Suicide Attempts in a General Hospital: A Case-Control

Objective: This study aims is to conduct a comparative analysis of the clinical and sociodemographic profiles of individuals referred to Consultation-Liaison Psychiatry (CLP) at a tertiary general hospital, specifically focusing on those seeking assistance due to suicide attempts (TS) versus CLP requests for other reasons (non-TS) between the years 2010 and 2020. Additionally, we aim to assess factors associated with suicide attempts. Method: This retrospective controlled study involves a thorough examination of medical records encompassing 3913 patients who received CLP services at the Hospital de Base (HB) and the Children and Maternity Hospital (HCM) of São José do Rio Preto Medical School Foundation (Funfarme) from June 2010 to June 2020. The patient cohort is categorized into two groups: those with requests for SA (n = 677) and those with requests for other reasons. Results: In the SA group, as opposed to the non SA group, statistically significant differences were observed for gender (predominantly female), employment status (employed), marital status (single), and age (younger). Notably, a higher prevalence of psychiatric antecedents (88.7%, n = 555 vs. 73.6% n = 2018) was found in the SA group, indicating a significant association. The frequency of SA requests remained stable over the years. Among the SA group, mood disorders were the most prevalent (39%, n = 372), followed by disorders related to substance use (21.2%, n = 202), and personality disorders (16%, n = 152). A history of previous suicide attempts emerged as a crucial factor for the recurrence of SA (p-value ≤ 0.001). Exogenous intoxication emerged as the most frequently employed method in attempts (79.6%, n = 539), particularly prevalent among patients diagnosed with mood disorders (41%, n = 314). A significant association was observed between the method of attempt and the nosological psychiatric diagnosis (χ2 = 42.277;p ≤ 0.001). Regarding outcomes, the majority of patients were referred for outpatient follow-up (23%, n = 336) in specialized mental health services or at the Primary Healthcare Unit, highlighting the general hospital’s pivotal role in integrating patients into the broader healthcare network. Conclusion: Variables such as gender (female), age group (young adults), and psychiatric history exhibited stronger associations with suicide attempts compared to the group assisted by CLP for other reasons. Furthermore, a noteworthy correlation between the method employed and the psychiatric diagnosis was identified.

Case Control Study of Impulsivity,Aggression,Pesticide Exposure and Suicide Attempts Using Pesticides among Farmers

A case-control study was conducted to investigate associations between organophosphate pesticide（OP）exposure,aggression,impulsivity,and attempted suicide.Questionnaires were used to collect information;impulsivity and aggression were measured by the Barratt Impulsivity Scale（BIS）and the Aggression Inventory（AI）.

The patient suicide attempt-An ethical dilemma case study

Case description:Nurses face more and more ethical dilemmas during their practice nowadays,especially when they are taking care of the patient at end of life stage.The case study demonstrates an ethical dilemma when nursing staff are taking care of an end stage aggressive prostate cancer patient Mr Green who expressed the suicide thoughts to one of the nurses and ask that nurse keep secret for him in Brisbane,QLD,Australia.Ethical dilemma identification:The ethical dilemma is identified as“if the nursing staff should tell other health care team members about patient's suicide attempt without patient's consent”.Analysis:To better solving this case and making the best moral decision,the ethical theory,the ethical principles and the Australian nurses'code of ethics values statement,the associated literature relative with this case are analyzed before the decision making.Ethical decision making:After consider all of the above factors,in this case,the best ethical decision for the patient is that the nurse share the information of Mr Green's suicide attempt with other health care professionals.Results:In Mr Green's case,the nurse chose to share the information of Mr Green's suicide attempt with other health care professionals.The nursing team followed the self-harm and suicide protocol of the hospital strictly,they maintained the effective communication with Mr Green,identified the factors which cause patient's suicide attempt,provided the appropriate nursing intervention to deal will these risk factors and collaborated with other health care professionals to prefect the further care.The patient transferred to a palliative care service with no sign of suicide attempt and other self-harm behaviors and passed away peacefully 76 days after discharged with his relatives and pastors accompany.

