青少年抑郁症患者的自杀、自伤与风险评估
作者: 《青少年抑郁症治疗手册》 / 1085次阅读 时间: 2020年5月22日
标签: 青少年抑郁 抑郁症
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Anderson (2008) locates the suicidal behavior in young people in relation to the developmental demands of adolescence:

Anderson (2008) 将年轻人的自杀行为定位在青少年时期的发展需求之上:

The adolescent has to move from everything being orientated upwards towards the parents and the adult world, to becoming an adult who is capable of being a parent. This means that all the more disturbed parts of the personality have to be helped into the new situation. In those vulnerable adolescents the violent and murderous version of human relations which exists in all of us breaks out from its place of residence in the mind and can be played out in reality. [p. 71]

青少年需要从凡事都向父母和成人世界看齐之中醒悟过来,成为一位有能力做父母的成年人。这意味着,人格中有问题的部分都需要获得帮助以进入新的情境。在我们每个人身上都有的暴力和谋杀的部分,对于脆弱的年轻人来说,它们可能会从内心的栖息地爆发出来,可能会在现实中上演。

Anderson relates suicidal behaviour to Bion’s (1957) concept of the psychotic part of the personality which develops “when the degree of violent explosiveness is not contained for the baby” and is “dominated by a preference for projection and evacuation” (Anderson, 2008, pp. 66, 67). In understanding such behaviour, Bell (2008) argues that “suicide attempts never take place for the stated reason” (p. 48) and are often motivated by an unconscious desire to inflict pain on the parents or carers (p. 50).

Anderson将自杀行为与比昂(1957)关于人格中的精神病性部分的概念联系在一起, “当婴儿暴力性的爆发没有得到涵容的时候” 就会发展出来,并且“会被投射和释放的倾向所左右”(Anderson, 2008,pp.66-67)。在对自杀行为的理解上,Bell (2008)认为,“尝试自杀行为的原因永远都不是说出来的那些理由”,而是常常受到无意识想要给父母或照顾者带来痛苦的愿望所驱使。

Today’s young people are often keenly aware of the reality of mental illness, including among their peers. Suicidal thoughts are likely to occur in the treatment of many, particularly among older adolescents. It will be important for the therapist to be aware of this and to enquire specifically whether the young person is thinking about suicide if the material suggests this and if the young person does not mention it him/herself. The fact that the therapist can entertain the possibility of suicidal thoughts or actions can in itself provide substantial steadying. This may not be sufficient, however, even when the associated emotional constellations can be accurately assessed and interpreted, to ensure the patient’s safety. The therapist will in this case need to make clear to the young person that he or she (the therapist) has the obligation to consult other professionals, and possibly to inform the parents, in the interests of the young person’s safety, which in extremis takes precedence over the duty of confidentiality.

现在,年轻人(包括他们的同辈),对心理疾病的现实通常有着敏锐的意识。自杀想法很可能会出现在很多治疗过程中,尤其是在年长些的青少年中。如果资料表明了这一点,他/她自己没有主动提及,对于治疗师来说,重要的是要对此有所觉察,并且要向青少年详细询问是否正在考虑自杀。治疗师能够涵容其自杀想法或行为的事实本身,就提供了一种持续的稳定性。不过,为了保证年轻人的安全,即便相关的情绪可以被准确地评估和解释也还是不够的。在这种情况下,治疗师需要清晰地让年轻人知道,为了保证他的安全,治疗师有义务与其他专业人员协商,有可能会通知其父母,在极端的情况下这一点会优先于保密责任。

The professional network here would include the parent worker, the case manager, and the supervisor. There will also be instances where a psychiatric assessment is necessary and where the use of medication or hospitalization may need to be considered. This will be with the aim of keeping the young person safe in the immediate term, and this needs to be made explicit. In many cases, the knowledge that professionals are working together to respond to a communication that is taken seriously will in itself have a stabilizing effect. It is also important for the clinic team to establish good communication with the young person’s physician or GP from the start. Holidays may be a time in which suicidal impulses are exacerbated, and it needs to be made clear, both to the young person and to the parents, what cover arrangements are in place. The young person may also convey intense anxiety about suicidality to his or her parents, siblings, or friends. Families, and sometimes the school, will require support in managing these communications and in responding appropriately.

此时,专业的关系网络包括父母工作者、个案管理者和督导。还有一些情况下,有必要进行精神科评估,也需要考虑药物治疗或者住院治疗。这么做的目的是在当前阶段内保证年轻人的安全,这一需要必须被明确的向其传达。在很多个案中,知道专业人员在严肃认真地沟通和共同工作,这本身就具有一个稳定化的效果。还有一点很重要,临床团队在一开始就要与年轻人的内科医生或全科医生建立良好的沟通。假期中自杀冲动可能会加剧,需要向年轻人及其父母明确哪些是恰当的安排。年轻人也可能会向其父母、兄弟姐妹或朋友表达对自杀的强烈焦虑。家庭或学校,在应对这种自杀冲动并做出恰当的反应方面需要得到支持。

Apart from such crises, it is anticipated that a routine risk assessment in line with clinical governance requirements will be carried out once a term, in the context of preparing termly summaries. It is essential that any material suggesting suicidal ideation should be communicated to the case manager and recorded in the file.

除了这类危机之外,可以预期的是,每学期要做一次符合临床管理要求的常规风险评估,通常是在准备期末总结的时候。一项基本要求是, 任何提示自杀意念的材料都应该与个案经理沟通并记录在案。

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TAG: 青少年抑郁 抑郁症
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