Notes

Outline

Kevin Leehey M.D. Child, Adolescent, and Adult Psychiatry Board Certified 296-4280 leeheymd.com

Community of Concern Workshop Depression and Self Destructive Behaviors

Overview What causes depression, anxiety, and self harm? What is Depression ? What is Anxiety ? What is stress? What is self destructive behavior ? How do I help my teen ?

Causes Genetics Life events, losses, environment, disappointments “Stress” - personal, family, peers, societal pressures Alcohol and other drugs Health problems ADD, ADHD, Learning Disorders  “Nature vs Nurture” - genes or experiences

Types of Depression Major Dysthymic disorder Depression NOS Bipolar Depression Existential or adolescent angst Personal and Family History PH, FH

Major Depression : for diagnosis 5 of below for at least 2 weeks Sad, mad, down most of every day Anhedonia - loss of interest, withdrawal Fatigue, loss of energy Sleep change - up or down Appetite change - up or down Feel worthless, hopeless, guilt, negative Agitation or slowed movements and thoughts Decreased concentration and ability to think, or decide Recurrent thoughts of death or suicide

Especially common in depressed teens : Irritable, cranky, negative Withdrawal, isolation Change or avoid friends Drop in school performance Quit or fail to follow through with activities, jobs, etc. Substance abuse Anxiety, worry about the future, hopeless, no longer trying, loss of motivation

Other Forms of Depression Dysthymia Depresson NOS Existential, “angst” Bipolar Depression PH and FH

Mania: while not one’s usual self for at least a week, a marked change Elevated, expansive, irritable, temper Inflated self esteem, grandiosity Markedly decreased need for eating or sleeping Pressured speech Racing thoughts Flight of ideas Loss of judgement, spend, sex, illegal, pleasure seek, substance abuse, gamble, unwise business ventures Agitation Distractible Psychosis can occur

Anxiety Excessive worry, fear, nervous Generalized Anxiety Disorder, GAD Panic, “anxiety attack” Separation anxiety, school anxiety Social anxiety Obsessive Compulsive Disorder, OCD O/C style, perfectionism Over-sensitive,over-reactive, control PH and Family history

Stress Forces from the outside (or inside) that impinge, affect, or impact us. Mild to moderate stress can promote growth.  Severe, sudden, or chronic stress cause biologic damage resulting in physical and emotional damage, disease. Trying to do too much too fast, pressure to grow up, achieve, excel Positive coping Negative coping

Co- and Extra-curricular Activities  studies show :  10-20 hours a week is best for most teens Kids who do <10 hours and kids who do >20 hours do less well in school Sports, clubs, music, job, youth groups, 4H, horses, volunteer, martial arts, etc.  learn a skill, develop a hobby, make new friends, build self esteem, manage time, get experience, build a resume, find a mentor, have positive fun

Self Destructive Behavior Any behavior that hurts you Substances Eating disorders Piercings ? Tattoos? The “choking game” Self harm, self mutilation Suicide

Self Harm Cut, scratch, burn, mutilate Trendy, myspace, “community”, “emo” Arms and more Mild to severe To release feelings physically; to convert emotional pain into physical Usually not suicide intent

Suicide “accidental”, uncertain intent, ambivalent, passive, nihilism Ideation, plan, intent, act #2 to 3 cause of death age 15-24 Firearms 80% in boys; 50% girls Overdoses, hanging, “accidents” Arizona in worst 5 “survivors”, the suffering of those left

Suicide - cont’d 1) Depressed, angry, substances 2) “the last person you’d ever expect” 3) Eating Disorders especially Bulimia 4) Psychosis or severe mental illness Disciplinary Crisis Connectedness, support system Lethality of method and intent Rate dropped 25 % in last decade Prevention, treatment

How do I help my Teen? Model healthy living and coping Reasonable expectations Be present, involved, and caring Avoid over-control and intrusion Focus on developing the life skills your teen will need for happy independence Encourage but limit electronics Use the Community of Concern

How do I help? - cont’d Teach or provide “teacher” of healthy coping skills, stress mgmt, values, spirituality, self esteem, goals The “relaxation response” Motor vehicles, firearms, substances Parenting books Therapy and counseling Medication

Therapy and Counseling Individual therapy- Cognitive Behavioral (CBT), Behavior Management, Interpersonal, Psychodynamic, Psycho-education Family therapy- Family system, Structural, Parenting, Psycho-education Intensive Outpatient Programs Residential Treatment Inpatient Hospitalization

Medication Safety - carefully prescribed and monitored the safety record is excellent The more “biologic” signs that are present the more likely medicine will help and is needed The more severe the anxiety or depression The stronger the family and personal history If therapy is not enough, not effective,  refused, or if medication is preferred

Medication - cont’d 25% best with therapy alone, 25% best with medicine alone, 50% best with combination for Major Depression or severe Anxiety SRI’s, buproprion, SNRI’s, etc. Bipolar disorder usually requires medicine Omega 3 (and 6) FA’s, supplements, vitamins, diet, exercise, other

Good night and good luck! Kevin Leehey M.D. 296-4280 leeheymd.com Return to www.leeheymd.com