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New York City
July 2002

Risky Teen Behavior
By Richard Frances, M.D.

Early 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. #

Dr. Richard Frances is President and Medical Director of Silver Hill Hospital in New Canaan, Connecticut.

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Education Update, Inc., P.O. Box 20005, New York, NY 10001.
Tel: (212) 481-5519. Fax: (212) 481-3919.Email: ednews1@aol.com.
All material is copyrighted and may not be printed without express consent of the publisher. © 2002.


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