there has been much controversy about the use of antidepressants for chldren and adolescents. The concern cetres around the ability for some newer selective serotonin reuptake inhibitors (SSRIs) to elicit self harming and suicidal behaviours in children. At present only paroxetine is recommended for the treatment of depression in children. It is important to note that available studies do not support the use of tricyclic antidepressants for depression in youth. In general medication should be considered as a first-line course of treatment for children and adolescents with severe symptoms that would prevent effective psychotherapy, those who are unable to undergo psychotheray, those with psychosis, and those with chronic or recurrent episodes. Following remission of symptoms,medication and/or psychotherapy should be continued for at least several months given the high risk of relapse and recurrance of depression. Anxiety Disorders in Children An anxiety disorder is a mental health problem that can affect people of all ages, including children. In fact, anxiety disorders ar the most common type of mental health disorder in children, affecting as many as 10% of young people. All children experience some anxiety; this is normal and expected. For example, when left alone at school for the first time, many children with show distress; a young child with his or her own room may develop a fear of the dark. Such anxiety becomes a problem when it interrups a child's normal activities, like attending school and making friends or sleeping. Persistent and intense anxiety that disrupts daily routine is a mental health problem that requires intervention. Symptoms of Different Anxiety Disorders Anxiety is a sense of worry, apprehension, fear and distress. Symptoms of anxiety typically fall into two groups: physical symptoms (headache, feeling sick) and the emotional symptoms of nervousness and fear. Anxiety disorders, when severe, can affect a child's thinking, decision-making ability, perceptions of the environment, learning and concentration. It raises blood pressure and heart rate and can cause vomiting, stomach pain, ulcers, diarrhoea, tingling, weakness and shortness of breath among other things. There are several types of anxiety disorders. The list below describes those most common to children. Generalised anxiety disorder Children with generalised anxiety disorder (GAD) have recurring fears and worries that they find difficult to control. They worry about almost everything- school, sports, being on time, even natural disasters. They may be restless, irritable tense or easily tired, and they may have trouble concentrating or sleeping. Children with GAD are usually eager to please others and may be "perfectionists", dissatisfied with their own less-than-perfect performance. Separation anxiety disorder Children with separation anxiety disorder have intense anxiety about being away from home or caregivers that affects their ability to function socially and in school. these children have a great need to stay at home or be close to their parents. Children with this disorder may worry excessively about their parents when they are apart from them. When they are together, the child may cling to parents, refuse to go to school, or be afraid to sleep alone. Repeated nightmares about separation and physical symptoms such as stomachaches and headaches are also common in children with separation anxiety disorder. Social phobia Social phobia usually emerges in the mid-teens and typically does not affect young children. Young people with this disorder have a constant fear of social or performance situations such as speaking in class or eating in public. the fear is often accompanied by physical symptoms such as sweating, blushing, heart palpitations, shortness of breath, or muscle tenseness. Young people with this disorder typically respond to these feelings by avoiding the feared situation. For example, they may stay home from school or avoid parties. Young people with social phobia are often overly sensitive to critisism, have trouble being assertive, and suffer from low self-esteem. Social phobia can be limited to specific situations, so the adolescent may fear dating and recreational events but be confident in academic and work situations. Obsessive-compulsive disorder Obsessive-compulsive disorder (OCD) typically begins in early childhood or adolescence. It is estimated that at any given time, 1 to over 3% of adolescents are experiencing symptoms of OCD. Children as young as 5 or 6 can show symptoms of OCD. Children with OCD have frequent and uncontrollable thoughts (called "obsessions") and may perform routines or rituals (called "compulsions") in an attempt to eliminate the thoughts. Those with the disorder often repeat behaviours to avoid some imagined consequence. Fior example, a compulsion common to people with OCD is excessive hand washing due to fear of germs. Other common compulsions inclue counting, repeating works silently, and rechecking completed tasks. In the case of OCD, these obsessions and compulsions take up so much time that they interfere with daily living and cause a young person a great deal of anxiety. Tourette's syndrome is more likely to be present in boys and in children who develop OCD at a younger age. While children and adolescents with OCD are more likely to have Attention Deficit Hyperactivity Disorder, learning disorders, opposititional behaviour, separation anxiety disorder and other anxiety disorders. Post-traumatic stress disorder Children who experience a physical or emotional trauma such as witnessing a shooting or disaster, surviving physical or sexual abuse, or being in a car accident may develop post-traumatic stress disorder (PTSD). Children are more easily traumatised than adults. An event that may not be traumatic to an adult - such as a bumpy plane ride - might be traumatic to a child. A child may "re-experience" the trauma through nightmares, constant thoughts about what happened,or reenacting the event while playing. a child with PTSD will experience symptoms of general anxiety, including irritability or trouble sleeping and eating. Children may exhibit other symptoms such as being easily startled. Panic disorder Children and adolescents with panic disorder have unexpected and repeated periods of intense fear or discomfort along with other symptoms such as racing heartbeat or feeling short of breath. These "panic attacks" can last for minutes to hours. Panic disorder often begins during adolescence, although it may start during childhood. Panic attacks can interfere with a child's or adolescents's relationships, schoolwork and, and normal development. Children and adolescents with panic disorder may begin to feel anxious most of the time, even when they are not having a panic attack. Some children with panic disorder develop agoraphobia, others can develop severe depression and may be at risk of suicidal behaviour. As an attempt to decrease anxiety, some adolescents with panic disorder will use alcohol or drugs. Panic disorder in children can be difficult to diagnose but once diagnosed the child usually responds well to treatment. Causes of Anxiety in Children There are many factors that contribute to the development of anxiety disorders in children. These may include genetic predisposition, psychological factors and environmental factors. You can read more about these and other causes here. Treatment for Anxiety Disorders in Children Anxiety disorders are treatable.Children who show persistent symptoms of an anxiety disorder should be referred to a child psychiatrist. Effective treatment for anxiety disorders may include some form of psychotherapy, behavioural therapy or medications. Tags: Mental Health, Childhood Depression, Bipolar Disorder About the Author www.rethink.org |
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