This issue of Adolescent Psychiatry spans the spectrum between evidence-based practice and practice-based evidence. A special section on eating disorders in this issue summarizes current knowledge about these challenging, all-too-prevalent, disorders and their treatment. Included in this section is an article on eating disorders in males, which are often overlooked. In this article, Stewart points out that this is because of the popular assumption that eating disorders only affect females, and the feminization of current diagnostic criteria. Anorexia nervosa, while among the most serious illnesses affecting adolescents, with a high rate of fatality, is treatable. However, the treatment must aggressively challenge the adolescent ’ s extreme level of control over the family.
Two reviews deal with bipolar disorder and marijuana dependence. In the first review, Bernstein has provided an update on current knowledge and best practices for treatment of bipolar disorder. She emphasizes a rational treatment approach that may include alternative and complementary medications. Jaffe summarizes his long experience with treating adolescents who use marijuana, pointing out the many myths that such teenagers use to justify their use, and giving suggestions for how to counter these beliefs. He believes that marijuana use is particularly pernicious for adolescents as they do not recognize the impairment that their use is associated with. He underscores his points with neurobiological evidence, showing the significant and longlasting effects that marijuana has on the brain.
The perspectives section contains three thought-provoking articles. Aggarwal and Pumariega discuss the many issues related to minors who were held at the U. S. naval base in Guantanamo in the aftermath of the terrorist attacks on the U. S. on September 11, 2011. As has been pointed out many times, detainees at Guantanamo lacked many of the legal protections available to prisoners on U. S. soil and this was no less true for adolescents than adults. It is clear that the base was not well equipped to provide adequately for their needs, with adverse consequences. Also in this section is a paper by Michael Kalogerakis, which summarizes his thinking about what needs to be done to promote mental health in children and adolescents, focusing on the role of families. The World Health Organization defines mental health as
… a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community. In this positive sense, mental health is the foundation for individual well-being and the effective functioning of a community. (http://www.who.int/mediacentre/factsheets/fs220/en/).
Two articles focus on the psychiatric inpatient treatment of adolescents. The authors-one group from Greece and another from the U. S.-describe how they have dealt with the challenges of limited resources in the face of unmet needs. Zilikis and colleagues describe the development of an adolescent inpatient program in which adolescents were hospitalized with adults and points out that there are some advantages to this arrangement. Shen, Dhillon, and McCarthy use the case of an adolescent with non-suicidal self-injury to discuss the role of the hospital as part of a continuum of care.
Duric and Elgen present findings from their research on Norwegian children and adolescents with ADHD who presented for treatment in a clinic after having been referred from community sources. Their findings confirm that these youngsters have high rates of comorbid psychiatric conditions and often suffer from cognitive impairment, mandating careful evaluation of all aspects of their functioning. They add to the world-wide perspective on this common disorder.
We are indebted to Glen Pearson who was able to obtain and edit “Embracing Spitfires,” a presentation given by James L. Cox at an ASAP meeting several years ago on his approach to adolescents who are difficult to engage in psychotherapy. Like others who have devoted their lives to psychotherapy with adolescents, Cox reminds us that this work is not for the faint of heart.
Finally, a new section, Letters to the Editor, appears in this issue, with two letters on Dwyer and Jarrel's article, the “Use of Mental Health Services By Youths Who Have Sexually Offended,” which appeared in the last issue (2011, pp. 240-250). I hope that this is the start of an ongoing dialogue between Adolescent Psychiatry and its readers.