Abnormal brain activity in adolescents with Internet addiction who attempt suicide: an assessment using functional magnetic resonance imaging

Internet addiction is associated with an increased risk of suicidal behavior and can lead to brain dysfunction among adolescents.However,whether brain dysfunction occurs in adolescents with Internet addiction who attempt suicide remains unknown.This observational cross-sectional study enrolled 41 young Internet addicts,aged from 15 to 20 years,from the Department of Psychiatry,the First Affiliated Hospital of Chongqing Medical University,China from January to May 2018.The participants included 21 individuals who attempted suicide and 20 individuals with Internet addiction without a suicidal attempt history.Brain images in the resting state were obtained by a 3.0 T magnetic resonance imaging scanner.The results showed that activity in the gyrus frontalis inferior of the right pars triangularis and the right pars opercularis was significantly increased in the suicidal attempt group compared with the non-suicidal attempt group.In the resting state,the prefrontal lobe of adolescents who had attempted suicide because of Internet addiction exhibited functional abnormalities,which may provide a new basis for studying suicide pathogenesis in Internet addicts.The study was authorized by the Ethics Committee of Chongqing Medical University,China(approval No.2017 Scientific Research Ethics(2017-157))on December 11,2017.

Prevalence and associated factors of suicide among hospitalized schizophrenic patients

BACKGROUND Previous studies found several factors associated with suicide in schizophrenic patients,such as age,sex,education level,history of suicide attempts,psychotic symptoms,social factors,and substance abuse.However,there might be some additional factors that were not considered in previous studies but may be correlated with a greater likelihood of suicide attempts,such as medication and treatment.AIM To investigate the prevalence of suicide attempts and identify the risk of suicidality in hospitalized schizophrenia patients.METHODS This is a cross-sectional study of schizophrenic patients admitted to a psychiatric hospital who were 18 years of age or more.The outcomes and possible suicide risk factors in these patients were collated.The current suicide risk was evaluated using the mini-international neuropsychiatric interview module for suicidality and categorized as none(0 points),mild(1-8 points),moderate(9-16 points),or severe(17 or more points).This study used ordinal logistic regression to assess the association of potential risk factors with the current suicide risk in schizophrenic patients.RESULTS Of 228 hospitalized schizophrenia patients,214(93.9%)were included in this study.The majority(79.0%)of patients were males.Females appeared to have a slightly higher suicidality risk than males,with borderline significance.With regard to the current suicide risk assessed with the mini-international neuropsychiatric interview,172(80.4%)schizophrenic patients scored zero,20(9.4%)had a mild risk,8(3.7%)had a moderate risk,and 14(6.5%)had a severe risk.The total prevalence of current suicide risk in these schizophrenic patients was 19.6%.Based on multivariable ordinal logistic regression analysis with backward elimination,it was found that younger age,a current major depressive episode,receiving fluoxetine or lithium carbonate in the previous month,or a relatively higher Charlson comorbidity index score were all significantly and independently associated with a higher level of suicide risk.CONCLUSION The prevalence rate of suicide attempts in schizophrenia is high.Considering risk factors in routine clinical assessments,environmental manipulations and adequate treatment might prevent or decrease suicide in these patients.

The Utility of Artificial Intelligence for Mood Analysis,Depression Detection,and Suicide Risk Management

Mood disorders are often an indication or a sign of depression,and individuals suffering from mood swings may face higher probability and increased suicidal tendencies.Depression-also called“clinical depression”or a“depressive disorder”-is a mood disorder that adversely impacts how an individual feels,thinks,and handles daily activities,such as sleeping,eating,or working.To be diagnosed with depression,symptoms must be present most of the time,nearly every day for at least minimum of 2 to 3 weeks.Feeling sad or having low emotional energy may be common among people.For most,however,these feelings are transitory and can be managed by changing daily life routines.But for some,prolonged mood disorders can lead to depression and foster suicidal tendencies.Suicide is a major public health concern.Over 47,000 people died by suicide in the United States in 2017.It is the 10th leading cause of death overall according to NIMH(National Institute of Mental Health).Suicide is complicated and tragic,but it is often preventable.Identifying the warning signs for suicide and how to get help can be a major mitigating factor.In this short communication,we are reviewing the promise and limitations of AI(artificial intelligence)with its integrated tools such as ML(machine learning)and DL(deep learning)for mood analysis as a means for detecting early signs of depression and increased suicidal tendencies for possible suicide risk management.

