Conducta suicida en niños y adolescentes ingresados en un hospital general: Análisis descriptivo / Features of adolescents hospitalized for a suicide attempt in a general hospital

Background: Worldwide, suicide is the third cause of death among adolescents. Aim: To determine the socio-demographic context and clinical characteristics of children and adolescents hospitalized for suicidal behavior in a general hospital. Material and Methods: Between 2007 and 2009, we evaluated 47 patients with a mean age of 15.3 years (87% women) admitted for suicidal behavior at the Clinical Hospital of the Catholic University of Chile. Demographic data of the participants were registered. Clinical interviews were done by a child and adolescent psychiatrist. Results: Fifty seven percent of patients lived with both parents. Fifty one percent had previous suicide attempts and 68% had a previous psychiatric treatment. The main trigger was a conflict with parents in 66%. The psychiatric diagnoses were major depressive episode in 74.5% and pathological development of personality in 43%. All suicide attempts were with drugs and 6.4% were associated with cuts. Seventeen percent of attempts were classified as medically serious and they were more common in older age groups. Non severe attempts were observed mainly in women (92.3%). Acetaminophen intake was recorded in 8.5% of cases. Admission to hospital increased in the final quarter of the year. High costs of hospitalization were observed associated to stays in high complexity units. Conclusions: The population studied shows a high incidence of prior suicidal behavior. Most of the studied patients had attempts that were not classified as serious. These occurred predominantly in women in all age ranges. Medically serious suicidal behavior is mainly observed in older adolescents.

[Features of adolescents hospitalized for a suicide attempt in a general hospital]. / Conducta suicida en niños y adolescentes ingresados en un hospital general. Análisis descriptivo.

BACKGROUND: Worldwide, suicide is the third cause of death among adolescents. AIM: To determine the socio-demographic context and clinical characteristics of children and adolescents hospitalized for suicidal behavior in a general hospital. MATERIAL AND METHODS: Between 2007 and 2009, we evaluated 47 patients with a mean age of 15.3 years (87% women) admitted for suicidal behavior at the Clinical Hospital of the Catholic University of Chile. Demographic data of the participants were registered. Clinical interviews were done by a child and adolescent psychiatrist. RESULTS: Fifty seven percent of patients lived with both parents. Fifty one percent had previous suicide attempts and 68% had a previous psychiatric treatment. The main trigger was a conflict with parents in 66%. The psychiatric diagnoses were major depressive episode in 74.5% and pathological development of personality in 43%. All suicide attempts were with drugs and 6.4% were associated with cuts. Seventeen percent of attempts were classified as medically serious and they were more common in older age groups. Non severe attempts were observed mainly in women (92.3%). Acetaminophen intake was recorded in 8.5% of cases. Admission to hospital increased in the final quarter of the year. High costs of hospitalization were observed associated to stays in high complexity units. CONCLUSIONS: The population studied shows a high incidence of prior suicidal behavior. Most of the studied patients had attempts that were not classified as serious. These occurred predominantly in women in all age ranges. Medically serious suicidal behavior is mainly observed in older adolescents.

Diabetes mellitus tipo 1 y psiquiatría infanto-juvenil / Type 1 diabetes mellitus and child-adolescent psychiatry

Objective: To review the psichological effects of DM1 on children and adolescents, and review a clinical case. Method: SIBUC (Electronic System of PUC Lybrary) Bibliographic search. Clinical Case: 13 year old adolescent diagnosed with DM1 since the age of 3, with poor treatment adherence, and poor social relationships. History of Anxiety Disorders diagnosed at age 10, partially treated with medications and psychotherapy. Currently anxious, hopeless regarding illness outcome. Treated with Sertraline and psychotherapy, presented behavioral and autonomy issues. Review: The relationship between DM1 and psychiatric topics is reviewed, including some hypotheses, issues such as attachment, body-self relationship, separation-individuation. Suggestions are made for parents and treatment teams for systematic follow up of these patients and in preventing and treating psychological complications of DM1. Conclusions: DM1 is associated to significant psychopathology in children and adolescents. Due to its complications, it needs to be prevented and treated promptly to improve the outcome of these patients.

Objetivo: Revisar los efectos psicológicos de la DM1 sobre los niños y adolescentes; comentar un caso clínico. Métodos: Búsqueda en la base de datos de SIBUC (Sistema Electrónico de Bibliotecas de la Pontificia Universidad Católica de Chile) de artículos que incluyeran "Diabetes Mellitus Insulino Dependiente" y "Patología Psiquiátrica en la Infancia y Adolescencia". Caso clínico: Adolescente de 13 años con diagnóstico de DM1 desde los 3 años, con mala adherencia al tratamiento y problemas relaciónales. Antecedentes de trastorno ansioso, diagnosticado a los 10 años, cuya terapia, farmacológica y terapéutica, fue parcialmente cumplida. Al consultar, angustiado y desesperanzado respecto al pronóstico de su enfermedad. Se inició Sertralina y psicoterapia, con regular evolución, presentando problemas conductuales y de autonomía. Revisión: Se revisa la asociación entre DM1 y patología psiquiátrica, la hipótesis de la génesis de estas asociaciones y temas como el apego, la relación cuerpo-self y la individuación. Se realizan sugerencias para los padres y para el equipo médico, respecto del seguimiento sistemático de estos pacientes, y así contribuir a una mejor prevención y tratamiento de la psicopatología asociada a la DM1. Conclusión: La DM1 se asocia a importante psicopatología en la infancia y adolescencia. Por sus importantes implicancias esta debe ser estudiada en mayor profundidad y la enfermedad prevenida y tratada oportunamente para mejorar el abordaje de estos pacientes.