genel tıp derg Genel Tıp Dergisi 2602-3741 Selcuk University İlaç İçerek İntihar Girişiminde Bulunanlarda Eksen-ı Tanı Sıklığı ve Klinik Özellikler Frequency of axis-ı diagnosis and clinical features of suicide attempters with drug overdose Erensoy Habib Üsküdar Universitesi, Psikiyatri Anabilim Dalı, İstanbul Aytaç Hasan Mervan Malazgirt Devlet Hastanesi, Psikiyatri Bölümü, Muş Berkol Tonguç Demir Bakırköy Prof. Dr. Mazhar Osman Ruh Sağlığı ve Sinir Hstalıkları Eğitim ve Araştırma Hastanesi, Psikiyatri Bölümü, İstanbul Tav Ava Şirin Kartal Dr. Lütfi Kırdar Eğitim ve Araştırma Hastanesi, Psikiyatri Bölümü, İstanbul 12 01 2020 30 4 224 234 Copyright © 1990, Genel Tıp Dergisi 1990 Genel Tıp Dergisi

Amaç: İntihar psikiyatrik bozuklukların en ciddi komplikasyonu olup intihar girişimlerinde en fazla kullanılan yöntem ilaç alımıdır. Bu çalışmada ilaç içerek intihar girişiminde bulunarak yoğun bakım servisinde gözlemde tutulan hastalarda sosyodemografik özellikler, psikososyal risk etkenleri ve psikiyatrik tanı dağılımlarının saptanması ve böylelikle erken müdahale yöntemlerine kılavuzluk sağlanması amaçlanmıştır.Gereç ve Yöntem: Çalışmamıza bir eğitim ve araştırma hastanesinin yoğun bakım servisinde, ilaç içerek intihar girişimi nedeni ile izlenen ve çalışmaya katılmaya onam veren 94 hasta alınmıştır. Hastalara sosyodemografik veri formu doldurulmuş ve tüm hastalara SCID-I uygulanmıştır. İntihar girişimi ile ilişkili olabilecek risk etkenleri belirlenip elde edilen veriler cinsiyet, eğitim düzeyi ve eksen-I tanı dağılımı gibi değişkenler açısından değerlendirilmiştir.Bulgular: Hastaların %95’i intihar girişimi ile ilişkili ailesel, duygusal veya sosyoekonomik bir stres etkeni tariflemiştir. Hastaların %72'sinde n=68 bir, %11'inde n=10 ise birden çok eksen-I bozukluk saptanmıştır. Çalışmamızda hastaların %68'inde n=64 major depresif bozukluk, %11'inde n=10 depresif uyum bozukluğu, %6'sında n=6 panik bozukluk, %6'sında n=6 alkol bağımlılığı, %2'sinde n=2 yaygın anksiyete bozukluğu ve %2'sinde n=2 akut stres bozukluğu tespit edilmiştir.Sonuç: İlaç içerek intihar girişiminde bulunan hastalarda eksen-I bozukluklar sık bulunmuş olup bunlar arasında major depresyon başı çekmektedir. Çalışmamızda yer alan hastaların tamamına yakını intihar girişimleri ile ilişkili olabilecek stres etkeni tariflemekte olup erken müdahale ve etkin bir psikiyatrik tedavi ciddi riskleri önleyebilir

Objective: Suicide is the most serious complication of psychiatric disorders. Drug intake is the most commonly used method in suicide attempts. The aim of this study was determining sociodemographic characteristics, psychosocial risk factors, and psychiatric diagnosis distributions in patients who were observed in the intensive care unit by attempting suicide with taking medication.Material and Methods: 94 of the patients who were followed up for suicidal attempt in a training and research hospital intensive care unit were included in the study. Sociodemographic data form was filled and SCID-I was applied to all patients. The risk factors that may be related with suicide attempt were determined and the obtained data were evaluated in terms of variables such as gender, education level and axis-I diagnosis distribution.Results: T95% of the patients