Dr. Henry Paul, MD

Psychiatrist, Author and Educator

CHECKLIST FOR PARENTS CONCERNED ABOUT TEEN SUICIDE — WHAT TO DO!

March 29th, 2014

If you suspect that your teen might be depressed or contemplating suicide then you need to act right away. Here is a quick list of things to look for:

  • Always take seriously any mention or discussion of death, dying, suicide, self destruction or other evidence of morbid thinking that your teenager may manifest
  • Talk to your teen, listen, don’t lecture, express love and reassurance, and realize that suicidal ideation and depression are usually temporary and treatable states but probably need immediate professional intervention.
  • If you are worried that your teenager may be contemplating suicide, remove any weapons, pills, or other objects of substances in the house to which he or she may have access to achieving the act.
  • Get professional help immediately. Remember that depression is almost always indicated in suicidal teenagers and that a combination of “talk therapy” and medication can turn things around.
  • Get the numbers and/or websites of suicide hotlines both to report any fears or concerns you may have and to learn more about the likelihood of your teen carrying through any suicide attempt if you remain unsure.
  • Note changes in behavior mentioned previously (including dressing in black) and take them seriously. Engage your teen in conversation about what’s going on with him or her in his or her life and what he or she intends by the changes in dress or behavior you have noticed.
  • Don’t Judge. Family supportiveness is crucial. The point is always to get your teen to talk, not to lecture or try to persuade him or her out of feelings.
  • Be especially alert if your family has had a history of suicide or suicide attempts.
  • Understand that in a minority of cases, if the depression or other underlying reasons for your teen’s suicidal thoughts and/or behavior indicate it, your teen may need hospitalization and a combination of therapy and medication.
  •  The most important thing you can do if you think your child is suicidal is to explore the situation openly. If your child states that he has suicidal ideas or intentions or plans then an immediate mental health evaluation is necessary. Go to the nearest hospital emergency room or mental health crisis unit.

Check my February blogs on Suicide for more information, and certainly feel free to contact me.

Statistics of Suicide
The Warning Signs of Suicide
What to Do If You Feel Your Child Might Be Suicidally Depressed

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

CDC SAYS 1 IN 68 CHILDREN IS ON THE AUTISM SPECTRUM – SO WHAT DOES THAT REALLY MEAN?

March 28th, 2014

This morning, almost every news outlet ran a story about the latest CDC study stating one in 68 children has Autism. Lenny Bernstein reported today in The Washington Post “To Your Health” section that “ The number of U.S. children with autism has surged to one in 68, the Centers for Disease Control and Prevention reported Thursday, a 30 percent increase since the agency estimated just two years ago that one child in 88 suffered from the disorder.

The new estimate, based on a review of records in 2010 for eight year olds in 11 states, also showed a marked increase in the number of children with higher IQs who fall somewhere on the autism spectrum, and a broad range of results depending on where a child lives. Only one child in 175 was diagnosed with autism in Alabama, while one in 45 was found to have the disorder in New Jersey.”

What does all this mean to parents? First, if you suspect that your child may be on the spectrum [read my earlier blog this week on the signs of Autism] then you need to have your child seen by a professional who will make a diagnosis. You will also need to speak with the CSE (Committee on Special Education) at your child’s school to discuss testing. The testing will identify what support services the school will be able to offer your child through an Independent Education Plan, known as the IEP.

As frightening as this diagnosis may be for parents there are children on the autism spectrum that are able to lead productive lives. Many celebrated people have been diagnosed or are suspected of being on the autism spectrum. The best thing you can do is to learn about autism and be sure your child receives all the services available in your area.

The Signs of Autism — I Think My Child Might Be on The Spectrum

DISCLAIMER

Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

THERE IS A “SUICIDE EPIDEMIC” – SO WHAT DO PARENTS DO?

March 28th, 2014

Sadly, teen suicide once again takes front and center in the news. Suicide is never more devastating than when a teenager makes the decision to end his or her own life. Last Saturday, New York City School Chancellor Carmen Farina said that ten students in the New York City public school system had taken their own lives in the past seven weeks creating a “suicide epidemic” in our schools.

City Health Department stats are showing a rise in youth suicides, with suicide the third leading cause of death for New Yorkers ages 15 to 24. In 2010, 58 people in that age group took their lives. In 2011, the toll was up to 64, and in 2012,it reached 66.

So how worried do parents have to be that their own teens may make this terrible choice? This is frightening for parents, particularly when you hear the current numbers. Most teens of course never consider suicide, but if you are worried there are things you need to know and signs to watch for.

What you need to know is that there are many theories out there as to why teens commit suicide; focusing on stress and family turmoil; confusion, self-doubt, the impact of recent humiliations; and the effects of alcohol and drugs. Moving, feeling isolated, sexual or physical abuse, and divorce and family break-up have also been implicated as triggers. Family history may also play a role: teens with relatives who have committed suicide may be more likely to consider it themselves.

