A Psychiatric emergency is a disturbance in thought, mood or action which causes sudden stress to the individual or sudden disability, thus requiring immediate management.

2. DEPARTMENT OF
HOMOEOPATHIC PSYCHIATRY

3. INTRODUCTION
 An Emergency is defined as an
unforeseen combination of
circumstances which calls for an
immediate action.
 A Psychiatric emergency is a
disturbance in thought, mood or
action which causes sudden stress
to the individual or sudden disability,
thus requiring immediate
management.

4. TYPES OF PSYCHIATRIC EMERGENCIES
 A psychiatric emergency can be one
or more of the following:
 A new psychiatric disorder with an
acute onset.
 A chronic pschatric diorder with a
relapse.
 An organic psychiatric disorder.
 An abnormal response to a stressful
situation.
 Iatrogenic emergencies.
 Alcohol or drug dependence.
 Deliberate harm to self or others.

5. SUICIDE
 Suicide (Latin suicidium, from sui
caedere, "to kill oneself") is the act of
intentionally causing one's own death
 Fatal act that represents the person’s
wish to die.
 Some plan for days and weeks before
acting it out while others take their lives
seemingly on impulse.

6. EPIDEMIOLOGY
 Over 8,00,000 people die due to
suicide every year.
 For every suicide there are many more
people who attempt suicide every
year. A prior suicide attempt is the
single most important risk factor for
suicide in the general population.
 Suicide is the second leading cause of
death among 15–29-year-olds.
 75% of global suicides occur in low-
and middle-income countries.

7. METHODS OF SUICIDE
Ingestion of pesticide, hanging and
firearms are among the most
common methods of suicide
globally.

8. RISK FACTORS
 GENDER DIFFERENCES
 AGE
 RACE
 RELIGION
 MARITAL STATUS
 OCCUPATION
 CLIMATE
 PHYSICAL HEALTH
 MENTAL ILLNESS
 PREVIOUS SUICIDAL BEHAVIOUR

9. GENDER
DIFFERENCES
•Men commit
suicide more
than four times
as often as
women.
•But women
attempt
suicide or have
suicidal
thoughts three
times as often
as men.
AGE
•Suicide is rare
before
puberty.
•Most suicides
now are
among those
aged 35 to 64.
RACE
•Suicide rates
among white
men and
women are
approximately
two to three
times high as
for African
American men
and women.

10. RELIGION
•Muslims have much
lower rates in
comparison to other
religions.
MARITAL STATUS
•Marriage lessens the
risk of suicide
significantly,especially
if there are children in
home.
•Divorce increases the
suicide risk.
OCCUPATION
•The higher the person’s
social status, the
greater the risk of
suicide.

11. PHYSICAL HEALTH
•A physical illness is
estimated to be an
important contributing
factor in about half of all
suicides.
•Certain drugs can
produce depression
which may lead to
suicide in some cases.
•Among these drugs are
reserpine,
corticosteroids,
antihypertensives and
some anticancer
agents.
MENTAL ILLNESS
•Almost 95% of all persons
who commit suicide or
attempt suicide have a
mental disorder.
PREVIOUS SUICIDAL
BEHAVIOUR
•A past suicide attempt is
perhaps the best
indicator that a patient
is at increased risk of
suicide.
•Studies show that about
40% of depressed
patients who commit
suicide have made a
previous attempt.

12. ETIOLOGY

13. Sociological Factors
 French Sociologist Emile Durkheim divided suicides into 3 social
categories:
Egoistic: Egoistic suicide applies to those who are not strongly
integrated to any social group.
Altruistic: Altruistic suicides applies to those susceptible to suicide
stemming from their excessive integration into a group.eg Soldiers
Anomic: Anomic suicide applies to persons whose integration into
society is disturbed so that they cannot follow customary norms of
behaviour.

