Download Depression and Anxiety Amongst Our Students

Depression and Anxiety
Amongst Our Students
Michelle Roling M.Ed., LMHC
Iowa State University
Student Counseling Services
Private Practice Clinician
Copyright Michelle Roling, M.Ed., LMHC 2007
ANXIETY
Copyright Michelle Roling, M.Ed., LMHC 2007
Statistics:
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Number one health problem in America
25% of adults struggle with anxiety
Stats in children are significantly under
reported and under-diagnosed
Estimated that the 25% is an accurate number
across age groups
Copyright Michelle Roling, M.Ed., LMHC 2007
Early Anxiety = Adult Struggle??
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Consensus in medical literature:
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many “adult psychiatric disorders” first manifest
themselves in childhood
when the childhood anxiety goes untreated it
progresses into more complex and difficult to
treat anxiety disorders
Copyright Michelle Roling, M.Ed., LMHC 2007
Common Signs:
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Feeling nervous
Feeling frightened for no reason
Worrying excessively
Feeling scared at times of separation
Shyness
Copyright Michelle Roling, M.Ed., LMHC 2007
What Causes Anxiety?
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Four areas to explore
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Psychological
Genetic
Biological
Medical
Copyright Michelle Roling, M.Ed., LMHC 2007
Psychological
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Increased internal and external stresses lessen
our ability to cope
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Psychodynamic-instincts and impulses conflict;
internal battle about what to do
Behavioral- “Doing” the anxious behaviors rather
than “doing” something that might manage the
emotions
Spiritual- emptiness, nothingness in life leading
to distress about mortality and eventual death
Copyright Michelle Roling, M.Ed., LMHC 2007
Genetic
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Studies show 50% ≥ of patients have family
member with an anxiety disorder
Twin studies echo this finding
Copyright Michelle Roling, M.Ed., LMHC 2007
Biological
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PET scans- evidence of abnormal functioning
in several areas of the brain
Several “chemicals” affected
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Serotonin
Norepinephrine
GABA
Copyright Michelle Roling, M.Ed., LMHC 2007
Medical
Medically induced anxiety
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Cardiovascular disease
Lung disease
Some tumors
Endocrine disorders- hypothyroidism
Neurological disorders
Copyright Michelle Roling, M.Ed., LMHC 2007
Types of Anxiety Disorders
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Generalized Anxiety Disorder (GAD)
Panic Disorder (PD)
Obsessive- Compulsive Disorder (OCD)
Posttraumatic Stress Disorder (PTSD)
Social Phobia (SOC)
Acute Stress Disorder
Specific Phobia
Adjustment Disorder with Anxiety
Anxiety Disorder due to General Medial Condition
Drug Induced Disorder
Anxiety Not Otherwise Specified (NOS)
Copyright Michelle Roling, M.Ed., LMHC 2007
Generalized Anxiety Disorder
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Excessive worry,
apprehension, anxiety
occurring most days
for 6 months or more
Concern over multiple
activities
Significant distress and
impact on general
function
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Struggle to control the
anxiety
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Restlessness
Feeling ‘keyed up”
On edge
Fatigued
Lack of concentration
Mind going blank
Tension
Sleep disturbance
Copyright Michelle Roling, M.Ed., LMHC 2007
Panic Disorder
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Recurrent unexpected panic attacks
Worry between attacks about having the next
attack
Marked changes in behavior
Frequently associated with Agoraphobia
Differentiated from panic attacks- 4 of 13 symptoms- sudden discrete
episodes of: ear palpitations; sweating; trembling/shaking; shortness of
breath; choking; chest discomfort/pain; nausea; dizzy/ lightheaded/ faint;
feelings of unreality/detached; fear of loosing control; fear of dying;
numbness/tingling; chills/hot flashes;
Copyright Michelle Roling, M.Ed., LMHC 2007
Obsessive Compulsive Disorder
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Persistent Obsessions
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Persistent Compulsions
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Unwanted thoughts, images, ideas and urges
Uncontrollable repetitive behaviors
Experience Notable Distress in their life
Often pertaining tocontamination/checking/cleanliness
Copyright Michelle Roling, M.Ed., LMHC 2007
Posttraumatic Stress Disorder
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Exposed to or witness to an event that
involved actual or perceived death or serious
bodily injury
Continued re-exposure
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Dreams, images, thoughts
Symptoms persist for more than 1 month
Copyright Michelle Roling, M.Ed., LMHC 2007
Social Phobia
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Fear of one or more social situations
Fear of being embarrassed or humiliated
Leading to avoidance of situations
Consider the impact of technological
interactions and the lack of face to face
communication!!!!