Perhaps, the most plausible overall reason for teenage suicide is only this: the teenager feels hopeless! This is often a symptom of major depression, as well as feeling caught in inner conflicts and/or environmental constraints or difficulties from which the teenager feels there is no escape. Because the most common psychiatric diagnosis associated with suicide is depression, it is crucial for parents to watch for symptoms that commonly indicate this condition. If your child is suffering from a recent onset of sad mood, irritability, withdrawal, eating or sleeping disorders, seems to have shown a marked decline in school performance, can’t concentrate, is fixating on a particularly painful experience of humiliation, or is afflicted by headaches of gastrointestinal complaints, regard it as an urgent “heads up.”

Often teens who are suicidal give verbal hints about suicide. “I cannot take it anymore” or “you’d be better off without me” are the kinds of warning statements a suicidal teenager often makes – warnings that are too frequently dismissed as evidence of passing adolescent mood swings. Also, talk of the afterlife, joining someone in heaven or dark and morbid interests and preoccupations. Also, dark music, internet searches having to do with death and/or suicide are red flags. Lastly writings or postings online are often warnings. Lastly a quick switch from depression to a good mood possibly associated with having “cleaned house” is a serious development.

If your teen has attempted suicide before, you need to be particularly alert: seek professional help right away.

I will follow-up with a blog tomorrow that deals with “What to Do.” Check out my February blogs on Suicide, too.  Certainly, if you have any questions, please email me.

Statistics of Suicide
The Warning Signs of Suicide
What to Do If You Feel Your Child Might Be Suicidally Depressed

CBS Local   Report: NYC Public Schools Have Seen 10 Student Suicides In 7 Weeks
New York Post  10 NYC schoolchildren have committed suicide in 2014

DISCLAIMER

Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

I THINK MY CHILD MIGHT BE ON THE SPECTRUM

March 24th, 2014

“I’m terrified, Doctor, Philip is almost two and he still hasn’t said a word. Could he be Autistic?”

Autism, today, is one of the most talked about, and feared, diagnoses for parents. Autism and Autism spectrum disorder (ASD) are both general terms for a group of complex disorders of brain development that affect each person in different ways, and can range from very mild to severe. Generally symptoms start before the age of three years old and last a lifetime. There are three types ASD’s; Autistic Disorder, Asperger Syndrome, and Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS; also called “atypical autism”). All three are characterized by varying degrees of difficulty with social interaction, verbal and nonverbal communication and repetitive behaviors. These symptoms include:

  • Impaired social relatedness
  • Lack of social reciprocity
  • Decreased peer relationships
  • Sharing deficits
  • Delayed or lack of language
  • Odd/repetitive speech
  • Poor conversational skills
  • Rigidity
  • An obsessive need for sameness
  • Rituals
  • Motor mannerisms
  • Preoccupations with parts of objects or narrow interests

As with so many other psychiatric syndromes, we don’t know exactly what causes autism, but we do know that it is not caused — as had once widely been thought — by cold, inattentive, negligent or unloving parents. Autism seems to be a disorder connected with dysfunction in the central nervous system. While no clear lesion or specific neurotransmitter has been isolated as the cause, we know that genetics plays a role.

As for treating with medication, antipsychotic drugs have only proven helpful in a narrow range of symptoms including irritability, tantrums, some of the motor issues, the occasional high anxiety of these children (sometimes to the point of psychosis), and repetitive behaviors. Unfortunately, there is little pharmacological help for the core of Autism, which is impaired communication and decreased relatedness.

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

WHEN ARE SLEEP MEDICATIONS NECESSARY FOR CHILDREN?

March 14th, 2014

Recent studies show a striking rise in the prescription of sleeping pills for children by pediatricians and child psychiatrists.  These doctors worry about the effects of disrupted sleep on children and mostly prescribe for this reason.  This is alarming to me and many others in the field.   Medications have side effects, and some could even lead to a habit forming situation.  In general, I rarely prescribe a sleeping agent for children and teens.  The few times that I do consider it necessary is when:

•    The situation continues moderately to severely despite all other remedies.

•    It is caused by another medication, which is necessary.

•    It is part of a mental disorder, and the treatment does not affect the insomnia.

Most sleeping problems pass.  As I mentioned in my earlier blogs, you need to try sleep hygiene techniques first.  They almost always work!  Other things that work include parent counseling and various behavioral interventions.   Oh, and remember that too much technology, over-scheduling, and caffeine could all play a part.   I can’t stress enough that medication should always be the last resort.

