Key Facts

•Globally, one in seven 10-19-year-olds experiences a mental disorder

- Accounting for 13% of the global burden of disease in this age group.
• Depression, Anxiety and Behavioral Disorders are among the leading causes of illness
and disability among adolescents.
• Suicide is the fourth leading cause of death among 15-29 year-olds.

Status of Mental Health System for Children in the Philippines

• National Statistics Office:
- Mental Health Illnesses rank as the third most common form of morbidity among Filipinos.
- In the assessment conducted on the Philippine mental health system, a prevalence of 16%
of mental disorders among children was reported.

Common Psychiatric Disorders in Children

0-12 y/o
1. Anxiety Disorders
2. Attention-Deficit/Hyperactivity Disorder (ADHD)
3. Autism Spectrum Disorder (ASD)
4. Eating Disorders (Obesity)
5. Depression and Other Mood Disorders
6. Post-Traumatic Stress Disorder (PTSD) (Child Abuse, Domestic Violence, Rape)
7. Schizophrenia

AUTISM SPECTRUM DISORDERS (ASD)

Set of Neurodevelopmental Disorders of unknown etiology that begins in early childhood
• General Features
- impaired social interactions and communication
- repetitive patterns of behaviour
- restricted interests, activities, and behaviours
• Two common types include :
- Autism
- Asperger Syndrome

NURSING ASSESSMENT
• Essential features usually become apparent by age 3 years
Signs of Autism
1. Inability to relate to people in an age-appropriate way or respond to social and emotional
cues - possibly labile emotions
2. Stereotypy (rigid, repetitive, machine-like movement with obsessive behaviour) such as
banging head, twirling in circles, biting self, or flapping arms or hands. (Possibly head injury)
3. Abnormal responses to sensory stimuli
- including aversion to touch, loud noises, and bright lights
4. Communication difficulties or delays in speech and language development
— possible echolalia
5. Ritualistic behaviours
- Such as rigid routines, lining up objects, playing with same toys repeatedly, eating only
certain types or colours of foods or foods that are arranged in a specific way
6. Cognitive development may be delayed
- But some children excel in specific areas such art, music, mathematics, or perceptual skills
(e.g., puzzle-solving)

Signs of Asperger Syndrome ("mild autism"):

- Many of same sensory and social issues of autism, but vocabulary and IQ are average to
above average

Diagnosis of ASD
- Through surveillance at healthcare visits and age-appropriate ASD Screening Tools

ASD Screening Tools

These screening tools are not diagnostic but can help identify individuals who may require
further evaluation by a qualified healthcare professional for a formal diagnosis of Autism
Spectrum Disorder.

1. Modified Checklist for Autism in Toddlers (M-CHAT):

- Designed for toddlers aged 16 to 30 months.
- Consists of 23 yes/ no questions about social communication and behaviour.
- Follow-up interviews are recommended for children who screen positive.

2. Childhood Autism Rating Scale (CARS):

- Assesses the severity of autism symptoms in children.
- Based on direct observation and caregiver report.
- Consists of 15 items rated on a scale from 1 to 4, with higher scores indicating greater
severity.
THERAPEUTIC MANAGEMENT
1. Stabilize environmental stimuli by minimizing unfamiliar sounds and lowering general
noise level
2. Orient to environment and provide comfort by encouraging presence and use of
favorite toys or objects
3. Assess client's routines, preferences, and habits; maintain consistency with these
whenever possible
4. Enhance communication by using short, direct sentences, visual cues, pictures,
computers, and other visual aids as appropriate to situation
5. Maintain client safety: monitor client at bath time and bedtime; prevent contact with
harmful objects; use bicycle helmets or mittens to protect client from harm.

MEDICATIONS
Risperidone (Risperdal) and Aripiprazole (Abilify) - are the only drugs approved by the
FDA for children with Autism Spectrum Disorder.
● Risperidone can be prescribed for children between 5 and 16 years old to help with
irritability and aggression.
● Aripiprazole can be prescribed for children between 6 and 17 years old.

Atypical- Monitor agranulocyte for the Risk of Infection

ATTENTION-DEFICIT HYPERACTIVITY DISORDER (ADHD)

• 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 (may act without thinking about what the result will be)
- overly active.