Copyright Michelle Roling, M.Ed., LMHC 2007
Acute Stress Disorder
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Exposed to or witness to an event that
involved actual or perceived death or serious
bodily injury
Continued re-exposure
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Dreams, images, thoughts
Symptoms persist for less than 1 month
Copyright Michelle Roling, M.Ed., LMHC 2007
Specific Phobia
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Fear is recognized as unreasonable and
excessive
Specific object or situation
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Animal type
Environmental type
Injection-Injury type
Situational type
Copyright Michelle Roling, M.Ed., LMHC 2007
Adjustment Disorder with Anxiety
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With or without depressed mood
Occurs within 3 months of an event
Does not last longer than 6 months past the
event ending
Copyright Michelle Roling, M.Ed., LMHC 2007
Anxiety due to medical condition
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Physiological consequences of a distinct
medical condition
Copyright Michelle Roling, M.Ed., LMHC 2007
Drug-induced Anxiety Disorder
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Physiological consequences of the use of a
drug/medication
Copyright Michelle Roling, M.Ed., LMHC 2007
Anxiety NOS
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When anxiety exists, but does not meet
criteria previously explained
Copyright Michelle Roling, M.Ed., LMHC 2007
How do we know WHEN to treat?
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Anxiety interferes with daily functioning
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Confidence
Attendance
Interaction
Remember that with treatment symptoms can
be reduced or eliminated for 70-90% of
patients when treated!
The earlier the less impact on the individual
Copyright Michelle Roling, M.Ed., LMHC 2007
Link between Anxiety and Depression
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Studies demonstrate that anxiety left untreated
can lead to the development of Major
Depressive Disorder
Dual diagnosis occurs regularly for students
Copyright Michelle Roling, M.Ed., LMHC 2007
Depression
Copyright Michelle Roling, M.Ed., LMHC 2007
Statistics
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In the last 25 years the general rate of suicide has
decreased while it has tripled for those between the
ages of 15-24
Suicide is the most common cause of death for this
population in the United States
Over 40% of students with depression think of
hurting themselves (FDA)
Nearly 1 in 6 students think about suicide in a year
(CDC)
Copyright Michelle Roling, M.Ed., LMHC 2007
Diagnosis
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Based on 5 symptoms lasting for
only 2 weeks or more
Copyright Michelle Roling, M.Ed., LMHC 2007
Common Signs
Major Depressive DO
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Depressed Mood much
of the day
Signs in Students:
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Irritable or cranky
moood; preoccupation
with song lyics that
suggest life is
meaningless
Copyright Michelle Roling, M.Ed., LMHC 2007
Common Signs
Major Depressive DO
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Decreased
interest/enjoyment in
once-favorite activities
Signs in Students:
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Loss if interest in
sports, video games
and activities with
friends
Copyright Michelle Roling, M.Ed., LMHC 2007
Common Signs
Major Depressive DO
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Significant weight
loss/gain
Signs in Students:
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Failure to gain weight
as normally expected;
anorexia or bulimia;
frequent complaints of
physical illness
(headache, stomach..)