Mental Health, Religion and Suicide

Suicide is one of the most common yet serious concerns, and a worldwide subject that individuals have debated from the past to the present. Suicidal ideation affects and disrupts the functionality of a human being regardless of age, gender, ethnicity, or even religion. This article aims to discuss suicide in general and from an Islamic perspective in specific, as research has shown that an Islamically oriented approach and intervention works better with the Muslim population in general. The paper also aims to have a broader view of how Islam categorized suicide classically and its modern implications, which also lets us explore the similarities, and differences between the Islamic perspective and different religions about suicide and related mental health concerns. A collection of both classic and modern sources was used to extract information and provide a scope of definitions to clarify suicide and religiosity concerning the teachings and opinion of Islam about the meaning of life, afterlife, and soul. It was found that the Muslim population showed a lower rate of suicide in comparison to individuals from other religions, and religious individuals showed faster recovery from suicidal ideation. Yet, Muslims are not immune to mental health conditions that would result in suicide. Therefore, further studies and research need to be conducted to understand the huge stigma around Muslim about mental health and suicide in the Muslim communities, to compare the effectiveness among the religious and the non-religious Muslims, and lastly to fill the gap as to why the Muslim population tends to be hesitant in seeking help regarding their psychological problems.

Acute intoxication cases admitted to the emergency department of a university hospital

BACKGROUND: This study aimed to describe the clinical and socio-demographic aspects of acute poisoning in 2010 in Duzce City, Northwest Anatolian Region of Turkey.METHODS: Acute poisoning was due to the intentional ingestion of drugs in young and adult people(≥16), who were treated at the Emergency Service of Duzce University Medical Hospital, Turkey from January 1, 2010 to December 31, 2010. In this retrospective and descriptive study, 95 patients were diagnosed with intoxications and 30 of them intentionally ingested drugs to commit suicide. Records of the patients diagnosed with intoxication were obtained from the Clinical Archive of the hospital. Their diagnoses were established according to the International Statistical Classification of Diseases and Related Health Problems. Codes X60-X84 of this classification were used to classify self-infringed drug injuries and drug poisoning.RESULTS: In this series, 35(36.8%) patients were male and 60 patients(63.2%) female. The male/female ratio was 1.0/1.7. The mean age of the patients was 33.1±14.2 years; 17(17.9%) patients were below 20 years old and 9(9.5%) were older than 50 years. Of these patients, 29(30.5%) were single, 7(7.4%) divorced or separated, and 59(62.1%) married. Their mean time for admission to the emergency service after the incident was 208±180(15–660) minutes. The mean time for admission to the emergency service for patients with food intoxication after the incident was 142±160 minutes, for those with drug intoxication 173±161 minutes, for those with carbon monoxide(CO) intoxication 315±209 minutes, and for those with undefined intoxication 289±166 minutes(P=0.005). Most of the intoxication cases occurred in winter(41.1%, 39 of 95 patients). Admissions to the emergency service were most common in December and April(21 and 16 of 95 patients, respectively). Sixty-five(68.4%) cases were involved in non-deliberate poisoning, whereas 30(31.6%) were involved in deliberate poisoning. Twenty-six of the 95 patients with acute poisonings had mortality risk at admission, however only one died from CO intoxication in the emergency service(1.1%). Suicide attempts were more common in females than in males(21 of 30 patients, 70%, P<0.05). CONCLUSION: In Duzce City of Turkey, most intoxication cases occurred in winter, especially in December. They had non-deliberate poisoning, but deliberate poisoning in suicide attempts was more common in females than in males.

Social Meanings of Attempted Suicide of Men in Bangladesh

Émile Durkheim’s Le Suicide(1897/2005)paved the way for the development of the sociology of suicide.However,Durkheim’s positivistic approach in studying suicide was trenchantly challenged by,amongst others,Jack Douglas,who,in Social Meanings of Suicide(1968),advocated extricating the social meanings of suicide from the interpretive tradition of social research.Drawing on Douglas’approach to the sociology of suicide,this paper reports and reflects on part of a study conducted across several rural areas of Jhenaidah,an area in Bangladesh highly affected by suicide,with 17 males who have attempted suicide.The responses of the participants were interpreted with a view to understanding the social meanings associated with their suicide attempts.Although there was a diversity of individual experiences among the participants with regard to suicide attempts,the paper synthesises these and reflects on three themes which most closely represent the commonalities of experience of the 17 men,namely:(i)inability to provide;(ii)intimate relationship stress;and(iii)loss of social status.In conclusion,the paper contributes to understanding suicide attempts by men as social meaningfully events,delineating the roles and complexities associated with constructions of masculine identities.

