Richard Frances, M.D.
detection and treatment of major psychiatric disorders that afflict
young people, including addiction, depression, bipolar disorder,
anxiety disorder, attention deficit disorder, and schizophrenia
can be the best way to prevent the serious consequences of mental
illness, including suicide.
Teenage suicide has doubled in the last 20 years and 70 percent
of suicides among young people involve chemical abuse or dependence.
Normal youngsters rarely attempt or succeed in suicide, and most
suicides are associated with treatable psychiatric conditions
including addiction. Parents, teachers and peers need to watch
for signs of low self-esteem, hopelessness, social isolation,
smoldering anger, crippling sadness and anxiety, use and abuse
of alcohol, marijuana and other drugs, impulsivity, poor judgment,
and poor communication with family, peers and teachers.
Screening and early treatment for psychiatric problems helps prevent
the progression and worsening of conditions that can lead up to
disaster. Other important signs include a positive family history
of major illnesses, including addiction, depression, bipolar illness,
anxiety disorders, and suicide. Watch for signs of these problems
in first degree relatives, including siblings. Most of the major
psychiatric illnesses begin in the teenage and young adult years,
and the earlier they are detected and treated, the better the
result. A variety of cognitive behavioral and psychodynamic treatments
are available and are most effective when combined with medications
in the treatment of these disorders. For young people with substance
abuse and additional psychiatric diagnosis, it is crucial to make
sure that both diagnoses are well treated and that the individual
is substance free while engaged in medication treatment and psychotherapy.
Twelve step, peer led and group, family and network therapy techniques
can be very helpful in working with this age group. An especially
critical time is the adolescentís first year away from home at
college with its often concomitant increase in substance use and
decrease in parental presence. One example of a psychiatric illness
that has a 15 percent mortality related to suicide is manic depressive
disorder which can be effectively treated with lithium and mood
stabilizers, and which is frequently associated with alcohol and
drug problems. Both problems must be successfully treated to avoid
the roller coaster ride of relapse. Well treated individuals with
this disorder can go on to productive lives and are often among
our most creative and effective people. Undetected or untreated
bipolar illness leads to enormous suffering in patients and their
families. Some characteristics for evaluating suicide risk include
presence of suicidal or homicidal ideation, intent or plans; access
to means for suicide and the lethality of those means; presence
of command hallucinations, other psychotic symptoms or severe
anxiety; presence of alcohol or substance use, history and seriousness
of previous attempts and family history of or recent exposure
to suicide. Abuse of substances increases impulsivity and worsens
judgment which can add fuel to self-destructive impulses.
It is important that schools, parents and the mental health community
work closely together to provide better screening, detection and
preventative treatment for major psychiatric illnesses. This will
lead to reduction of the devastating effects of suicide on family,
schools and community. #
Richard Frances is President and Medical Director of Silver Hill
Hospital in New Canaan, Connecticut.
Update, Inc., P.O. Box 20005, New York, NY 10001.
Tel: (212) 481-5519. Fax: (212) 481-3919.Email: email@example.com.
All material is copyrighted and may not be printed without express
consent of the publisher. © 2002.