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SUICIDE AND DELIBERATE SELF-HARM

Risks and Management. Topics. Definition. Epidemiology and demographic characteristics.Etiology.Risk assessment

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SUICIDE AND DELIBERATE SELF-HARM

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    1. SUICIDE AND DELIBERATE SELF-HARM DR. WALID SHNAIGAT

    3. Topics Definition. Epidemiology and demographic characteristics. Etiology. Risk assessment & management.

    4. Definition Suicide is an act with a fatal outcome, deliberately initiated and performed by the person in full knowledge and expectation of its fatal outcome The word suicide is derived from Latin meaning self murder

    5. Suicide is one of ten leading causes of death in the world (8th) & third in U.K. USA: 12/100 000 per year. Europe 2-41.5/100 000 per year. Variable rates (time and country) Lower in Mediterranean countries, very low in Islamic, and large Catholic population countries. There is an overall global escalation, marked in younger age. Lower in black.

    6. Methods U. K :self poisoning using car exhaust fumes is the most common method used by men (33%), hanging (28%) , over dose (15%), jumping, cutting, silent suicide,...Etc. U.S.A :gunshot and other violent method are common. In women. Drug overdose accounts for almost (50%)

    7. Demographic characteristics 3 times higher in males. Higher in the elderly. Rising above 45 of age. More in singles, widowers, divorced, and socially secluded. Higher in social class V then I. 2 times higher than the expected in doctors, more in female doctors. Higher in immigrants, and prisoners.

    8. Etiology Complex behavior, with biopsychosocial roots. Psychological factors : 80%-90% of completers had mental illness. Mood disorders (depression). > than 50% of completers were depressed. 12%-15% of depressives commit suicide. Alcohol & substance dependence: (10%-12% of Alcoholics), & Heroin dependence increases rate by 20 times. Schizophrenia: 10% Personality disorders: (5% in antisocials)

    9. Social factors: Durkheim proposed a relationship between suicide and social condition Economy (prosperity,depression). Poverty and unemployment War times. Rates decreased Media influences. .

    10. Physiological factors Genetics contribution. Family, twins, & adoption studies. Neurochemistry Low 5HIAA in CSF Abnormal Dexamethsone sup.test. Low platelets MAO in relatives of completers. Abnormal skin conductance test. High urinary cortisol. Non is a specific marker.

    11. Special conditions Rational suicide: Suicide is based on logical appraisal for the need of death. Children & adolescents: 0.7/100 000 below 15 years of age. Pacts: two people agree to commit suicide at the same time (uncommon) Mass suicide: Jamestown 913 individuals, 1978 Suicide post homicide: depression, jealousy, paranoia, intoxication.

    12. Risk factors Male, old age. Depression, Alcoholism. A strong correlate is hopelessness. Single, social seclusion. Previous attempt, raise risk 100 times, 30%- 40% had past attempt. Carefully organized plans, precaution against discovery. Final act. Serious or lethal method. Chronic painful medical illness Epilepsy (4 times higher), HIV, cancer, head injury,… Persistence of intentions or suicidal behaviors.

    13. Assessment All physician should be aware of general risk factors. Unhurried, empathetic interview & tactful enquirers (2/3rd convey messages). Collateral information. Differentiating DSH, or self injuries (20-50 times more common than suicide).

    21. Completers vs. Attempters Completers Attempters Males Females Older(above 45 years) Younger Depression,alcohol, schizophrenia Personality disorder Depression, alcohol Careful plan Impulsive act Precautions against discovery Final act Highly lethal means Serious intentions

    22. Thanks

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