Common Mental Health Problems and Psychoactive Substance Use during Adolescence and Youth
WHO defines mental health as: “a state of well-being in which the individual realizes his or her abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make contributions to his or her community
Worldwide 10-20% of children and adolescents experience mental disorders. .
Half of all mental illnesses begin by the age of 14 and three-quarters by mid-20s.
In Ethiopia, mental illness is the leading non-communicable disorder in terms of burden measured in disability adjusted life years.
At a prevalence of 12-25%, childhood mental illnesses make the biggest contribution to burden of mental illnesses in the health sector.
Adolescents with mental disorders face major challenges such as
stigma,
isolation
discrimination, as well as lack of access to health care and education facilities, which violets their fundamental human rights.
The burden of mental health Problems in Ethiopia
Understanding Neuropsychiatric Problems (NPD)
The Neuropsychiatric disorder is the manifestation of several disorders that often affect adolescents’ challenges in cognitive and affect with challenging behavior for parenting and make the adolescents vulnerable as well. Below are developmental profile of common NPD is discussed:
Typical developmental profile-ASD (autism spectrum disorder)
Autism spectrum disorder (ASD) is a developmental disability caused by differences in the brain. Diagnosing children with ASD as early as possible is important to make sure children receive the services and supports, they need to reach their full potential
In childhood
School age
In Adolescence
As an adult
Diagnostic Methods of ASDs
Developmental Monitoring is an active, on-going process of watching a child grow and encouraging conversations between parents and providers about a child’s skills and abilities.
Developmental Screening takes a closer look at how your child is developing.
Developmental Diagnosis A brief test using a screening tool does not provide a diagnosis, but it can indicate whether a child is on the right development track or if a specialist should take a closer look.
Treatment for ASD
Treatments for autism spectrum disorder (ASD) seek to reduce symptoms that interfere with daily functioning and quality of life. These treatments generally can be broken down into the following categories.
Behavioural approaches
Developmental Approaches:
Educational approaches
Social-Relational approaches
Pharmacological approach
Psychological approach
Complementary and Alternative treatments
Typical developmental profile-ADHD (attention deficit hyperactivity disorder)
ADHD is one of the most common neurodevelopmental disorders of childhood.
It is usually first diagnosed in childhood and often lasts into adulthood. Children with ADHD may have trouble paying attention, controlling impulsive behaviors be overly active.
Childhood
School age
In adolescence
In adult life:
How is ADHD diagnosed?
DSM-5 Criteria for ADHD Diagnosis
People with ADHD show a persistent pattern of inattention and/or hyperactivity–impulsivity that interferes with functioning or development: Based on the types of symptoms, three kinds of ADHD can occur
Combined Presentation
Predominantly Inattentive Presentation Predominantly Hyperactive-Impulsive Presentation
Recognizing mental health problems in Adolescents and youth
Although these problems are fairly common often go unnoticed, because change of mood and temporary deviant behaviors are part of the normal adolescent process and many young people will experiment with drugs or certain behaviors as part of normal exploration of their own identity
Thus it is imperative for one to look into the following three aspects such as
Duration
Persistence and severity of fixed symptoms
Impact of Symptoms
Risk factors of common mental health problems in AY:
Risk factors of mental health problem in adolescents and youth can be classified in to four
biological,
psychological,
social factors, and
environmental factors.
Consequences of Mental Health Problems in AY:
mental health disorders are associated with low educational performance, increased risk taking behavior, substance use, indulging in crime, poor sexual and reproductive health, self-harm and inadequate self-care. All these contributed to increased life time risk of morbidity and premature death.
Management of common mental health illnesses
Mood disorders and depression
At any given time, 1 in 20 adolescents meets clinical criteria for a mood disorder and up to one in four children will experience a mood disorder by their late adolescence. Mood disorders include a major depressive disorder, bipolar disorder, and premenstrual dysphoric disorder. Depression is more common in female adolescents than in male adolescents.
Anxiety disorders: Continued
Anxiety is different from fear.
Fear is a normal emotional response of all human beings to actual or perceived danger.
Normal fear is adaptive and necessary for survival
Anxiety is a general term for several disorders that cause nervousness, fear, apprehension, and worrying
Anxiety disorders can be classified in to several more specific types. The most common are briefly described below.
