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[自杀与青少年。II. 社会心理因素与临床方面]

[Suicide and adolescence. II. Psychosocial factors and clinical aspects].

作者信息

Cassorla R M

出版信息

Acta Psiquiatr Psicol Am Lat. 1980 Mar;26(1):42-7.

PMID:7348045
Abstract

In this study, that follows another one, where the normal characteristics of adolescence that may influence suicidal behavior were focalised, a critical review of the psycho-social elements involved in the matter is done; attention is also given to the clinical picture. The family influences are very important and frequently we find antecedents of suicidal behavior in parents or in near relatives. The homes are usually unhappy with a father absent or "feeble". It is not rare the presence of a dominant-rejecting mother. The home is poor in love expressions, and the intra and extra family reactions tend to lead to the youth social isolation. With the changes that normally happens in adolescence, the repressed aggressive impulses increase and tend for discharge at this phase, but usually the youth turns them against himself. The emergent genital sexuality is also perceived as threatening by the parents. Though lacking more detailed studies, it seems that families of suicidal adolescents are very similar to the families of depressive ones. In females, cultural influences such as greater tolerance to suicidal attempts behavior, perhaps explain the higher incidence of this behavior. Men usually use violent methods for consumating the suicide, and often their mental status is more severe than in females. The precipitant factors vary a lot but they usually give evidence of a conflictive situation. It is suspected that often the patient unconsciously puts himself in the difficult situation. The influence of mental illness in the suicidal behavior of adolescents is complicated by several classificatory systems and the possibility of considering abnormal aspects that normally occur during adolescence. In the clinical picture is important to consider the patient report about his suicidal thoughts. The evaluation of the defences, the intensity of the conflict and the suicidal ideas involved, will determine our conduct. An important feature is that, in adolescents, depressive symptoms usually occur as "equivalents". The prognostic is worse when it is impossible to modify family relationships and when social life continues unpoverished. In 40% of the cases a new suicide attempt is done, and the risk is greater during the year that follows the first attempt. Prevention may be done by trying to understand and discuss adolescents problems with them in their peer groups. Public campaigns and courses with moral appeals should be avoided because they increase feelings of guilt. Special attention has to be given in each case to social and family situations. An early diagnosis by pediatricians, clinicians, teachers and law authorities is very important. To do this work they need to have instruction about the adolescence developments.

摘要

在本研究中,继另一项聚焦于可能影响自杀行为的青春期正常特征的研究之后,对该问题所涉及的心理社会因素进行了批判性回顾;同时也关注了临床表现。家庭影响非常重要,我们经常会在父母或近亲中发现自杀行为的先例。家庭通常不幸福,父亲缺席或“软弱”。强势且排斥孩子的母亲并不罕见。家庭中缺乏爱的表达,家庭内外的反应往往导致年轻人社交孤立。随着青春期正常发生的变化,被压抑的攻击冲动会增加,并倾向于在这个阶段释放,但通常年轻人会将这些冲动转向自己。新出现的生殖器性行为也被父母视为具有威胁性。尽管缺乏更详细的研究,但自杀青少年的家庭似乎与抑郁青少年的家庭非常相似。在女性中,对自杀未遂行为的更大容忍度等文化影响,可能解释了这种行为的较高发生率。男性通常使用暴力手段实施自杀,而且他们的精神状态往往比女性更严重。诱发因素差异很大,但通常表明存在冲突情况。人们怀疑患者常常在无意识中将自己置于困境之中。精神疾病对青少年自杀行为的影响因多种分类系统以及考虑青春期正常出现的异常方面的可能性而变得复杂。在临床表现中,考虑患者关于自杀想法的报告很重要。对防御机制、冲突强度和所涉及的自杀想法的评估,将决定我们的行为。一个重要特征是,在青少年中,抑郁症状通常以“等效症状”出现。当无法改变家庭关系且社会生活持续匮乏时,预后会更差。在40%的案例中会再次尝试自杀,且在首次尝试后的一年内风险更大。预防可以通过在同龄人团体中尝试理解并与青少年讨论他们的问题来实现。应避免开展带有道德诉求的公众活动和课程,因为它们会增加内疚感。在每个案例中都必须特别关注社会和家庭情况。儿科医生、临床医生、教师和法律当局的早期诊断非常重要。为了开展这项工作,他们需要了解青春期的发育情况。

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