Correspondence (letter to the editor): Taking More Time

The issue of “adolescence, brain development and mental disorders“ is central to child and adolescent psychiatry, because the early diagnosis of mental disorders (prodromal symptoms) and the differentiation between “normal“ age-specific behavioral peculiarities in puberty is not always easy and generates risks in two directions: on the one hand, over-interpretation of “normal“ behavioral peculiarities and their pathologization, which, especially in this stage of life characterized by the need to find one’s own identity and a high degree of suggestibility, entails the risk that adolescents may accept a diagnosis as their own identity, resulting in iatrogenic undesirable developments. On the other hand, there is the trivialization of prodromal symptoms, e.g. he or she “will grow out of it“, which may have unfavorable consequences. Therefore, a careful specialist diagnosis, taking into account all aspects, is required to enable initiation of proper treatment. “Early interventions“ as well as exceedingly long watchful waiting may be fatal. A psychiatric illness, if not treated, may have serious consequences for further brain development, especially in the sensitive adolescence phase. Incorrect interpretation of symptoms, for example, misdiagnosing age-specific mood swings, or typical adolescent narcissistic or histrionic patterns as psychiatric illnesses, and focusing the adolescent on them (pathologization), may as well have fatal consequences for the further brain development, because, for example, many psychiatric drugs interfere with relevant brain processes and may cause disorders under certain circumstances. In addition, the self-image of being a mentally ill person may have consequences for the development of one’s own personality and subsequently for brain development.

My appeal: Take time for thorough diagnostics, including family dynamics/the life circumstances. In case a definite diagnosis can be established, be courageous and initiate consequent treatment. In case of uncertain diagnosis, regular specialist follow-ups/drug withdrawal trials should be undertaken. In addition, a cost-benefit analysis of medication should be performed together with the patient at various times along the treatment course