I. Suicide
Commonest cause of death among Psychiatric Patients
Suicide deliberate self harm (DSH) Human act of self intentioned and self-inflicted cessation (death) attempted suicide.
Suicidal Gesture Attempted Suicide Action never intends to die Attempted suicide women completed suicide 2-4 times commoner in men.
Some Common Themes in Suicide
1. It is a crisis that causes intense suffering and feelings of hopelessness and helplessness.
2. There is a conflict between survival and unbearable stress.
3. There is a narrowing of the persons perceived options
4. There is a wish to escape (it is an escape rather than a going-towards).
5. There is often a wish to punish self and / or punish significant others with guilt.
Epidemiology
Top 10 causes of death 9.9 / lakh population / year (1994 figures) 10-15 / lakh population the world ranges 5-30 / lakh population attempted suicide to completed 10:! India Highest Suicide - 18-30 years highest Pondicherry, West Bengal, Madras & Bangalore.
Etiology:
Common causes of suicide are
1.Psychiatric Disorders
1.Depression
1-Major depression
2-Depression secondary to serious physical illness.
3-Reactive depression
2. Alcoholism and drug dependence
3. Schizophrenia
and biochemical factors{low levels of 5-HIAA]
II. Physical Disorders
- incurable or painful physical disorders, AIDS, often commit suicide- 13.5% of all
III. Psychosocial Factors
Examination, Failure in Love, Dowry Difficulties, Marital Difficulties, Illegitimate Pregnancy, Family Dispute, Psychopathology, Loss of a loved object, Occupational and Financial Difficulties.
Methods Used
Ingestion of Poisons (about 35%) followed by Hanging (about 23%), Drowning (about 9%), Jumping in front of a train (4 %), Burning (12%)
Men often Violent Methods
Medico Legal Aspects
Section 309 of IPC states that Attempts to Commit Suicide and does any towards the commission of such offence Punishable with simple imprisonment which may extend to one year also be liable to fine.
Section 309 of IPC was repealed by the Court of India in 1994, 1996, Attempt to Suicide - Punishable Offence. So the Section 309 IPC continues.
Major Risk Factors For Suicide
The presence of the following factors increases the risk of completed suicide:
1. Age > 40 years
2. Male Sex
3. Staying Single
4. Previous suicidal attempt(s)
5. Depression (risk about 25 times more than normal)
i. Presence of guilt, self-accusation, agitation, nihilistic ideation, worth-lessness, Hypochondriacal delusions and / or severe insomnia.
ii. More at the beginning or towards the end of a depressive episode
6. Suicidal preoccupation (e.g. a suicide note is written or detailed plans are made for committing suicide)
7. Alcohol or drug dependence
8. Severe, disabling, painful or untreatable physical illness
9. Recent serious loss or major stressful life event
10. Social Isolation
Common Misconceptions about suicide
(Modified about Shneidman and Farberow, 1961)
Misconceptions Facts
1. People who talk about suicide, dont commit suicide-- Nearly 80 % of persons who commit suicide,
2. Suicide happens without warning--give definite warnings and / or clues about their suicidal intentions
3. Suicidal persons are fully intent on dying-- Most suicidal persons are undecided about dying or living.
4. Once a person is suicidal, he is suicidal forever.-- Suicidal person is suicidal only for a limited period of time
5. All suicidal persons are mentally ill or psychotic-- Although the suicidal person is often extremely unhappy, he is not necessarily mentally ill
Management
No longer treatable.
Prevention Centres Emergency Services Welfare Centres (of the Patient)
1. All suicidal Threats, Gestures
2. Seriousness of the situation and take remedial
i. Physical Surroundings, Sharp Objects, Ropes, Drugs, Firearms etc.
ii. Surveillance
3. Acute Psychiatric Emergency
4. Counseling and Guidance
i. The Desire
ii. Ongoing life stressors, Teaching coping skills, Interpersonal skills
5. Medication or ECT
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