14. Psychological Factors
 Freud’s Theory
 In his paper “Mourning and Melancholia,” Sigmund Freud stated his belief that
suicide represents aggression turned inward against an introjected, ambivalently
cathected love object.
 Menninger’s Theory
 Karl Menninger, in Man Against Himself, concieved of suicide as inverted
homicide because of a patient’s anger toward another person.
 He also described three components of hostility in suicide:
 The wish to kill
 The wish to be killed and
 The wish to die

15. Recent Theories
 Suicidologists believe that much can be learned about the
psychodynamics of suicidal patients from their fantasies about what would
happen if they commit suicide.
Such fantasies include:
• Wishes for revenge, power, control, punishment
• Escape
• Rescue, rebirth, reunion with the dead, or a new life.
 Depressed persons may attempt suicide just as they appear to be
recovering from their depression.
 A study of Aaron Beck showed that hopelessness was one of the most
accurate indicators of long term suicidal risk.

16. BIOLOGICAL FACTORS
 A group at the Karolinska Institute in Sweden first noted that low
concentrations of the serotonin metabolite 5-hydroxyindoleacetic acid(5-
HIAA) in the lumbar cerebrospinal fluid(CSF) were associated with suicidal
behaviour.
 Postmortem neurochemical studies have reported modest decreases in
5-HIAA
 Low concentrations of 5-HIAA in CSF also predict future suicidal behaviour.

17. GENETIC FACTORS
 Suicidal behaviour, as with other psychiatric disorders,
tends to run in families.
 In psychiatric patients, a family history of suicide
increases the risk of attempted suicides and that of
completed suicides.

18. VARIABLES ENHANCING RISK OF
SUICIDE AMONG VULNERABLE GROUPS
 Adolescence and late life
 Criminal behaviour

19.  Disposition of personal property
 Divorced, separated or single
 Early loss or seperation from parents

20.  Family History of suicide
 Hallucinations

21.  Hopelessness
 Hypochondriasis
 Impulsivity

22.  Increasing stress
 Lack of future plans
 Insomnia

23.  Lethality of previous attempt
 Living alone
 Low self esteem

24.  Physical illness or impairment
 Recent childbirth
 Recent loss

25.  Severe psychiatric illness
 Sexual abuse
 Unemployment

26. VENN DIAGRAM SUMMARIZING SUICIDE DATA AND ITS RELATION TO MOOD
DISORDER AND SUICIDE ATTEMPTS
MOOD DISORDER
SUICIDE ATTEMPTS
SUICIDE
15% of mood disorder
subsequently suicide
10% of suicide attempts subsequently
suicide within 10 years

27. Robin Williams
 Robin McLaurin Williams (July 21, 1951 –
August 11, 2014) was an American actor
and comedian. Starting as a stand-up
comedian in San Francisco and Los
Angeles in the mid-1970s, he is credited
with leading San Francisco's comedy
renaissance.

28.  During the late 1970s and early 1980s, Williams had an addiction to
cocaine. Williams turned to exercise and cycling to help alleviate his
depression shortly after friend's death.
 In 2003, he started drinking alcohol again while working on a film in Alaska.
 His publicist Mara Buxbaum commented that he was suffering from severe
depression prior to his death. Williams' wife Susan stated that in the period
before his death, he had been sober, but was diagnosed with early
stage Parkinson's disease, which was something he was "not yet ready to
share publicly.

29.  Williams committed suicide on August 11, 2014 in his home in Paradise Cay,
California at the age of 63. In the initial report released on August 12, the
Marin County Sheriff's Office deputy coroner stated Williams had hanged
himself with a belt and died from asphyxiation.
 The final autopsy report, released in November 2014, affirmed that Williams
had committed suicide as initially described. Neither alcohol nor illegal
drugs were involved, while any prescription drugs present in Williams' body
were at "therapeutic" levels.
 The report also noted that Williams had been suffering "a recent increase in
paranoia.“ Williams' doctors reportedly believe that Lewy body dementia
"was the critical factor" that led to his suicide.

30. COMMON MISCONCEPTIONS ABOUT
SUICIDE
MISCONCEPTIONS FACTS
1. People who talk about suicide
don’t commit suicide.
Suicide happens without warning.
2. Suicidal persons are fully intent on
dying.
3. Once a person is suicidal, he is
suicidal forever.
4. All suicidal persons are mentally ill
or psychotic.
Nearly 80% of persons who commit
suicide, give definite warnings and
clues about their suicidal intentions.
Most suicidal persons are undecided
about dying or living.
Suicidal person is suicidal only for a
limited period of time.
Although the suicidal person is often
extremely unhappy, he is not
necessarily mentally ill.

