Suicidal adolescents. How to help them before it's too late.

Primary care physicians should interview and assess troubled adolescent patients for level of suicidal intent. Several practical interventions by the physician can help adolescents with vague suicidal ideation who are not at high risk. Follow-up by the primary care physician is necessary, with continued monitoring to detect increases in the severity of either depression or suicidal thoughts. The emotional support of the family is essential in limiting risk for completion of suicide. If family support is inadequate, other support must be obtained. However, psychiatric referral is indicated for patients exhibiting a high risk of suicide, as indicated by: (1) clearly expressed suicidal intent, (2) an overt plan for suicide with means to carry out the plan, (3) previous suicide attempt(s), and (4) suicidal ideation judged to be high or accompanied by psychosis, substance abuse, or past suicidal behavior.

Compliance revisited: further notes on the problem of nonadherence to medical regimens.

A study of outpatients at a community hospital reveals that 46% consistently defaulted on some aspects of their medical regimens. The more complex the regimen, the more likely the patient was to default, with particular neglect of directives regulating personal habits, work, and diet. The authors recommend an educational intervention program to inform patients of the risks in noncompliance.