SIGNS AND SYMPTOMS

• daydream a lot
• forget or lose things a lot
• squirm or fidget
• talk too much
• make careless mistakes or take unnecessary risks
• have a hard time resisting temptation
• have trouble taking turns
• have difficulty getting along with others

MEDICATIONS
Atomoxetine (Strattera)
- increasing attention and the ability to focus while reducing hyperactivity and impulsivity.
The goal of the medication is to control ADHD symptoms rather than cure them
Methylphenidate (Ritalin)
- Used to treat ADHD. It belongs to a class of drugs known as stimulants.
- It can help increase ability to pay attention, stay focused on an activity, and control
behavior problems.
- It may also help organize one's tasks and improve listening skills.
ADHD
● Inattention
● Hyperactivity
● Mind-wandering
● Time Blindness
● Working Memory
● Risk Taking
● Forgetful
● Craves novelty

OVERLAP
● Sensory Issues
● Hyper-fixation
● Interrupting
● Insomnia
● Restlessness
● Stimming
● Fidgeting
● Difficulty with friendships
● Creative
● OCD tendencies
● Executive function struggles
● Emotional dysregulation
● Depression/Anxiety

AUTISM
● Social signals unclear
● Deficits in Reciprocal Communication
● Special Interests
● Prefers routine
● Rigid with rules
● Literal
● Detail-focused
● Social overload
● Social isolation

SUBSTANCE USE DISORDER

UNABLE to CONTROL USE Of LEGAL or ILLEGAL SUBSTANCES

1. Against medical advice

2. Against social norm

3 STAGES
1. DEPENDENCE
● REPEATEDLY USED
2. TOLERANCE
● AMOUNT to HAVE SAME EFFECT
 3. ADDICTION
● RECURRENT & UNCONTROLLED

Alcoholism
Abuse:
To use wrongfully or in a harmful way. Improper treatment or conduct that may result in
injury.

Dependence/Addiction:
A compulsive or chronic requirement. The need is so strong as to generate distress (either
physical or psychological) if left unfulfilled.

Intoxication:
A physical and mental state of exhilaration and emotional frenzy or lethargy and stupor.

Withdrawal:
The physiological and mental readjustment that accompanies the discontinuation of an
addictive substance.

Mild 2-11
Moderate 4-11
Severe 6-11

Substance use disorders span a wide variety of problems arising from substance use,
and cover 11 different criteria.

The 11 DSM-5 Criteria for a Substance Use Disorder

1. Took more extensive amounts/ extended time. Using the substance in larger amounts
or for longer than it's meant to be.
2. Repeated efforts to control use or quit. Wanting to cut down or stop using the
substance but not succeeding.
3. Full time spent using. Consuming a lot of time getting, using, or recovering from use of
the substance.
4. Craving. Desires and urges to use the substance.
5. Disregarded major roles. Not accomplishing what is need to be done at work, home, or
school because of substance use.
6. Social or interpersonal dilemmas. Resuming to use even when it causes problems in
relationships.
7. Missed activities. Giving up significant social, occupational, or recreational activities
because of substance use.
8. Hazardous use. Using substances again and again even when it places the person in
danger.
9. Physical or psychological problems. Extending the use even if physical or
psychological problems arise.
10. Tolerance. Requiring more of the substance to get the effect the person desires.
11. Withdrawal. Development of withdrawal symptoms, which can be alleviated by taking
more of the substance.
In order to be diagnosed with a substance use disorder,
Substance Use Disorder the person must meet two or more of these criteria within a
12-month period.

Mild Substance Use Disorder - possesses two or three of the criteria.

Moderate Substance Use Disorder - Four to five criteria
Severe Substance Use Disorder - six or more criteria

Pharmacologic Management
Two main purposes:
● to permit safe withdrawal from alcohol, sedative-hypnotics, and benzodiazepines
● to prevent relapse

1. Benzodiazepines. Alcohol withdrawal is usually managed with a

benzodiazepine-anxiolytic agent, which is used to suppress the symptoms of abstinence.

2. Disulfiram (Antabuse) may be prescribed to help deter clients from drinking. Cause
change in taste & smell that can cause nausea.

3. Acamprosate (Campral) may be prescribed for clients recovering from alcohol abuse or
dependence to help reduce cravings for alcohol and decrease the physical and emotional
discomfort that occurs especially in the first few months of recover.

