Psychiatry and Society

Adolescence is a time of transition . Most parents find themselves bewildered by the changes in their previously affectionate and obedient children. Mood changes, withdrawal, monosyllabic answers and arguments find most parents asking, “What have we done wrong?” Adolescence is marked by profound changes brought about by the hormonal surge at puberty. The physical changes are accompanied by emotional, behavioural and intellectual changes to which the child has to adapt rapidly. “As their bodies, brains and worlds rearrange themselves, you (parents) will need to do your own reshuffling.” Changing role of parenting adolescents The need for autonomy, independence and a search for one’s own unique identity is an essential part of adolescence. Often, this is achieved by questioning and testing existing rules and norms. Make space for this quest. Handle an occasional error of judgement with explanations rather than with accusations and confrontation. The essentials of parenting ...

Self-cutting in adolescents is the strongest predictor for subsequent suicide attempts. It is a clear signal of severe psychological pain being released physically by the act of self-cutting. However, relief is only temporary, and if ignored self-cutting can progress to suicide. Self-cutting and Suicide Repeated self-cutting in adolescents is the strongest predictor of attempted suicide. 70% of those who self-cut will attempt suicide at least once. The number of suicide attempts increases with the number of years engaged in self-cutting (Nock 2006). The risk of attempted suicide is higher than with any other psychiatric disorder including depression and borderline personality disorder. Self-cutting may be a uniquely important risk factor for suicide because its presence is associated with both increased desire and capability for suicide (Klonsky 2013). Ms LM, 15 years old, was brought by her parents for counselling after a suicide attempt. She subsequently revealed repeated se...

Treat schizophrenia as you would any other serious medical illness in your teenager "My 18yr son is aggressive, hearing voices, and not sleeping." "Since the last two months he is not attending college. He talks to himself in his room and is not going out with his friends." "He feels he is being tracked through the TV and yesterday assaulted his mother when she put it on." "We tried taking him to our doctor but he refuses saying there is nothing wrong with him." This is a common introduction to the more severely ill teenagers presenting at Pathfinder Clinic. Why teenagers with schizophrenia refuse to see a psychiatrist  Teenagers refuse to see a psychiatrist for illness related and personal reasons Illness related factors Schizophrenia is a brain disease. Your teenager has difficulties recognising his own symptoms. In schizophrenia there are changes in brain structure, chemistry and functioning. The individual is unable to ...

ADHD teens with appropriate life skills can live independently Does your  teenager with  ADHD have the life skills to survive in hostel? She did well in her 12th board exams and scored high in the CET. To attend the engineering college of her choice she has to move from home to a hostel in another city. Given her difficulty organising her daily schedule, would she be better off doing the same subjects at the local engineering college? The answer would depend on her personality and the life skills she has acquired. ADHD teenager personality types Teenagers with ADHD are of 3 character types: the optimistic, the terrified and the lost. They are placed into these categories depending on their productivity and anxiety (either too much or too little). The optimistic teen does not worry. He is excited about the independence that college life will bring, but may not realise that freedom comes with responsibilities (financial, social and personal). If he's still disor...

   Conduct disorder and behaviour problems in children  make the news when a 5-year old or a grandmother is killed while extorting money. Aggression in children  is just one of the offenses associated with conduct disorders . The seemingly lesser offenses of stealing in thousands from the home, or smoking 'weed' with their friends, pale in contrast. At the lowest end of the spectrum are those children who repeatedly confront authority in school or at home. Dubbed as 'monster kids' these children are viewed indulgently as being mischievous, naughty, 'bad', or 'delinquent'. Very seldom are they seen as having a mental health problem - a conduct disorder. What is Conduct Disorder? Behaviour problems that are persistent , violate the rights of others, go against societal norms, and disrupt family life, indicate a conduct disorder and merit psychiatric assessment. Conduct disorder is amongst the commonest childhood disord...

Cannabis or marijuana use by teenagers and adolescents is highly associated with the onset of psychosis and schizophrenia. Cannabis goes by many names including hash , pot, grass, weed, or ganja . This gateway drug is falsely thought to be innocuous and as having no lasting effects. Cannabis use by teenagers is often not recognised as a problem. Cannabis is cheap and easily accessible in most student populations. Pune is a major hub for the cannabis drug trade. This week a quarter tonnne of ganja was found dumped in a well. Cannabis use is rampant in Pune colleges and hostels, where students assiduosly guard and maintain their 'stash'. During the 57th National School Games the highest number of students testing positive for marijuana came from Maharashtra. Regular cannabis use increases the risk for schizophrenia and psychosis by upto 4 times. There is increasing evidence that cannabis use can precipitate schizophrenia in vulnerable individuals. This is especially so...

