Biomedical Papers, 2010 (vol. 154), issue 3

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2010, 154(3):265-273 | 10.5507/bp.2010.041

SUICIDAL PATIENTS

Jan Praskoa,b,c,d, Tomas Divekya,b, Ales Grambala,b, Klara Latalovaa,b
a Department of Psychiatry, University Hospital Olomouc, I. P. Pavlova 6, 775 20 Olomouc, Czech Republic
b Psychiatry Clinic, Faculty of Medicine and Dentistry, Palacky University Olomouc, I. P. Pavlova 6, 775 20 Olomouc
c Prague Psychiatric Centre, Ustavni 91, 181 03 Prague 8
d Centre of Neuropsychiatric Studies, Ustavni 91, 181 03 Prague 8

Backround. Suicide is the eighth leading cause of death in adults and the second leading cause of death in the 15- to 24-year-old age group. Suicidal impulses and suicidal behavior result from emotionally unbearable feeling of mental suffering and cognitive narrowing that prevent resolution to experienced stress, that is, in a situation when personal coping mechanisms have failed. Suicide attempts are a frequent cause of hospital admissions, in particular to anesthesiology and resuscitation departments.

Risk factors: Women attempt suicide three times more often than men. Four times more men than women complete suicide. More than 90% of people who complete suicide are diagnosed with severe mental illness and 50% suffer from depression at the time of suicide. Assessment. Physicians should be aware of possible suicidal behavior in any patient with mental illness, especially if accompanied by depressive symptoms. The physician should approach the topic of suicide carefully and discreetly, only after a therapeutic relationship with the patient has been established. Management. Patient protection, usually in the setting of a closed psychiatric ward, is necessary if he or she has a clear plan and means to commit suicide. After the patient's safety is secured, treatment may be initiated. If the patient is treated on an outpatient basis, his/her condition must be carefully monitored.

Keywords: Suicide risk, Assessment, Therapeutic relationship, Hospitalization, Pharmacotherapy, Clinical care organization

