1. SUICIDE Eman abahussain, MD clinicat Assistant professer,
Consultant Psychiatrist
King Saud University College of Medicine

2. SUICIDE 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 year olds globally in 2012
in Suicide accounted for 1.4% of all deaths worldwide, making it the 15th leading cause.

3. 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

4. METHODS USED 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

5. Common underlying factors:
Psychiatric disorders:
Depressive disorder
Substance abuse.
Bipolar disorder
Schizophrenia
Personality disorder
Chronic medical illness
Family Hx. Of Affective Illness or suicide

6. 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)

7. Sociodemographic risk factors
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

8. Psychological factors/theories
Freud: aggression turned inward
Escape from rage
Guilt; self-punishment or Hopelessness.
Rebirth or reunion fantasies
Control over a relationship
Revenge

9. Sociological factors 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

10. Highly important underlying risk factors
History of previous attempts
Depression
Alcohol or drug abuse

11. Suicide and Schizophrenia (I)
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

12. Suicide and Schizophrenia (II)
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

13. Assessment 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

14. Frequency, Duration of suicidal thoughts
Controllability.
Deterrents.
Reasons for Ideation
Presence of homicidal ideation

16. MANAGEMENT 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

17. Long-term:
Maintenance of treatment
OPD follow-up
Social support
easy contact to service(crisis centers and hotlines)
Watch of relapse

18. Parasuicide or attempted suicide or deliberate self harm

19. 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.

20. Risk Factors - no intention to be dead - female Young
- not planned act.
- no intention to be dead
- female
Young
Personality problem
- previous attempts.
-non lethal method
- psychosocial stresses.
- broken home background

21. Methods
Drug over dose
Self injury: laceration of wrist
jumping

22. Management of DSH - assessment of physical seriousness
- assessment for Suicide Risk Factor.
- treatment of any Psychiatric Illness.
- psychotherapy.
-problem solving and counseling.

24. Thank you