Common Mental Disorders Depression - New Zealand Doctor

Anxiety disorders
The defining features of the most common anxiety disorders in young people are
as follows: 188,205
• separation anxiety: developmentally inappropriate and excessive worry
concerning separation from parent and home, refusal to go to school, reluctance
to be home alone, nightmares and/or physical complaints, for at least 4 weeks. 205
Refusing to go to school differs from truancy in that parents are often aware of the
child’s absence from school and the child is compliant in other respects 205
• generalised anxiety disorder: excessive and uncontrolled worry, difficulty
concentrating, restlessness, irritability, sleep problems, fatigue, and/or muscle
tension, for at least 6 months 188
• panic disorder: spontaneous recurrent episodes of panic, with palpitations, sweating,
trembling or dry mouth and other physiological and psychological symptoms. 188
Separation anxiety is more common in younger children, while generalised anxiety
disorder and panic attacks are more often diagnosed in adolescents. Other types of
anxiety disorder include phobias, obsessive compulsive disorder and post-traumatic
stress disorder. Symptoms overlap and many young people will meet criteria for more
than one type of anxiety disorder. 205
Anxiety disorders often present with somatic symptoms and other conditions, such as
hypoglycaemia, migraine, seizure and other neurological problems, must be excluded. 188
Attention-deficit hyperactivity disorder
The defining features of ADHD are as follows: 205
• difficulty sustaining attention, makes careless mistakes
• often does not listen when spoken to directly
• avoids difficult tasks
• easily distracted, disorganised and forgetful
• often fidgets, leaves seat in classroom or feels restless
• runs about or climbs in inappropriate situations (in young children)
• often interrupts.
Attention-deficit hyperactivity disorder, especially when associated with conduct
disorder, increases the risk of behavioural problems and substance use disorders
in adolescence. 205 It is six times more common in boys than girls. 188 The diagnosis
requires information from external sources, such as teachers, as well as the child’s
parents or caregiver, and usually involves specialist assessment. 205
36
Identification of Common Mental Disorders and Management of Depression in Primary Care