Common Mental Health Problems and
Psychoactive Substance Use during
Adolescence and Youth
Chapter 10
Enabling objectives:
Identify common mental illness and their burden
among adolescence and youth
Identify common substances and drugs use by
adolescent and youth at the local context
Discuss management of common mental health
illnesses and substance abuses
Identify the common psycho-active substance use
and disorders, and consequences of substance use
Apply HEADSS assessment summary
Chapter outline
Burden of common mental illness during
adolescence and youth
Development related mental health problems in
Adolescent and youth
Recognizing Mental health problems in Adolescents
and youth
Management of common mental health illnesses
Use of Psychoactive Substances by Adolescent and
Youth
Summary
BURDEN OF COMMON MENTAL ILLNESS
DURING ADOLESCENCE AND YOUTH
WHO defines mental health as: “a state of well-
being in which the individual realizes his or her
abilities, can cope with the normal stresses of life,
can work productively and fruitfully, and is able to
make contributions to his or her community
Worldwide 10-20% of children and adolescents
experience mental disorders. .
Continued
Half of all mental illnesses begin by the age of 14
and three-quarters by mid-20s.
In Ethiopia, mental illness is the leading non-
communicable disorder in terms of burden
measured in disability adjusted life years.
At a prevalence of 12-25%, childhood mental
illnesses make the biggest contribution to burden
of mental illnesses in the health sector.
Continued
Adolescents with mental disorders face major
challenges such as
stigma,
isolation
discrimination, as well as lack of access to
health care and education facilities, which violets
their fundamental human rights.
The burden of mental health
Problems in Ethiopia
Mental Illness Prevalence/incidence per 10,000 population (by %)
Schizophrenia 0 .5
Bipolar disorder 0.6
Depression and Anxiety 21.6
Major Depression 6.8
Suicide 0.77
Epilepsy 1
Suicide attempt 3.20
Alcohol drinking 1.9
Khat use Disorders 5
Alcohol dependence 1
Cannabis use 0.5
ADHD 12-25
Source: FDRE-Mental Health Strategic Plan (2020-2025)
DEVELOPMENT RELATED MENTAL HEALTH
PROBLEMS IN ADOLESCENT AND YOUTH
Activity 10.1
What common development related health
problems you come across previously?
Time: 5 min
Understanding Neuropsychiatric Problems
(NPD)
The Neuropsychiatric disorder is the
manifestation of several disorders that often
affect adolescents’ challenges in cognitive and
affect with challenging behavior for parenting and
make the adolescents vulnerable as well. Below
are developmental profile of common NPD is
discussed:
Typical developmental profile-ASD (autism
spectrum disorder)
.
Autism spectrum disorder (ASD) is a developmental
disability caused by differences in the brain.
Diagnosing children with ASD as early as possible is
important to make sure children receive the
services and supports, they need to reach their full
potential
In childhood
School age
In Adolescence
As an adult
Diagnostic Methods of ASDs
Developmental Monitoring is an active, on-going
process of watching a child grow and encouraging
conversations between parents and providers about
a child’s skills and abilities.
Developmental Screening takes a closer look at
how your child is developing.
Developmental Diagnosis A brief test using a
screening tool does not provide a diagnosis, but it
can indicate whether a child is on the right
development track or if a specialist should take a
closer look.
Treatment for ASD
Treatments for autism spectrum disorder (ASD) seek
to reduce symptoms that interfere with daily
functioning and quality of life. These treatments
generally can be broken down into the following
categories.
Behavioural approaches
Developmental Approaches:
Educational approaches
Social-Relational approaches
Pharmacological approach
Psychological approach
Complementary and Alternative treatments
Typical developmental profile-ADHD (attention
deficit hyperactivity disorder)
ADHD is one of the most
common neurodevelopmental disorders of
childhood.
It is usually first diagnosed in childhood and often
lasts into adulthood. Children with ADHD may have
trouble paying attention, controlling impulsive
behaviors be overly active.
