Subject(s)
Anticonvulsants/administration & dosage , Kleine-Levin Syndrome/drug therapy , Valproic Acid/administration & dosage , Adolescent , Anger/drug effects , Anticonvulsants/pharmacokinetics , Attention Deficit Disorder with Hyperactivity/blood , Attention Deficit Disorder with Hyperactivity/diagnosis , Attention Deficit Disorder with Hyperactivity/drug therapy , Bipolar Disorder/blood , Bipolar Disorder/diagnosis , Bipolar Disorder/drug therapy , Dose-Response Relationship, Drug , Drug Therapy, Combination , Humans , Kleine-Levin Syndrome/blood , Kleine-Levin Syndrome/diagnosis , Male , Valproic Acid/pharmacokineticsSubject(s)
Mutism/psychology , Phobic Disorders/psychology , Adolescent , Adult , Child , Child, Preschool , Humans , Male , Mutism/diagnosis , Phobic Disorders/diagnosis , Shyness , Social Environment , Verbal BehaviorABSTRACT
Evidence suggests a significant association between use of psychoactive substances among adolescents and suicidal behavior among adolescents during the past two decades. Accumulating evidence, although not unanimous, supports the hypothesis of psychoactive substance abuse among adolescents as a risk factor for a range of suicidal behavior--ideation, attempted suicide, and completed suicide. With increasing rates of psychoactive substance abuse for the adolescent population during the past 20 years, this appears to be an increasingly important factor. It is not known if the association is causal. Psychoactive substance abuse appears to be associated with a greater frequency and repetitiveness of suicide attempts, more medically lethal attempts, a measured seriousness of intention, and greater suicidal ideation. Additional data support a specific association between alcohol intoxication and suicide by firearms among adolescents. Adolescents who abuse psychoactive substances, particularly those with any type of depressive disorder, appear to be at higher risk for suicidal behavior and may need appropriate psychiatric treatment.
Subject(s)
Adolescent Behavior , Psychotropic Drugs , Substance-Related Disorders/psychology , Suicide , Adolescent , Female , Humans , Male , Personality Disorders/psychologyABSTRACT
Diagnosis of Wilson's Disease in the early stages may be elusive in patients presenting without neurological symptoms. A case history is presented which demonstrates the pitfalls in making the diagnosis. Presenting psychiatric symptoms were nonspecific. Ceruloplasmin level was initially elevated to normal range. Liver biopsy showed early nonspecific cirrhosis; staining for copper did not show the dramatic effects expected with Wilson's Disease. Neurological examination, including NMR, was within normal limits. Kayser-Fleischer rings are no longer considered pathognomic. Urinary copper excretion helped to establish the diagnosis.
Subject(s)
Hepatolenticular Degeneration/diagnosis , Neurocognitive Disorders/diagnosis , Adolescent , Depressive Disorder/diagnosis , Female , Humans , Liver Function Tests , Suicide, Attempted/psychology , ViolenceSubject(s)
Mutism/psychology , Phobic Disorders/psychology , Social Environment , Adolescent , Adult , Child , Follow-Up Studies , Humans , Male , PanicSubject(s)
Depressive Disorder/psychology , Military Personnel/psychology , Paternal Deprivation , Child , HumansABSTRACT
The physician is uniquely qualified to manage the multiple facets of attention-deficit hyperactivity disorder. This clinically oriented update reviews the current state of the art regarding diagnosis and management of hyperactive children. Three case reports emphasize the wide variation of clinical problems presented by this frequently occurring disorder of childhood. Epidemiology, differential diagnosis, associated features, neurobiologic mechanisms, treatment, long-term outcome, and attention-deficit disorder in adults are addressed. Although medication is an important tool in the treatment of this condition, follow-up studies confirm the importance of a multimodal treatment approach.
Subject(s)
Attention Deficit Disorder with Hyperactivity/diagnosis , Adolescent , Attention Deficit Disorder with Hyperactivity/therapy , Child , Combined Modality Therapy , Diagnosis, Differential , Female , Follow-Up Studies , Humans , MaleSubject(s)
Adolescent Psychiatry , Depressive Disorder/psychology , Suicide, Attempted/psychology , Adolescent , Female , Humans , MaleABSTRACT
Of 100 adolescents who showed evidence of a depressive disorder and were given the dexamethasone suppression test (DST), 42% had abnormal results. Several had mixed or contradictory symptoms and the DST helped in diagnosis of an affective disorder and in treatment planning.
Subject(s)
Depressive Disorder/diagnosis , Dexamethasone , Adolescent , Bipolar Disorder/blood , Bipolar Disorder/diagnosis , Depressive Disorder/blood , Evaluation Studies as Topic , Female , Humans , Hydrocortisone/blood , Male , Retrospective StudiesABSTRACT
The rate of adolescent suicides has been increasing over the past decade. This article is a review of the literature regarding the adolescent who attempts suicide with emphasis on the underlying pathology and shows that a true adolescent suicide attempt should be viewed as a cardinal symptom in establishing the identity of a serious psychiatric disorder. This seriousness is reflected in terms of increased lethality, degree of internal pain, decreased reality testing, and evidence of underlying long-standing pathology. Most often there is evidence of a depressive syndrome and also underlying personality disorders.
Subject(s)
Mental Disorders/diagnosis , Suicide, Attempted/psychology , Adolescent , Humans , Life Change Events , Mental Disorders/psychology , Prognosis , Reality TestingABSTRACT
Although suicide among adolescents has been increasing over the past decade, there are surprisingly few clinical studies regarding teen-agers who have attempted suicide. A previous study showed borderline personality disorder as the most common underlying personality problem among a group of predominantly hospitalized adolescents. This paper focuses on the clinical characteristics of 22 teen-agers with a borderline personality disorder who had attempted suicide. The essential pattern of a borderline personality was a persistent instability in a variety of areas, including interpersonal relations, mood, behavior, and self-image. The most prominent characteristics associated with suicide attempts by these adolescents were a tendency to react severely to loss, poorly controlled anger, and self-defeating impulsivity. Many of the characteristic behavioral symptoms of these borderline patients must be determined by a longitudinal history of the teen-ager's life. Specific treatment approaches are needed for these patients.
