Suicide crisis

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A suicide crisis, suicidal crisis or potential suicide is a situation in which a person is attempting to kill themselves or is seriously contemplating or planning to do so. It is considered by public safety authorities, medical practice, and emergency services to be a medical emergency, requiring immediate suicide intervention and emergency medical treatment. Suicidal presentations occur when an individual faces an emotional, physical, or social problem they feel they cannot overcome and considers suicide to be a solution. Clinicians usually attempt to re-frame suicidal crises, point out that suicide is not a solution and help the individual identify and solve or tolerate the problems. [1]

Contents

Nature

Most cases of potential suicide have warning signs. [2] [3] [4] Attempting to kill oneself, talking about or planning suicide, writing a suicide note, talking or thinking frequently about death, exhibiting a death wish by expressing it verbally or by taking potentially deadly risks, or taking steps towards attempting suicide (e.g., obtaining rope and tying it to a ligature point to attempt a hanging or stockpiling pills for an attempted overdose) are all indicators of a suicide crisis. More subtle clues include preparing for death for no apparent reason (such as putting affairs in order, changing a will, etc.), writing goodbye letters, and visiting or calling family members or friends to say farewell. The person may also start giving away previously valued items (because they "no longer need them"). In other cases, the person who seemed depressed and suicidal may become normal or filled with energy or calmness again; these people particularly need to be watched because the return to normalcy could be because they have come to terms with whatever act is next (e.g., a plan to attempt suicide and "escape" from their problems).

Depression is a major causative factor of suicide, and individuals with depression are considered a high-risk group for suicidal behavior. However, suicidal behaviour is not just restricted to patients diagnosed with some form of depression. [5] More than 90% of all suicides are related to a mood disorder, such as bipolar disorder, depression, addiction, PTSD, or other psychiatric illnesses, such as schizophrenia. [6] The deeper the depression, the greater the risk, [7] often manifested in feelings or expressions of apathy, helplessness, hopelessness, or worthlessness. [8]

Suicide is often committed in response to a cause of depression, such as the cessation of a romantic relationship, serious illness or injury (like the loss of a limb or blindness), the death of a loved one, financial problems or poverty, guilt or fear of getting caught for something the person did, drug abuse, old age, concerns with gender identity, among others. [9]

In 2006, WHO conducted a study on suicide around the world. The results in Canada showed that 80-90% of suicide attempts (an estimation, due to the complications of predicting attempted suicide). 90% of attempted suicides investigated led to hospitalizations. 12% of attempts were in hospitals.[ citation needed ]

Treatments

Crisis hotlines, such as the National Suicide Prevention Lifeline, enable people to get immediate emergency telephone counselling Lifelinelogo.svg
Crisis hotlines, such as the National Suicide Prevention Lifeline, enable people to get immediate emergency telephone counselling

Ketamine has been tested for treatment-resistant bipolar depression, major depressive disorder, and people in a suicidal crisis in emergency rooms, and is being used this way off-label. [10] [11] The drug is given by a single intravenous infusion at doses less than those used in anesthesia, and preliminary data have indicated it produces a rapid (within 2 hours) and relatively sustained (about 1–2 weeks long) significant reduction in symptoms in some patients. [12] Initial studies with ketamine have sparked scientific and clinical interest due to its rapid onset, [13] and because it appears to work by blocking NMDA receptors for glutamate, a different mechanism from most modern antidepressants that operate on other targets. [10] [14] Some studies have shown that lithium medication can reduce suicidal ideation within 48 hours of administration.

Intervention

Intervention is important to stop someone in a suicidal crisis from harming or killing themselves. Every sign of suicide should be taken seriously. Steps to take in order to help defuse the situation or get the person in crisis to safety include: [15]

If a friend or loved one is talking about suicide but is not yet in crisis, the following steps should be taken to help them get professional help and feel supported: [15]

See also

Related Research Articles

<span class="mw-page-title-main">Bipolar disorder</span> Mental disorder that causes periods of depression and abnormally elevated mood

Bipolar disorder, previously known as manic depression, is a mental disorder characterized by periods of depression and periods of abnormally elevated mood that each last from days to weeks. If the elevated mood is severe or associated with psychosis, it is called mania; if it is less severe, it is called hypomania. During mania, an individual behaves or feels abnormally energetic, happy or irritable, and they often make impulsive decisions with little regard for the consequences. There is usually also a reduced need for sleep during manic phases. During periods of depression, the individual may experience crying and have a negative outlook on life and poor eye contact with others. The risk of suicide is high; over a period of 20 years, 6% of those with bipolar disorder died by suicide, while 30–40% engaged in self-harm. Other mental health issues, such as anxiety disorders and substance use disorders, are commonly associated with bipolar disorder.

