It is more than just a reproductive healthcare visit: experiences from an adolescent medicine clinic.

The gynecologist may be the only physician that an adolescent depends on for primary and reproductive healthcare services. Because adolescent females often make personal healthcare decisions without the benefit of supportive parents/caregivers, it is imperative that the gynecologist understands the developmental issues encountered during this phase of life. The objective of this study is to identify cited complaints of adolescent females seeking reproductive care and, thus, provide gynecologists with needed information about the medical/mental health issues that may be encountered during routine reproductive care exams. The study group was adolescent females between the ages of 12 and 20 years old. The medical records of 479 adolescent females seeking reproductive care from an adolescent medicine clinic at a southeastern teaching medical center were reviewed to determine the most frequently cited medical/mental health complaints of adolescent females initiating a "routine" gynecological exam. Results indicated that adolescent females present for "routine" reproductive care exams with a myriad of concerns without formally requesting medical/mental health intervention upon initial presentation. The identified primary healthcare needs of adolescent females seeking reproductive healthcare include: 1) issues related to reproductive dysfunction (60%); 2) gastroenterological pain/issues (15%) 3) mental health issues (15%) and 4) general medical physical complaints (10%). Gynecologists are often asked to serve as a primary care provider as well as a reproductive healthcare specialist. Identification of the specific healthcare needs (reproductive and otherwise) of adolescent females will assist gynecologists in being uniquely prepared to practice in the setting of their choice.

Depression in pregnant adolescents: considerations for treatment.

Pregnancy in adolescents continues to be a major public health concern in the US. Depression in adolescent females, is also a major health concern. Adolescence is a time of rapid metabolic, hormonal, physiologic, and developmental changes, and when the physiologic and psychological changes that occur during pregnancy are superimposed upon normal developmental changes, a complex medical picture may emerge which can include depressive symptomatology. Treating depression in the pregnant adolescent is complex due to the concerns about the use of selective serotonin reuptake inhibitors (SSRIs) in any pregnant woman, the fact that only one SSRI (fluoxetine) is FDA-approved for depression in the pediatric population, the concern over the black box warning for antidepressants in the pediatric population, and the reality that untreated depression in pregnancy has been shown to be associated with poor outcomes for both mother and baby. This article discusses these concerns and provides some recommendations/considerations for treatment of depression in pregnant adolescents.

Obesity, hypertension, and mental health evaluation in adolescents: a comprehensive approach.

The global epidemic of childhood and adolescent obesity in developing and developed countries has become a major public health concern. Given the relation between obesity and hypertension as documented in several landmark studies, it is no surprise that as the prevalence of obesity has increased in the pediatric population, the rates of hypertension have also increased substantially. Hypertension is one of the most important risk factors for cardiovascular diseases and stroke; therefore, evaluation and initiation of appropriate treatment are extremely important in the pediatric population. Evaluation for secondary causes of hypertension, including renovascular, renoparenchymal, and endocrine disease is the approach most commonly used in healthcare settings, with the goal to detect abnormalities that already have or might, if left unrecognized, affect the physical health of the child in the future. Children and adolescents are commonly evaluated for organic disease even in situations in which secondary hypertension is unlikely and overweight or obesity is most likely the primary factor contributing to hypertension. Psychological and psychosocial factors, which may play an important role in the etiology of obesity and related blood pressure elevation, are often addressed inadequately or completely ignored, potentially reducing long-term therapy success and increasing the incidence of avoidable complications. It is proposed that a comprehensive evaluation by a behavioral health provider will improve outcomes and potentially reduce long-term morbidity and hypertension-related end organ disease. A framework for mental health evaluation is provided.

Adolescent health care in a teaching service: the point of view of the patients.

UNLABELLED: The study compared adolescents' expectations before medical consultations with their opinions obtained after the consultations and identified features related to satisfaction with medical care provided by medical students. METHODS: We carried out a cross-sectional study in a primary health care service from a medical school in Brazil. Assessment instruments: before and after consultation questionnaires. Studied variables: age, gender, reasons for seeking medical care, expectations, comfort, perception, opinion, satisfaction, and the intention to come back for another consultation. We used qui-square tests, and the significance level was set at 0.05. RESULTS: First, the adolescents did not differentiate the treatment, reporting discomfort. Despite this, they reported good expectations. After consultation, they could distinguish the students from physicians, realized the specificity of the treatment, and indicated high levels of satisfaction, as well as positive experiences regarding health care provided by the students.

