Adolescents, mental health and gun violence – preventing catastrophic outcomes

A recent paper discusses the public health implications of guns, adolescents and mental health. Guns are commonly used weapons in homicides and completed suicides. Access to firearms put youths who are vulnerable to psychiatric illness at increased risk of acting on a suicidal or homicidal idea. In the United States, this is a significant issue, owing to the relative ease with which firearms can be accessed, and although weapons are not as readily available in Australia, the threat still remains. Owing to the prevalence of gun-related morbidity and mortality, healthcare professionals have focussed their attention on identifying youths at risk of homicide or suicide. The authors stressed that in order to reduce the risk of gun-related suicide or homicide, families with children who suffer from psychiatric disorders need to ensure that there is no access to firearms in the home. A recent study found that only one quarter of families with depressed or potentially self-injurious youths actually removed firearms from their homes after being encouraged to do so, and 17% of families with a depressed adolescent and no firearms acquired firearms within two years. Ideally, firearms should not be kept in the house at all, but should this not be possible, guns should be stored locked and unloaded with ammunition stored and locked in a separate location. The authors noted that a diagnosis of schizophrenia is often associated with increased rates of violent behaviour in symptomatic individuals, and puts the patient at increased risk of committing a homicidal act than an unaffected individual. Furthermore, the risk of violent behaviour is highest in the first year following the diagnosis, and first-degree family members are the most frequent victims of violence. “These findings all demonstrate the need for special vigilance on the part of the clinician regarding monitoring for safety-related issues...,” they stated. Identification and treatment of early-onset schizophrenia is vital. While childhood-onset schizophrenia is rare, onset during adolescences is common and insidious. Early onset schizophrenia is also associated with poorer outcome than later-onset schizophrenia. Adolescents present with delusions, hallucinations, and disordered though similar to adult manifestations of the disorder. Adolescents are usually treated with antipsychotic medications, and unfortunately, they usually take longer than adults to achieve recovery, and they are at greater risk of developing extrapyramidal side effects and weight gain than adults treated with antipsychotic medications. These side effects are common causes of nonadherence. “Adherence to a treatment regimen that includes effective antipsychotic medication is essential in ensuring optimal care for the patient while reducing the risk of harm befalling the patient, the patient’s family, or others in the community,” they asserted. The collection of collateral information from family, teachers, and other people in frequent contact with the patient is essential. The authors recommend that treating physicians have young patients sign release-of-information forms since family members often notice symptoms of relapse before a patient reports any symptoms or exhibits behavioural deterioration in the clinical setting. “They concluded, “when working with adolescents suffering from psychotic illnesses, it is important for clinicians to work with both the patient and those in the patient’s support systems to ensure that these youths have the best opportunity to achieve recovery while minimising the risk of potentially tragic outcomes.” Reference...