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KARACHI: The number of teenagers suffering from psychological problems has dramatically increased over the years. A worrisome reflection of the phenomenon is the increasing number of teenagers reporting with deliberate self-poisoning at health facilities, experts tell Dawn.
According to these experts, the country has also witnessed an increase in the number of suicide cases. Depression, they say, is the most common mental disorder leading to deliberate self-harm behaviour and suicides while lack of awareness, social stigma attached to seeking help for psychological problems and costly treatment deprive the majority of people of getting timely clinical and counselling support.
Speaking to Dawn, Prof Dr Jamal Ara, national coordinator for chemical safety and head of the National Poison Control Centre (NPCC) at the Jinnah Postgraduate Medical Centre (JPMC), said that an alarming number of teenagers were reporting with (deliberate) poisoning these days at the centre that should serve as a wake-up call for society, especially for parents.
“Over a decade ago, we received only a few cases involving teenagers. Now, the majority of those reporting at the NPCC involve teenagers. It’s time we started thinking what is happening in the minds of our future generation that is giving them suicidal tendencies,” she said.
The data collected by the NPCC from 2000 to 2005 shows that teenagers were not a major group of patients five years ago.
However, there has been a significant increase in the number of patients with ages between 14 and 19 from 2005 onward.
Over 12,000 patients were admitted to the NPCC from 2006 to 2010 and more than 60 per cent of these patients were teenagers. Forty per cent of the patients aged between 25 and 55 years. The ratio of female self-poisoning patients was higher.
The centre receives five to six cases of poisoning daily. Most of them involve the consumption of insecticides (containing organophosphate compounds) by teenagers. There are also cases of ingestion of kerosene oil, drug overdose and corrosive agents, for instance bleaching compounds.
On account of lack of cooperation from public and private sector hospitals, the NPCC data only include the cases being reported at the centre catering mainly to patients belonging to the middle and lower strata of society.
According to the staff, it’s very rare that relatives accompanying the patient divulge the reasons that forced the teenager to consume toxic chemicals and they usually contend that the ‘incident happened by mistake’. The statement helps police not to carry out any investigation.
Organophosphates
According to the information available on the net, organophosphate (OP) compounds are a diverse group of chemicals that kill insects by disrupting their brains and nervous systems. Unfortunately, these chemicals can also harm the brains and nervous systems of animals and humans. These chemicals stop a key enzyme in the nervous system called cholinesterase from working, and this can make people ill.
Organophosphates are absorbed by inhalation, ingestion and skin penetration. To some degree, the occurrence of poisoning depends on the rate at which the pesticide is absorbed.
The primary signs of organophosphate poisoning include salivation, bronchorrhea (production of heavy watery sputum), respiratory distress, sweating, colicky abdominal pain, diarrhea, miosis (constriction of the pupil of the eye to millimeters or less), muscle-twitching, high irritability, dizziness, vomiting and slow heartbeat leading to asystole (no cardiac electrical activity).
“The symptoms vary, depending on the type and the dose of insecticide consumed. A few patients report in a state of coma.
Though a majority of poisoning victims are saved, cases arriving five to six hours late can critically endanger a person’s life, especially of those who suffer severe respiratory distress and required to be on a ventilator.
“Mortality usually occur due to severe respiratory distress or pulmonary aspiration (when a foreign object, that could be food or vomit, end up in the lungs),” she explained.
Patients who had consumed a mixture of different poisonous substances were very difficult to treat as doctors found it hard to know from the complicated symptoms what was actually happening in the body, she said.
“A victim of poisoning should be immediately taken to a tertiary care hospital. While at home, the victim should be helped to throw up. A simple method is to insert a finger into the mouth to stimulate the throat,” she said.
Long-term effects
According to Prof Jamal Ara, patients are usually admitted for a week and as the immediate effects of poison fade away, there are chances that patients develop long-term health problems, for instance muscle weakness.
“People who ingest corrosive agents develop strictures in the esophagus that causes swallowing difficulties. In such cases, the esophageal cavity is either operated or dilated with the help of a tube,” she said.
Once discharged, patients are referred to the hospital’s psychiatric department to help families provide emotional support to the victim. However, a few teenage patients report at the facility.
Speaking to Dawn, Dr Iqbal Afridi, head of the psychiatry department, said that people generally considered seeking help for psychological problems as a shame for their families while others believed it was not as important as to seek medical help in case of a medical condition.
“Earlier, there were legal problems as well and the person attempting suicide was considered liable for prosecution. However, the Mental Health Ordinance passed in 2001 has changed the situation. Now, a medical board is required to determine the victim’s psychological health before any legal action could be taken against him or her,” he said.
Inexpensive medicines with minimal side-effects were now available to treat psychological disorders such as depression, he said.
Sharing his views, Prof Dr Murad Moosa Khan, chairman of the department of psychiatry, Aga Khan University and Hospital, said that there had been a gradual but significant increase in the number of teenagers seeking help or being referred for psychological problems.
“Many have a history of suicide-attempt, but a majority has had suicidal ideation, that is, thinking about committing suicide in the past.
“The factors causing psychological problems in teenagers include academics, relationship problems, conflicts with parents, peer pressure, bullying, drug abuse (which may be used as a coping mechanism but becomes a problem) and religious conflicts,” he said.
According to Dr Khan, though there are no national figures for suicides, it does appear from the evidence available that the number of suicides has increased over the last 10 to 15 years in the country.
The reasons, he said, were multiple and included adverse social circumstances leading to high levels of mental distress leading to people becoming clinically depressed.
“Depression is the most common and important mental disorder in suicides. It is estimated that up to a third of the Pakistani population may be suffering from clinical depression. The World Health Organisation’s 2003 estimates say that more than 15,000 people commit suicide every year in Pakistan,” he said.
Referring to a study conducted in Karachi, Dr Khan said though a majority of the patients interviewed suffered from depression, none of them had ever been treated for it.
