Best-PracticeAssessmentandTreatmentofSMIin课件.pptVIP

Best-Practice Assessment and Treatment of SMI in Adolescents Michael G. McDonell, Ph.D. Acting Assistant Professor Department of Psychiatry University of Washington School of Medicine mikemcd@u.washington.edu Tax induced psychosis SED-SMI (Alphabet Soup) Why talk about SMI in Adolescents? Disorders often present in adolescence/early adulthood They present unique challenges to the child mental health system and child/adolescent clinicians Focus on psychotherapy rather than case management in the youth system Little expertise in treating these disorders in child/adolescent clinicians Current controversies make treatment challenging Diagnostic uncertainty Disagreement about diagnostic criteria for children Little data on diagnostic stability (e.g. bipolar disorder) across time Little awareness of available treatments SMI Assessment and Diagnosis Occam’s Razor: its horses not zebras Rare cases are usually explained by Simplicity: simplest explanation Most reasonable: most common/obvious explanation. SMI (bipolar schizophrenia) is a zebra Other childhood disorders are horses Assessment is a process of Ruling Out other disorders Prevalence of Adolescent Onset Schizophrenia Adult onset Schizophrenia Lifetime prevalence of 1% Onset mid 20-30s Females 5 year later onset (Loranger, 1984) Adolescent Onset: Onset 18 yoa Rare: 15 yoa (14/100,000) Very EOS (VEOS) 12 years of age Extremely rare: (1.6/100,000) Mostly males Adolescent Onset Schizophrenia Symptoms (McDonell McClellan, 2007) Symptoms Positive symptoms (more common in older adolescents) Hallucinations Delusion: organized delusions less common Thought disorder Loose associations Illogical thinking Impaired discourse skills Less common: incoherence and poverty of speech/thought Negative symptoms Impaired social functioning, typically a change from previous functioning Decreased self-care, motivation Onset/course Onset: Prodromal phase Acute onset vs. Insidious onset Course is typically episodic and