Suicide and others

1. DADA M.USMAN

2.  DSH is an act of intentionally injuring oneself,
irrespective of the actual outcome.
 SUICIDE
 Suicide is a type of deliberate self-harm (DSH) and is
defined as a human act of self-intentioned and self-
inflicted cessation (death). It ends with a fatal outcome.

3.  Attempted suicide
 is an unsuccessful suicidal act with a nonfatal outcome.
 Suicidal gesture,
 is an attempted suicide where the person performing
the action never intends to die by the act. However,
some of these persons may accidentally die during the
act.

4.  Close to 800 000 people die due to suicide every year,
which is one person every 40 seconds.
 79% of suicides occurred in low- and middle-income
countries in 2016
 for each adult who died of suicide there may have been
more than 20 others attempting suicide
 2-10% of all persons who attempt suicide, eventually
complete suicide in the next 10 years.

5.  Attempted suicide is more common in women while
completed suicide is 2-4 times commoner in men.
 4.3 to 17% of the psychiatric patient population will
engage in deliberate self-harm.
 Up to 40% of people who deliberately harm
themselves will go on to become repeat offenders

8. 1. People who talk about suicide, do not commit suicide.
2. Suicide happens without warning
fact. -- Nearly 80% of persons who commit suicide, give
definite warnings and/or clues about their suicidal intentions.
3. Suicidal persons are fully intent on dying
fact- Most suicidal persons are undecided about dying or
living.
4. Once a person is suicidal, he/she is suicidal forever.
fact- Suicidal person is usually suicidal only for a limited
period of time
5. All suicidal persons are mentally ill or psychotic .
Fact - Although a suicidal person is often extremely unhappy, he/she
is not necessarily mentally ill

11. The presence of following factors increases the risk of
completed suicide:
 1. Age>40 years < 19yrs
 2. Male gender
 3. Staying single
 4. Previous suicidal attempt(s)
 5. Depression (risk about 25 times more than usual)

12.  6. Suicidal preoccupation (for example, a written ‘suicide
note’ and/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
 11. Higher degree of impulsivity
 12. Occupation- unemployed, medical personnel (
psychiatrists and anaesthetists)

13. Genetic factors
concordance rate of 18% in monozygotic twins.
Biochemical factors
low levels of 5-HIAA are important in some cases
of suicide.
Physical Disorders
Patients with incurable or painful physical
disorders, such as cancer and AIDS, often commit
suicide.

14. PHYSICAL ILLNESS RISK COMPARED TO GENERAL
POPULAT
HIV/AIDS 21-36 TIMES RISK
EPILEPSY 5 X
SPINAL CORD INJURIES 5-10X
RENAL FAILURE ON DIALYSIS 40X
PUD 5X
GIT CANCERS 5X

15. Psychosocial Factors
Durkheim”s theory
-divided suicides into 3
a. egoistic- poorly integrated into a group, explains why
rate of suicide is higher in urban communities (cities)
compared to rural ones.
b. Altruistic – excessively integrated into a group e.g a
soldier who sacrifices his life in battle.
c. Anomic – integration into a group is disturbed so they
can not follow customary norms of behavior. Explains why
economic challenges makes people more vulnerable to
suicide.

16. Freud
 Believes suicide represents aggression turned inwards.
 Suicides cannot occur without prior desire to kill someone
else. E.g teenager’s feeling towards her boyfriend’s new
girlfriend
Recent theories
 They focus more on the fantasies about the consequences of
suicide expressed by suicidal patients.
 Such fantasies include; desire for revenge, power,
punishment, atonement, sacrifice, rebirth or reunion with the
dead. May explain mass suicides

17.  Psychiatric disorders
 95% of suicide victims suffered from a psy illness
 45-70% of such patients suffer from depression
 60% of psy inpatients who commit suicide do so within
6mths of discharge.

18.  Diagnosis
DIAGNOSIS SUICIDE RATE (%)
MAJOR DEPRESSION 15
BIPOLAR DISORDER 10-15
SCHIZOPHRENIA 10
ALCOHOL DEPENDENCE 2
BORDERLINE PERSONALITY
DISORDER
4-9.5
ANTISOCIAL PERSONALITY 5

19.  Depression and suicide
 Presence of guilt, self-accusation, nihilistic ideation,
worthlessness, hypochondriacal delusions and/or severe
insomnia
 Hopelessness is a strong indication of suicide
 Risk is usually higher at the beginning or towards the end of a
depressive episode
 Risk often higher soon after response to treatment rather than
at the peak of depression; this applies to all forms of treatment
but particularly so with antidepressant treatment
 higher risk of suicide in the week after discharge from a
psychiatric inpatient unit

20.  LIFE EVENTS
- failure in an examination
- love affairs
- marital difficulties
- illegitimate pregnancy,
- family problem,
- loss of a loved object by death or otherwise
- occupational and financial difficulties,
- social isolation.

21.  Men often tend to use more violent methods for
suicide as compared with women.
 The commonest modes of committing suicide are
 ingestion of poison / insecticides
 hanging
 drowning
 jumping in front of a train or another vehicle
 firearms

22.  Sex - male
 Age - <19yrs and > 45yrs
 Disorders - psychiatric disorders e.g depression and
chronic medical conditions
 Previous attempt or planned future intent
 Excessive alcohol consumption
 Rational thinking loss (psychosis)
 Seperated/divorced/widowed
 Organized or serious attempt
No social support
Substance use disorder

23.  Others
 Lethality- method used
swallowing insecticides > 5 tabs of
pcm
 Identification with family members
who committed suicide

24.  Once suicide is committed, it is obviously no longer
treatable.
 The management of suicide, therefore, lies in
preventing the act.

25.  Take all the suicidal threats, gestures and/or attempts
seriously
 notify a psychiatrist or a mental health professional.
 Acute psychiatric emergency interview and proper risk
assessment by psychiatrist
 precautionary measures including
i. searching the patient and belongings
thoroughly with aim of removing all means of
committing suicide, such as sharp objects, ropes,
drugs, firearms,
ii. Surveillance, depending on the severity of risk..

26.  Counselling and guidance
 to deal with the desire to attempt suicide.
 to deal with on-going life stressors, and teaching
coping skills and interpersonal skills.
 Treatment of the psychiatric disorder(s) with
medication, psychotherapy and/or ECT. ECT is the
treatment of choice for patients with major depression
with suicidal risk.

28.  Medicolegal Aspects
Under the law, suicide and attempted suicide are
punishable offenses.

30. MIND
YOUR
MIND

31. THANK YOU

ALHAMDULILLAH