31. PREVENTION AND CONTROL
 Suicides are preventable. There are a number of measures
that can be taken at population, sub-population and
individual levels to prevent suicide and suicide attempts.
These include:
Reducing access to the means of suicide (e.G. Pesticides,
firearms, certain medications)
Introducing alcohol policies to reduce the harmful use of
alcohol.

32. Early identification, treatment and care of people with
mental and substance use disorders, chronic pain and
acute emotional distress.
Training of non-specialized health workers in the
assessment and management of suicidal behaviour.
Follow-up care for people who attempted suicide and
provision of community support.

33. GOALS TO REDUCE SUICIDE
Promote awareness that suicide is a public
health problem that is preventable.
Develop broad base support for suicide
prevention.
Develop and implement strategies to reduce
the stigma associated with being a consumer of
mental health, substance abuse and suicide
prevention service.

34. Develop and implement suicide prevention
program.
Implement training for recognition of at-risk
behaviour and delivery of effective treatment.
Develop and promote effective clinical and
professional practices.

35. Improve access to, and community linkages
with, mental health and substance abuse
services.
Improve reporting and portrayals of suicidal
behaviour, mental illness and sustance abuse in
the entertainment and news media.
Promote and support research on suicide and
suicide prevention.
Improve and expand surveillance systems.

36. WHO RESPONSE
WHO recognizes suicide as a public health
priority. The first WHO World Suicide Report
“Preventing suicide: A global imperative”
published in 2014, aims to increase the
awareness of the public health significance
of suicide and suicide attempts and to
make suicide prevention a high priority on
the global public health agenda.

37. It also aims to encourage and
support countries to develop or
strengthen comprehensive suicide
prevention strategies in a
multisectoral public health
approach.

38. Suicide is one of the priority conditions in the
WHO Mental Health Gap Action Programme
(mhGAP) launched in 2008, which provides
evidence-based technical guidance to
scale up service provision and care in
countries for mental, neurological and
substance use disorders.
In the WHO Mental Health Action Plan 2013-
2020, WHO Member States have committed
themselves to working towards the global
target of reducing the suicide rate in
countries by 10% by 2020.

39. World Suicide Prevention Day (WSPD)
 World Suicide Prevention Day (WSPD), on 10 September,
is organized by the International Association for Suicide
Prevention (IASP). The purpose of this day is to raise
awareness around the globe that suicide can be
prevented.
 In past years, over 300 activities in around 70 countries
were reported to IASP, including educational and
commemorative events, press briefings and
conferences, as well as Facebook and Twitter coverage.

40. HOMOEOPATHIC MANAGEMENT

41. SYPHILIS
This miasm is held to be responsible for
many psychological disorders, including
alcoholism, depression, suicidal impulses,
insanity.

42.  Syphilitic people have tendency to destruction, destruction at every single
moment, and it delight them.
 An even religious syphilitic person destroy by the name of god. They kill
people in different religion.
 The syphilitic’s person anger is more violent, explosive anger that scares the
people around them.
 The syphilitic person’s sadness and joy are also tendency to be destructive.
Anyone losing his senses on a happy occasion is syphilitic miasm.
 A strong desire to put an end to one’s life (Suicide or Murder) is syphilitic
miasm. Generally, the syphilitic person does not experience joy.
 Destructiveness is the predominant physical feature such as an ulcer
(destructive process). There is destruction of shape, structure of the tissue.

43. DR.HAHNEMANN ON SUICIDE
 In the Allgemeine Anzeiger der Deutschen,
1819, Hahnemann published a short article on "Uncharitableness
Towards Suicides." He mentions the epidemic prevalence of suicide,
maintains that it is a form of insanity and says : (Lesser Writings," New
York, p. 695.)
"This most unnatural of all human purposes, this
disorder of the mind that renders them weary, of life, might always
be with certainty cured if the medicinal powers of pure gold for the
cure of this sad condition were known. The smallest dose of
pulverized gold attenuated to the billionth degree, or the smallest
part of a drop of an equally diluted solution of pure gold, which
may be mixed in his drink without his knowledge, immediately and
permanently removes this fearful state of the (body and) mind, and
the unfortunate being is saved."

