Dr James Schaller
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Suicidal Behavior

Nancy broke up with her boyfriend and had an intense argument with her mother. A few hours later her sister walked into her room and found two bottles by her bed -- it was unclear if she took anything from them. She was very hard to wake up. And fell right back to sleep after 20 seconds of being awake. Her mother called 911 and Nancy was treated in the emergency room and then transferred to a psychiatric hospital.

Suicide is a leading cause of death in youth.

Balanced Solutions, Crucial Basics & Preventive Measures

  1. Do not trivialize suicide talk or youth suicidal "gestures," like taking a small number of Benadryl or scratching a wrist, as just attempts to get "attention." They may be attempting to get attention, but why use this form of "communication" to get nurture and care? If they do not get "attention" they are at higher risk to commit suicide.
  2. Feel free to ask the youth if they are having thoughts or desires to hurt themselves. If they refuse to discuss it, call their therapist and/or psychiatrist.
  3. Remove all guns, very sharp knives, Tylenol, Aspirin and Motrin from the home. Simply, any full bottle of any medication has some risk. This applies to any prescription or over the counter medication.
  4. Buy a bottle of pharmaceutical charcoal. If your child takes an overdose and is awake, they can take some capsules while you wait for an ambulance or drive them to an emergency room. These will absorb some of what they swallowed.
  5. If a youth takes pills in an overdose bring any bottles that might have been taken. Do not leave them at home. Emergency room physicians should never assume just one type of medication was taken, since combinations are common.
  6. Youth who abuse drugs are at higher risk for suicide. Nothing can rule out drug abuse except regular toxicology screens.
  7. Youth with relatives who have tried to commit suicide are at higher risk. Suicide is a genetic coping method.
  8. If a youth has trouble with suicidal tendencies they must not have psychiatric medication prescribed by a neurologist, internist, family, doctor or pediatrician. If they are not suicidal for 9 months, and money is very tight, they can be referred back to these individuals for refills, but only if they are seeing a child psychologist weekly or someone with at least five years experience working with youth.
  9. Common triggers that increase risk of suicide:

    1. Anxiety, panic or agitation
    2. Hopeless feelings
    3. Loneliness and isolation
    4. Sudden losses of loved ones: parents, grandparents, romances, friends and changes in home or school.
    5. Feeling trapped or unsafe

Two Other Suicide Triggers Deserve Special Focus.

*Medication Blood Levels Drop

Many medications stop working as the liver gets used to them. The liver does not make enzymes in a wasteful way. It will make more of the enzymes to break down and remove a medication if it is exposed to it. Meaning? Expect a medication to need at least two increases after a successful dose. If no one is monitoring the medications effectiveness, a youth can become depressed and hopeless again. They are not going to think they need their medication raised. They will feel it failed and they will become hopeless.

*Invasive Probing Therapy

When a youth is actively suicidal and hopeless, it is not helpful to aggressively probe into possible past abuse, the details of their sad feelings or past hurts. While it is wise to know their current feelings and suicidal status, the therapist should not build up, encouraged, supported and given hope. Having them talk about the death of their beloved grandmother two years ago will only undermine them now, and remind them that all loved ones die. How is that useful to a struggling youth now?

  1. Therapists and parents can make appeals about cognitive distortions, e.g., "If my 'love' rejects me I cannot live." Remember Romeo and Juliet were adolescents, not adults. And adolescents think in "all or none" and "black and white" terms.
  2. In-Patient Hospitalization--If your child is actively suicidal or has made a suicide gesture, they may require in-patient hospitalization. If a youth is unstable and cannot be controlled, or cannot be supervised 24 hours a day, they may need hospitalization. If you want your child hospitalized, they may or may not agree. If they refuse, states have differing laws on your authority. Your local crisis center will be able to tell you what the law is for your state. Their number is in the blue pages in your local phone book. If you want your child hospitalized against their will, you need to have exact facts about their suicidality, such as specific recent suicidal comments and actions.

    Hospitalization durations vary depending on how rapid your child seems to improve, how compliant they are with treatment, your insurance companies reviewer, and the option of an intensive day program. (Your child sleeps at home and spends the day at the treatment facility).
  3. Generally, in-patient facilities do not cure but only stabilize. Occasionally, staff considers discharge after only 3 days. But each youth is unique. Have your arguments ready for why this is unwise. If a child needs a medication to work because of severe depression, mania or other mental illness, do not expect fast results. Sometimes medications work slower in children. Other youth improve quickly perhaps due to a structured environment or because they are removed from something pulling them down, e.g., drug use or friction with friends or family.

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