An 18 year old student complains of lack of interest in studies for last 6 months. He has frequent quarrels with his parents and has frequent headaches. The most appropriate clinical approach would be:
B i.e. Rule out depressionLet us consider the options one by one. This can be a normal behaviour but use definitely need to rule out of few disorders before reaching this conclusion. Recent studies have suggested a possible correlation b/w migraine and behavioural problems. There is nothing in the question to point out towards migraine as a cause of the headache, not there are any specific behavioural problems that can be linked to migraine.Diagnostic criteria for appositional defiantdisorder (ADD) A. A pattern of negativistic, hostile, and defiant behaviour lasting for atleast 6 months, during which four (or more) of the following are present?Often loses temperOften argues with adultsOften actively defies or refuses to comply with adults' requests or rules.Often deliberately annoys peopleOften blames others for his or her mistakes or misbehaviourIs often touchy or easily annoyed by othersIs often spiteful and resentfulIs often spiteful or vindictiveNote: Consider a criterion met only if the behaviour occurs more frequently than is typically observed in individuals of comparable age and developmental level.B. The disturbance in behaviour causes clinically significant impairment in social, academic, or occupational functioning.C. The behaviours do not occur exclusively during the course of a psychotic or mood disorder.D. Criteria are not met for conduct disorder, and if the individual is 18 years or older, criteria are not met for antisocial personality disorder.Clinical manifestations of depression in children and adolescents AnhedoniaLoss of interest andenthusiasm in play,socializing, school, andusual activities; boredom;loss of pleasureDysphoric moodTearfulness; sad, downturned expression; slumpedposture; quick temper;irritability; angerFatigabilityLethargy and tiredness; noplay after schoolMorbid ideationSelf-deprecating thoughts,statements; thoughts ofdisaster, abandonment,death, suicide, orhopelessness.Somatic symptomsChanges in sleep or appetitepatterns; difficulty inconcentrating; bodilycomplaints, paicularlyheadache and stomachache.QFrequent quarrels with parents and lack of interest in studies for last 6 months are both consistent with a diagnosis of oppositional defiant disorder. However, children with oppositional disorder typically present to the clinic by the age of 8 years. Also headache has not been mentioned as a manifestation in this disorder. The presence of frequent headaches and age of presentation (18 years) make the diagnosis of appositional delusional disorders unlikely. So symptoms of the patient here are not enough to be diagnosed as ADD.Depression can occur at any age including adolescents and young adults. Lack of interest in school is a known feature (anhedonia). Restlessness & irritability are pa of dysphoric mood & explain frequent quarrels with parents. Also somatic symptoms like headache/ heaviness of head are known associations
Leave him as normal adolescent problem
Rule out depression.
Rule out migraine.
Rule out an oppositional defiant disorder.