Suicidal behavior

Suicidal behavior includes 3 types of suicidal actions: completed suicide, suicidal attempts, suicidal gestures (deeds). Thoughts and plans for suicide are described as a suicidal ideation.

Completed suicide is a suicidal action that led to death. A suicidal attempt is an action aimed at suicide, but not leading to death. Often, suicidal attempts include at least a certain ambivalence about the desire to die and may be a cry for help. Suicidal gestures (acts) are attempts with extremely low lethal potential (for example, applying superficial cuts on the wrists, overdosing of vitamins). Suicidal gestures and suicidal ideation are most often a request for help from people who still want to live. They are the main ways of communicating feelings of despair and hopelessness. However, it is difficult to get rid of them.

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Epidemiology of suicidal behavior

Statistics of suicidal behavior is based primarily on death certificates and investigation reports and underestimates the true prevalence. Suicides rank 11th among causes of death in the US, with 30 622 completed suicides in 2001. This is the third leading cause of death among people aged 15 to 24 years. Men aged 75 years and over have the highest death toll from suicide. Among all age groups, men commit suicide more often than women in a ratio of 4: 1.

It is believed that every year more than 700,000 people attempt suicide attempts. For each death from suicide, about 25 suicidal attempts are made. However, about 10% of people who attempted suicide attempts eventually committed suicide, because many people make repeated suicidal attempts. About 20-30% of people who have made a suicide attempt repeat it throughout the year. Approximately three women commit suicide attempts on one man, making such an attempt. The index of suicidal attempts is disproportionately high among adolescent girls. Suicides accumulate in families.

People who have strong relationships have significantly less suicidal risk than single people. The indicators of suicidal attempts and completed suicides are higher among those living alone. Suicides are less common among members of most religious groups (especially Catholics).

Group suicides, in which many people participate or only 2 (such as lovers or spouses), constitute an extreme form of personal identification with other people.

The suicide note leaves about 1 in 6 who committed suicide. The content can reveal a mental disorder that led to a suicidal act.

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Causes of suicidal behavior

The main curative risk factor is depression. Other factors include social factors (frustration and loss) and personality disorders (impulsiveness and aggression). Traumatic experiences in childhood, especially the stress of a destroyed home, parental deprivation and violence, are much more common among people committing suicidal actions. Suicide is sometimes the final action in a chain of self-destructive behavior, such as alcoholism, irresponsible driving, violent and antisocial behavior. Often one factor (usually the destruction of important relationships) is the last straw. Severe somatic diseases, especially chronic and accompanied by pain, play an important role in about 20% of suicides among the elderly.

Alcohol and substance abuse can increase disinhibition and impulsivity, as well as worsen the mood; are potentially lethal combination. About 30% of people who make a suicidal attempt, drink alcohol before trying, and approximately 1/2of them were at this moment in a state of intoxication. Alcoholics are prone to suicide, even if they do not drink.

Some patients with schizophrenia commit suicide, sometimes due to the depression to which these patients are prone. The method of suicide can be strange and violent. Suicidal attempts are not common, although they may be the first sign of a mental disorder that occurs early in schizophrenia.

People with personality disorders are prone to suicidal attempts, especially emotionally immature people with borderline or antisocial personality disorder, because they have poor frustration tolerance and they react to stress impulsively, with violence and aggression.

Aggression towards others is sometimes evident in suicidal behavior. In rare cases, former lovers or spouses are involved in a suicidal murder in which one person kills another and then commits suicide.

Risk factors and anxiety signs of suicide

• Personal and social factors
• Male
• Age> 65 years
• Previous suicide attempts
• Drawing up of a detailed suicidal plan, taking steps to implement the plan (purchase of weapons, medicines), precautionary measures regarding the disclosure of the plan
• Personally significant anniversaries
• The presence of suicides or affective disorders in the family
• Unemployment or financial difficulties, especially if they lead to a pronounced fall in economic status
• Recent separation, divorce or widowhood
• Social isolation with a real or imaginary bad attitude of relatives or friends

[10], [11], [12]

Symptoms of suicidal behavior

• Depressive disorders, especially at the beginning or nearer the end of the disease
• Severe motor agitation, anxiety and anxiety with severe insomnia
• Expressed feelings of guilt, hopelessness; ideas of self-blame or nihilistic delirium
• Delusional or circumspect ideas of a physical illness (for example, oncology, heart disease, sexually transmitted diseases)
• Imperative hallucinations
• Impulsive, unfriendly person
• Abuse of alcohol or psychoactive substances, especially those that arose recently
• Chronic, painful or disabling physical illnesses, especially in previously healthy patients

The use of medications that may contribute to suicidal behavior (for example, sudden discontinuation of paroxetine and some other antidepressants may lead to increased anxiety and depression, which in turn increases the risk of suicidal behavior) disorders, especially depression, are often a risk factor for suicide, recognizing these possible factors and the initiation of appropriate treatment are an important contribution that a general practitioner can do to prevent suicide.

Every depressed patient should be interviewed for suicidal thoughts. Fears that such questions will push the patient to the idea of self-harm are groundless. The questioning will help the doctor to get a clearer picture of the depth of depression, support a constructive discussion and convey the doctor's awareness of the depth of despair and the desperation of the patient.

