Dr. Henry Paul, MD

Psychiatrist, Author and Educator

FEWER TEENS ARE HAVING SEX – WHAT DOES THAT REALLY MEAN?

July 27th, 2015

A new study from the U.S. Centers for Disease Control and Prevention reported last week that fewer American teens were having sex than teens a generation ago. The report is based on interviews between 2011 and 2013 with about 2,000 teens ages 15 to 19.

Sex and teens are a very charged topic. Although it is well-known that even young children have many sexual feelings and impulses, the physical changes that come with puberty bring sex center stage. According to this report, the proportion of teens who said they’d had sex has decreased. The numbers have steadily fallen between the 1980’s and 2000s. Certainly, the risks that come with unprotected sex are much better understood by today’s teens. Having said that parents still need to be vigilant in talking with their teens about sex. With so much sex in the media and social media teens, today are inundated with provocative sexual messages.

I found it also interesting that the report showed a rise in the use of the morning-after-pill with little change in the use of other contraceptives. More than half of the teen girls in the study said that they were using the birth control pill. They also said that they have relied on their partners to use condoms. I think the accessibility of contraceptives has led to more using them.
The key to sex education is for parents to talk to their kids. Keep the lines of communication open and remember that your kids do listen.

Click here to read the CBS News story on the study. Questions? Email me at drpaul@henrypaulmd.com

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.

KIDS ONLY PRETEND NOT TO LISTEN

July 9th, 2015

I want to start by saying parents do have a lot more influence with their children than they think. Don’t be fooled by your kids appearing not to listen to you. They’re listening. And when it comes to preventing substance abuse what you say is important.

In 2013, SAMSHA (Substance Abuse and Mental Health Services Administration) reported that “according to the 2004 to 2011 National Surveys on Drug Use and Health, 1 in 5 (22.3 percent) parents of teens aged 12 to 17 thought that what they said would have little influence on whether their child used drugs. Nearly 1 in 10 parents of teens (9.1 percent) said they did not talk to their child about the dangers of using alcohol, tobacco, or other drugs in the past year. Nonetheless, among the parents who had not talked to their child, the majority (67.7 percent) thought what they say would influence whether their child uses drugs.”

A 2013 study by the MetLife Foundation and The Partnership at Drugfree.org reported, “Teen prescription drug misuse and abuse continues to be a significant health problem threatening the well-being of American youth. Currently, one in four teens (24 percent) admits to having misused or abused a prescription drug at least once in their lifetime. It is a bigger problem than many parents know or really understand.

Parent permissiveness and lax attitudes toward misuse and abuse of prescription medicines, coupled with teens’ ease of access to prescription medicines in the home are linked to teen medicine misuse and abuse. The availability of prescription drugs (in the family medicine cabinet, in the homes of friends and family) makes them that much easier to misuse and abuse, and the new survey findings stress that teens are more likely to misuse and abuse prescription medicines if they think their parents are okay with it.”

I have stated over-and-over again that the line of communication between parents and children, particularly teens, needs to be a good one. Whether discussing drugs, sexual preference, depression, peer pressure or any of the many other stresses that affect kids and teens today, you have to engage in the conversation. As important as talking to your kids is listening to them. Listen to their concerns and try to understand how they feel. Do your homework too. Read up on substance abuse and teens. Understand how difficult it is for a teen to “come out”. Seek support when you need it. There are plenty of groups including drug awareness and substance prevention coalitions that will help you.

The MetLife Foundation and The Partnership at Drugfree.org concluded that “Parents and caregivers are missing a key opportunity to play an active role in helping curb the trend of teen medicine misuse and abuse. Parents can safeguard prescriptions in their home, educate themselves about the dangers and risks of this dangerous behavior (for their teens and themselves), and communicate those risks to their children.”

Lastly, I want to remind parents that communication isn’t always verbal. Body language and actions can speak volumes about what is going on in a teenager’s life. Know the signs of substance abuse, bullying, eating disorders and more. The more you understand what your kids face growing up in the world today the better able you are to help. A number of my blogs deal directly with teen struggles with sexual identity, learning disorders and drug and substance abuse. Take a look. Another good reference is the SAMSHA handbook, “Navigating the Teen Years: A Parent’s Handbook for Raising Healthy Teens”. Check it out.

Read the study: The MetLife Foundation and The Partnership at Drugfree.org

Disclaimer
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.

A VERY SAD STORY

March 17th, 2015

Suicide is every parent’s nightmare. On an ongoing basis, there are pressures in teenager’s lives that we know about, and we don’t know about. It’s never simple. In the case of 13 year-old Cayman Naib who was found near his home with a self-inflicted gunshot wound last week, I am sure there are a lot of questions that friends, teachers, and family are asking themselves.

According to the CNN story, Naib left shortly after receiving an email from the school about overdue homework. Most likely that was not the trigger for his suicide. As an adolescent psychiatrist, I know that these stories are usually far from complete. I believe there might have been signs of pre-suicidality that were missed. A suicide rarely happens out of the blue after an email about homework, although sometimes a suicide does appear to come out of nowhere. More often some social rejection or another stressor is present.

