Suicide and suicide attempt

In the past 20 years, the number of self-reflections among girls aged 15-19 has increased by 250%, and the annual frequency of this phenomenon in this population group in some regions is more than 1%. Most self-poisoning usually does not result in fatalities. Self-poisoning accounts for 4.7% of total admissions to general hospitals of individuals aged 12-20 years.

[1], [2], [3],

Reasons for suicide attempts

Most often the previous event is a quarrel with someone very close (usually a girl with a young man).

In recent decades, the severance of sexual relationships has become characteristic of an even younger age, i.e. This is when the partners have not yet gained experience in overcoming such situations - stresses. With the modern reduction of family ties, the serious support needed at such a moment is in love with families, is very inadequate. Another important factor in suicide may be a weakening of religious feelings. It is also important and availability of drugs (especially psychotropic drugs - these drugs are most popular for self-poisoning). It is also often the role of the desire to imitate - if, for example, a suicide attempt was made by this or that celebrity. This is especially true of the United States and Japan, where a complicated suicide causes the death of more than 600 children a year. Often the reason for suicide is the backlog in school. Relate this to your own nasty mood after endlessly overcoming hundreds of pages of thick directories, so that, for God's sake, slam these books and allow yourself to rest well.

There are six stages (stages) in an attempt to help survive in a similar situation:

• Assessment of the condition of the victim.
• Establishment of contact with the victim and offer him help.
• Discussion with the victim's family, how problems can be overcome.
• The resolution of the problem itself: make it easier for the victim to understand the predicament he has been in, and make him remember how he / she overcame a similar situation in the past. The purpose of such a conversation is to help solve personal and social problems, as well as to revive the victim's greater ability to deal with difficulties in the future.
• Warning: it is necessary that psychotherapeutic assistance is available, if necessary, the patient should be hospitalized in an appropriate clinic or provide it 24 hours a day with the phone service ("helpline").
• Follow-up: follow-up either with the family as a whole, or only with the victim.

Assessment of the condition of the victim

Imagine that you are in a dash and in front of you a goal surrounded by three circles (rings). The inner "ring" is the circumstances that led to this attempt at self-poisoning. Find out the following: what happened directly on this day? Was it okay since the morning? When, in fact, did the events and moods that led to the idea of the inevitability of self-poisoning arose? Find out everything to the smallest detail. What was the last incentive (for example, a note in the newspaper about suicide)? What were the actions of the victim after he attempted self-poisoning? How did he imagine the unfolding of events after the self-poisoning attempt he had made? The average "ring" in the circle of "goal" is the definition of the background on which these sad events developed, ie, how did things go in the months preceding the event? Perhaps, an attempt at self-poisoning could have been committed almost at any time in recent months? What kind of relationship (with those surrounding the affected people) is the most important to the victim during this time? The outer "ring" around the "goal" is the characteristics of the patient's family and the anamnesis of the victim. After you have gone through all these three "rings", you are directly at the point of "goal" - what are the intentions behind the very attempt at self-poisoning, what are the feelings and intentions of the victim at the moment? Maybe this very attempt is an expression of the desire to die (this is a gloomy symptom that should not be ignored)? Or was it the desire to inform someone about the incident or the desire to somehow change the circumstances of life more intolerable? Ask the victim: "If you were discharged from the hospital today, how would you cope with your difficulties?"

[4], [5], [6]

"Contract" with the victim

• The doctor-therapist promises to listen to the victim and help him if the latter agrees to be completely frank and will tell the doctor about any suicidal thoughts and plans that will arise from him.
• The agreement with the patient that the discussed problems will be presented in very detailed and clear.
• It establishes an agreement with the victim on the nature of the exchange of information to achieve the goal.
• The question is asked about who else will be involved in the treatment of the victim (for example, other family members, friends, general practitioner, who watches the patient).
• The time and place of meetings between the doctor and the patient are established.
• The patient's responsibility to the doctor is agreed upon and the promise to work with him effectively and carry out any "homework".

