Suicide
Defined as:- termination of one’s life intentionally.
3rd leading cause of death between 15-24 yr.
Suicidal patient is one- who attempted, tried to attempt or frequently thought of attempting suicide.
Emergent intervention is required- as suicide can be prevented.
Prevalence of suicide- 10-15% in depression, 10% in schizophrenia, number rises when alcoholism is comorbid.
Rate is 11.2 per lac in 2011, India
One person commit suicide every 40 sec. globally
Poisoning ,hanging, self immolation, slitting of wrist & overdose of sleeping pills are some common means.
“Risk assessment is the integral part of evaluation and management”.
Warning signs of suicide
1. A person talks about death, threatens of committing/
discussing suicide.
2. Discuss different methods of suicide.
3. A person mentions suicide ideation.
4. A person attempts an act of deliberate self harm.
5. A person is seen making good bye gestures or communications, writing of will/ other acts suggestive of suicidal plan.
6. A person has suffered recent major loss of life or
property.
7. Hopelessness.
8. Severe agitation/ anxiety.
Presentation
1. Such patients have either- frequently thought of/ contemplated suicide/have
planned the act/ have attempted the act.
2. Such patients are brought by family members.
Risk factors
1. Female gender,
2. Elderly age group,
3. Depression/ psychiatric illness
4. Poor social support,
5. Single status,
6. Alcohol abuse,
7. Chronic physical illnesses,
8. Family history.
Suicide risk assessment
Integral part of management of such patients.
Establishes severity of situation and likelihood of future death by suicide.
Types of suicide risk
1. Low suicide risk:- less severe psychiatric illnesses, better social support, fewer attempts, have employed less lethal means of suicide such as superficial cut marks on wrist.
2. Moderate suicidal risk:- presence of psychiatric disorder, multiple attempts, attempts in last few days, low-moderate lethality attempts like pills, alcoholism.
3. High suicide risk:- severe psychiatric illness, attempt in last few hours, lethal attempts like hanging/ gunshot/ pesticide, poor social support.
General Interventions of emergency management
Physical restraint
Pharmacotherapy
Hospitalization
Management of medical problems
Crisis intervention:
Supportive psychotherapy
Environmental manipulation
Dealing with spouse, friends
Goal of intervention- to prevent completed suicide.
If intervention done timely, suicide is preventable.
Suicide risk assessment is important.
Steps in management of suicide:-
Step 1:- Assess physical condition of the patient.
( vitals, pallor, cyanosis, higher mental functions, local injury/wound etc.)
Step 2:- If found medically stable, calm down patient, do risk assessment.
Step 3:- Evaluate for underlying psychiatric illness, history and mental status examination need to be done.
Step 4:- Once suicide risk assessed, admit the patient.
-Instruct hospital staff and family member for 24
hour vigilance.
-Remove potentially harmful objects from patients
vicinity.
-All medications should be supervised.
Prevention
1. Early recognition of suicide risk factors.
2. Early diagnosis and prompt treatment of mental disorders like schizophrenia, depression, bipolar disorder and substance abuse.
3. Identify warning signs- talks, threats, thoughts or previous attempts of deliberate self harm.
4. Directly asking patients about – death wishes, suicidal ideations,intentions.
5. 24 hour strict vigilance is advised till underlying psychiatric illness responds to treatment.
