Download Kevin Leehey M.D. Child, Adolescent, and Adult Psychiatry Board

Kevin Leehey M.D.
Child, Adolescent, and Adult Psychiatry
Board Certified
296-4280
leeheymd.com
Community of Concern
Workshop
 Depression and Self Destructive Behaviors
Kevin Leehey, M.D.
296-4280
Overview
What causes depression, anxiety,
and self harm?
What is Depression ?
What is Anxiety ?
What is stress?
What is self destructive behavior ?
How do I help my teen ?
Kevin Leehey, M.D.
296-4280
Causes
Genetics
Life events, losses, environment,
disappointments
“Stress” - personal, family, peers,
societal pressures
Alcohol and other drugs
Health problems
ADD, ADHD, Learning Disorders
 “Nature vs Nurture” - genes or
experiences
Kevin Leehey, M.D.
296-4280
Types of Depression
Major
Dysthymic disorder
Depression NOS
Bipolar Depression
Existential or adolescent angst
Personal and Family History PH, FH
Kevin Leehey, M.D.
296-4280
Major Depression :
for diagnosis
5 of below for at least 2 weeks
Sad, mad, down most of every day
Anhedonia - loss of interest, withdrawal
Fatigue, loss of energy
Sleep change - up or down
Appetite change - up or down
Feel worthless, hopeless, guilt, negative
Agitation or slowed movements and
thoughts
Decreased concentration and ability to
think, or decide
Recurrent thoughts of death or suicide
Kevin Leehey, M.D.
296-4280
Especially common in
depressed teens :
Irritable, cranky, negative
Withdrawal, isolation
Change or avoid friends
Drop in school performance
Quit or fail to follow through with
activities, jobs, etc.
Substance abuse
Anxiety, worry about the future,
hopeless, no longer trying, loss of
motivation
Kevin Leehey, M.D.
296-4280
Other Forms of Depression
Dysthymia
Depresson NOS
Existential, “angst”
Bipolar Depression
PH and FH
Kevin Leehey, M.D.
296-4280
Mania:
while not one’s usual self for at least a
week, a marked change
Elevated, expansive, irritable, temper
Inflated self esteem, grandiosity
Markedly decreased need for eating or
sleeping
Pressured speech
Racing thoughts
Flight of ideas
Loss of judgement, spend, sex, illegal,
pleasure seek, substance abuse,
gamble, unwise business ventures
Agitation
Distractible
Kevin Leehey, M.D.
296-4280
Psychosis can occur
Anxiety
Excessive worry, fear, nervous
Generalized Anxiety Disorder, GAD
Panic, “anxiety attack”
Separation anxiety, school anxiety
Social anxiety
Obsessive Compulsive Disorder, OCD
O/C style, perfectionism
Over-sensitive,over-reactive, control
PH and Family history
Kevin Leehey, M.D.
296-4280
Stress
Forces from the outside (or inside) that
impinge, affect, or impact us.
Mild to moderate stress can promote
growth. Severe, sudden, or chronic
stress cause biologic damage resulting
in physical and emotional damage,
disease.
Trying to do too much too fast, pressure
to grow up, achieve, excel
Positive coping
Negative coping
Kevin Leehey, M.D.
296-4280
Co- and Extra-curricular
Activities
 studies show :
 10-20 hours a week is best for most
teens
Kids who do <10 hours and kids who do
>20 hours do less well in school
Sports, clubs, music, job, youth groups,
4H, horses, volunteer, martial arts, etc.
 learn a skill, develop a hobby, make
new friends, build self esteem, manage
time, get experience, build a resume,
find a mentor, have positive fun Kevin Leehey, M.D.
296-4280
Self Destructive Behavior
Any behavior that hurts you
Substances
Eating disorders
Piercings ? Tattoos?
The “choking game”
Self harm, self mutilation
Suicide
Kevin Leehey, M.D.
296-4280
Self Harm
Cut, scratch, burn, mutilate
Trendy, myspace, “community”, “emo”
Arms and more
Mild to severe
To release feelings physically; to
convert emotional pain into physical
Usually not suicide intent
Kevin Leehey, M.D.
296-4280
Suicide
“accidental”, uncertain intent,
ambivalent, passive, nihilism
Ideation, plan, intent, act
#2 to 3 cause of death age 15-24
Firearms 80% in boys; 50% girls
Overdoses, hanging, “accidents”
Arizona in worst 5
“survivors”, the suffering of those left
Kevin Leehey, M.D.
296-4280
Suicide -
cont’d
1) Depressed, angry, substances
2) “the last person you’d ever expect”
3) Eating Disorders especially Bulimia
4) Psychosis or severe mental illness
Disciplinary Crisis
Connectedness, support system
Lethality of method and intent
Rate dropped 25 % in last decade
Prevention, treatment
Kevin Leehey, M.D.
296-4280
How do I help my Teen?
Model healthy living and coping
Reasonable expectations
Be present, involved, and caring
Avoid over-control and intrusion
Focus on developing the life skills your
teen will need for happy independence
Encourage but limit electronics
Use the Community of Concern
Kevin Leehey, M.D.
296-4280
How do I help? -
cont’d
Teach or provide “teacher” of healthy
coping skills, stress mgmt, values,
spirituality, self esteem, goals
The “relaxation response”
Motor vehicles, firearms, substances
Parenting books
Therapy and counseling
Medication
Kevin Leehey, M.D.
296-4280
Therapy and Counseling
Individual therapy-
Cognitive Behavioral
(CBT), Behavior Management, Interpersonal,
Psychodynamic, Psycho-education
Family therapy-
Family system,
Structural, Parenting, Psycho-education
Intensive Outpatient Programs
Residential Treatment
Inpatient Hospitalization
Kevin Leehey, M.D.
296-4280
Medication
Safety - carefully prescribed and
monitored the safety record is excellent
The more “biologic” signs that are
present the more likely medicine will
help and is needed
The more severe the anxiety or
depression
The stronger the family and personal
history
If therapy is not enough, not effective,
refused, or if medication is preferred
Kevin Leehey, M.D.
296-4280
Medication -
cont’d
25% best with therapy alone, 25% best
with medicine alone, 50% best with
combination for Major Depression or
severe Anxiety
SRI’s, buproprion, SNRI’s, etc.
Bipolar disorder usually requires
medicine
Omega 3 (and 6) FA’s, supplements,
vitamins, diet, exercise, other
Kevin Leehey, M.D.
296-4280
Good night and good luck!
Kevin Leehey M.D.
296-4280
leeheymd.com
Kevin Leehey, M.D.
296-4280