Outline

Definition

and Terms Epidemiology Pathophysiology Risk factors Protective factors Warning signs Myth and facts Prevention

Suicide:(Latin suicidium, from sui caedere, "to kill oneself") is the act of intentionally causing one's own death Suicide Attempt: A non-fatal, self-inflicted destructive act with intent to die. Suicidal Ideation: Thoughts of harming or killing oneself. Passive vs. active suicidal idiation Suicidal Communication: Direct or indirect expressions of suicidal ideation or of intent to harm or kill oneself, expressed verbally or through writing, artwork, or other means. Suicidality: All suicide-related behaviors and thoughts including completing or attempting suicide, suicidal ideation or communications.

Epidemiology
The 10th leading cause of death worldwide In 2020 1.53 million people die from suicide

world wide. Accounts 1.5% of all deaths 1 death every 40 minutes, from suicide and an attempt every 1-2minutes Males attempt 3x lesser than females but commit 4x grater than females. So Who do you think is effective?

Figure 1: Suicide rates in selected regions and countries

Pathophysiology
Post-mortem

studies have shown changes in central neurotransmission functions, particularly to serotonin and noradrenalin systems Low cholesterol concentrations are associated with an increased risk of suicide Dysfunction of hypothalamic - pituitaryadrenal axis might predict suicide in patients with depression, whether or not they have attempted suicide

Psychiatric disorders Past suicide attempts Symptom risk factors(e.g. chronic pain) Sociodemographic risk factors Environmental risk factors (e.g. easy access to lethal means) Family history

Most common psychiatric risk factors resulting in suicide: Depression* Unipolar and Bipolar Depression Alcohol abuse and dependence Drug abuse and dependence

Schizophrenia
*Especially when combined with alcohol and drug abuse

Other psychiatric risk factors with potential to result in suicide (account for significantly fewer suicides than Depression):

Post Traumatic Stress Disorder (PTSD) Eating disorders Borderline personality disorder Antisocial personality disorder

Hopelessness

Impulsivity
Anxiety Command

/ Aggression
hallucinations

Male Over age 65 White Separated, widowed or divorced Living alone Being unemployed or retired

Occupation: health-related occupations higher

(dentists, doctors, nurses, social workers)
..especially high in women physicians

factors

Children in the home, except among those with postpartum psychosis Pregnancy Religious beliefs Life satisfaction Reality testing ability

Positive coping skills

Positive social support Positive therapeutic relationship

Suicide (risk) Assessment: refers to the establishment of a clinical judgment of risk in the very near future, based on the weighing of a very large mass of available clinical detail.

Risk assessment carried out in a systematic, disciplined way is more than a guess or intuition, it is reasoned It is necessary exercise in estimating probability over short periods.

Appreciate the complexity of suicide / multiple contributing factors Conduct a thorough psychiatric examination, identifying risk factors and protective factors and distinguishing risk factors which can be modified from those which cannot Ask directly about suicide; The Specific Suicide Inquiry Determine level of suicide risk: low, moderate, high Determine treatment setting and plan Document assessments

Previous suicide attempt(s)

Significant depressive symptoms - hopelessness

Male gender First decade of illness (however, rate remains

elevated throughout lifetime)

Poor premorbid functioning Current substance abuse Poor current work and social functioning Recent hospital discharge

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MYTH:
People

who talk about suicide don't complete suicide.

FACT:
Many

people(80%) who die by suicide have given definite warnings to family and friends of their intentions. Always take any comment about suicide seriously.
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MYTH: Suicide happens without warning.

FACT: Most suicidal people give clues and signs regarding their suicidal intentions.

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MYTH: Suicidal people are fully intent on dying. FACT: Most suicidal people are undecided about living or dying, which is called suicidal ambivalence. A part of them wants to live; however, death seems like the only way out of their pain and suffering. They may allow themselves to "gamble with death," leaving it up to others to save them.
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MYTH: Men are more likely to be suicidal. FACT: Men are four times more likely to kill themselves than women. Women attempt suicide three times more often than men do.

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MYTH: Asking a depressed person about suicide will push him/her to complete suicide.

FACT: Studies have shown that patients with depression have these ideas and talking about them does not increase the risk of them taking their own life.
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MYTH: Improvement following a suicide attempt or crisis means that the risk is over.
FACT: Most suicides occur within days or weeks of "improvement," when the individual has the energy and motivation to actually follow through with his/her suicidal thoughts. The highest suicide rates are immediately
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MYTH: Once a person attempts suicide, the pain and shame they experience afterward will keep them from trying again. FACT: The most common psychiatric illness that ends in suicide is Major Depression, a recurring illness. Every time a patient gets depressed, the risk
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Somatic treatment modalities

Psychotherapy

ECT used to treat acute suicidal behavior

Benzodiazepines may reduce risk by treating anxiety Antidepressants Lithium, Anticonvulsants

Antipsychotics, recent study on Clozapine

Research shows that when it comes to treating depression, all therapy is NOT created equal. Study shows applying correct techniques reduce suicide attempts by 50% over 18 month period

To be effective, psychotherapy must be:

Specifically designed to treat depression Relatively short-term (10-16 weeks) Structured (therapist should be able to give step-by-step treatment instructions that any other therapist can easily follow) Examples: CBT, Interpersonal Therapy (IPT), Dialectical Behavior Therapy (DBT)

I. II. III.

Show you care and be genuine Ask about suicide, Be direct but non-confrontational Provide help:

Reassure the person Outline safety plan

Reassess for safety and suicide risk

frequently!!!

Anon, 2009. Trends in the Prevalence of Suicide Related Behaviors. Prevention, p.2009. Hawton, K. & Heeringen, K.V., 2009. Seminar Suicide. Seminar, 373. Jos, B., Bertolote, M. & Fleischmann, A., 2002. A global perspective in the epidemiology of suicide. World Health, (2), pp.7-9. Leo, D.D. & Evans, R., INTERNATIONAL SUICIDE RATES RECENT TRENDS AND. Suicide. Preventive, U.S. et al., 2004. Clinical Guidelines Screening for Suicide Risk in Adults: A Summary of Anon, DMH Suicide Prevention Presentation. R., Month, T.H.E. & Magdoff, F., 2008. The World Food Crisis. Wall Street Journal, pp.1-15. Sadock, Benjamin James; 2007. Sadock, Virginia Alcott Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 10th Edition The Evidence for. Annals of Internal Medicine, 140(10).