Contains alcohol
1. Shaving cream
2. Cough syrup
3. Alcohol containing beverages
4. Mouthwash

4. Methadone a potent synthetic opiate, is used as a substitute for heroin in some

maintenance programs.
5. Levomethadyl is a narcotic analgesic whose only purpose is the treatment of opiate
dependence.
6. Naltrexone (ReVia) is an opioid antagonist often used to treat an overdose, It can also be
used to treat alcohol abuse. Known: Narcan & ANTIDOTE

Effects of Chronic Alcohol Use

Physical effect: peripheral neuropathy, alcoholic (myopathy, cardiomyopathy, hepatitis,
cirrhosis)
Use During pregnancy: Fetal alcohol syndrome
Associated brain conditions - Dementia and Wernicke's disease due to thiamine (Vit.B1)
deficiency
Korsakoff's psychosis: syndrome of confusion, loss of recent memory, confabulation.
WALA MAY MA DUMDUMAN.
Wernicke-Korsakoff Syndrome is a neurological disorder caused by the lack of thiamine
(vitamin B1).
● The disorder includes Wernicke Encephalopathy and Korsakoff Amnesic Syndrome
which are not different conditions but different stages of the same disease
(Wernicke-Korsakoff syndrome).
Wernicke's Encephalopathy represents the "acute" phase of the disorder and Korsakoff's
Amnesic Syndrome represents the disorder progressing to a "chronic" or long-lasting stage.
• The disorder's main features are problems in
- acquiring new information or
- establishing new memories, and in retrieving previous memories.

Wernicke's (Acute Phase) Clinical Features

- Confusion
- Opthalmoplegia
- Ataxia
- Thiamine (Treatment)

Korsakoff's Psychosis (Chronic Phase)

- Retrograde Amnesia
- Anterograde Amnesia
- Confabulation
- Korsakoff's Psychosis

Effects of Alcohol
• Intoxication occurs at blood alcohol levels between 100 and 200 mg/dL,
● Death reported at levels ranging from 400 to 700 mg/dL
• Withdrawal symptoms begins within 4-6
hrs after last drink
● May progress to delirium tremens on 2nd or 3rd day
● Use of Librium of Serax is common for substitution therapy

The Most Common Substance Use Disorders

2. Sedatives, hypnotics, and anxiolytics - This class of drugs includes all central nervous
system depressants, barbiturates, nonbarbiturate hypnotics, and anxiolytics, particularly
benzodiazepines
- Effects of drugs include symptoms of intoxication and withdrawal symptoms which are
similar to those of alcohol.
3. Stimulants (amphetamines, cocaine) - Are drugs that stimulate or excite the central
nervous system; intoxication from stimulants develops rapidly
- Effects include the high or euphoric feeling, hyperactivity, hypervigilance, talkativeness,
anxiety, grandiosity, hallucinations, stereotypic or repetitive behavior, anger, fighting, and
impaired judgment.

4. Cannabis (Marijuana) - Is the most widely used illicit substance

- Research has shown that cannabis has short-term effects of lowering intraocular pressure.
- Symptoms of intoxication include impaired motor coordination, inappropriate laughter,
impaired judgment, and short-term memory, and distortions of time and perception.
- Red eyes

5. Opioids - Popular drugs of abuse because they desensitize the user to both physiologic
and psychological pain and induce a sense of euphoria and well-being
- Opioid intoxication develops soon after the initial euphoric feeling
- Symptoms include apathy, lethargy, listlessness, impaired judgment, psychomotor
retardation or agitation, constricted pupils, drowsiness, slurred speech, and impaired
attention and memory.
- Contricted pupils

6. Hallucinogen - Are substances that distort the user's perception of reality and produce
symptoms similar to psychosis, including hallucinations and depersonalization
- Hallucinogen intoxication is marked by several maladaptive behavioral or psychological
changes; anxiety, depression, paranoid ideation, ideas of reference, fear of losing one's
mind, and potentially dangerous behavior such as jumping out the window in the belief that
one could fly.

7. Inhalants - Are a diverse group of drugs that includes anesthetics, nitrates, and organic
solvents that are inhaled for their effects; the most common substances in this category are
aliphatic and aromatic hydrocarbons found in gasoline, glue, paint thinner, and spray paint
- Inhalant intoxication involves dizziness, nystagmus, lack of coordination, slurred speech,
unsteady gait, tremor, muscle weakness, and blurred vision.