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CHAPTER 37 • Mental Disorders of Childhood and Adolescence

children or adolescents are in distress because of the dis turbing and relentless nature of the symptoms. The needs of the family and the developmental needs of the child or adolescent will guide nursing interven tions. If medication is prescribed, it is important to emphasize safe management of medications. Because the antidepressants have a boxed warning regarding suicide risk in adolescents, the nurse must discuss with the par ents and child the importance of monitoring moods and keeping regularly scheduled mental health appointments. MOOD DISORDERS Mood disorders in children and adolescents are a major public health concern. The prevalence of depression is estimated to be 21% (5 million) of the U.S. popula tion. Rates of depressive episodes are higher in females (29.2%) as compared to males (11.5%). Nearly 55% of adolescents with depression report that they are not receiving treatment for their illness (NIMH, 2023). Lifetime prevalence of bipolar disorder among adoles cents aged 13 to 18 years is estimated to be 2.9%, of which 2.6% have severe impairment. Bipolar disorder in adolescents is found to be higher in females (3.3%) than in males (2.6%) (NIMH, 2024b). (See Chapters 25 and 26 for a complete discussion of these disorders.) Recognizing Cues: Relevant Assessment Information Children with mood disorders may not spontaneously express feelings (e.g., sadness, irritability) and are more likely to show their suffering through their behavior. These children may act out their feelings rather than discuss them. Thus, behavior issues may accompany depression. Reports from parents are important sources of information about changes in sleep patterns, appetite, activity level and interests, and emotional stability. Spirituality Assessment For many people, religious practices and spirituality shape their values, belief systems and traditions, and provide a sense of meaning and belonging (Camino Gaztambide et al., 2022). Religion and spirituality have distinct effects on both physical and mental health (Hochstetler & Hill, 2024). Spiritual well-being can be a protective factor against depression (Aggarwal et al., 2023). Spiritual health also has a role in suicide preven tion in that it has been found to give meaning to life and create hope and motivation (Atoofi et al., 2024; van den Brink et al., 2023). Negative religious coping (e.g., religious guilt or feeling abandoned by or blaming God), however, has been associated with increased depressive symptoms (Aggarwal et al., 2023; Leavitt-Alcantara et al., 2023).

distinguish between typical childhood rituals and wor ries and pathologic rituals and obsessional thoughts. Obsessional thoughts are recurrent, nagging, and both ersome. Although children may describe obsessions as occurring “out of the blue,” external events may trigger obsessions. For example, a child may fear contamination whenever they are in contact with a certain individual or object. Likewise, compulsions waste time, cause distress, and interfere with daily life (Box 37.12). The severity of the child’s and family’s response to OCD will determine the appropriate interventions. When the obsessions and compulsions emerge, these Kim’s medical history was negative for serious illness or injury. She was born after an uncomplicated pregnancy, labor, and delivery and achieved developmental milestones at appropriate times. Indeed, her mother could recall no unusual issues in the first few years of life except that Kim was typically anxious in unfamiliar situations. Kim’s mother reports a prior history of panic attacks, but the family history is otherwise negative for anxiety disorders, including OCD. Building Clinical Judgment 1. What assessment information would you want to elicit from Kim? 2. What additional information should be considered from Kim’s mother about her history of panic attacks? 3. What nursing interventions should be considered if Kim were your patient? BOX 37.12 Clinical Judgment Vignette: Obsessive-Compulsive Disorder Kim, an 11-year-old fifth grader, comes for evaluation because her mother and teacher have become increasingly concerned about her repetitive behaviors. In retrospect, Kim’s mother recalls first noticing repetitive rituals about 2 years before, but she did not become alarmed about these behaviors until recently when they began to interfere with daily living. At the time of referral, Kim exhibits complicated jumping rituals that involve a specific number of jumps and a particular manner of jumping. She also turns light switch es off and on and performs complex movements, such as blinking in patterns and thrusting her arms back and forth a certain number of times. Her mother also reports Kim’s near-constant request for reassurance about her own safety. In recent months, her incessant demands for reassurance have been more frequent and elaborate. For example, Kim’s mother has to answer three times that everything is all right and then say, “I swear to it.” At the evaluation, Kim expresses fears that some ill fate, such as catastrophic illness or injury, will befall her. This fear is triggered by contact with any individual who seems sick, chance exposures to foul smells or dirt, and minor scrapes or bumps. When the fear is triggered, she becomes increasingly anxious and consumed with the fear that she will develop an illness and die. Sometimes her fears are specific, such as cancer or AIDS. Other times her fears are more ambiguous, as evidenced by statements such as “Something bad will happen” if she doesn’t complete the ritual. Kim acknowledges that the ritual is probably not related to the feared event, but she is reluctant to take a chance. If the ritual does not reduce her anxiety, she seeks reassurance from her mother.

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