PE6.6 | Adolescent Mental Health — Summary & Reflection

KEY TAKEAWAYS

Common adolescent mental health problems include depression (MDD — irritability may substitute for depressed mood in adolescents; ≥5 of 9 symptoms for ≥2 weeks), anxiety disorders (GAD ≥6 months; in children only 1 somatic symptom required), and ADHD (inattentive features dominate in adolescence). The PHQ-A screens for depression (score ≥10 = moderate = active treatment indicated; item 9 positive = suicide risk assessment mandatory). Suicidal ideation requires structured assessment of plan, intent, means access, previous attempt, and protective factors; high-risk features mandate emergency psychiatric referral; lower-risk situations require safety planning and close follow-up. The MHCA 2017 decriminalised suicide attempts. Management follows a stepped-care model: psychoeducation + lifestyle for mild; CBT for mild-to-moderate; fluoxetine + CBT for moderate-to-severe MDD (TADS trial evidence; FDA black-box warning: monitor weekly at start for increased suicidal ideation). ADHD management: methylphenidate (0.3–1 mg/kg/day) + academic accommodations.

REFLECT

The 15-year-old boy in the opening vignette was described by his mother as 'lazy and disrespectful.' His presenting features — irritability, hypersomnia, anhedonia (stopped football), reduced appetite, and suicidal ideation — meet the DSM-5 criteria for major depressive disorder adapted for adolescents. Reflect on the family dynamics: the mother's attribution of his symptoms to character rather than illness is a barrier to treatment. How would you explain the diagnosis to this mother in a way that: (a) does not blame her; (b) does not invalidate the behavioural concerns she has; and (c) opens the door to her active participation in his treatment (Family-Based involvement)? What language would you use, and what misconceptions would you need to proactively address?