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

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Kevin Leehey M.D.Child, Adolescent, and Adult
PsychiatryBoard Certified

• 296-4280
• leeheymd.com

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Community of Concern Workshop

• Depression and Self Destructive Behaviors

Kevin Leehey, M.D. 296-4280
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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
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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
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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
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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
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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
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Other Forms of Depression

• Dysthymia
• Depresson NOS
• Existential, angst
• Bipolar Depression
• PH and FH

Kevin Leehey, M.D. 296-4280
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Mania while not ones 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
• Psychosis can occur

Kevin Leehey, M.D. 296-4280
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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
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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
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Co- and Extra-curricular Activities

• studies show
• 10-20 hours a week is best for most teens
• Kids who do lt10 hours and kids who do gt20 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
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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
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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
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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
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Suicide - contd

• 1) Depressed, angry, substances
• 2) the last person youd 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
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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
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How do I help? - contd

• 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
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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
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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
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Medication - contd

• 25 best with therapy alone, 25 best with
  medicine alone, 50 best with combination for
  Major Depression or severe Anxiety
• SRIs, buproprion, SNRIs, etc.
• Bipolar disorder usually requires medicine
• Omega 3 (and 6) FAs, supplements, vitamins,
  diet, exercise, other

Kevin Leehey, M.D. 296-4280
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Good night and good luck!

• Kevin Leehey M.D.
• 296-4280
• leeheymd.com

Kevin Leehey, M.D. 296-4280