Ase study, Social/cultural, Medicine-URGENT , needed in top 12 hrs

Julian
Presentation
You are the junior doctor on call in the Emergency Department.
Julian, age 15, arrives in A&E with a friend (slightly older  possibly 17/18 yrs old). Friend, smelling of alcohol, says to the staff that Julians really done it this time. Hes taken all the tablets this time. Friend knows thats bad for you and so has brought him in. Julian refuses to give any information so all the history is from the friend.
History
Julian is 15, his twin sisters doing really well at school and sports and Julian resents her success. His parents expect him to do at least as well, if not better, when it comes to the exams though they keep telling him that hell have to work hard to keep up with her. Friend says theres a lot of bad feeling in the family and it gets Julian down. He says Julian has threatened to do it before and may have taken 1 or 2 in the past, but this time has emptied the packet. Luckily hes brought the packet with him  32 x 500mg Paracetamol. Friend rings Julians parents to tell them that Julians in A&E; that hes OK, but will be there for a while. Friend leaves before Julians parents arrive. When they come Julian agrees to see them but insists that they are not told about why he came to A&E.
Julian: Age 15
Academically very bright. Won form prize every year. Currently studying GCSEs at school
Child of: Anthony and Mary
Brother of: Kathryn
Anthony: Age 46
Baker small family business. Wanted to go to university but had to leave school at 16 to help in the family business when his dad had a heart attack. Always resented this and felt he could have done better for himself. Determined that his son and daughter will have the opportunities he didn t have and they will succeed at academic careers. Not a drinker but enjoys the 19th hole his usual is a double malt whisky. His time there is essential for his business connections. He does not see much of his sisters as they were never close and they have moved away from the area. He thinks that as daughters they should do more for their parents but he himself only visits them once or twice a year.
Mary: Age 42
Quiet personality. Fulfils her husbands expectations of a traditional wife: worked sporadically after getting married, and since the arrival of her children (Julian and Kathryn) has stayed at home. Tendency to being nervous and anxious, on Prozac. Doesnt drive. Nice house in the suburbs, off the bus routes. Larger than average garden and has a gardener weekly (sometimes twice weekly in summer). Parents live fairly close by Mary can walk there but its too far for her parents. She visits them regularly (most days) and does their shopping. Increasingly concerned about her mothers mental state and their capacity to remain independent.
Kathryn: Age 15
Academically good, almost top stream especially in maths.
Keen sportswoman. Runs cross-country for school and has been selected for county trials.

TASK:
Write 2 A-4 pages case study on social and cultural aspect of the case.
Here are some references and a short summary (PRECIS) how it should look like, but in a longer version:
Social & Cultural: Adolescence can be a turbulent time. Teenagers like Julian are facing a variety of new experiences that could prove to be overwhelming and hard to deal with. Julian has attempted suicide (termed parasuicide by the WHO), which in this case could be interpreted as a cry for help. Reasons for teenage suicidal behaviour are usually classified into environmental and psychological; in Julian s case probably the former is more apparent. He might have felt overwhelmed by the whole family situation and that he had nowhere to turn. A fear of failure and letting himself, family, friends and school down could have been a trigger factor for his decision. There is pressure to achieve good exam results from the government and schools. This may be added to by pressure from his father, who has high expectations for his children. He might have felt pressured to reach those expectations, especially if he feels he has to do as well as his sister. At 15, Julian is not a child nor is he an adult. During this entire period of transition from childhood to adulthood, he might have felt in a cultural limbo, being neither an obedient teen nor a responsible adult, making him feel resentful .Self image, fitting in, and being popular are very important at this age. This could be why he started drinking. He might have felt different, inadequate or deprived in some way, making him feel depressed. He will need a lot of support from his family. Family therapy/support groups could be useful to encourage communication and prevent further suicide attempts.

At least 5 references are needed
 Teen Help Online : teen.htm
 Hewton K, van Heeringen K, The International Handbook of Suicide and Attempted Suicide, John Wiley and Sons Ltd. Chichester England, 2002.
&#61551; Suicide rates in adolescence (15-24years of age), 2005, available from the at <au/internet/wcms/publishing.nsf>
&#61551; Kerfoot M, McNiven F, Brief family intervention in adolescents who deliberately self harm. J R Soc Med 1997;90:484-487 , available on the at <gov/picrender.fcgi?artid1296524&blobtypepdf >
&#61551; Williams R, Suicide prevention  the challenge confronted an NHS advisory service, Crown Copyright, London, 1994
&#61551; SAVE. Suicide Awareness Voices of Education
behaviour/suicide.html