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Psychiatric disorders in adolescence

Psychiatric disorders in adolescence

Although adolescence is often associated with a period of stress and turmoil, most adolescents manage the transition between childhood and adulthood without major problems. It is a period, however, during which there are major changes in body image, self-esteem, relationships with parents and mood. Awareness about sexual orientation and identity are also heightened. The rate at which children mature differs with early maturing boys showing some social advantage over boys who mature later.

Early maturing girls, on the other hand tend to experience some depression and anxiety compared with late maturers. Discomfort and embarrassment about body shape and size are comparatively greater in this group. Conflicts with parents and emotional and behavioural problems are also more commonly experienced. The term ‘identity crisis’ was used originally by Erikson, to describe the process of development during adolescence, leading to a welldeveloped notion of self. Experimentation with different roles and beliefs is not uncommon. There are large differences in the rate and pace of change in the development of personal identity. This period of change before identity crisis is resolved was termed ‘identity confusion’ by Erikson. Adolescence is a period of transition between childhood and adulthood and, in most cultures, is heralded by the onset of puberty while termination is often socially and culturally determined. The interplay of social and biological influences play an important part in the disorders of adolescence. Prevalence rates for disorder range from 8–20 per cent. Emotional conduct disorders are the most commonly diagnosed and, in a proportion of adolescents, are the continuation of unresolved disorders in earlier childhood. Conduct problems become more pronounced with the onset of adolescence and may result in forensic involvement. Substance misuse is likely to play a part in disturbed and offending behaviour. Anxiety disorders related to school attendance, phobias and agoraphobia may have its onset in adolescence.

Obsessive-compulsive disorders presenting with obsessional ideas, ruminations and ritual and can be associated with anxiety, depression or Tourette’s syndrome. Depressive disorders, mania and bipolar disorders are more common during adolescent than in childhood. Self-harm and suicide rates also show an increase. A proportion of children with pervasive developmental disorders develop epilepsy during adolescence. Behavioural disturbance can increase and children may show difficulties in understanding and expressing sexual behaviour. Although schizophrenia can occur in younger children, its onset before puberty is rare. Males are more vulnerable and it is usually preceded by a stage of behavioural and social difficulties and this may make early diagnosis difficult. Eating disorders, such as anorexia nervosa and bulimia nervosa have their onset during adolescence. In anorexia nervosa onset before puberty is uncommon. The prevalence rises from 0.1 per cent in 11- to 15-year-olds to 1 per cent in 16- to 18-year-olds; the male/female ratio being 1:10. Bulimia peaks a few years later.

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