[7], [8]

Treatment with tricyclic antidepressants and related compounds

Excited and possessed by fears of patients should be appointed

• sedative antidepressants, for example, amitriptyline (50 mg every 8-24 hours inside). It should be started with a dose of 25-50 mg per night; doethine (Dothiepin) (50 mg every 8-24 hours, by mouth, starting at a dose of 50-75 mg per night);
• doxepin (Doxepin) (75 mg every 8-12 hours inside, starting at a dose of 10-50 mg per night);
• mianserin (30 mg every 8-24 hours inside, starting at a dose of 30 mg per night);
• Trimipramine (25-50 mg every 8 hours, starting at a dose of 50 mg 2 hours before bedtime).

The less sedative antidepressants include clomipramine (50 mg every 8-24 hours inside, starting at a dose of 10 mg / day, this drug is especially effective in case of phobias and obsessive manifestations, desipramine (25 mg every 8-24 hours inside, dose is not increased slowly more than 200 mg / day), imipramine (10-25 mg every 8-24 hours inwards, increasing the dose to 8 tablets of 25 mg per day), lofepramine (70 mg every 8-12 hours inside, starting with doses of 70 mg / day), nortriptyline (25 mg every 6-24 h inside, starting with 10 mg every 12 h), protriptyline (Protriptyline) (5-10 mg orally in the morning, at noon and at 4:00 pm in order to Usually to avoid insomnia, no more than 6 tablets of 10 mg per day, this drug also has a stimulating effect).

The elderly are prescribed smaller doses.

Side effects

Convulsions (dose-dependent action), arrhythmias, cardiac arrest is possible (especially in the treatment of amitriptyline, which is contraindicated within a few weeks after myocardial infarction and is especially dangerous in case of an overdose, so this drug should be administered in small doses and monitor the patient's condition on a regular basis for suicidal intentions).

Anticholinergic effects (dry mouth, indistinct vision, constipation, urinary retention, drowsiness and sweating) may occur when any of the above-mentioned tricyclic compounds and their derivatives are taken, especially when taking nortriptyline, amitriptyline, and imipramine. All this should be explained to the patient. Tell him also that with time the severity of these unwanted effects will decrease, and during the intake of these drugs you need to refrain from driving and working with machinery. It is necessary to control the intraocular pressure.

Adverse reactions from the liver and blood system can also be observed, especially when taking mianserin. Soon after the beginning of treatment, agranulocytosis may appear, therefore monthly clinical analysis of peripheral blood should be performed.

Interactions with other medications

Contraceptive steroids inhibit the action of tricyclic antidepressants. Side effects of antidepressant drugs may be aggravated by the simultaneous use of phenothiazines. The action of certain antihypertensive agents (for example, clonidine, but not beta-blockers) can be weakened.

Inadequate therapeutic efficacy of antidepressants

Before thinking about this, specify if the patient took the drug prescribed to him in full dose and at least for a month. (The fact is that one should not expect a therapeutic effect earlier than this time.) Then, specify whether the patient did the doctor's instructions correctly, and if all this is so, rethink whether the diagnosis is correct. Should not you apply ECT (electroconvulsive therapy) or small doses of Flupenthixol (0.5 1 mg orally in the morning), or tryptophan (0.5-2 g every 8 hours inside after a meal), or a monoamine oxidase (MAO) inhibitor, but not together with tricyclic compounds (they should not be used within 21 days after using MAO inhibitors)? In such cases, you can appoint phenelzine (Phenelzine) to 15 mg every 8 hours inside. But at the same time, there arises the danger of hypertensive crisis provoked by certain food products and medicines, for example cheese, pickled herring, drugs, yeast preparations [Marmite], often used anti-cold medications, levodopa, tricyclic antidepressants. A hypertensive crisis can occur even after almost 2 weeks after the end of treatment with MAO inhibitors. Therefore, such a patient should carry a card with him where it is written that he is taking MAO inhibitors, and lists food products that he can not use. But, of course, this does not mean that these products should be completely excluded from use: the frequency of hypertensive crises is only about 17 cases per 98 000 patients per year. And at the same time, the benefits of using MAO inhibitors can be very noticeable, especially when the patient has increased sensitivity to the cool attitude of friends, a slight short-term mood improvement depending on the environment, bulimia, severe drowsiness, fatigue, a penchant for panic fears, irritability, anger or hypochondria.