Adolescent Health

INTRODUCTION

Adolescence is the name given to the psychosocial life stage which starts around the time of puberty; considered to span between the ages of 10 and 19 yrs.

ADOLESCENT DEVELOPMENT PERIODS

Early adolescence (10–14 yrs): ‘Am I normal?’

Middle adolescence (14–17 yrs): ‘Who am I?’

Late adolescence (17–19 yrs): ‘Where am I going?’

Sexual development: 102–103

HALLMARKS OF THE ADOLESCENT

The main hallmarks of the adolescent are:

• self-consciousness

• self-awareness

• self-centredness

• lack of confidence

NEEDS OF THE ADOLESCENT

Adolescents have basic needs that will allow them the optimal environmental conditions for their development:

• ‘room’ to move

• privacy and confidentiality

• security (e.g. stable home)

• acceptance by peers

• someone to ‘lean on’ (e.g. youth leader)

• special ‘heroes’

• establishment of an adult sexual role

• one good trustworthy friend

THE CLINICAL APPROACH

Consider the mnemonic HEADS in the history:

• H—home

• E—education, employment, eating (consider disorders) and exercise, economic situation

• A—activities, affect, ambition, anxieties

• D—drugs including cigarettes and alcohol, depression

• S—sex, stress, suicide, self-esteem, safety

During this process it is necessary to be aware of the fundamental development tasks of adolescence, namely:

• establishing identity and self-image

• emancipation from the family and self-reliance

• establishing an appropriate adult sexual role

• developing a personal moral code

• making career and vocational choices

• ego identity and self-esteem

If consulted it is necessary to conduct a physical examination and order very basic investigations if only to exclude organic disease and provide the proper basis for effective counselling. Areas of counselling and anticipation guidance that are most relevant are:

• emotional problems/depression

• significant loss (e.g. breakdown of ‘first’ love)

• sexuality

• contraception

• guilt about masturbation or other concerns

DEPRESSION, PARASUICIDE AND SUICIDE

Up to 25% of adolescents suffer from a mental health and/or substance abuse problem, especially anxiety and depression. Difficult to treat and heavily reliant on a trusting relationship with their GP.

When dealing with adolescents it is important always to be on the lookout for depression and the possibility of suicide, which is the second most common cause of death in this group. Males successfully complete suicide 4 times more often than females, while females attempt suicide 8–20 times more often than males.

Treatment of depression

Non-pharmacological interventions (all grades):

• general support and education

• family therapy

• interpersonal psychotherapy

• CBT

Medication:

• mild: not recommended

• moderate to severe: consider fluoxetine 10 mg/d ↑ to 20 mg/d (max. 80); continue for 6–12 mths after recovery

Referral to a psychiatrist is advisable.