had a familial, emotional or socioeconomic stress associated with suicide attempt. While 72% n=68 of the patients had only one axis-I disorder, 11% n=10 had multiple axis I disorders. In our study, 68% n=64 of the patients had major depressive disorder, 11% n=10 had depressive adjustment disorder, 6% n=6 had panic disorder, 6% n=6 had alcohol dependence, 2% n=2 had generalized anxiety disorder and 2% n=2 had acute stress disorder.Conclusion: Axis-I disorders were found to be frequent in patients who attempted suicide by taking a drug and major depression was the leading one. Almost all of the patients in our study have been described as stressors that may be related to suicide attempts and early intervention and effective psychiatric treatment can prevent serious risks

 İntihar girişimi ilaç zehirlenmesi eştanı Suicide attempt drug overdose comorbidity Hoertel N, Franco S, Wall MM, Oquendo MA, Kerridge BT, Limosin F, Blanco C. Mental disorders and risk of suicide attempt: a national prospective study. Molecular Psychiatry 2015; 20:718. Serious Suicide Attempts: Systematic Review of Psychologi- cal Risk Factors. Front Psychiatry 2018. Na EJ, Lee H, Myung W, Fava M, Mischoulon D, Paik JW, Hong JP, Kwan WC, Kim H Jeon, HJ. Risks of Completed Suicide of Community Individuals with ICD-10 Disorders Across Age Groups: A Nationwide Population-Based Nes- ted Case-Control Study in South Korea. Psychiatry Investi- gation 2019; 16:314-24. Chihara I, Ae R, Kudo Y, Uehara R, Makino N, Matsubara Y,Sasahara T, Aoyama Y, Kotani K, Nakamura Y. Suicidal patients presenting to secondary and tertiary emergen- cy departments and referral to a psychiatrist: a populati- on-based descriptive study from Japan. BMC Psychiatry 2018;18:112. O'Connor RC, O'Neill SM. Mental health and suicide risk in Northern Ireland: a legacy of the Troubles?. The Lancet Psychiatry 2015; 2:582-4. Dyvesether SM, Nordentoft M, Forman JL, Erlangsen A. Join point regression analysis of suicides in Denmark du- ring 1980-2015. Methods 2018; 60:X84. Homan KJ, Sim LA, Fargo JD, Twohig MP. Five-year pros- pective investigation of self-harm/suicide-related behaviors in the development of borderline personality disorder. Per- sonality Disorders: Theory, Research, and Treatment 2017; 8:183. Tong Y, Phillips MR, Conner KR. DSM-IV Axis II persona- lity disorders and suicide and attempted suicide in China. The British Journal of Psychiatry 2016; 209:319-26. Mc Millan KA, Asmundson GJ, Sareen J. Comorbid PTSD and social anxiety disorder: associations with quality of life and suicide attempts. The Journal of Nervous and Mental Disease 2017; 205:732-7. Freeman A, Mergl R, Kohls E, Székely A, Gusmao R, Arensman E, Koburger N, Hegerl U, Rummel-Kluge C. A cross-national study on gender differences in suicide intent. BMC Psychiatry 2017; 17:234. Burrell LV, Mehlum L, Qin P. Sudden parental death from external causes and risk of suicide in the bereaved offspring: a national study. J Psychiat Res 2018; 96: 49-56. Kerr WC, Kaplan MS, Huguet N, Caetano R, Giesbrecht N, McFarland BH. Economic recession, alcohol, and suicide rates: comparative effects of poverty, foreclosure, and job- loss. Am J Prevent Med 2017; 52:469-75. Dunlavy AC, Juárez S, Toivanen S, Rostila M.Suicide risk