Brazilian medical school student impressions of the graduate training in adolescent medicine.

UNLABELLED: The aim of this study was to identify expectations, difficulties, skills, and attitudes of students during graduate training in adolescent medicine. METHODS: We obtained data by means of questionnaires completed by medical students, in their first and last day of practical training in an adolescent outpatient clinic. RESULTS: Among 103 students, we identified the following feelings: inappropriate/insufficient previous knowledge; difficulties in providing care assistance; good expectancy and intention to work with adolescents; and physician/patient relation as crucial to learning. CONCLUSION: The students reported positive experiences, as well as personal and professional enrichment during their training in the adolescent health care service. PRACTICAL IMPLICATIONS: Practical training in adolescent medicine must be encouraged during the graduation course.

Navigating adolescence with a chronic health condition: a perspective on the psychological effects of HAIR-AN syndrome on adolescent girls.

HAIR-AN syndrome is a subphenotype of polycystic ovary syndrome and is characterized by acne, obesity, hirsutism, and acanthosis nigricans. It usually manifests in early adolescence, a time of significant developmental change in females across physical, cognitive, social, and emotional domains. We contend that adolescent development for females is difficult, even in the best of circumstances, and having a chronic health condition, like HAIR-AN syndrome, will likely impact the afflicted individual's development and psychological well-being. While many researchers have discussed the long-term health effects of HAIR-AN and similar disorders, little has been written about the potential psychological sequelae of HAIR-AN on the adolescent girl. We discuss the normal developmental sequence for adolescent girls across early, middle, and late adolescence; discuss common mental health problems that adolescents experience; define HAIR-AN syndrome and its clinical manifestations; and discuss its likely psychological impact on adolescent girls. We also make suggestions for future clinical interventions and research in the area of HAIR-AN syndrome and its psychological sequelae.

Holistic health: does it really include mental health?

Holistic health, incorporating mind and body as equally important and unified components of health, is a concept utilized in some health care arenas in the United States (U.S.) over the past 30 years. However, in the U.S., mental health is not seen as conceptually integral to physical health and, thus, holistic health cannot be realized until the historical concept of mind-body dualism, continuing stigma regarding mental illness, lack of mental health parity in insurance, and inaccurate public perceptions regarding mental illness are adequately addressed and resolved. Until then, mental and physical health will continue to be viewed as disparate entities rather than parts of a unified whole. We conclude that the U.S. currently does not generally incorporate the tenets of holistic health in its view of the mental and physical health of its citizens, and provide some suggestions for changing that viewpoint.

From healing the whole person: an argument for therapeutic touch as a complement to traditional medical practice.

The growing popularity and use of therapeutic touch (TT) is an issue that has generated controversy and concern within the medical community. While anecdotal and traditional scientific evidence suggest that TT would be an advantageous addition for clinics and hospitals to include in their armamentarium of complementary interventions within the realm of traditional medicine, TT has not become widely available in the U.S. One reason for the lack of availability may be the dearth of conclusive scientific support for TT's efficacy and, therefore, its inclusion in clinic and hospital treatment planning would give it the appearance of legitimate practice, which it may not yet deserve. Whether or not deserved, if TT were added to hospital and clinic treatment protocols without substantial scientific support, it would be thought to have the implicit support of the scientific community, at which point the question of its efficacy would be moot in the minds of many people; thus patients would utilize it, because they believe it works rather than because it works. Since TT has not yet been scientifically proven as per Western standards, leaders of the health care community are likely wary of lending support to TT at this time. If TT can be found to be a scientifically sound therapeutic technique, then it will be more readily accepted in the health care community. This paper reviews TT.

Infatuation and Attraction to a Dissimilar Other: Why is Love Blind?

The present experiment attempted to increase understanding of the "love is blind" phenomenon. White male American undergraduates exposed to an infatuation induction with an attitudinally dissimilar female confederate showed greater attraction to her than unexposed control subjects. The use of a misattribution-of-arousal manipulation eliminated this difference in attraction between the infatuation induction and control groups, thereby providing support for the role of positive emotional arousal in creating attraction toward the dissimilar other in the infatuation condition. Evidence was also found that suggested that attraction toward the dissimilar other was based not on a distortion by the subjects of her dissimilar attitudes, but rather on a more favorable evaluation of these attitudes.