The Treatment of Pediatric Suicidal Behavior
Tóm tắt
Psychotherapies have stronger empirical support of efficacy and do not have safety concerns associated with many medications; thus, at present, psychotherapy is an appropriate first-line treatment for suicidal ideation and behavior in youth. Integrated Cognitive-Behavioral Therapy (I-CBT) and Multisystemic Therapy (MST) have the strongest preliminary evidence for psychotherapeutic treatment of suicidal behavior in preadolescents and adolescents with a history of suicidal behavior. Mentalization-Based Treatment for Adolescents (MBT-A), Developmental Group Psychotherapy (DGP), and Dialectical Behavior Therapy for Adolescents (DBT-A) have received some support for youth engaging in non-suicidal and/or suicidal self-injurious behaviors. Resourceful Adolescent Parent Program (RAP-P) may be effective in reducing suicidal thoughts and/or self-injurious behaviors (Table 1). In children with a history of recurrent suicidal behavior and for whom psychotherapy alone is ineffective, psychopharmacological treatment may be necessary. Responsible pharmacological treatment of pediatric suicidal behavior requires understanding of the current dearth of efficacy evidence and the limitations of safety evidence within pediatric populations, the range of possible serious side effects, and the potential use of medications, including less toxic SSRIs (Barbey and Roose J Clin Psychiatry 59:42–8, 1998) [IV], as a suicide method. Time to effect of antidepressants may coincide with heightened suicide risk (Simon et al. Am J Psychiatr 163(1):41–7, 2006) [I], and, thus, patients should be monitored particularly closely during this time period. Psychotropic medications for pediatric patients should be part of a comprehensive and integrated treatment and monitoring strategy, including therapeutic drug monitoring and coordinated communication among providers, caregivers, and patients. Although suicide attempts in children younger than five are extremely rare, they do occur (Rosenthal and Rosenthal Am J Psychiatr 141(4):520–25, 1984) [IV]; treatment will focus on family factors and will typically employ dyadic models of psychotherapy to develop or reestablish co-regulation between the child and the caregiver.
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