Adolescent Mental Health

Abstract

IntroductionMental or emotional problems of humans have probably existed ever since Homo sapiens emerged as a species (1). History notes medical treatments dating back to the Ebers Papyrus (1500 BCE) that lists over 700 medicines made from various sources-animal, vegetable, mineral, others (2). Scholars in China and India developed large pharmacopoeias dealing with various disorders over several thousands of years (3). However, the ancient philosopher, Aristotle (384-322 BCE), was quite skeptical of the powers of medicine as noted with his opine: ...the physician does not cure man, except in an incidental sense (4).Distinguishing medical and psychological problems of children and adolescents required thousands of years of observation since most energy was spent on adult disorders. Health care advances usually were initially targeted for adults and gradually over the past 1,000 years, considered the health of children. Rhazes (Muhammad ibn Zakariya Razi [865-925 CE]) was the most famous physician of ancient Persia and his brilliant observations as well as writings initiated the birth of pediatric knowledge with his book on children's disorders at the same time that Western civilization knowledge was lost in the Dark Ages. Eventually those in the West emerged from their intellectual abyss with textbooks covering children by Trotula Platearius of Salerno, Italy (De Mylierum Passionibus) in 1050 CE and by Thomas Phaer in 1544 CE (The Boke of Chyldren). Thomas Phaer was an English pediatrician, lawyer, and author of the first book on pediatrics in the English language; this landmark treatise was the first to provide a distinction between the critical stages of childhood and adulthood setting the stage for further research on problems of childhood. Four centuries later, medical problems of children were finally appreciated with the formation of the American Academy of Pediatrics in 1930. The American Academy of Child Psychiatry was formed in 1953 to study psychiatric problems of children and the Journal of the American Academy of Child and Adolescent Psychiatry began in 1962 to record research discoveries in mental health disorders of children and adolescents (5).Mental health drugsThe field of modern psychopharmacology began in the 1930s with the availability of various psychoactive medications such as barbiturates, antihistamines, and psychostimulants (6). The seminal work of Bradley in 1937 identified Benzedrine (racemic mixture of levoamphetamine and dextroamphetamine) as a drug that improved the behavior of 30 children in Providence, Rhode Island, USA who had various emotional and behavioral problems (7). In the same year Molitch and Eccles conducted what may be the first placebo-controlled work in child psychiatry to show the positive effect of Benzadrine on 93 males labeled as juvenile delinquents (8).Chlorpromazine was introduced in 1950 as the first of many future antipsychotic medications to treat psychosis in adults.Also, in the 1950s, there was the introduction of two antidepressant classes, a monoamine-oxidase inhibitor (iproniazid) and a tricyclic antidepressant (imipramine) (9,10).Methylphenidate (MPH) was first identified in 1959 by Knobel in Kansas, USA as medication that would improve the behavior of children with hyperkinesis and organicity after MPH was first introduced to the market in 1957 (10).Lithium, antidepressants, and benzodiazepines were placed in the general market before 1965 and the use of psychopharmacology was then firmly placed in the armamentarium of adult psychiatrists dealing with adult mental disorders.Though pediatric psychopharmacology was developed first with the work of Bradley (1937) and Knobel (1959), further development of drugs to treat mental disorders of children and adolescents was essentially halted for most of the 20th century until the 1990s.This delay was due to a combination of factors including the belief that psychotherapy was best for management of pediatric patients with mental illness and the main emphasis by pharmaceutical companies on developing medications for adults with mental illness. …