Supportive short-term family therapy by nursing staff in the inpatient unit: Preventing dependence and rehospitalization in the acutely ill and suicidal adolescent

Abstract

A 14-year-old girl was admitted after attempting suicide by swallowing over 50 pins. On admission, she complained of abdominal pain. A flat abdominal X-ray revealed numerous needle-like objects in the large intestine. After a period of observation we were able to diagnose her as suffering from a major depressive episode with psychotic features, post-traumatic stress disorder, physical abuse, neglect and inhalant abuse. Medically, the pins were spontaneously evacuated with her stools without any intervention. The mode of the suicide attempt was an important clue to raise suspicion of a psychotic episode. Two issues are discussed: I) A "psychiatric" issue: the way in which an attempt is made should be considered as a factor not just for the evaluation of the suicidal risk, but also for the psychopathology. This case demonstrates that a bizarre attempt should raise the suspicion of a psychotic disorder. 2) A "general medical" issue: our experience with this patient was in accordance with common medical expectant management for patients who have swallowed multiple sharp objects once they have reached the large intestine. We conclude: 1) In the preliminary psychiatric evaluation, more emphasis should be placed on how bizarre the means of the suicide attempt as a possible sign of a psychotic psychopathology. 2) Treatment for adolescents who swallow numerous sharp objects should consist of expectant management once those objects reach the large intestine.

Adolescent psychiatric patients and their parents: Comparison with a non-clinical cohort

“…This situation is unfortunate as psychiatric inpatient services for children and adolescents account for approximately seven percent of the total mental health inpatient services (8)(9)(10). Although some studies have documented a link between family and adolescent psychopathology (11)(12)(13)(14), greater research is needed to complete the framework for an understanding of how adolescents treated in inpatient psychiatric hospitals and their families compare with non-hospitalized adolescents and their families.…”

Family Treatments for Individuals at Risk for Suicide

“…In particular, since family is associated with the onset and recurrence of adolescent depression and suicide, engaging them could lead to more change in the suicidal individual. Another promising intervention presented in an article by Gokhshtein et al (2005) suggests the efficacy of a supportive short-term family therapy. In this intervention the researchers propose that a supportive family environment can help an individual in crisis achieve therapeutic outcomes without extensive hospitalization.…”