<span class="mw-page-title-main">Major depressive disorder</span> Mental disorder involving persistent low mood, low self-esteem, and loss of interest

Major depressive disorder (MDD), also known as clinical depression, is a mental disorder characterized by at least two weeks of pervasive low mood, low self-esteem, and loss of interest or pleasure in normally enjoyable activities. Introduced by a group of US clinicians in the mid-1970s, the term was adopted by the American Psychiatric Association for this symptom cluster under mood disorders in the 1980 version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), and has become widely used since.

Suicide is the second leading cause of death for people in the United States from the ages of 9 to 56.

<span class="mw-page-title-main">Suicide prevention</span> Collective efforts to reduce the incidence of suicide

Suicide prevention is a collection of efforts to reduce the risk of suicide. Suicide is often preventable, and the efforts to prevent it may occur at the individual, relationship, community, and society level. Suicide is a serious public health problem that can have long-lasting effects on individuals, families, and communities. Preventing suicide requires strategies at all levels of society. This includes prevention and protective strategies for individuals, families, and communities. Suicide can be prevented by learning the warning signs, promoting prevention and resilience, and committing to social change.

<span class="mw-page-title-main">Emergency psychiatry</span> Clinical application of psychiatry in emergency settings

Emergency psychiatry is the clinical application of psychiatry in emergency settings. Conditions requiring psychiatric interventions may include attempted suicide, substance abuse, depression, psychosis, violence or other rapid changes in behavior.

Suicide intervention is a direct effort to prevent a person or persons from attempting to take their own life or lives intentionally.

<span class="mw-page-title-main">Suicidal ideation</span> Thoughts, ideas, or ruminations about the possibility of ending ones life

Suicidal ideation, or suicidal thoughts, is the thought process of having ideas, or ruminations about the possibility of ending one's own life. It is not a diagnosis but is a symptom of some mental disorders, use of certain psychoactive drugs, and can also occur in response to adverse life events without the presence of a mental disorder.

A major depressive episode (MDE) is a period characterized by symptoms of major depressive disorder. Those affected primarily exhibit a depressive mood for at least two weeks or more, and a loss of interest or pleasure in everyday activities. Other symptoms can include feelings of emptiness, hopelessness, anxiety, worthlessness, guilt, irritability, changes in appetite, difficulties in concentration, difficulties remembering details, making decisions, and thoughts of suicide. Insomnia or hypersomnia and aches, pains, or digestive problems that are resistant to treatment may also be present.

<span class="mw-page-title-main">Men's health</span>

Men's health is a state of complete physical, mental, and social well-being, as experienced by men, and not merely the absence of disease. Differences in men's health compared to women's can be attributed to biological factors, behavioural factors, and social factors.

The emphasis of the treatment of bipolar disorder is on effective management of the long-term course of the illness, which can involve treatment of emergent symptoms. Treatment methods include pharmacological and psychological techniques.

Suicide risk assessment is a process of estimating the likelihood for a person to attempt or die by suicide. The goal of a thorough risk assessment is to learn about the circumstances of an individual person with regard to suicide, including warning signs, risk factors, and protective factors. Risk for suicide is re-evaluated throughout the course of care to assess the patient's response to personal situational changes and clinical interventions. Accurate and defensible risk assessment requires a clinician to integrate a clinical judgment with the latest evidence-based practice, although accurate prediction of low base rate events, such as suicide, is inherently difficult and prone to false positives.

<span class="mw-page-title-main">Esketamine</span> Medication

Esketamine, also known as (S)-ketamine or S(+)-ketamine, is the S(+) enantiomer of ketamine. It is a dissociative hallucinogen drug used as a general anesthetic and as an antidepressant for treatment of depression. It is sold under the brand names Spravato, Ketanest, among others. Esketamine is the active enantiomer of ketamine in terms of NMDA receptor antagonism and is more potent than racemic ketamine.

