ADOLESCENT HEALTH

Engaging Adolescent & Managing Adolescent’s Mental Health

DR. MOHD FAIDHI BIN MAZLAM
 CASE 1 (KFQ)
17 years old male student, previously healthy, brought in by his
mother to the emergency department. She notices him to be
behaving oddly over the past three months. His academic
performances have deteriorated. At times, he appears angry and
believes that some secret agents are following him. He also had been
hearing voices commenting on his good look.

Delusion – persecutory (believes that some secret agents are

following him)
Hallucination – auditory (hearing voices commenting on his good
look)
Duration – 3 months
 ABNORMAL BEHAVIOUR
Acute psychosis in adolescent.
Differential diagnosis?
1. Substance induced psychotic disorder
2. Schizophreniform disorder
3. Psychosis associated with medical conditions
• metabolic derangement (fluid/electrolyte/thyroid)
• acute brain injury (trauma/SOL)
• infection(systemic/local)
 ABNORMAL BEHAVIOUR
Acute psychosis in adolescent.

Immediate investigations?
1. Urine drug screen
2. Urea and electrolytes
3. CT brain
 ABNORMAL BEHAVIOUR
Acute psychosis in adolescent.

Source: Manual Managing Mental Health

Problems Among Adolescents for Primary
Health Providers (2014)
Source: Manual Managing Mental Health Problems Among Adolescents for Primary Health Providers (2014)
 ABNORMAL BEHAVIOUR
Acute psychosis in adolescent.

Next!

How do you approach this

patient?
Clinical Approach for Engaging Adolescent
• C’RET – Confidential / Rapport / Empathy / Trust
• Confidentiality with three exceptions
• At risk of harming themselves
• At risk of harming others
• At risk of being harmed (physical or sexual)
• Build rapport – introduce your name, role, reason for
interview
• See parents and adolescent together, then separately
• HEADSS assessment
 Home HEEADSS Assessment Drugs
2nd out of 4 siblings, living together with parents Cigarettes
and all siblings. Fairly good relationship with them Alcohol

Education H Smoke cigarette, denies alcohol,

just started experimenting drugs
Employment E
Form 5 student, dislike school, no s Sexualit
bullying, average performance, y
No sexual partner, denies
only interested in sport activities, sexual activity, knows about
bad relationship with teachers e STI, comfortable of being
male
Eating s Suicide
Exercise
A Depression
Usual diet, normal weight, satisfied
with body weight/image, jogs every Denies depression
now and then symptoms, no suicidal
s ideation/attempts

Activity D
Peer Group Safety
Not many friends at school, has other circle of NIL - Injury, violence, self-harm,
friends to hang out with, hates staying at Prepared by Fadhilah
motor vehicle safety, victim,
home, spends most of his leisure time outside (MMED FMS) physical/mental/sexual abuse
playing video games
 Further history?
• He admitted to taking pill kuda for the past two
months, in significant amount (5-10 pills/day)
• Took the drugs just for fun and experimentation
• Last pill taken was last night
• Introduced by friends at neighborhood area. Hang out
with them almost every day
• Parents and friends at school did not know about him
involved with this
• Denied any other drug used including intravenous or
inhalational drugs
 Management
AIMS
• To alleviate symptoms
• Aim for abstinence
• Restore function – social, education

• OUTPATIENT or INPATIENT? : need discussion with patient

& family members – manageable, not aggressive, good
family support  OUTPATIENT
• NON-PHARMACOLOGICAL : Family involvement,
psychoeducation, behavioural therapy, psychosocial therapy
(eg. support group, OT)
• Rehabilitation center ( eg. Cure and Care Service Center)
• PHARMACOLOGICAL: Short term atypical anti-psychotics
(eg, T Risperidone)
• Referral to psychiatric team : monitoring and follow up
 CASE 2
15 years old Malay female, came to your practice for follow
up. She has underlying Type I Diabetes Mellitus. During
consultation, she mentioned to you that she has been feeling
low, sad and tired all the time. She also said that her memory
has been affected recently, she cannot focus in the class. She
has also had lack of interest for her hobbies and finding it
difficult to be able to enjoy everyday activities such as
watching the television or sharing a meal with her family. After
long conversation, she finally said that “I don’t want to live
anymore. I want to die!”. She said I’ve tried before but failed.
 LOW MOOD WITH SUICIDE RISK.
What are the differential diagnoses?
Differential diagnosis?
1. Major depressive disorder
2. Adjustment disorder
3. Acute stress reaction
 LOW MOOD
What are the
differential diagnoses?
D depressed mood
E energy loss (fatigue)
P pleasure lost (anhedonia)
R retarded movement (or psychomotor agitation)
E eating changes (appetite / weight)
S sleep changes (insomnia / hypersomnia)
S suicidal
I I’m guilty
O only to be blamed (worthless)
N no concentration

Source: Manual Managing Mental Health

Problems Among Adolescents for Primary
Health Providers (2014)
Source: Manual Managing Mental Health Problems Among Adolescents for Primary Health Providers (2014)
 Management
• Assess suicide risk
• Refer to psychiatric team
 CASE 3 (SBA)
18 years old boy, active smoker, presented to you with prolonged productive
cough for the past 4 months. No hemoptysis or constitutional symptoms. No
diurnal variation, no exercise-induced symptom. No previous history of asthma
or any other illnesses. Family history nil of note. No PTB contact. Upon further
questioning, he works at night club and used to take alcohol on regular basis.
Vital signs normal, clinically afebrile but appeared anxious. Noted injected
eyes with no discharge. Lungs clear, CXR was normal, PTB work-up was
negative.

What is the most likely cause of his condition?

A COPD
B Asthma
C Pneumonia
D Cannabis
E Cocaine
 Cannabis / Marijuana
• World most commonly used illicit substance
• Active component: tetrahydrocannabinol
• Acute intoxication: Euphoria, anxiety, sensation of slowed time,
red eyes, dry mouth and increased appetite
• Cannabis –induced psychosis
• Chronic use:
• respiratory problems  asthma, chronic bronchitis
• Immunosuppresion
• Withdrawal: irritability, anxiety, insomnia, headache, sweating,
aggression
 CASE 3 (SBA)
18 years old boy, active smoker, presented to you with prolonged productive
cough for the past 4 months. No hemoptysis or constitutional symptoms. No
diurnal variation, no exercise-induced symptom. No previous history of asthma
or any other illnesses. Family history nil of note. No PTB contact. Upon further
questioning, he works at night club and used to take alcohol on regular basis.
Vital signs normal, clinically afebrile but appeared anxious. Noted injected
eyes with no discharge. Lungs clear, CXR was normal, PTB work-up was
negative.

What is the most likely cause of his condition?

A COPD
B Asthma
C Pneumonia
D Cannabis
E Cocaine
 References
1. National Health Morbidity Survey (NHMS), 2017
2. Manual Managing Mental Health Problems Among
Adolescents for Primary Health Providers, 2014
3. Paediatric Protocols for Malaysian Hospital 4th Edition, 2018
4. Enganging the Adolescent Module Using HEADSS Framework