Psychological testing of all students is not practical, but the good education of teachers (see our recent blog) and parents to signs of depression or other mental disorders is best.

I think it needs to be pointed out that suicide does not discriminate. The best defense against these situations is knowledge, and the courage of parents to ask the right questions. Here is a list of warning signs that I posted for parents in an earlier blog.

I want to make it clear that knowing the warning signs of suicide can save lives, but it certainly is no guarantee. Hopefully, families that are faced with the suicide of a loved one can eventually find peace, and they need to know that this is not their fault.

Click here for more on Cayman Naib’s story.

DOES LEGALIZING POT SOMEHOW MAKE IT A SAFE DRUG? I DON’T THINK SO!

July 9th, 2014

“Washington States First Legal Marijuana Shops Set to Open Amid Chaos”

That was the lead story on the NBC News website Tuesday, and a slew of other national media outlets, too. With the state of Washington now the second state to legalize marijuana, the controversy over the drug continues to grow. In November 2012, Washington and Colorado stunned much of the world by voting to legalize marijuana for adults over 21, and to create state-licensed systems for growing, selling and taxing the pot. Now, comes the question what should we tell our kids about marijuana?

If you did not already know, marijuana is the second most popular drug in America. Up to 63 percent of teenagers admit using it during high school, and some teens smoke it on a daily basis. There has long been controversy over whether-or-not marijuana is a “gateway drug,” one that leads to further and more serious abuse of other substances. While this debate is ongoing, it is known that a high percentage of people who use more serious drugs, such as cocaine or heroin, started by using marijuana. What the science is saying is that the marijuana does lead to some degree of physical as well as psychological dependence.

With the legalization of the drug in two states, and most likely with more states to follow, it is important that parents talk to their kids about the dangers of marijuana. Make it clear that marijuana is a dangerous and addictive drug and its use can impede functioning and possibly lead to more serious future consequences. Parents, particularly those who experimented with marijuana in their teens may have a tendency to minimize the drug’s dangers. If you have used pot and you have shared this with your kids, tell them why you stopped! Encourage them not to experiment with it and tell them why. Marijuana, in some people, can cause hallucinations and can precipitate severe anxiety to the point of paranoid mental states. Sometimes marijuana can also provoke the emergence of underlying psychotic disorders that may require hospitalization.

Look for the signs of marijuana use in your teenager. These include bloodshot eyes, short-term memory impairment, apathy or lack of motivation, acting silly or “drunk”, impaired body coordination, and the smell of sweet, acrid smoke on hair and clothing.

If you suspect marijuana usage by your child consult your family doctor, or substance abuse counselor or another mental health practitioner. There are also a number of groups that deal specifically with recovery from marijuana use. Most importantly talk to your child. That is always the best place to start.

PREDICTING THE NEXT SHOOTER

June 4th, 2014

The debate about gun control will undoubtedly be fueled by this latest shooting in California. But the dialogue that needs to happen is about recognizing the problem. The question we need to ask is “What do you do when you think someone is dangerous to others?”

For the parents of Elliott Rodger, and a psychiatrist who treated Denver shooter James Holmes, they did recognize something was wrong. In the case of Rodgers the parents tried to contact law enforcement, who, when they checked on Rodger, found him to be okay. The parents knew that not to be the case, so now we have to ask “What more could they have been done?”

The simple fact is that all of us have blind spots because some truths are too much to bear. This is especially true when we feel that a person is getting out of control. Rage, anger, violence and abuse are very frightening things to experience for all of us, and, as a result, we shy away from confrontation. We get scared and hope it passes. We try to rationalize away irrational rage. When we are frightened our judgment gets clouded and decisions we make are often made to allay our own discomfort.

Reporting about a family member or friend also brings all sorts of anxiety. First, we might fear becoming a target of the destructive rage if we confront the person or suggest intervention. Second, we don’t want to make the whole thing worse. We might picture a physical altercation where we become the victim. Thus, the whole subject evokes a good deal of anxiety.

As a psychiatrist, I have even seen this anxiety in professionals who work in the field, too. Unconsciously, professionals can also become scared dealing with a patient who talks about mass shootings and murder. In these cases, the therapist might unconsciously change the subject to suicide rather than talking about killing others. In these instances, because of the anxiety created around the discussion the therapist may give shallow advice such as suggesting increased exercise to calm someone down. Sadly, I have even seen angry patients dismissed from care because of therapist anxiety. The dismissal is usually rationalized in some way. At the very least, I have seen people with overt red flags who are not probed enough or who are sent on their way because the professional is reluctant to become more deeply involved in discussing the details of their fantasies for fear of going to an uncomfortable place. This is why continued clinical practice and training and peer support remain such necessary tools. There are also professional violence screening tools which help in the consultation room.

Professionals and lay people alike should always ask for help when confronted with such anxiety-inducing situations. We are all human and prone to anxiety. There is no shame in being anxious. Reaching out can sometimes save a life. We will never be able to predict and prevent all violence, but there is a room for improvement.