The risk of suicide increases at the beginning of depression treatment, when psychomotor inhibition and indecision decrease, and the reduced mood improves only partially. Therefore, psychoactive drugs should be selected carefully and be prescribed in non-lethal quantities, so that the use of all the contents of the package is not lethal. There is some evidence that some antidepressants increase the risk of suicidal behavior, especially in adolescents. Patients should be warned when they start taking antidepressants, that their condition may initially worsen, and instruct them about the need to call a doctor if the condition worsens.

Even in people who threaten with unavoidable suicide (for example, patients who call and declare their intention to take a lethal dose of drugs or if they are threatened with a jump from a height), there may still be some desire to live. A doctor or any other person who has been approached by a suicidal patient for help should support his desire to live. Emergency psychiatric care consists in establishing contact and open communication with a person; a reminder to him of his personality (ie, the periodic repetition of his name); help in sorting out the problems that caused the crisis; proposing constructive assistance in solving these problems; support in affirmative action; a reminder of the care and desire to help him and his family and friends.

Methods of choosing a suicide

The choice of methods is determined by cultural factors and accessibility, as well as the seriousness of intentions. Some methods (for example, jumps from height) make survival virtually impossible, while others (for example, drug use) retain the ability to survive. However, the use of methods that are not fatal does not necessarily mean that the intentions were less serious. Strange, ornate ways of suicide testify to the underlying psychosis. Overdosing of medicines is the most common way of suicidal attempts. Methods using violent means, such as firearms and hanging, are rarely used in suicidal attempts. Some methods, such as driving a car into the abyss, can endanger the lives of others. Suicide with the help of the police is an unusual form of suicide, in which a person commits an act (for example, waving a gun) than forcing a police officer to kill him.

Suicide committed with outside help

Suicide, committed with outside help, relates to situations where a doctor or other professional provides some assistance to a subject who wants to end his life. Assistance may consist in the discharge of medicines that can be stockpiled for taking a lethal dose, advice on a painless way to commit suicide or prescribing a lethal dose of the drug. Assistance in committing suicide is an ambiguous and illegal act in most US states. Despite this, patients with painful, debilitating and non-curable conditions can develop a discussion about this with a doctor. Assistance in committing suicide can set difficult ethical questions for the physician.

Sutic management

A health worker who has learned that a patient is thinking of suicide, in most legal systems, should inform authorized structures for intervention. Failure to do so can lead to criminal and civilian consequences. Such patients should not be left alone until they are in a safe environment. Transportation to psychiatric institutions should be accompanied by trained professionals (for example, ambulance, police), not family members or friends.

Any suicidal action, regardless of whether it was an attempt or an act, must be taken seriously. Anyone with serious self-harm should be examined and treated for physical damage. If an overdose of a potentially lethal drug is confirmed, immediate action should be taken to prevent absorption and accelerate excretion, prescribe an antidote, if available, and provide supportive treatment (see chapter 326 on page 3464).

Initial evaluation should be performed by one of the staff specially trained in assessing and treating suicidal behavior. However, a psychiatric examination should be performed as soon as possible for all patients. A decision must be made whether the patient needs to be hospitalized, in applying coercive, restrictive measures. Patients with psychotic disorders, delirium, epilepsy, some with severe depression and those in a state of unresolved crisis, should be placed in a psychiatric ward.

After a suicidal attempt, the patient can deny any problems, since severe depression leading to suicidal actions may be accompanied by a short period of high mood. However, the risk of suicide later remains high, despite the resolution of the patient's problems.

The psychiatric examination reveals some problems that are important in committing a suicidal attempt, and helps the doctor plan appropriate treatment. It consists in establishing mutual understanding; understanding of the suicide attempt, its basis, previous events and circumstances in which it was undertaken; understanding of existing difficulties and problems; careful reflection of personal and family ties, which often have to do with a suicidal attempt; a full assessment of the patient's mental state, with a special emphasis on recognizing depression, anxiety, agitation, panic attacks, severe insomnia or other psychiatric disorders and substance abuse that require specific treatment in addition to crisis intervention; communication with close family members and friends; contacting your family doctor.

Prevention of suicide

Prevention requires identifying people at risk of suicide and initiating appropriate interventions.

Although some suicidal attempts and completed suicides are extremely unexpected, even for close relatives and colleagues, clear hints about the upcoming actions can be addressed to family members, friends or medical workers. Such messages are often explicit - such as discussion of plans or sudden writing or changing a will. However, caveats may be less explicit, such as commenting on the emptiness of life or what would be better if he died.

On average, a primary care physician is confronted with 6 or more suicidal patients at the reception each year. About 77% of people who committed suicide were examined by a doctor during the year before suicide and about 32% were under psychiatric supervision for the previous year. Since severe, painful somatic diseases, substance abuse and mental disorders,

The effect of suicide

Any suicidal action has a pronounced emotional effect on everyone involved in it. The doctor, family and friends can experience guilt, shame, remorse for not being able to prevent suicide, as well as anger towards a suicide or other people. A doctor can provide meaningful help to the family and friends of the deceased in coping with their feelings of guilt and regret.