Adolescent Medicine

One in every six people experiences depression at least once in a lifetime. Females are more prone to major depressive disorders as compared to males. Symptoms of depression include sleep disturbance, loss of interest in different activities, guilt, loss of energy and concentration, appetite changes, psychomotor agitation, and Suicidality. Cognitive behavioral therapy and Interpersonal psychotherapy along with medication help to improve the symptoms. It is, however, important to rule out mimicking conditions like hypothyroidism, CNS lesions, and anemia.

Patients with substance abuse present as unconscious, hyperstimulated, or psychotic as a result of an overdose. Acute management includes basic life support, sedation, and treatment of other side effects of the drug. Naloxone is used to reverse the effects of opioid overdose. Hypo/Hyperthermia is treated accordingly. Cases of drug ingestions require GI decontamination using activated charcoal. Aggressive behavior is treated through pharmacological interventions. Incidents of drug abuse can be decreased through parental monitoring and supportive family relationships.

Syphilis is becoming more commonly seen in adolescents, especially in men. Syphilis is caused by Treponema pallidum. The main risk factors for acquiring syphilis are multiple sexual partners, having previous history of syphilis and having a partner with syphilis. Nontreponemal reactive tests are available for screening purposes whereas treponemal specific reactive tests can be used to confirm the diagnosis. Once the diagnosis is confirmed, penicillin G should be administered. Response to penicillin G is excellent but doxycycline, ceftriaxone or azithromycin might be indicated in selected cases who are allergic to penicillin G.

Vulvovaginitis is a common condition in adolescents—especially sexually active girls. The diagnosis is usually confirmed by the presence of vulvitis in addition to a vaginal discharge. The physical characteristics of the vaginal discharge can point towards the most likely etiology. Gram stain, wet preparations and culture and sensitivity tests are indicated to define an exact etiology of vaginitis in the adolescent girl as the treatment is dependent on the etiology. Treatment of bacterial vaginosis is mainly metronidazole. Candida vaginitis responds well to clotrimazole. Chlamydial and gonorrheal vaginitis should be treated with azithromycin plus ceftriaxone. Trichomonas vaginitis should be treated with metronidazole.

Dysmenorrhea in adolescents is a very common problem that can be either primary or secondary. Primary dysmenorrhea is a condition that is characterized by cyclic lower abdominal painful cramps, nausea and vomiting. Secondary dysmenorrhea is usually caused by endometriosis and patients usually present with both cyclic and acyclic lower abdominal pain. The management of primary dysmenorrhea mainly revolves around the use of nonsteroidal anti-inflammatory drugs or oral contraceptive pills. Patients who fail to respond to this conservative approach should undergo a diagnostic and therapeutic laparoscopy to exclude endometriosis.

Pelvic inflammatory disease is a common disorder among young women, especially adolescents. The most important risk factor for pelvic inflammatory disease is previous history of a sexually transmitted infection. Sexually transmitted infections are more commonly identified in adolescents due to physiologic, anatomic and behavioral differences from adult females. Antibiotic therapy that covers chlamydia and gonorrhea is the mainstay of treatment for pelvic inflammatory disease in adolescents.

Human papillomavirus infection is common in adolescents and can present with genital warts, precancerous lesions or cervical cancer many decades after acquiring the infection. Genital warts are the most common presentation in adolescents and are usually diagnosed clinically. Screening programs with pap smears and liquid-based cytology are the main tools for the early detection of HPV-associated precancerous lesions. DNA testing is available for HPV typing. Treatment of genital warts can include observation alone or destructive therapy. Treatment of HPV-related precancerous lesions, such as low-grade squamous intraepithelial lesions, should be close monitoring and follow-up. Treatment of cervical cancer is usually inefficient; therefore we should focus on the prevention of the condition by the administration of human papillomavirus vaccines before the initiation of sexual activity.

Learn more about the use of immunofluorescence to differentiate between Bullous Pemphigoid and Memphis Vulgaris.

Breast masses are uncommon in adolescents but can cause significant distress to the affected individual. They are usually benign fibroadenomas, intraductal papilloma, or phyllodes tumors. Malignant phyllodes tumors and primary breast cancer are very rare in adolescents but have been diagnosed before. Treatment of benign lesions is usually local excision, whereas malignant lesions usually need complete surgical resection. Chemotherapy and radiotherapy are not recommended in adolescents with breast cancer.

The absence of menses in a woman is the definition of amenorrhea. Primary amenorrhea is defined as the absence of menses in a 16-year-old girl with secondary sexual characteristics or a 14-year-old girl without secondary sexual characteristics. Secondary amenorrhea is defined as the absence of menses for six consecutive months in a female with a previous irregular pattern of menstruation. If the menstrual cycle is regular, then secondary amenorrhea can be diagnosed in a female who does not have her menses for only three consecutive months.

The acute scrotum is an emergency condition that is characterized by scrotal pain, swelling, and redness which are of acute onset. The most important diagnosis to exclude is testicular torsion, as the testicular tissues cannot withstand ischemia for more than few hours.

Dysfunctional uterine bleeding is very common in adolescents because of the high frequency of anovulatory cycles in this age group. The diagnosis of dysfunctional uterine bleeding is based on the exclusion of all the other causes of abnormal uterine bleeding in an adolescent. The most common causes of abnormal uterine bleeding include coagulopathies, pregnancy, trauma, and endocrinopathies. Menstrual history is essential in establishing the diagnosis and medical history should be focused on the exclusion of the possible causes of abnormal uterine bleeding. The determining of the hemoglobin levels is important because treatment is dependent on that. Mild dysfunctional uterine bleeding usually does not need any form of medical treatment. Moderate dysfunctional uterine bleeding should be treated with oral contraceptive pills and patients with severe dysfunctional uterine bleeding who are hemodynamically unstable should be admitted for inpatient care.

Contraception is a term that includes any method that aims to prevent pregnancy. These methods can be based on certain behaviors, physical barriers, chemical compounds or hormonal therapies.