Copyright Michelle Roling, M.Ed., LMHC 2007
Common Signs
Major Depressive DO
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Insomnia or
hypersomnia
Signs in Students:
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Excessive late-night
TV; refusal to wake
for school in the
morning
Copyright Michelle Roling, M.Ed., LMHC 2007
Common Signs
Major Depressive DO
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Psychomotor
agitation/retardation
Signs in Students:
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Talk of running away
from home or efforts to
do so
Copyright Michelle Roling, M.Ed., LMHC 2007
Common Signs
Major Depressive DO
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Fatigue or loss of
energy
Signs in Students:
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Persistent boredom
Copyright Michelle Roling, M.Ed., LMHC 2007
Common Signs
Major Depressive DO
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Low-self-esteem;
feeling of guilt
Signs in Students:
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Oppositional and or
negative behavior
Copyright Michelle Roling, M.Ed., LMHC 2007
Common Signs
Major Depressive DO
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Decreased ability to
concentrate; indecisive
Signs in Students:
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Poor performance in
school; frequent
absences
Copyright Michelle Roling, M.Ed., LMHC 2007
Common Signs
Major Depressive DO
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Recurrent suicidal
ideation or behavior
Signs in Students:
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Recurrent suicidal
ideation or behaviorswriting about death,
giving away favorite
things
Copyright Michelle Roling, M.Ed., LMHC 2007
Pay attention to general changes in
your student:
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Appearance- self-neglect or new attention to
self
Isolation
Recklessness
Outbursts- depression often hides behind
anger
Copyright Michelle Roling, M.Ed., LMHC 2007
What Causes Depression?
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Three factors to consider
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Biological factors
Psychological factors
Environmental factors
Copyright Michelle Roling, M.Ed., LMHC 2007
Biological factors
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Genetic link-familial and inherited
Pre-frontal cortex changes-larger left-side
Neurotransmitters-decreased (norephinephrine, dopamine and
serotonin)
Hydrocortisone- increased
Gender trends- important re: prevention strategies
adults f = m
young adults f ≥ m
adolescents f ≥ m
pre-puberty f ≤ m
childhood f = m
Copyright Michelle Roling, M.Ed., LMHC 2007
Psychological factors
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The way people think and behave
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Irrational and illogical thought process
Negative cognitive view
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Real loss or symbolic loss
Unconscious anger over loss weakens the ego
Self-hate and self-destructive behavior
Gloominess, pessimism, self-criticism, skepticism…
Learned helplessness
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Prolonged exposure to uncontrollable events leading to
apathy
Copyright Michelle Roling, M.Ed., LMHC 2007
Environmental factors
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Stressful experiences
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divorce of parents
Siblings
Moves
hormonal changes…
Social roles: f- loss of relationships; mdisappointment re: sports
Copyright Michelle Roling, M.Ed., LMHC 2007
Types of Depressive Disorders
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Major Depression
Dysthymia
Bi-polar
Adjustment Disorder with Depression
Copyright Michelle Roling, M.Ed., LMHC 2007
How do we know WHEN to treat?
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Children with depression are 5 times more
likely to attempt suicide
If there is a gun in the home there is 5 times
more likeliness of a suicide by the student
Early intervention is ideal!!!!!!
Copyright Michelle Roling, M.Ed., LMHC 2007
Treatment for Anxiety and Depression
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Accurate Diagnosis
Therapy
Medication
Team approach
Copyright Michelle Roling, M.Ed., LMHC 2007
Diagnosis
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Assessments
Medical physical
Asking questions
Copyright Michelle Roling, M.Ed., LMHC 2007
Therapy
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Talk, talk, talk
Challenge negative cognitions
Incorporate self-care
Model
Coping skills
Copyright Michelle Roling, M.Ed., LMHC 2007
Medications
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People are scared due to FDA warnings
First line of defense for biologically based
disorders
Copyright Michelle Roling, M.Ed., LMHC 2007
Treatment team
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Student
Parents
Therapist
Doctor
School staff
Copyright Michelle Roling, M.Ed., LMHC 2007
Ideas for schools --
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Coping carts
Self-care days
Drop boxes for comments/concerns
Ask for help cards
Open discussions re: mood
Activities in class encouraging self-disclosurebibliotherapy/reports/journals/art/book
alterations/awareness weeks/passive and active
programming
Copyright Michelle Roling, M.Ed., LMHC 2007
Resources
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www.nami.org
www.teenshealth.org
www.aboutourkids.org- great book list
Depression in Children and Adolescents:
information for Families and Educators
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www.naspcenter.org
Copyright Michelle Roling, M.Ed., LMHC 2007