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Aims

To develop an understanding of:

  • Life’s transitions
  • Child to adult
  • Puberty
  • Development of identity:
  • social identity
    • cultural identity
    • gender identity
    • sexual identity
  • Interaction between stress, personality and mental illness
  • Introduction to psychiatry
  • Accessibility of health care for young people

Key concepts

  • Late adolescence – a time of transition
  • Biological and psychological factors –individual vulnerability
  • Depression - a spectrum of conditions
    • a change in usual thinking and behaviours that interferes with ability to perform activities of daily living.
  • Emerging sexuality during this phase of development.

Nic Newling

  • Had a serious depressive illness as an adolescent
  • Before 13, life was very good, was good at school. Life unravelled in year 7 (anxious, stressed, pressured himself to do well in school, get angry, panicky). Take on too many of the world's problems he couldn't solve
    • Feel like a hollow empty shell
    • Anxiety, depressive, then psychosis. Incorrect diagnosis because of stages
    • Forgets a lot of it
    • Slept a lot
    • Not wanting to talk to people
    • Withdrew from friends
    • Became a lot quieter and less interesting
    • Talking about death, depression
    • Constant suicidal thoughts; thought it was normal (1.5 years of just suicidal)
    • Couldn't read any more, think clearly, not talk to people
    • Looked at different ways to kill himself with different objects
  • Asked mother if it was normal to want to kill himself, which rang alarm bells
  • Took a long time to get help - wrong diagnoses and medications (4-5 years, all his teenage life. All the side-effects of medication and no benefit)
    • Had bipolar and not just depression
    • In year 8 he was in a psychiatric ward - very quickly gone from overachiever to straight down; really confusing, meeting everyone else in a bad place. Couldn't do even easy work given to him
  • Medication since 13 to help depression. Zoloft antidepressant.
    • Has been through 15-20 types, couldn't find the right medication
      • But actually had the wrong diagnosis (not that the medication was wrong). Once he had the right diagnosis, the right medication came very quickly
  • 16 years old, found a doctor who was committed to finding the right diagnosis.
    • Never presented with a "high" of bipolar; only with a "low"
    • Doctor observed him having a "high" in bipolar
    • High - invulnerable, everything is great (hours/days/weeks/month)
      • Feel like everything else changes (not he himself changed)
    • Never present with being high (just a brief break from being depressed)
  • Had shock therapy (ECT)
  • Was on antidepressant/antipsychotic
  • Treatment for bipolar: antidepressant/mood stabiliser, which helped out in a few months
    • Couldn't experience teenage years because of failed medications
    • That's why he had ECT (he was still suicidal)
  • Feels more stable than most of his friends who don't have bipolar (takes a low maintenance dose)
    • Like taking a vitamin in the morning
    • Doesn't notice any side effects nowadays
    • In the past, sleeping a lot and weight gain (one of the old antipsychotics: went from 55kg to 105kg)
  • Be more flexible with what you expect out of life and yourself (if things need to change, that's okay)
    • Encourages us to not get caught up in life
    • Getting overwhelmed in the past (just overwhelming himself, no-one else was bugging him to study)
  • Both brothers have had unipolar depression (all three struggling and on medication)
    • Elder brother (middle) committed suicide when Nic was 16; even though Nic was considered as highest risk
      • Mother and doctors were more worried about Nic after that point
  • Brother's death was a wake up call
  • Only thing stopping him from committing suicide was his family and guilt if he killed himself
    • Only enjoyment he got out of life was thinking about death
    • Because his brother committed suicide and it had a huge impact on him (predicting the impact of his suicide on his family)
  • Take home messages:
    • Medical profession get used to seeing things in theory (data, stats etc). Easy to keep stats in mind rather than thinking about patients as people
    • Doctors who really help are the ones who really care about him (who stick with him). If he doesn't turn up, call him, don't let him not take medications
    • A great doctor must take a genuine human interest in patients (treat them as family)
  • Young people getting mental health care
    • Kids don't know what is out there (so many services that could help him but he didn't know they were there)
    • Most people go to the doctor, give up on it after that doesn't work (don't understand all the other pathways)
  • High - don't recognise that you're high (unless psychotic), followed by a low
    • Sometimes think you're okay
    • Bipolar: Experience coincidences more, spend more money, spiritual experiences, much higher sex drive, see something attractive
    • Doctors fail when they tick boxes and say "you have 7/10, take the depression medication" - just because they can justify giving these depression medications... even though the diagnosis
  • The high is REAL - things actually do come to you, and you do benefit, people give things to you, your life improves. People lose creativity and intelligence. People with bipolar don't take the medication to survive, but they have to take the medication or else they'll commit suicide.
    • Life levels out but feels far too stable and far too normal
  • Shock therapy - not for him, but works for other people
    • Not barbaric, and for people who get it done, it is done well for him
  • Excuse: glandular fever and chronic fatigue (for being not at school for 9 months)
    • The right choice is to be secretive (with public)
    • But open with healthcare providers and close friends

So how common is depression in teens?

  • Lifetime rates of unipolar depression (major depressive disorder and dysthymia) reach adult rates of 20%-25% by 18 years of age
  • In Australia, the 1995 National Survey of Mental Health and Wellbeing found a prevalence of 27% mental disorders for those in the 18-24 year age range
  • 50% of all life-long psychiatric disorders start by 14 years of age, and 75% by 24 years of age
  • Peak age of first onset of affective disorders is typically 15-19 years
  • Up to 60% of adults experience their first mental problem by age 21
  • David (16) in the scenario has bipolar
    • William's half brother
    • David is very good at schience

David

  • Was a high achiever and had wanted to be a doctor since he was 9 years old
  • 12 years old parents divorced
  • Developed a low mood during divorced, while his sister lived with their mother
  • Family history - sister and mother had mood disorders
  • David's new step brother has Down syndrome
  • David felt cast aside and isolated. He felt he was in the way
  • Coping strategies - study and friends
  • In year 9, he got low marks in science NAPLAN and found it devastating
  • Parents were distracted by William
  • Lost his motivation
  • David started staying in bed all day, feeling hopeless instead of going to school
  • Looked it up on google and found that he needed some help, but was reluctant to ask
  • Last thing he wanted to do was go to a GP (didn't want his family to know)
  • Support: kids helpline, youth beyondblue, reachout, biteback, headspace
  • Counselling service: http://www.counselling.unsw.edu.au, Ute Vollmer