Mental health and diet quality are closely linked . The food choices you made as a teenager affect the development of conduct and emotional problems that continue into adulthood. Lifestyle diseases such as heart disease, diabetes and obesity are attributed to changes in diet and exercise habits. Recently there is increasing evidence that diet and exercise also have a major influence on mental health. Dieting peaks after the festival season. This post will help you avoid the 'isms' and fads and point you in the direction indicated by current research. A good quality diet predicts better mental health Evaluating the quality of the complete diet provides a better and more consistent picture of nutrition status than focusing on individual nutrients like magnesium or food groups like various fatty acids (omega, polyunsaturated). A traditional diet of vegetables, fruit, meat, fish, and whole grains is associated with lower risk for depression and for anxiety disorders as compared...

Parental supervision protects boisterous children from injury: More time unsupervised corresponds to more injury  “To my parents we were just two girls in the bedroom” . What exactly was going on? Without adequate supervision the parents of this teenager never found out; the memories returned to haunt her in adulthood. Studies comparing children with and without parental supervision show that lax parental supervision is associated with injury in toddlers and preschoolers; conduct problems in school going children; and road accidents, addictions, gambling and sexual risk taking in teenagers. Parental supervision has three dimensions (Gitanjali 2004) Attention - watching or listening  Proximity - within or beyond reach  Continuity - constant, intermittent, or not at all  Two factors determine the degree to which a child would be left unsupervised (Morrongiello 2008) Parent’s conscientiousness  - the more conscientious the parent more the sup...

(or why the 25 year age-bar on alcohol consumption could be reasonable) Does alcohol have specific neurotoxic effects on the adolescent or young adult brain? This question is the only important one for deciding whether the 25 year age-bar on alcohol consumption in Maharashtra is justifiable. While the debate rages two students from the premier medical college of India drowned in an alcohol fuelled swimming pool misadventure, and in an unrelated incident on the same night five inebriated youths were arrested for disturbing the peace in a residential area. We have seen how to recognise problem alcohol drinking in teenagers , and how to refuse alcohol . This article probes the specific effects of alcohol on the maturing brain. Infancy Alcohol is a neurotoxin. It distorts the normal architecture of the developing brain. This distortion starts during pregnancy when imbibed maternal alcohol crosses the placenta into the foetus. In the foetus alcohol acts on the specially vulnerab...

Whitener (correction fluid) inhalation caused the death of a Pune student recently. Whitener is abused as an inhalant in India. Whitener exerts its effects through trichloroethane , a volatile solvent. Inhalants  include other substances such as petrol and toluene. These substances are cheap, accessible and readily available to children and adolescents. Epidemiology Solvent abuse is prevalent among street children and working kids . Teenagers start using solvents to gain entry into a gang, and occasionally as experimentation. Its use in a college student is unusual. But this may be a developing pattern indicating spread of the habit into middle class homes. (Kumar S 2008). Most adolescents are one-time or short-term users. Those who abuse inhalants persistently usually have conduct disorders. Methods of inhalant abuse Sniffing - direct inhalation from a container or piece of clothing sprayed with the substance. Huffing - holding a soaked cloth over the nose o...

Stressed youths relaxing Academic stress is a significant aspect of youth. Youth is the developmental phase between puberty and working adulthood. It is a period of continuing student-hood. This is a distinctive feature of youth - it exists only for those who undergo post-secondary education. This is for the privileged few who do not join the workforce full-time after schooling. Youth is a valuable time for serious experimentation. The young person is not fettered by long-term commitments. In contrast to adolescence, youth is a period of independence - the peer group is no longer a dominant influence. There is greater freedom to develop as an individual. The young person evolves a personal perspective on life and develops a sense of direction before tackling the duties of adulthood. However this stage of life is by no means stress-free. By definition youth is associated with academics. Academic demands are perceived as significant stressors by youths (Rao 2000, Goff 2011). The...

Parents worry that social networks like Facebook could have harmful psychological effects on their children. They seek consultation for social network related behaviour of their teenagers when academic grades fall due to excessive time spent on Facebook, when the teenager is subjected to cyberstalking, or when they themselves are disturbed by the online self-profile of their child. What do we know about some of these social networking behaviours that bring parents and their children to the Clinic? Friends, self-presentation and self-esteem Posting a profile assists the teenager in gaining self-awareness. Becoming self-aware by viewing one's own Facebook profile enhances self-esteem (Gonzales and Hanock, 2010). A larger number of Facebook friends and  an exaggerated positive self-presentation does enhance the teenager’s well-being. However this is not necessarily associated with a sense of belonging to a supportive group. A more honest self-presentation does increase ha...