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

OTHER SLEEP DISORDERS IN CHILDREN AND TEENS – NIGHT TERROR DISORDER

March 11th, 2014

In my last couple of blogs, I have been discussing a group of sleep disorders in children called Parasomnias.  I have addressed two of the four parasomnias in children; nightmares and sleepwalking.  Today I will discuss night terror.

Night terror disorder is quite frightening for parents or to anyone who witnesses it.  Typically the child bolts upright from sleep with eyes wide open (although often not able to recognize family members), appears frightened often to the point of panic, and is screaming, confused, and inconsolable. The heart rate is elevated; there is shortness of breath, and he might be sweating, as well. There is what appears to be acute terrifying distress. The child usually cannot be awakened. The episode usually occurs in the first third of the night, and he falls right back to sleep.  There is amnesia for the event the next morning.

Although this is a dramatic event, it is not particularly serious in the long term.  It occurs rarely and usually disappears by teenage years. Some hypothesized causes are fatigue, new environments, fever, obstructive sleep apnea, and stress of some sort.  As with nightmares the way to handle this is to be reassuring and comforting and for you not to panic.  Practicing good sleep hygiene is a parent’s best bet.  If these night terror attacks become frequent and/or disrupt family life, the use of benzodiazepines for a short amount of time has been found helpful. Some parents have reported that 1-5 hydoxytryptophan, which is sold over the counter and metabolized to become serotonin in the body, has allayed these terror attacks.

Our next blog is bedwetting  and it will conclude this short blog series on  parasomnias.

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

SLEEP DISORDERS IN CHILDREN AND TEENS – SLEEPWALKING

March 6th, 2014

In the last blog, we discussed nightmares.  Now, we are going to look at sleepwalking.  This parasomnia is characterized by a child getting up and walking around. Eyes are open, but responsiveness is either absent or inappropriate. Walking around can vary from quiet walking to agitated running. There is usually a glassy dazed stare. Sometimes the child can go to the bathroom or engage in other activities.  Rarely there is violence. There is amnesia for the event. After the episode, the child can be found sleeping somewhere in the house.

There appears to be a genetic contribution to causation. Additionally, sleep deprivation, a chaotic environment, stress, some sleeping pills, and antipsychotic drugs, stimulants, or antihistamines might cause these episodes. It is also associated with PTSD, panic disorder and possibly dissociative identity disorder. Some medical conditions including gastroesophageal reflux, fever, asthma, and obstructive sleep apnea are present.

As in other parasomnias, treatment becomes necessary if there is resultant family disturbance or increased frequency.  Since children can hurt themselves by accidents such as falling down stairs or getting outside the house, safety measures have to be taken such as trying to make the first floor of a house the sleeping  location, locking doors and windows, clearing obstructions, putting heavy drapes over glass windows, and possibly setting an alarm which will sound if the child gets out of bed.  Treatment consists of clearing up any associated medical conditions and rarely the use of medication including the short term benzodiapine Klonopin or Trazadone.

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

 

OTHER SLEEP DISORDERS IN CHILDREN AND TEENS — NIGHTMARES

March 5th, 2014

Sandy has been scaring us. She seems to wake up screaming, terrified, and agitated. She bolts up. After a few minutes she goes back to sleep. It not only scares us but she doesn’t even remember the whole thing the next morning.

There is a group of sleep disorders called Parasomnias. These syndromes present as unusual behaviors or movements that occur during sleep. They occur mostly in children and are rarely serious. They usually are gone by adolescence and the most effective interventions are parent education and counseling.  Medication is rarely needed for most cases. They are rarely associated with major mental disorders. The most common ones encountered in practice are Nightmares, Night Terrors, Sleepwalking, and Bedwetting.

I will discuss all four in my next few blogs, but we’ll start with nightmares today.  Nightmares or bad dreams are quite common in young people. These are dreams in which the child experiences himself in danger, vulnerable, frightened, and helpless. There is great distress, sometimes even panic and horror. Common themes often involve being chased, drowning, and other frightening losses of control. These dreams usually happen in the second part of the night, and the child often wakes up scared and remembers the dream content.

The child is often quite anxious, possibly believing that the dream was reality. He has a fast heart rate and might be perspiring, as well.  Children usually need soothing and reassurance. Sometimes from the content of the nightmare the parent will be able to figure out what might be causing a passing stress or anxiety and might be able to help. Of course, there might be causes for repetitive nightmares such as chronic stress/anxiety. Some physiological causes might be the administration of certain antidepressants or stimulant medication for ADHD and post-traumatic stress disorder. If nightmares have become disruptive to the point of interfering with functioning then treatment to decrease stress, a fitness program, relaxation therapy, yoga, and even meditation have all been reported to help. In the most severe cases, such as those following a severe stressor, medication has been used with success and includes the antidepressants Trazadone or Serzone, some mood stabilizer, and possibly a Benzodiazepine anti-anxiety drug for the short term (a week or so).

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.