Wellness 911

Abstract

Giving young patients coping strategies can help emergency physicians tooFigureFigureFigureFigureThose of us who trained before the advent of smartphones remember when psychiatric patients did not command so much real estate in the emergency department. Back then, pediatric psychiatric patients were unusual. We remember naïvely thinking, “What could a kid be suicidal about?” Time have changed. Pediatric psychiatric patients seem ubiquitous today, and seeing these young people suffering isn't great for our own well-being, leaving us frustrated and even annoyed and depressed. But we can feel better when we feel like we can help. We recently covered some strategies to help these young patients other than (or in addition to) getting them admitted to psych, such as showing empathy, looking to the future, and exploring healthy habits for exercise, diet, and screen time. (EMN. 2023;45[4B]; https://bit.ly/3UIDyMX.) Here are a few more factors that might be affecting this population. Sleep and Phones Anyone who knows an adolescent knows that getting enough sleep is a struggle for them. They spend seven or more hours at school each day, have after-school activities and social time, and stay up late trying to get homework done. Poor sleep quality or inadequate sleep is a known risk factor for suicidality in adolescents. (Curr Psychiatry Rep. 2015;17[3]:554; https://bit.ly/3AB0t3i.) Many, if not most, teens sleep with their phones in their rooms, often in their beds. Phones in the bedroom are known to disrupt sleep, especially in young people who engage with them throughout the night. (Nat Sci Sleep. 2020;12:357; https://bit.ly/3oQxqWQ.) Reminding families to have teens turn in their phones to parents at bedtime is one way to help these patients get the rest they need to keep their brains healthy. Time Outside Just as research demonstrates that increased screen time has a negative effect on children's mental health, it also shows that decreased time outdoors, also called “green time,” negatively affects mental well-being. (PLoS One. 2020;15[9]:e0237725; https://bit.ly/3Av1rhL.) How much green time is enough? Research suggests 120 minutes a week is enough to produce health benefits. (Sci Rep. 2019;9[1]:7730; https://bit.ly/41Zredy.) Coping Strategies Many of these patients have school-related triggers for their suicidal thoughts, including bullying, loneliness, and academic performance concerns. Some of these young people also struggle with perfectionism. Sharing stories of our own past failures and later successes may provide a measure of relief for some of these patients. Reminding them that what other people say about them is 100 percent about those people and nothing to do with them might also be helpful. Discussing healthy coping strategies for stress, anxiety, and depression is also a good idea. There are so many healthy ways to manage emotions without self-harm—art, going for a walk, calling a friend, watching a funny movie, hugging a family member, the list goes on. (PsychCentral. Jan. 13, 2018; https://bit.ly/40DL3pK.) These patients can usually identify one or more coping strategies that appeal to them. Medication and Supplements Knowing which medications our patients have been prescribed and whether they have been taking them is, of course, essential to understanding the etiology of their mental health issues. We recently had a suicidal patient who had never taken antidepressants, only a medication for chronic post-concussion headaches, which he had stopped taking about three weeks prior to his ED visit. That medication was venlafaxine (Effexor)—he had been taking an antidepressant without knowing it, one that is known to have withdrawal side effects, including suicidal thoughts. Many depressed pediatric patients also have ADHD, and if they haven't been taking their ADHD medication, their impulsivity and emotional dysregulation could be worsened. Some depressed patients may have undiagnosed ADHD, which if treated, could improve their symptoms. Supplements such as omega 3, vitamins D and B complex, and magnesium have also shown some benefit in treating anxiety and depression. Ketamine Research in pediatric patients about the safety and efficacy of ketamine for treating depression is ongoing. (Am J Psychiatry. 2022;17[4]2; https://bit.ly/40IcfU7.) Ketamine infusion therapy is showing promise for treating adults and pediatric patients with suicidal thoughts. Share this article on Twitter and Facebook. Access the links in EMN by reading this on our website: www.EM-News.com. Comments? Write to us at [email protected].