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Eman abahussain, MD clinicat Assistant professer, Consultant Psychiatrist King Saud University College of Medicine intentional Self killing Over 800,000 people die due to suicide every year and there are many more who attempt suicide Suicide occurs throughout the life span and was the second leading cause of death among 15-29 year olds globally in 2012 in 2012. Suicide accounted for 1.4% of all deaths worldwide, making it the 15th leading cause. Over 90% of suicide victims have a diagnosable psychiatric disorder—over half have a depressive disorder Suicidal behaviors are the most common psychiatric emergency In Saudi Arabia no data are available firearm 61% in men and 37% in women Self-poisoning. around 30% of global suicides more common in women hanging, cutting, burning , jumping from high places etc Psychiatric disorders: Depressive disorder Substance abuse. Bipolar disorder Schizophrenia Personality disorder Chronic medical illness Family Hx. Of Affective Illness or suicide Risk of suicide increase in the weeks following psychiatric contact after beginning of treatment Previous Suicidal Attempts impulsiveness History of childhood abuse (physical, verbal, or sexual) Male Age >45 and adolescence Divorced ,widow>single>married living alone unemployed. Recent bereavement, separation, loss. Financial problems Certain occupations: police officers, physicians Poor social support Stressful life events migration –incarceration Lower rates among Muslims, Jews and Catholics, presumably due to religious prohibition Freud: aggression turned inward Escape from rage Guilt; self-punishment or Hopelessness. Rebirth or reunion fantasies Control over a relationship Revenge Durkheim theory: three social categories: egotistic suicide: occurred in individuals who lost their sense of integration with their social group Altruistic suicide: ###sacrificed their lives for the good of the social group Anomic suicide:##with disturbed integration History of previous attempts Depression Alcohol or drug abuse 33-50% with schizophrenia will attempt suicide Approximately 10% with schizophrenia die by suicide Gender: equal attempt ratio, more men die by suicide Risk factors : Isolation (single, living alone, unemployed) Substance abuse 50% have made previous suicide attempt Small % because of hallucinations or delusions Young men early in the course of illness. Depressive symptoms(75%) hopelessness and helplessness After resolution of an acute psychotic exacerbation Days, weeks, months after hospitalization Persons with more “insight” thought to be at higher risk of suicide History Mental state presence of risk factors Careful evaluation of: thoughts wither life is not worth living Wish to be dead non specific Suicidal thoughts. Suicidal thought with intent to act. Suicidal thoughts with specific Plan Preparatory Acts (Suicidal note ) Actual attempt Lethality of the method Frequency, Duration of suicidal thoughts Controllability. Deterrents. Reasons for Ideation Presence of homicidal ideation Short term: Detect high risk group. Admission: psychiatric vs. medical wards Instructions to nurses(level of observation, policy for visitors) Management of medical problems Involvement of family Treat psychiatric disorder Manage social stress Psychological treatments Long-term: Maintenance of treatment OPD follow-up Social support easy contact to service(crisis centers and hotlines) Watch of relapse Parasuicide or attempted suicide or deliberate self harm An act of self damage carried out with destructive intent without the will to finish one’s life. Causes:- personality disorder(impulsive behavior, attention seeking behavior) - alcoholism. - situational crisis. - not planned act. - no intention to be dead - female -Young -Personality problem - previous attempts. -non lethal method - psychosocial stresses. - broken home background Drug over dose Self injury: laceration of wrist jumping - assessment of physical seriousness - assessment for Suicide Risk Factor. - treatment of any Psychiatric Illness. - psychotherapy. -problem solving and counseling. Thank you