Suicidal thinking and behavior remains difficult to predict and challenging to address.

As a resident in the mid-1980s, I made an annual trek from Naval Hospital San Diego to UCLA, bringing a year of painful experiences to the renowned Dr. Edwin Schneidman. He taught us his “3 Ps” for intervening in these difficult cases. Dr. Schneidman talked about how to reduce the “Pain” the patient was feeling and the “Press” the patient was feeling to act on that pain, as well as how to increase the “Perturbations” or number of options of how to act. Charismatic and colorful, his ideas were thought-provoking. For instance, Dr. Schneidman offered that a college professor might raise a student’s grade to passing if it would save that student’s life.

During this same epoch, Dr. Cynthia Pfeffer, who we interviewed for this issue, was doing groundbreaking research on suicide in children and adolescents. Our Q&A covers the history and current ideas about suicide that breathe context into how we address suicide. Also in this issue, Dr. Eve Dreyfus helps us think through using lithium for suicidal episodes in children and adolescents. In addition, we’ve provided resources on the topic of suicide that I hope you will find useful.

As always, I welcome your comments at jfeder@thecarlatreport.com.

Regards,
Josh Feder, MD