Nejtek et al The patient was admitted to the adolescent inpatient facility and was given long-lasting methylphenidate (ie, Concerta®, 36 mg/qAM reduced to 18 mg/qAM by day 3) and escitalopram (Lexapro; 20 mg/qAM). Family therapy and psychological testing were also scheduled. The mother showed noncompliance as she: (1) failed to attend appoint- ments with clinicians, and (2) neglected to attend family therapy sessions with her son during his inpatient stay. Physi- cians and staff made repeated attempts to consult with the mother about her son’s treatment plan, and they documented that the mother responded with verbal assaults, aggression, and exhibited extreme mood lability. On day 3, the patient’s depression decreased. Learning that his mother would not attend his family therapy session with him on day 6, his depression returned. The professional opinion of our physicians and staff was that patient decompensation was triggered chronologically by the mother’s persistent neglect of her son’s mental health condition evident in her noncompli- ance. Thus, maternal neglect was reported to Child Protective Services. On day 7, the patient denied any suicidal ideation, how- ever, he admitted to anger towards his mother. He reported to hospital staff and Child Protective Services on day 8 that he feared going home with his mother. A meeting with the attending physician, patient, and his mother was scheduled on day 9. During the meeting, the mother appeared to be psy- chotic, delusional, and was verbally threatening. Although fearful, the patient lacked sufficient mood symptoms to warrant further hospitalization and was discharged to his mother’s custody. Upon discharge, the patient walked to the parking lot to meet his mother. Before the patient could reach the mother’s car, witnesses reported that she drove off the hospital premises. Evidence shows that the mother returned home and later filed a missing person report with the police department. A Child Protective Services follow-up assessment with the patient and his mother is pending. Without consistent Child Protective Services oversight with combined medical and psychosocial follow-up, the prognosis and quality of life for this adolescent is considered very poor. Over a half million adolescents between 15–19 years old in 2001 attempted suicide that warranted hospitalization.5 Depression alone, does not predict adolescent suicide as abusive and hostile family environments are equally predictive.6–8 Data show that the leading cause for sui- cide ideation, attempts, and completion in adolescents is persistent and unresolved parental conflict.7,8 In this case report, the mental instability of the mother observed 68 submit your manuscript | www.dovepress.com Dovepress Dovepress by health professionals and Child Protective Services is disturbing. Whether or not this child’s mother met criteria for a mental illness arrest warrant based on her erratic behavior and the dialogue with her son’s physicians is unknown. It is known, however, that offspring who suffer caregiver abuse have an 80% risk for developing multiple mental disorders, violent behaviors, and poorer global cognitive functioning.9–13 Treating maternal mental illness significantly ameliorates offspring mental disposition.14 Thus, treating the mother of this adolescent patient seems clinically relevant and necessary. This case study reminds clinicians that adolescent mental health is critically dependent upon parental compliance and the environment in which they are raised. When parental neglect and treatment noncompliance is obvious (as in this report), mental health law and institutional health policies should be comprehensively stringent enough to adequately intercede and protect adolescents who are in need of mental health services. In this example, psychiatric treatment of the mother may have produced a more effective intervention and prevention regimen for both the adolescent and the mother. Disclosures Dr Winter discloses support from Janssen and Bristol Myers Squibb. Dr Winter is a current member of the Speaker’s Bureau for AstraZeneca, Merck, Forest and Pfizer. Drs Nestel Hardy report no conflicts of interest in this work. References 1. US Department of Health and Human Services. Administration on Children, Youth and Families, and Child Maltreatment. Washington, DC: US Government Printing Office; 2009. 2. Bowlby J. Maternal Care and Mental Health. Geneva, Switzerland: World Health Organization; 1952. 3. Bowlby J. Attachment and Loss. Vol. 1: Attachment. London, UK: Hogarth Press; 1969. 4. Fonagy P, Gergely G, Jurist E, Target M. Affect Regulation, Mentalization, and the Development of the Self. New York, NY: Other Press; 2002. 5. Shaffer D, Waslick B. The Many Faces of Depression in Children and Adolescents. 1st edition. Washington, DC: American Psychiatric Association; 2002. 6. Zalsman G, Brent DA, Weersing VR. Depressive disorders in childhood and adolescence: An overview: epidemiology, clinical manifestation and risk factors. Child Adolesc Psychiatr Clin N Am. 2006;15(4): 827–841, vii. 7. Brent DA. Risk factors for adolescent suicide and suicidal behavior: mental and substance abuse disorders, family environmental factors, and life stress. Suicide Life Threat Behav. 1995;25(Suppl):52–63. 8. Brent DA, Johnson BA, Perper J, et al. Personality disorder, personality traits, impulsive violence, and completed suicide in adolescents. J Am Acad Child Adolesc Psychiatry. 1994;33(8):1080–1086. 9. Silverman AB, Reinherz HZ, Giaconia RM. The long-term sequelae of child and adolescent abuse: A longitudinal community study. Child Abuse Negl. 1996;20(8):709–723. Neuropsychiatric Disease and Treatment 2010:6