Transcranial and Repetitive Transcranial Magnetic Stimulation Driving a Noninvasive Depression Treatment

These days the most devasting disease that is even worse than the new pandemic COVID19 is commonly spreading and exists is human depression to be more specific.The world-wide episode of depression is something that has no permanent cure either among the youngsters in particular and older people in general.Researchers and scientists in the field of medicine and psychology are looking for some noninvasive approaches to treat this disease.Present chemical medications available in the market that are subscribed to patients are not effective as one set of solution across all the patients and in case of deep depression invasive solution such as clinical Electro-Convulsive Therapy(ECT)in most cases should not be prescribed due to tremendous and devasting side effects of it on patients that are going through such treatment for long term as a means of solution to their depression problem.New studies and clinical results are supporting a new generation of magnetic treatment approach that is known as Transcranial Magnetic Stimulation(TMS)or in case of a longer term suggests repetitive Transcranial Magnetic Stimulation(rTMS),both as very non-invasive approaches with almost no adverse side effects on patients that are receiving such clinical treatments.In this paper we study these two recently approved approaches by Food and Drug Administration(FDA)as well as a newly suggested electric energy medicine by utilizing a new form of wave that is known as a Scalar Wave,which is a non-linear,non-Hertzian,standing wave capable of supporting significant effects including carrying information and inducing higher levels of cellular energy,which greatly enhances the performance and effectiveness of the body and immune system.

A Case Report: Challenge in Treatment of a Rare Condition of Gonadal Agenesis and Bipolar Disease

Background: We report a rare case of congenital bilateral testicular agenesis who presented with a suicide attempt. We pose the question of testosterone therapy could improve his mental health. Case Report: A 36-year-old man was admitted to a psychiatric ward after the suicide attempt. An endocrinology consult is requested to address if hormone replacement therapy could improve his depression and future suicide attempts. His past medical history is significant for gonadal agenesis, testicular implants placement at age 16, bipolar type 1 diagnosed 2 years ago before the presentation. The patient received testosterone replacement treatment at age 13 - 15 years. Since that time, he has not been placed on any testosterone therapy. Physical exam revealed minimal axillary and pubic hair, testicular implants with a microphallus. Laboratory values reflect hypergonadotropic hypogonadism consistent with testicular agenesis. He was suicidal and testosterone treatment was deferred. Discussion: It is a rare case of congenital testicular agenesis with bipolar disorder which was resistant to therapy. The patient had profound hypogonadism, which needed testosterone replacement therapy. However, the therapy was deferred because of an acute psychotic condition. This case also highlights that there is no strong evidence of the effect of hormonal therapy on mental health in this group.

An Unusual Cervical Penetrating Wound Extended to the Right Pleural Dome

The solution of continuity of the tissues of the neck with rupture of the platysma muscle is called a cervical penetrating wound. The authors report a case of an unusual penetrating neck wound extended to the pleural dome by stabbing a psychiatric patient. They describe the diagnostic circumstances, the therapeutic approach and discuss data from the literature. It was a 26-year-old young woman, who was received in ENT for a penetrating neck wound with a stab wound following a suicide attempt. The diagnosis of a penetrating stab wound to the neck extending to the right pleural dome was retained. The exploratory cervicotomy with the extraction of the foreign body found a knife blade penetrating the anterior base of the right side of the neck to the right pleural dome, sparing the noble vasculo-nervous and aero-digestive organs of the neck. The postoperative course was simple and the evolution was favourable. This unusual penetrating wound of the neck is spectacular and remarkable for the absence of involvement of noble organs despite the involvement of the pleural dome. However, it remains a concern in psychiatric patients and requires multidisciplinary management and systemic management in order to avoid recurrence.

Endovascular repair of giant traumatic pseudoaneurysm of the common carotid artery

BACKGROUND: Delayed presentation of carotid artery pseudoaneurysm following many years after self-inflicted penetrating injury of the neck is extremely rare. Open surgical carotid repair may involve sternotomy for proximal vascular control. Endovascular treatment is evolving as a lessinvasive treatment option.METHODS: We report a 55-year-old man with a history of paranoid schizophrenia who presented with a progressively enlarging left sided neck mass many years after attempted suicide. CT scan confirmed a 6 cm pseudoaneurysm arising from the common carotid artery.RESULTS: Through an open retrograde puncture of the distal common carotid artery, the common carotid pseudoaneurysm was successfully repaired with a BARD fluency carotid stentgraft of 8 mm×80 mm(BARD, Tempe, AZ). The patient recovered well with no neurological deficits and was discharged on postoperative day 4. Dual antiplatelet agents of aspirin and clopidogrel were given for six months and then clopidogrel was administered lifelong. The neck mass decreased in size gradually and became non pulsatile upon follow-up.CONCLUSION: Endovascular stenting of giant carotid pseudoaneurysm is an acceptable less invasive treatment option for giant carotid pseudoaneurysm. Long-term follow-up and a greater number of cases are mandatory to establish the safety of this strategy.