among native-and foreign-origin persons in Sweden: a lon- gitudinal examination of the role of unemployment status. Social Psychiatry and Psychiatric Epidemiology 2018; 1-12. Puzo Q, Mehlum L, Qin P. Socio-economic status and risk for suicide by immigration background in Norway: A regis- ter-based national study. J Psychiat Res 2018; 100:99-106. Turecki G, Brent DA. Suicide and suicidal behaviour. The Lancet 2016; 387: 1227-39. Lorant V, de Gelder R, Kapadia D, Borrell C, Kalediene R, Kovács K, … & Rodríguez-Sanz M. Socioeconomic inequ- alities in suicide in Europe: the wideninggap. The British Journal of Psychiatry 2018; 212:356-61. Shain B. Suicide and suicide attempts in adolescents. Pedi- atrics 2016; 138:e20161420. Sadock BJ, Sadock VA, Kaplan HI. Kaplan and Sadock's Comprehensive TextBook of Psychiatry. 10th ed Philadelp- hia: Lippincott Williams and Wilkins, 2017. Kumar PR, Vincent SD. Features of Parasuicide Cases Pre- sented to Hospital Melaka in Year 2015-“A Wake-up Call”. Malaysian J Psychiat 2017; 25:47-59. Veisani Y, Mohamadian F, Delpisheh A, Khazaei S. So- cio-demographic factors associated with choosing violent methods of suicide, 2011-2016, Ilamprovince. Asian J Psy- chiat 2018; 35:72-5. Kim Y, Ng CFS, Chung Y, Kim H, Honda Y, Guo YL et al. Airpollution and suicide in 10 cities in Northeast Asia: a time-stratified case-crossover analysis. Environmental He- alth Perspectives 2018; 126:037002. First MB, Spitzer RL, Gibbon M et al. Structured Clinical Interview for DSM-IV ClinicalVersion (SCID-I/CV). Ame- rican Psychiatric Pres,Washington DC, 1997. Çorapçıoğlu A, Aydemir Ö, Yıldız M ve ark. DSM IV Eksen I Bozuklukları (SCID- I) için Yapılandırılmış Klinik Gö- rüşme-Klinik Versiyon. Ankara: Hekimler Birliği Yayınevi, 1999. Hanuscin C, Zahmatkesh G, Shirazi A, Pan D, Teklehaima- not S, Bazargan-Hejazi S. Socio-demographic and mental health profile of admitted cases of self-inflicted harm in the US population. Int J Env Res Public Health 2018; 15:77. Snyder DJ, Ballard ED, Stanley IH, Ludi E, Kohn-Godbout J, Horowitz LM. Patient opinions about screening for suici- de risk in the adult medical inpatient unit. J Behav Health Serv Res 2017: 44(3):364-72. Jimenez-Trevino L, Saiz PA, Corcoran P, Burón P, Gar- cía-Portilla MP, Chinea ER et al. Factors associated with hospitalization after suicide spectrum behaviors: results from a multicenter study in Spain. Arc Suicide Res 2015; 19:17-34. Kim JJ, La Porte LM, Saleh MP, Allweiss S, Adams MG, Zhou Y, Silver RK. Suicide risk among perinatal women who report thoughts of self-harm on depression screens. Obst Gynecol 2015; 125:885-93. Franklin JC, Ribeiro JD, Fox KR, Bentley KH, Kleiman EM, Huang X et al. Risk factors for suicidal thoughts and beha- viors: a meta-analysis of 50 years of research. Psychol Bull 2017; 143(2):187. Vijayakumar L. Suicide in women. Ind J Psychiat 2015; 57:233. Mergl R, Koburger N, Heinrichs K, Székely, A, Tóth MD, Coyne J et al. What are reasons for the large gender dif- ferences in the lethality of suicidal acts? An epidemiologi- cal analysis in four European countries. PloSone 2015; 10:e0129062. Hocaoglu Ç & Aytaç HM. Özel Grup ve Kurum İntiharları (Cezaevi, Asker, Polis). Turkiye Klinikleri Psychiatry-Speci- al Topics 2016; 9:37-50.