Focused Issue of This Month Mental Disorders in Adolescents Dong-Hyun Ahn, MD Department of Psychiatry, Hanyang University College of Medicine E - mail : ahndh@hanyang.ac.kr J Korean Med Assoc 2009; 52(8): 745-757 Abstract In spite of misconception and/or neglect concerning mental disorders of adolescence, increasing attention to adolescents mental health problems arises from a number of sources. A perspective from developmental psychopathology provides a conceptual tool for understanding the range of processes and mechanism underlying how and why psychopathology in adolescents emerges. This will enable primary physicians to diagnose and/or provide treatments to adolescents with mental health problems in clinical practice. More information about mental disorders in adolescents will be needed for primary physicians in the future. Adolescents mental disorders are significant societal problem. Physicians should perform a leadership in multidisciplinary approach for diagnosis and treatment of mental disorders in adolescents. Keywords: Adolescent; Mental disorder; Diagnosis; Treatment 745
Ahn DH Neuropsychiatric conditions Malignant neoplasms Cardiovascular diseases male female male female male female 0% 0~4 years 5~9 years 10~14 years 15~19 years 20+ years 25% 50% 75% 100% Figure 1. Burden of disease in disability-adjusted life years (DALYs) attributable to specific causes by age and sex in the year 2000 (3). Table 1. Classification of mental disorders in adolescents cluster specific disorders 1. developmental disorder MR, ASD, LLD 2. behavioral disorder ADHD, ODD, CD 3. emotional disorder SAD, Other AXDs, somatoform disorder, MDD 4. psychophysiologic disorder Sleep, elimination, and eating disorders 5. other disorder Tic/TS, psychosis, adjustment disorder, others MR: mental retardation, ASD: autism spectrum disorder, LLD: learning and language disorder, ADHD: attention deficit- hyperactivity disorder, ODD: oppositional defiant disorder, CD: conduct disorder, SAD: separation anxiety disorder, AXDs: anxiety disorders, MDD: major depressive disorder, Tic/TS: tic disorder and Tourette disorder 746
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Ahn DH Table 2. Prevalence and sex-ratio of mental disorders in adolescents category specific disorder estimated prevalence sex- ratio Emotion mood major depressive disorder common M < F bipolar disorder) NK M = F anxiety panic disorder very rare M < F social phobia rare M < F obsessive-compulsive disorder rare M > F Behavior substance alcohol intoxication very common M > F substance abuse common M > F conduct conduct disorder very common M > F impulse control pathologic gambling very rare M > F trichotillomania rare M < F Physical eating anorexia nervosa very rare M << F bulimia nervosa less common M < F sleep narcolepsy very rare M = F somatization body dysmorphophbia NK M = F Prevalence is estimated as following: very common, > 10%: common, 5~10%; less common, 2~ 5%: rare, 1~2%: very rare, < 1%: NK, not unknown (6). 748
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Ahn DH Table 3. Classification of psychotropic drugs by effect category specific drugs stimulants methylphenidate (MPH -IR, Concerta, Metadate- CD ), d - amphetamine* Antipsychotics haloperidol, risperidone, olanzapine, etc Antidpressants TCAs (imipramine), SSRIs (Prozac, etc), SNRIs(Venlafaxine, etc) Anxiolytics lorazepam, diazepam, alprazolam, Stilnox Mood stabilizer lithium, carbamazepine, valproic acid, Lamictal Not classified desmopresin, naltrexone, atomoxetine, *Not available in Korea 754
Mental Disorders in Adolescents Table 4. Psychopharmacotherapy for DSM-IV diagnoses Diagnosis Target symptoms Medications Developmental Disorders Mental retardation (MR) aggression, propranolol, clonidine self - injurous behavior clonazepam, lithium opiate antagonist, antipsychotics Autism self - injurous behavior similar to MR aggression, hyperactivity Behavioral Disorders ADHD hyperactivity, impulsive stimulants, atomoxetine inattention clonidine, SSRIs, bupropion, Conduct disorder aggression, irritability stimulants, antipsychotics self - injurous behavior similar to MR Emotional Disorders GAD overanxious benzodiazepines, buspirone diphenhydramine, SSRIs, Panic disorder panic sertraline, paroxetine, alprazolam, clonazepam, TCAs Obsessive-compulsive disorder clomipramine, SSRIs Mood Disorders MDD depressive mood, etc. Antidepressants lithium augmentation Bipolar disorder irritability, anger lithiu, valproic acid elated mood carbamazepine, risperidone Tic Disorder Tourettes diorder motor and vocal tic haloperidol, pimozide, clonidine, desipramine Others Schizophrenia antipsychotics Enuresis DDAVP, imipramine Sleepwalking disorder diazepam, imipramine 755
Ahn DH 11. Mash EJ, Dozois DJA. Child psychopathology: A developmental -systemic perspective. IN: Mash EJ, Barkley RA, ed. Child Psychopathology, 2nd ed. New York: The Guilford Press, 2003: 3-71. 12. 13. Remschmidt H, Belfer M. Mental health care for children and adolescents worldwide: A review. World Psychiatry 2005; 4: 147-153. 14. 15. Volkmar FR, Lord C, Klin A, Schultz R, Cook EH. Autism and the pervasive developmental disorders. IN: Martin A, Volkmar FR, ed. Lewis s child and adolescent psychiatry, 4th ed. Philadelphia: Lippincott Williams & Wilkins, 2007: 383-400. 16. Skodol AE, Shaffer D, Gurland B. Psychopathology Across the Life Cycle. IN: Tasman A, Kay J, Lieberman JA, ed. Psychiatry. Philadelphia: WB Saunders, 1997: 449-476. 17. 18. 19. 10. American Academy of Child & Adolescent Psychiatry. Practice parameters for the psychiatric assessment of children and adolescents. J Am Acad child Adolesc Psychiatr 1997; 36: 4-20. 11. Popper CW. Introduction: Therapeutic empiricism and therapeutic basics. J Child Adolesc Psychopharmacology 1990; 1: 3-5. 12. 13. 14. Green WH. Child and Adolescent Clinical Psychopharmacology. 2nd ed. Baltimore: Williams & Wilkins, 1996 15. 16. 756
Mental Disorders in Adolescents Peer Reviewers Commentary 757