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The following points highlight the eight major disorders that are common during adolescence. The disorders are: 1. Anxiety Disorders 2. Depression 3. Conduct Disorder 4. Schizophrenia 5. Suicide among Adolescents 6. Mental Retardation 7. Accident Proneness 8. Eating Disorders.
1. Anxiety Disorders:
During adolescence, the features of anxiety disorder are a mixture of symptoms of anxiety occurring during childhood and in adults.
Three types of anxiety disorders are described in DSM-IV.
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They are:
(i) Avoidant disorder of childhood or adolescence:
In this disorder, there is a persistent and excessive shrinking from contact with unfamiliar people, that is of sufficient severity to interfere with social functioning in peer relationships. The duration is of at least 6 months and is coupled with a clear desire for social involvement with familiar people, such as family members and peers the person knows well. Relationships with family members and other familiar figures are warm and satisfying. This diagnosis should not be made if the person is 18 or older.
(ii) Overanxious disorder:
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This essentially consists of excessive and unrealistic anxiety or worry for a period of 6 months or longer. Children and adolescents with the disorder tend to be extremely self-conscious, worry about future events (e.g., examinations, the possibility of injury, or inclusion in peer group activities), or about meeting expectations (e.g., deadlines, keeping appointments, or performing chores).
(iii) Separation anxiety disorder:
Separation anxiety disorder is a clinical syndrome with predominant feature or excessive anxiety on separation from the major attachment figures, home or other familiar surroundings. When so separated, such children may experience anxiety to the point of panic, beyond that is expected at their developmental level.
All these three childhood anxiety disorders may occur in adolescents. Apart from this, an adolescent may be diagnosed as having almost all of the adult anxiety disorders too. Panic disorder with or without agoraphobia, agoraphobia without history of panic disorder, social phobia, simple phobia, obsessive compulsive disorder, post-traumatic stress disorder, and generalized anxiety disorder can occur, as described in DSM-IV. Treatment includes behaviour therapy and anxiolytic drugs.
2. Depression:
In DSM-IV, depression in adolescents is included in the diagnostic classification applicable to adults. Although not included in the diagnostic criteria, certain special features pertaining to adolescents are delineated. They are antisocial behaviour, substance abuse, failure to attend to personal appearance, increased emotionality and school difficulties. Other features are withdrawal from social activities, sulkiness, restlessness, aggression, reluctance to participate in family activities and desire to leave home with accompanying feelings of not being not being understood.
It has been suggested that adolescent depression is often masked by other disorders like school phobia, anorexia, conduct disorders and stomach aches. Mood congruent hallucinations, feelings of persecution, delusion of guilt, hopelessness, which are symptoms of adult depression, are not seen to the same extent in adolescents. Adolescents experience fatigue, boredom and hypersomnia.
Affective symptoms of depression are seen in other psychiatric syndromes in children and adolescents. These include anxiety states, such as separation anxiety, agoraphobia or panic disorder. Conduct disorders and depression are often found together.
However, as the treatment of the depressed adolescent must take into account multiple factors, the psychodynamic, cognitive, behavioural and family approaches are also useful, depending upon the individual patient.
3. Conduct Disorder:
The essential feature of conduct disorder is a repetitive and persistent pattern of conduct in which either the basic rights of others or major age appropriate societal norms or rules are violated. Conduct disorder is fairly common during childhood and adolescence.
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Multiple-component treatment packages, with a strong operant and contingency management, are being introduced.
4. Schizophrenia:
The peak age of onset of schizophrenia for men is between the ages of 15 and 25, and for women is between 25 and 35. However, when a schizophreniform disorder occurs before puberty, it seems to affect both sexes. There is usually a family history of schizophrenia. This illness has to be differentiated from infantile autism, especially when it occurs in younger children.
Sometimes, the illness may start with a depressive facade suggesting an affective illness and later on become a full blown schizophrenic psychosis.
5. Suicide among Adolescents:
Among adolescents, Glaser describes different subtypes as follows:
(i) Suicidal behaviour as a response to depression and a coping mechanism to terminate perceived physical and psychological suffering.
(ii) A ‘Cry for help’, the suicidal behaviour is an overt demonstration of depression, calling for a solution.
(iii) Result of psychotic/schizophrenic-like disorder.
(iv) An impulsive act intended to gain advantage that may not be in the least interest of the teenager. In females while completed suicide are more often committed by males. Epidemiology of suicidal behaviour faces the problem of under reporting, even in developed countries.
6. Mental Retardation:
Learning the appropriate means of social interaction, morals, sexual development and other events of adolescence must be considered when understanding the adolescent mentally retarded individual.
7. Accident Proneness:
Violence is the leading cause of death in adolescents, and accidents or ‘accident proneness’ may reflect suicidal tendencies. Adolescent deaths make up a large part of car or motorcycle fatalities. Nicholi has described ‘the motorcycle syndrome’, a cluster of psychiatric symptoms in accident prone cyclists including unusual preoccupation with the motorcycle, a history of accident proneness, persistent fear of bodily injury, extreme passivity and inability to compete, a defective self-image and poor impulse control.
8. Eating Disorders:
Problems concerned with eating and weight have become increasingly frequent reasons for referral. The prevalence of anorexia nervosa in adolescents is increasing and although bulimia nervosa occurs chiefly in young adult women, it is not uncommonly found in late adolescents. Obesity is rarely the main reason for psychiatric referral despite its high prevalence, and its effects on self-esteem, confidence and relationships with peers.