Received: January 1, 2010; Accepted: April 27, 2010


References

  1. Shneidman E. Overview: a multidimensional approach to suicide. In: Jacobs D, Brown H, eds. Suicide: Understanding and Responding. Madison, Conn: International Universities Press; 1989. p.130. Vymětal J. Lékařská psychologie. Praha: Portál; 2003. 397 s.
  2. Beck AT, Brown G, Steer RA. Prediction of eventual suicide in psychiatric inpatients by clinical ratings of hopelessness. J Consult Clin Psychol 1989; 57:309310.
  3. Mann J. Psychobiological predictors of suicide. J Clin Psychiatry 1987; 48: 3943. Go to PubMed...
  4. Schulsinger R, Kety S, Rosenthal D, et al. A family study of suicide. In: Schou M, Stromgren E, eds. Origins, Prevention and Treatment of Affective Disorders. New York, NY: Academic Press; 1979. p. 277287.
  5. Asberg M, Nordstrom P, Traskman-Bendz L. Cerebrospinal fluid studies of suicide: an overview. In: Mann JJ, Stanley M, eds. Psychobiology of Suicidal Behavior. New York, NY: The New York Academy of Sciences; 1986. p.243255.
  6. Bostwick JM. Suicidality, In Wise MG and Rundell JR (eds): The American Psychiatric Publishing Textbook of Consultation- Liaison Psychiatry. Psychiatry in the Medically Ill, 2nd Edition. Washington DC, American Psychiatric Publishing 2002; 127148.
  7. Kochanek KD, Murphy SL, Anderson RN, et al. Final data for 2002. National Vital Statistics Reports. Vol 53. No 5. Hyattsville, Md: National Center for Health Statistics 2004.
  8. Johnson SL. Therapists Guide to Clinical Intervention. London: Academic Press; 2004. p.562.
  9. Allebeck P, Bolund C, Ringback G. Increased suicide rates in cancer patients: a cohort study based on the Swedish cancer-environment register. J Clin Epidemiol 1989; 42:611616. Go to original source... Go to PubMed...
  10. De Leo D, Scocco P, Marietta P, et al. Physical illness and parasuicide: evidence from the European Parasuicide Study Interview Schedule (EPSIS/WHO-EURO). Int J Psychol Med 1999; 29: 149163.
  11. Druss B, Pincus H. Suicidal ideation and suicide attempts in general medical illnesses. Arch Intern Med 2000; 160:15221526. Go to original source... Go to PubMed...
  12. Akechi T, Okuyama T, Sugawara Y, et al. Suicidality in terminally ill Japanese patients with cancer. Cancer 2004; 100:183191. Go to original source... Go to PubMed...
  13. Breitbart W, Rosenfeld B, Pessin H, et al. Depression, hopelessness, and desire for hastened death in terminally ill patients with cancer. JAMA 2000; 284:29072911. Go to original source... Go to PubMed...
  14. Hietanen P, Lonnqvist J. Cancer and suicide. Ann Oncol 1991; 2:1923. Go to PubMed...
  15. Goodwin RD, Marusic A, Hoven C. Suicide attempts in the United States: the role of physical illness. Soc Sci Med 2003; 56:1783 1788. Go to original source...
  16. Kaminer Y, Robbins DR. Insulin misuse: a review of an overlooked psychiatric problem. Psychosomatics 1989; 30:1924. Go to original source... Go to PubMed...
  17. Timonen M, Villo K, Hakko H, et al. Suicides in persons suffering from rheumatoid arthritis. Rheumatology 2003; 42:287291. Go to original source... Go to PubMed...
  18. Karassa FB, Magliano M, Isenberg DA. Suicide attempts in patients with systemic lupus erythematosus. Ann Rheum Dis 2003; 62:5860. Go to original source... Go to PubMed...
  19. Fukuchi T, Kanemoto I, Kato M, et al. Death in epilepsy with special attention to suicide cases. Epilepsy Res 2002; 51:233236. Go to original source... Go to PubMed...
  20. Breslau N, Davis GC, Andreski P. Migraine, psychiatric disorders, and suicide attempts: an epidemiologic study of young adults. Psychiatry Res 1991; 37:1123. Go to original source... Go to PubMed...
  21. Gupta MA, Gupta AC. Depression and suicidal ideation in dermatology patients with acne, alopecia areata, atopic dermatitis, and psoriasis. Br J Dermatol 1998; 139:846850. Go to original source... Go to PubMed...
  22. Juurlink DN, Herrmann N, Szalai JP, et al. Medical illness and the risk of suicide in the elderly. Arch Intern Med 2004; 164:1179 1184. Go to original source... Go to PubMed...
  23. Quan H, Arboleda-Florez J, Fick GH, et al. Association between physical illness and suicide among the elderly. Soc Psychiatry Psychiatr Epidemiol 2002; 37:190197. Go to original source... Go to PubMed...
  24. Murphy GE. Suicide and attempted suicide. In: Winokur G, Clayton PJ (eds): The Medical Basis of Psychiatry. Philadelphia PA: WB Saunders; 1986. p.562579.
  25. Henriksson MM, Aro HM, Marttunen MJ, et al. Mental disorders and comorbidity in suicide. Am J Psychiatry 1993; 150:935940. Go to PubMed...
  26. Nordstrom P, Samuelsson M, Asberg M. Survival analysis of suicide risk after attempted suicide. Acta Psychiatr Scand 1995; 91:336340. Go to original source... Go to PubMed...
  27. Guze SB and Robins E. Suicide and primary affective disorders. Br J Psychiatry 1970; 117:437438. Go to PubMed...
  28. Miles CP. Conditions predisposing to suicide: a review. J Nerv Ment Dis 1977; 164:231246.
  29. Hawton K. Suicide and attempted suicide. In: Paykel ES (ed): Handbook of Affective Disorders, 2nd Edition. New York: Guilford; 1992. p.635650.
  30. Harris EC, Barraclough B. Suicide as an outcome of mental disorders: a meta-analysis. Br J Psychiatry 1997; 170:205228. Go to original source... Go to PubMed...
  31. Borges G, Walters EE, Kessler RC. Associations of substance use, abuse, and dependence with subsequent suicidal behavior. Am J Epidemiol 2000; 151:781789. Go to original source... Go to PubMed...
  32. Furst S and Ostow M. The psychodynamics of suicide. In: Hankoff LD, Einsidler B (eds): Suicide: Theory and Clinical Aspects. PSG Publishing, Littleton MA 1979; 165178.
  33. Suominen KH, Isometsa ET, Henriksson MM, et al. Suicide attempts and personality disorder. Acta Psychiatr Scand 2002; 102:118125. Go to original source... Go to PubMed...
  34. Linehan MM. Behavioral treatments of suicidal behaviors: definitional obfuscation and treatment outcomes. Ann N Y Acad Sci 1997; 836:302328. Go to original source... Go to PubMed...
  35. Patterson WM, Dohn HH, Bird J et al: Evaluation of suicidal patients: the SAD PERSONS scale. Psychosomatics 1983; 24:343 349. Go to original source... Go to PubMed...
  36. McClain CS, Rosenfeld B, Breitbart W. Effect of spiritual wellbeing on end-of-life despair in terminally-ill cancer patients. Lancet 2003; 10:16031607. Go to original source...
  37. Malone KM, Oquendo MA, Haas GL, et al. Protective factors against suicidal acts in major depression: reasons for living. Am J Psychiatry 2000; 157:10841088. Go to original source... Go to PubMed...
  38. American Psychiatric Association (APA). Practice guideline for the assessment and treatment of patients with suicidal behaviors. Am J Psychiatry 2003; 160 (Suppl):160.
  39. Meltzer H, Alphs I, Green A, et al. Clozapine treatment for suicidality in schizophrenia: International Suicide Prevention Trial (InterSePT). Arch Gen Psychiatry 2003; 60:8289. Go to original source... Go to PubMed...
  40. Švestka J. Therapy and prophylaxis of manic-depressive psychosis with lithium carbonate, with respect to possibility of prediction to the therapeutic result. In: Advances in psychopharmacology and psychopharmacotherapy. Acta Facult Med Univ Brun 1979; 65:25102.
  41. Hanuš H, Zapletálek M. Suicidal activity of patients with affective disorders during the preventive use of lithium. Čs Psychiatrie 1984; 80:97100.
  42. Tondo L, Isaccsson G, Baldessarini RJ. Suicidal behavior in bipolar disorder: risk and prevention. CNS Drugs 2003; 17:491511. Go to original source... Go to PubMed...