Bipolar II disorder (BP-II) is a mood disorder on the bipolar spectrum, characterized by at least one episode of hypomania and at least one episode of major depression. Diagnosis for BP-II requires that the individual must never have experienced a full manic episode. Otherwise, one manic episode meets the criteria for bipolar I disorder (BP-I).

Youth suicide is when a young person, generally categorized as someone below the legal age of majority, deliberately ends their own life. Rates of youth suicide and attempted youth suicide in Western societies and other countries are high. Youth suicide attempts are more common among girls, but adolescent males are the ones who usually carry out suicide. Suicide rates in youths have nearly tripled between the 1960s and 1980s. For example, in Australia suicide is second only to motor vehicle accidents as its leading cause of death for people aged 15 to 25.

<span class="mw-page-title-main">Suicide</span> Intentional act of causing ones own death

Suicide is the act of intentionally causing one's own death. Mental disorders, physical disorders, and substance abuse are risk factors. Some suicides are impulsive acts due to stress, relationship problems, or harassment and bullying. Those who have previously attempted suicide are at a higher risk for future attempts. Effective suicide prevention efforts include limiting access to methods of suicide such as firearms, drugs, and poisons; treating mental disorders and substance abuse; careful media reporting about suicide; improving economic conditions; and dialectical behaviour therapy (DBT). Although crisis hotlines are common resources, their effectiveness has not been well studied.

<span class="mw-page-title-main">Depression in childhood and adolescence</span> Pediatric depressive disorders

Major depressive disorder, often simply referred to as depression, is a mental disorder characterized by prolonged unhappiness or irritability. It is accompanied by a constellation of somatic and cognitive signs and symptoms such as fatigue, apathy, sleep problems, loss of appetite, loss of engagement, low self-regard/worthlessness, difficulty concentrating or indecisiveness, or recurrent thoughts of death or suicide.

A suicide attempt is an act in which an individual tries to kill themselves but survives. Mental health professionals discourage describing suicide attempts as "failed" or "unsuccessful", as doing so may imply that a suicide resulting in death is a successful or desirable outcome.

<span class="mw-page-title-main">Igor Galynker</span> American psychiatrist

Igor Galynker is an American psychiatrist, clinician and researcher. His research interests include bipolar disorder, suicide prevention, and the role of family dynamics in psychiatric illness. He has published on these topics both in professional journals and in the lay press. His recent research has been devoted to describing Suicide Crisis Syndrome (SCS), an acute suicidal cognitive-affective state predictive of imminent suicidal behavior.

In colleges and universities in the United States, suicide is one of the most common causes of death among students. Each year, approximately 24,000 college students attempt suicide while 1,100 students succeed in their attempt, making suicide the second-leading cause of death among U.S. college students. Roughly 12% of college students report the occurrence of suicide ideation during their first four years in college, with 2.6% percent reporting persistent suicide ideation. 65% of college students reported that they knew someone who has either attempted or died by suicide, showing that the majority of students on college campuses are exposed to suicide or suicidal attempts.

Ketamine-assisted psychotherapy(KAP) is the use of prescribed doses of ketamine, the drug, as an adjunct to psychotherapy sessions. KAP shows significant potential in treating mental disorders such as treatment-resistant depression (TRD), anxiety, obsessive–compulsive disorders (OCD), post-traumatic stress disorders (PTSD), and other conditions. It can also be used for those experiencing substance abuse and physical pain. While it is primarily used as a veterinary anaesthetic, ketamine has also been found to have rapid analgesic and hallucinogenic effects, which has sparked interest in its use as an antidepressant. Despite initial trials of its use in the treatment of mental disorders focussing primarily on its antidepressant effects, newer studies are attempting to harness its psychedelic effects to bring about altered states of consciousness, which will augment the adjunct psychotherapy. Ketamine's neuroplasticity-promoting effects strengthen the cognitive restructuring that takes place through traditional psychotherapy, thereby leading to long-lasting behavioural change. KAP offers promising directions for research on new antidepressant alternatives, but is still not sufficiently defined or evaluated as a treatment combination.

References

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