When adolescents have suicidal thi...

When adolescents have suicidal thinkings the idea typically is transient and precipitated on a specific stressful event. Suicidal speculations are common in high-school-age children, with a higher rate of ideation and attempts in girls than in lads About 2,000 adolescents successfully commit suicide annually in the United Sates, making this the third leading cause of death among characters 15 to 24 years of age. The rate of suicide attempts increased between the 1960 and the 1980 because of access to fire-arms and increased sub-stance abuse in this age dispose The recent decline in suicide rates is probably because of decreased substance abuse and the wide-spread use of antidepressant medication. Ingestion of over-the-counter medicines is the mostly common suicide attempt method, and firearms are the mostly common cause of completed suicide.

Kennedy and associates reviewed the literature to identify risk factors and management plans for adolescents who make trial of to commit suicide. Risk factors include psychiatric conditions (i.e., depressive disorders, substance abuse, and disruptive disorders); previous suicide attempts; family history of psychiatric disorder; history of physical or sexual abuse; and gay, lesbian, or bisexual orientation.

according to law, the assessment and management of suicide attempts in the pass department can be performed without parental acquiescence Because safety is the first consideration, patients should be searched in succession arrival, and clothes should be remov to hinder the patient from unexpectedly leaving the necessity department. The evaluation should be performed compassionately and in a timely manner, with shut up attention to family members who are instant Adolescents who feel that they are well treated are more likely to adhere to to come outpatient treatment. The patient's suicidal intent should be assessed, with the understanding that discussions of suicide will not increase the likelihood of futurity attempts. Positive thoughts should be reinforced. Information also should be gathered from family, friends, and whoever is choke to the patient. Suicidal scales may be useful in determining the likelihood of another attempt, unless predictive values for these scales have not been tested

A physical examination should conceal all systems, especially vital signs, even of consciousness and orientation, and signs of toxic syndrome Evidence of physical trauma or abuse should be noted. Ancillary studies that might be useful include urine toxicology, pregnancy standard specific drug levels (if overdose is suspected), and other experiments depending on the specific situation. Organic causes for psychiatric conditions should be evaluated. The treatment goal includes immediate and long-term safety of the patient. Short-term indigences can be handled in the pass department or in the hospital. Long-term wants require family involvement and psychotherapy when necessary, along with a plan the patient can tread close upon to deal with suicidal feelings without resorting to suicidal behavior.

The authors infer that disposition depends on the evaluation of suicide risk, the mental health resources available in the exigency department, and the health institution's policies about management of suicidal adolescents. Inpatient care is advisable for adolescents with psychiatric disorders, substance abuse, inability to establish a trusting relationship with a medical care-giver, serious medical issues, multiple suicide attempts, or poor social support. Although it is not absolutely necessary, an attempt should be made to obtain parental approval for hospitalization. Outpatient treatment should be considered solitary for the minority of adolescents with depressed levels of suicidality who have vigorous supervision and support at abiding-place Follow-up must be arranged with an appropriate mental health professional. Prescription medication treatment should be avoided in the conjuncture department situation.

Kennedy SP et al. conjuncture department management of suicidal adolescents. Ann Emerg M April 2004;43:452-60

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