Childhood
School age
In adolescence
In adult life:
Continued
How is ADHD diagnosed?
DSM-5 Criteria for ADHD Diagnosis
People with ADHD show a persistent pattern
of inattention and/or hyperactivity–
impulsivity that interferes with functioning or
development: Based on the types of symptoms,
three kinds of ADHD can occur
A. Combined Presentation
B. Predominantly Inattentive Presentation
Predominantly Hyperactive-Impulsive
Presentation
RECOGNIZING MENTAL HEALTH
PROBLEMS IN ADOLESCENTS AND
YOUTH
Although these problems are fairly common often
go unnoticed, because change of mood and
temporary deviant behaviors are part of the
normal adolescent process and many young
people will experiment with drugs or certain
behaviors as part of normal exploration of their
own identity
Continued
Thus it is imperative for one to look into the
following three aspects such as
Duration
Persistence and severity of fixed symptoms
Impact of Symptoms
Risk factors of common mental health
problems in AY:
Risk factors of mental health problem in
adolescents and youth can be classified in to four
1. biological,
2. psychological,
3. social factors, and
4. environmental factors.
Consequences of Mental Health Problems in
AY:
mental health disorders are associated with low
educational performance, increased risk taking
behavior, substance use, indulging in crime, poor
sexual and reproductive health, self-harm and
inadequate self-care. All these contributed to
increased life time risk of morbidity and premature
death.
MANAGEMENT OF COMMON
MENTAL HEALTH ILLNESSES
Mood disorders and depression
At any given time, 1 in 20 adolescents meets
clinical criteria for a mood disorder and up to one
in four children will experience a mood disorder
by their late adolescence. Mood disorders include
a major depressive disorder, bipolar disorder, and
premenstrual dysphoric disorder. Depression is
more common in female adolescents than in male
adolescents.
Anxiety disorders:
Continued
Anxiety is different from fear.
Fear is a normal emotional response of all human
beings to actual or perceived danger.
Normal fear is adaptive and necessary for
survival
Anxiety is a general term for several disorders
that cause nervousness, fear, apprehension, and
worrying
Continued
Anxiety disorders can be classified in to
several more specific types. The most
common are briefly described below.
Generalized anxiety disorder
Panic disorder:
Specific and Social Phobias
Suicide
It is a fatal act that represents the person's wish to
die. There is a range, between thinking about
Suicide and acting it out. Suicidal ideation occurs in
all age groups and with greatest frequency in
children and adolescent with severe mood
disorders.
Continued
Completed suicide occurs about five times more
often in adolescent boys than in girls, although
the rate of suicide attempts is at least three boys.
Suicidal ideation is not a static phenomenon; it
can wax and wane with time.
The crude suicide rates in Ethiopia are reported to
have increased from 7.9 to 8.4 per 100,000
population from 2005 to 2015 (WHO b, 2017).
The most important risk factors
for suicide are:
1. Psychiatric disorders .
2. Past or recent social stressors .
3. Suicide in the family or among friends or peers,
4. Low access to psychological help and
5. Access to means for committing suicide.
6. Additional risk factors in suicide include
exposure to family violence, impulsivity, and
substance abuse.
Psychotic Disorder
Activity 10.2
What are the common psychiatric
problems that oculus as a psychiatric
illness in Ethiopia among adolescents and
youths?
Time: 5min
Continued
Psychotic disorders are mental disorders which
are characterized by impairment in a person’s
perception of reality. It can be manifested by
abnormal sensory perceptions (hallucinations),
thought abnormalities (including disorders of
thought content or process), and behavioral
disturbances (including catatonia and
disorganized behavior)
Activity
EE is a 12-year-old girl who was recently forced to move to a new
neighborhood because her grandmother died and the family’s
economic situation changed. Before, she had been a cheerful girl
who attended school and was helpful with her younger siblings. In
the last month, she has been refusing to help or getting angry
when her mother asks her; she also has frequently said that she is
not hungry and does not want to eat with the rest of the family.