Generalized anxiety disorder
Panic disorder:
Specific and Social Phobias
Suicide
It is a fatal act that represents the person's wish to die. There is a range, between thinking about Suicide and acting it out. Suicidal ideation occurs in all age groups and with greatest frequency in children and adolescent with severe mood disorders.
Completed suicide occurs about five times more often in adolescent boys than in girls, although the rate of suicide attempts is at least three boys.
Suicidal ideation is not a static phenomenon; it can wax and wane with time.
The crude suicide rates in Ethiopia are reported to have increased from 7.9 to 8.4 per 100,000 population from 2005 to 2015 (WHO b, 2017).
The most important risk factors for suicide are:
1.Psychiatric disorders .
2.Past or recent social stressors .
3.Suicide in the family or among friends or peers,
4.Low access to psychological help and
5Access to means for committing suicide.
6.Additional risk factors in suicide include exposure to family violence, impulsivity, and substance abuse.
Psychotic disorders are mental disorders which are characterized by impairment in a person’s perception of reality. It can be manifested by abnormal sensory perceptions (hallucinations), thought abnormalities (including disorders of thought content or process), and behavioral disturbances (including catatonia and disorganized behavior)
Use of Psychoactive Substances by Adolescent and Youth
Psychoactive substance is a drug or other substance that affects how the brain works and causes changes in mood, awareness, thoughts, feelings, or behavior.
The commonly used psychoactive substances include alcohol, caffeine, nicotine, marijuana, and certain pain medicines.
Substance use disorder (SUD) is a mental disorder that affects a person’s brain and behavior, leading to a person’s inability to control their use of substances such as legal or illegal drugs, alcohol, or medications. A substance use disorder involves using too much alcohol, tobacco or other drugs.
There are four types of drugs/Substances
Depressants: the most commonly found types of drugs in society are depressants. Alcohol ,Sedatives/hypnotics .,Daterape drugs and Volatile solvents
Stimulants ,Increase energy, alertness, and wakefulness. Such as Nicotine ,Cocaine ,Amphetamines and Caffeine .
Opioids: Opioids: These are pain-killing drugs that increase feelings of happiness or euphoria and create a tranquilizing effect.
Heroin, morphine, opium, buprenorphine, methadone, pet hidine and Cough syrup with codeine.
Hallucinogens: .They can also cause a person to perceive time differently, feel detached from their surroundings, or feel deeply insightful.
Lysergic acid diethyl amine, Mescaline, psilocybin, peyote, tryp tamines and Cannabis
Assessment of Adolescents and Youth for Mental Health Problems
Adolescence should be a time of healthy growth and development. Indeed, it is a critical period with significant physical, emotional, and mental changes. Despite robust physical health, adolescent risky behaviors may result in lifelong consequences as well as increased morbidity and mortality.
HEADSSS assessment tool
Home, Education, Activities, Drugs, SRH, Suicide, Safety, Support
The HEEADSSS review of systems is a tool to understand adolescent behavior and assess risk-taking behaviors to provide appropriate interventions.
Interventions
Effective regulatory interventions for addictive substances which can be implemented at international, national, regional and local jurisdictional levels include taxation, restrictions on availability and total bans on all forms of direct and indirect advertising.
media interventions,
comprehensive community interventions and
school-based interventions.
SUMMARY
Mental health disorders and substance use are common health problems of young people.
Depression, anxiety, eating disorder, attention deficit hyperactivity disorders and substance misuse are the commonest forms of mental health disorders in this population.
The risk factors of mental health disorders are largely preventable and could be targeted at family, community and school level.
Identifying mental health disorders in this population requires careful history taking and evaluation of the symptoms as some of the changes are just part of the normal developmental process of adolescents.
Alcohol, tobacco, marijuana and inhalants are commonly used by adolescent and youth. .
Substance use co-occurs with the other mental health disorders and through check for use is important while treating young people with mental health disorder.
Family, schools and community at large are places where interventions against substance use could be implemented.
Motivational Interviewing focuses on exploring and resolving ambivalence and centres on motivational processes within the individual that facilitate change
Motivational Interviewing is grounded in a respectful stance with a focus on building rapport in the initial stages of the counselling relationship
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