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Jan
13

Erratic Teenage Behavior: Part 2 of 3 on Adolescent Medicine

Cara Lyle

Cara Lyle

The 2013 Commonwealth Medical College Healthcare Journalism Award: Congratulations to Cara A. Lyle, as the recipient of the 2013 TCMC Healthcare Journalism Award by Dr. Paul Mackarey! The award recognizes Cara’s excellence and dedication as a medical student and healthcare journalist.

Cara A. Lyle is a 4th year medical student and a member of the second class at The Commonwealth Medical College (TCMC). She was born in Pittsburgh, PA and raised in Ford City, PA.  She earned a Bachelor of Science in Biology with a Minor in Chemistry at The University of Pittsburgh.  She is currently applying for a residency in General Surgery.  She enjoys spending time with her family, art and art history, traveling and staying active by working-out, going for walks or playing sports.  Writing has also been a special interest of hers throughout her education and she is excited to continue to pursue this interest while in medical school.

 

A TALE OF TWO TEENS

Teen 1 is a 16 year old female involved in volleyball and student government.  She does well in school and often achieves honor roll.  She recently got into an argument with her best friend that has left her alienated from her larger group of friends.  Since the argument, she is very moody and refuses to discuss any details with her parents.  She has however, been able to talk to her older sister about the problem.  She still attends and enjoys participating in her extracurricular activities.  She continues to maintain her good grades.

Teen 2 is a 17 year old male involved in wrestling and science club.  He does well in school and often achieves honor roll.  He recently got into an argument with his best friend that has left him alienated from his larger group of friends.  Since the argument he is very moody.  He refuses to discuss any details with his parents.  He has never been very close with his older sister and does not feel comfortable discussing any details with her either.  He started acting out in class which has led to his first detention.  He is unable to concentrate during class and as a result his grades have declined.  He stopped attending wrestling practice because he no longer enjoys participating in the activity and his father discovered an empty bottle of alcohol in his dresser drawer while putting his clothes away.

Can you find the similarities and differences between these two teens?  Which teen is showing signs of depression?  What are the signs of depression that the teen is demonstrating?  Which teen is at an increased risk for death by suicide?  In an interview with Dr. Linda Thomas-Hemak, President/CEO of The Wright Center, she discussed the difficulty in differentiating between normal adolescent hormonal mood swings from the abnormal. It is the purpose of this column to assist you in this challenge through improved education and heightened awareness in order to seek appropriate intervention.

According to The National Institutes of Health, the top three most common causes of death for children and teens ages 5-14 are accidents, cancer and genetic conditions present since birth.  The top three most common causes of death for teens and young adults ages 15-24 are accidents, homicide and suicide.  This dramatic shift in the types of causes of death for adolescents and young adults accounts for the increase in death rates following puberty.

This shift in the types of causes of death also brings in the concept of “preventable” causes of death.  Preventable is in quotations to signify the challenges we face in trying to prevent suicide.  According to an article in the Journal of the American Medical Association, of the many suicide-prevention interventions they examined, only physician education in depression recognition and treatment and restriction of access to lethal means of taking one’s life reduced suicide rates, while all other strategies need more evidence to demonstrate an effect.

Lastly, by recognizing the warning signs of depression and risk factors for suicide we can begin to understand the differences between normal and abnormal teen mood swings and behavior changes.

Dr. Thomas-Hemak also discussed her view on the warning signs during our interview:

“Most mood swings are not pathological, but if you mix them with a lack of social support, with substance abuse and complex substance utilization, they all are linked and enable each other.  One of the warning signs is if social, school or work performance or behaviors are affected.  If anyone (parent, teacher, and friend) thinks there’s a problem, then it deserves attention.”

 SIGNS AND RISK FACTORS OF DEPRESSION IN TEENAGERS

 

Signs of Depression

  • Depressed mood most of the time
  • Loss of interest or pleasure in activities
  • Weight loss or gain
  • Trouble sleeping or sleeping too much
  • Loss of energy
  • Feelings of worthlessness
  • Hopelessness toward future
  • Lack of concentration
  • Recurring thoughts of death
  • Complaints of psychosomatic symptoms

Risk Factors for Suicide

  • Specific
    • Previous suicide attempt
    • Mood disorder (major depressive disorder)
    • Substance abuse disorder (especially in males)
    • Aged 16 years or older, male and living alone
    • History of physical or sexual abuse
  • Less Specific
    • Recent dramatic personality change
    • Psychosocial stressor (trouble with family or friends or a disciplinary crisis)
    • Writing, thinking, or talking about death or dying
    • Altered mental status (hearing voices, violence, intoxication)

 A TALE OF TWO TEENS REVISITED

With this information, let’s return to our two teens.  The similarities among the two teens include involvement in extracurricular activities, good school performance and a recent psychosocial stressor.

The difference between the two teens is how the psychosocial stressor has affected them.  Teen 1’s coping mechanisms are more likely to be the normal mood swings of adolescence in the setting of a psychosocial stressor.  Teen 2 lacks social support and his personality is changing.  Teen 2 is showing signs of depression including loss of interest or pleasure in activities he used to enjoy and lack of concentration.  Teen 2 has also begun abusing alcohol.  All of these put Teen 2 at greater risk for suicide.

Now that we better understand the difference between normal adolescent mood swings and behavioral changes and those that are cause for concern, what do we do?  Find in Adolescent Medicine Part 3 of 3:  “Tips for Addressing Concerns with Adolescents.”
For More Information About this topic:

Pediatric Research:

The Journal of the American Medical Association (JAMA)

http://www.adolescenthealth.org/Fellowships_Training/3635.htm>

http://www.nlm.nih.gov/medlineplus/ency/article/001915.htm

MEDICAL CONSULTANTS:

Dr. Linda Thomas-Hemak, MD: President/CEO of The Wright Center for Graduate Medical Education and The Wright Center Medical Group, P.C.  She is dually board certified in Internal Medicine and Pediatrics. She leads The Wright Center for Primary Care Mid Valley practice, a level 3 NCQA designated Patient-Centered Medical Home.

Deborah Spring, MD: is board certified in Family Practice with board certification in the sub-specialties of Adolescent Medicine and Geriatric Medicine.  She practices in Kingston, Pa.

Visit your doctor regularly and listen to your body.

Keep moving, eat healthy foods, exercise regularly, and live long and well!

Read Dr. Mackarey’s Health & Exercise Forum in the Scranton Times-Tribune every Monday. Next week: Adolescent Medicine Part 3 of 3.

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor  in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice in downtown Scranton and is an associate professor of clinical medicine at The Commonwealth Medical College.