Asia Pacific Journal of Pediatric and Child Health

Abstract Ref Number = APCP1225

Poster Presentation

MAJOR DEPRESSION WITH ACUTE PSYCHOTIC DUE TO BULLYING, A CASE ADOLESCENT WITH SEVERE MALNUTRITION

Muhamad Rully

Background : Adolescent still have characteristic of growth and development, so that approaching disease in this group age is different from adult. Mental health and nutrition problems are frequently happen and connected each other in adolescent. Case Presentation Summary : Boy, 14 years old, 24 kg, came with recurrent vomiting accompanied by decrease of appetite and weight loss since 2 weeks. There were no fever, pale, abdominal mass or lymph node enlargement. Head trauma history, drugs, and alcohol consumption were denied. Patient was hospitalized with diagnoses dyspepsia, polycythemia vera, and severe malnutrition. After early management, patient was referred for further evaluation. There were electrolyte imbalance, slight increase of amylase and lipase. Thorax x-ray, ECG, sputum analysis, abdominal US and colon in loop were in normal limit. After the abnormalities of electrolyte were corrected, he was planned to abdominal CT evaluation. Patient came to emergency department after referral evaluation with hypovolemia shock and hypoglycemia. After resuscitation, his laboratory revealed normal ESR, blood glucose, liver and kidney function, but high specific gravity urine. Patient was rehydrated in 24 hours, given antibiotic, anti-emetic, and mixed diet with F-100. In follow up, patient look depressed with experience of visual and auditory hallucination. After further history taking, this patient had experience of bullying at school. Pediatric symptoms checklist screening showed impaired in internalization, and Strengths and Difficulties Questionnaire also revealed impaired in emotional and peer problems. Diagnose major depression with acute psychotic was established. After 7 days taken haloperidol, patient had less vomit and hallucination, and also normal specific gravity urine. Four weeks follow-up, his body weight gradually increased to 28 kg with good tolerance and no side effect. Learning Points/Discussion : Mental health problems has to be considered as a cause of malnutrition in adolescent. PSC and SDQ are an example reliable screening tools for detection mental health problems in adolescent.

Keywords: mental health malnutrition screening