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

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.

WHAT TO DO IF YOU FEEL YOUR CHILD MIGHT BE SUICIDALLY DEPRESSED

February 18th, 2014

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.

Unfortunately, things are not always that clear, so first ask yourself is my child or teenager depressed? If after a week or two, a sad mood does not budge or gets worse and signs of depression are present, be concerned. Talk to your child openly about how he or she is feeling. Include direct questions about suicide. Many parents mistakenly feel that by asking about suicide they will put it in a child’s mind. This does not happen. It is important to know what your child is thinking and direct questioning is the best way to find out. You can ask directly about suicidal ideas, rehearsals, preparations, and the like. This can also be done by asking something like: Sometimes when we feel like this, thoughts of dying or wanting to take your own life can pop up. Has that ever happened to you? Further probing can include other questions like:

Do you think about death?
Do you feel like you want to disappear?
Do you feel hopeless?
Do you think about the afterlife?

It is also essential that you look for possible signs of preparation: a note or other writing, a weapon, or hoarded medication. Increased drug use is also a high risk sign

If, after open, kind, and compassionate questioning of your sad child, without lecturing or criticizing, you see no progress in the depression, and have little or no handle on understanding the situation, and see any signs of possible suicidal intent, then a mental health assessment is needed. No time should be wasted in getting professional attention.

THE WARNING SIGNS OF SUICIDE

February 13th, 2014

Potentially suicidal young people frequently show warning signs. What follows is a list of some of the thoughts, feelings, and actions that could indicate that a young person is contemplating suicide. They range from internal, unexpressed thoughts, like wanting to die, to overt actions, like writing a note or collecting drugs or weapons.

Thoughts of death
Wanting to die
Prior suicide attempts/gestures
Feeling that the world would be better off if they were dead
Feeling useless and hopeless
Giving verbal hints about not being able to take it anymore
Writing about death
Getting absorbed in music, video sites, or activities stressing death or suicide
Talking of the afterlife
Dressing in black
Becoming absorbed in morbid subjects
Having an inappropriate burst of enthusiasm or cheerfulness after being depressed (this sometimes indicates that a person has decided to commit suicide)
Cleaning house and putting his/her things in order
Writing a suicide note
Buying books or researching modes of suicide
Idealizing celebrities who have committed suicide or died in other ways
Engaging in drunken driving
Accumulating weapons

If you see any of these signs you should be immediately concerned and contact a medical health professional right away. In my next blog I will discuss having an open conversation with your sad/depressed child if you suspect that he or she might be contemplating suicide, but is not showing any clear signs like those listed above.

THE STATISTICS OF SUICIDE

February 11th, 2014

Of course, suicide is always a worry when there is talk about depression. While suicide is quite uncommon for younger children, we do see an increase starting at about nine years old. By 13 to 14 years old, the rate of suicide increases and becomes the third highest cause of death for 10 to 24 year-olds. The rate of suicide under ten years old is about .8/100,000 children, it doubles in the 10 to 14 year old group but then increases to about 8/100,000 by 15 to 19 years old. Suicide attempts are often reported as accidents and are not reflected in the statistics — like the depressed teenager who crashes the car into a tree. About two thousand suicides in youngsters occur in the United States each year. There are about one hundred thousand world-wide. While depression is the main risk factor associated with youth suicide, other conditions also raise the risk:

· Behavior disorders

· Physical/sexual abuser

· Severe anxiety

· Eating disorders

· Suicide in the family

· Substance abuse

· Being bullied

· Family disruption

There are many triggers for suicide including being rejected socially or in a love relationship, school failure or expulsion, being caught by the police doing an antisocial act, feeling humiliated, being intoxicated, and experiencing family stress. Hopelessness, often found in depressed youngsters, is one of the most indicative signs of a possible suicide attempt.

So where do antidepressants fit into adolescent/teen suicide? After some preliminary studies had come out from the FDA in 2003 and 2005 saying that there was an increased risk in suicidal thoughts in children, adolescents and young adults, parents became scared to have their child on any of these medications. There was, and still is, a lot of information on the Internet to dissuade parents from using antidepressants, so I understand the fear.

Here’s how I see it. When the studies came out, many psychiatrists, me included, spoke out nationally emphasizing that if, in fact, this was a risk, it was so rare that most of us had never seen it and that proper monitoring by the prescribing physician would, in all probability, be enough to ward off any tragedy. Despite this, the new prescribing of antidepressants dropped markedly. Tragically the suicide rate increased in teenagers. No scientific correlation was made, but it seems that this was related to less use of the antidepressants which could have treated the depression and prevented the suicide.

The reality is that, if prescribed correctly under the guidance of an experienced psychiatrist, I do not think there is an increased risk of suicide. Further studies about particular drugs with proper control groups will clarify this. What I recommend is that parents do not withhold antidepressants on what we know so far, but parents should be cautious and make sure that their child is being monitored for every possible side effect.