44. HOMOEOPATHIC THERAPEUTICS

45. REMEDIES ACCORDING TO DIFFERENT
WAYS OF ATTEMPTING SUICIDE
Drowning
• Antim Crude
• Belladonna
• Drosera
• Helleborus
• Hyoscyamus
• Pulsatilla
• Rhus Tox
• Secal Cor
• Silicea
• Veratrum
Alb
Hanging
• Arsenic
• Belladonna
Poison
• Lilium Tig
Shooting
• Antim Crude
• Aurum Met
• Carbo Veg
• Hepar Sulph
• Nat. Sulph
• Nux Vomica
• Pulsatilla
Throwing
himself from
Height
• Aurum Met
• Belladonna
• Crotalus
• Nux Vomica
• Stramonium

46. Patient is constantly sad.
Desire to cut his throat but
fears death.
Impulse when he sees sharp
instuments or blood.
Impulse to kill himself.
Mental symptoms < in
morning
Alumina

47. Anacardium
Tendency towards
suicide by shooting.
Imagines he hears
voices of people
who are far away.

48. Antimonium Crudum
Ecstasy and exalted
love with great anxiety
about his fate and
inclination to shoot
himself.
Life seems a burden.

49. Arsenicum Album
Thoughts of death
and incurability of his
complaints.
Suicidal tendency
especially by hanging.

50. Aurum Mettalicum
 Melancholy with inquietude and
desire to die.
 Irresistible desire to weep.
 Sees obstacles everywhere.
 Hopeless, suicidal, inclined to
jump of heights.
 Feels life is not desirable and
thought of death alone gives
pleasure.
 Great anguish which even
induces a disposition to suicide.

51. Belladonna
Patient wishes others to
destroy him.
Will beg physicians and
attendants to do so
Wishes to suicide by
drowning.

52. Capsicum
Almost overwhelmed by
persistent thoughts of suicide.
He does not want to kill himself.
He resist the thought and yet
they persists and he is
tormented by these thoughts.
Homesickness

53. Cinchona
Fixed ideas that he is
unhappy.
Full of fear at night.
Wants to commit
suicide but lack
courage.

54. Cimicifuga
Suspicious of
everything.
Taciturn, takes no
interest in anything
Suicidal mood but
fears death.
Mania from business
failure or disappointed
love

55. Lachesis
Meditates upon suicide and
finally settles back into an
apathetic state in which
there is an aversion to
everything , to work and
even to think.
Hysterical symptoms,
weeping, mental prostration.

56. NATRUM SULPH
 Sadness, inclined to weep, melancholy
with periodical attack of mania.
 Satiety of life, Suicidal- Has to use all self
control to prevent shooting himself.
 Mental troubles < from jar or knock on
the head or a fall about the head.

57. PSORINUM
 Religious melancholia, full of
fears and evil forebodings
 Very depressed, sad
 Suicidal thoughts, fear of falling
in business, wishes to die inspite
of the best hopes.

58. RHUS TOX
Anxiety and timidity <at twilight
Wants to drown himself yet he has
fear of death.

59. SPIGELIA
Great fear of
pointed things,
pins, moroseness to
the extent of
suicidal mania.

60. HEPAR SULPH
Patient is sad, low spirited
Terrific visions of dead persons
Impulse to suicide
< in evening

61. ZINC MET
Sadness
>Evening.
Feels calm when
thinking of suicide.

62. BIBLIOGRAPHY
 Kaplan & Sadock’s; 2007; Synopsis of Psychiatry ;10th Edition; NewDelhi: India Wolters
Kluwer Pvt Ltd.
 Ahuja Neeraj, 2011; A short textbook of Psychiatry;11TH Edition; NewDelhi: India
Jaypee brothers Medical Publishers(P) Ltd.
 Boericke William; 2010; Homoeopathic Materia Medica; 3rd Revised Augmented
Edition; NewDelhi: India B.Jain publisher(p) LTD.
 Lilienthal Samuel. 1925 ; Homoeopathic Therapeutics; 5nd Edition; NewDelhi: India
B.Jain publisher(p) LTD.
 www.google.co.in

63. THANK YOU