Her mother is worried about her but also very annoyed that EE is
not being helpful in this time when the family must adapt to new
surroundings.
Continued
EE’s mother does not understand the change in her
daughter and thinks it might be because she is
becoming an adolescent.
Instruction:
Discuss on the following points.
1. List the behavioral changes observed on EE?
2. What do people think about people with problems like EE’s?
3. What do people assume are the causes of these sorts of
problems?
4. If people try to help children like EE, what do they do or suggest?
5. What gets in the way of getting help for children like EE?
Time:10 min
USE OF PSYCHOACTIVE
SUBSTANCES BY ADOLESCENT AND
YOUTH
Psychoactive substance is a drug or other
substance that affects how the brain works and
causes changes in mood, awareness, thoughts,
feelings, or behavior.
The commonly used psychoactive substances
include alcohol, caffeine, nicotine, marijuana, and
certain pain medicines.
Continued
Substance use disorder (SUD) is a mental
disorder that affects a person’s brain and
behavior, leading to a person’s inability to control
their use of substances such as legal or illegal
drugs, alcohol, or medications. A substance use
disorder involves using too much alcohol, tobacco
or other drugs.
Activity
Describe common drugs or substances
used by adolescents and youths?
Time: 5: min
There are four types of
drugs/Substances
Depressants: the most commonly found types of
drugs in society are depressants.
Alcohol ,Sedatives/hypnotics .,Daterape
drugs and Volatile solvents
Stimulants ,Increase energy, alertness, and
wakefulness. Such as
Nicotine ,Cocaine ,Amphetamines and Caffeine .
Opioids: Opioids: These are pain-killing drugs that
increase feelings of happiness or euphoria and
Continued
Heroin, morphine, opium, buprenorphine,
methadone, pet hidine and Cough syrup with
codeine.
Hallucinogens: .They can also cause a person to
perceive time differently, feel detached from their
surroundings, or feel deeply insightful.
Lysergic acid diethyl amine, Mescaline,
psilocybin, peyote, tryp tamines and Cannabis
Assessment of Adolescents and
Youth for Mental Health Problems
Adolescence should be a time of healthy
growth and development. Indeed, it is a
critical period with significant physical,
emotional, and mental changes. Despite
robust physical health, adolescent risky
behaviors may result in lifelong
consequences as well as increased
morbidity and mortality.
HEADSSS assessment tool
Home, Education, Activities, Drugs, SRH,
Suicide, Safety, Support
The HEEADSSS review of systems is a tool to
understand adolescent behavior and assess risk-
taking behaviors to provide appropriate
interventions.
Interventions
Effective regulatory interventions for addictive
substances which can be implemented at
international, national, regional and local
jurisdictional levels include taxation, restrictions on
availability and total bans on all forms of direct and
indirect advertising.
A. media interventions,
B. comprehensive community interventions and
C. school-based interventions.
Chapter Summary
Mental health disorders and substance use are
common health problems of young people.
Depression, anxiety, eating disorder, attention
deficit hyperactivity disorders and substance
misuse are the commonest forms of mental
health disorders in this population.
The risk factors of mental health disorders are
largely preventable and could be targeted at
family, community and school level.
Continued
Identifying mental health disorders in this
population requires careful history taking and
evaluation of the symptoms as some of the
changes are just part of the normal
developmental process of adolescents.
Alcohol, tobacco, marijuana and inhalants are
commonly used by adolescent and youth. .
Substance use co-occurs with the other mental
health disorders and through check for use is
Continued
Family, schools and community at large are
places where interventions against substance use
could be implemented.
Motivational Interviewing focuses on exploring
and resolving ambivalence and centres on
motivational processes within the individual that
facilitate change
Motivational Interviewing is grounded in a
respectful stance with a focus on building rapport
in the initial stages of the counselling relationship
Continued
