Psikiyatrik Hastalıklarda İntihar ve Acil Serviste İntihar Girişimine Müdahale: Güncel Bir Gözden Geçirme

Year 2023, , 125 - 131, 01.11.2023

Selime Çelik , Banu Karakus Yılmaz , Abdullah Burak Uygur

https://doi.org/10.38175/phnx.1246884

Abstract

Dünya Sağlık Örgütü’ne göre intihar kişinin hayatını sona erdirme niyetiyle gerçekleştirdiği kendine zarar verici bir eylem olarak tanımlanmaktadır. Epidemiyolojik olarak intihar, önlenebilir erken ölümlerin önde gelen nedenlerinden biridir. Ülkemizde ve dünyada giderek artan bir halk sağlığı sorunu haline gelen intihar nedeniyle, dünya çapında her yıl 800.000’den fazla insan ölmektedir. İntihar; intihar girişimi ve tamamlanmış intihar (ölümle sonuçlanan) olarak gruplandırılmaktadır. Acil servisler genellikle intihar olgularıyla ilk karşılaşılan hastane birimidir ve intihar sonucu ölen insanların yaklaşık %40’ının ölümlerinden önceki yıl içinde en az bir kez acil servis başvurularının olduğu görülmektedir. Bu nedenle, acil servis hizmetleri fiziksel sağlık sorunlarıyla ilgilenmenin yanı sıra hastanın ruh sağlığı ihtiyaçlarını değerlendirmek açısından da kritik bir öneme sahiptir ve ciddi bir fırsatı temsil eder. İntihar girişimine acil serviste müdahale ve sonrasında yapılması gerekenler büyük önem arz etmektedir. İntihar ve intihar girişimleri çoğu durumda ruhsal bozukluklarla ilişkilendirilmiştir. İntihar girişimi sonucu ölenlerin %90’ından fazlasında bir psikiyatrik bozukluk olduğu düşünülmektedir. En sık rastlanan temel tanılar ise duygudurum bozuklukları, şizofreni ve madde kullanım bozukluklarıdır. Bireylerin intihar riskinin değerlendirilmesi ve risk altındaki bireylerin erken teşhis ve tedavilerinde çok sayıda değişkenin dikkate alınması gerekmektedir. Bu değişkenlerin en önemlilerinden biri de intihar için risk oluşturan eşlik eden psikiyatrik hastalıklardır. İntihar davranışı ile psikiyatrik hastalıkların birlikteliği düşünüldüğünde intihar girişiminde bulunan tüm hastalar için psikiyatri konsültasyonunun gerekli olduğu görülmektedir. Fakat gerçekleştirilen çalışma sonuçlarından da görüldüğü üzere; intihar girişimi sonrası acil servisten istenen psikiyatri konsültasyon sayıları oldukça düşüktür. Bu durum aynı zamanda hastaların yetersiz psikiyatrik destek aldıklarının da bir göstergesidir. İntihar girişimi sonrası hastalara yeterli destek sağlanabilmesi için psikiyatri konsültasyonlarının sayısının artırılması ve acil servis çalışanlarının "intihar" ile ilgili eğitim almalarının hastalara katkı sağlayabileceği görülmektedir. Bu derlemede psikiyatrik hastalıklarda intihar davranışı ve acil serviste intihar girişimine yaklaşım konusunun ele alınması amaçlanmıştır.

Keywords

intihar, acil servis, psikiyatrik hastalıklar, komorbidite

Psychiatric Diseases, Suicide and Intervention to Suicide Attempts in the Emergency Service: A Current Review

Abstract

According to the World Health Organization, suicide is defined as a self-harming act committed with the intention of ending one’s life. Epidemiologically, suicide is one of the leading causes of preventable premature death. Due to suicide, which has become an increasing public health problem in our country and in the world, more than 800,000 people die worldwide every year. Suicide; suicide attempt and completed suicide (leading to death) are grouped together. Emergency services are usually the first hospital unit where suicide cases are encountered, and it is seen that approximately 40% of people who die as a result of suicide have applied to the emergency department at least once in the year before their death. Therefore, emergency services represent a critical opportunity and represent a critical opportunity to assess the mental health needs of the patient, as well as to deal with physical health problems. Intervention in the emergency service and what to do after the suicide attempt are of great importance. Suicide and suicide attempt have been associated with mental disorders in most cases. The most common basic diagnoses are mood disorders, schizophrenia and substance use disorders. Many variables should be taken into account in the assessment of suicide risk of individuals and in the early diagnosis and treatment of individuals at risk. One of the most important of these variables is comorbid psychiatric diseases. Considering the association of suicidal behavior and psychiatric diseases, it is seen that psychiatric consultation is necessary for all patients who attempt suicide. However, as can be seen from the results of the study carried out; The number of psychiatric consultations requested from the emergency department after a suicide attempt is quite low. This is also an indication that patients receive inadequate psychiatric support. It is seen that increasing the number of psychiatric consultations and training of emergency service personnel about “suicide” may contribute to patients in order to provide adequate support to patients after a suicide attempt. In this review, It is aimed to discuss the issue of suicidal behavior in psychiatric disorders and the approach to suicide attempt in the emergency department.

Keywords

Suicide, emergency service, psychiatric diseases, comorbidity

References

• World Health Organization. Preventing suicide: A global imperative. World Health Organization, 2014.
• World Health Organization. "The European mental health action plan 2013–2020." World Health Organization, 2015.
• Gairin I, House A, Owens D. Attendance at the accident and emergency department in the year before suicide: Retrospective study. The British Journal of Psychiatry. 2003;183(1):28-33.
• Windfuhr K, Kapur N. Suicide and mental illness: a clinical review of 15 years findings from the UK National Confidential Inquiry into Suicide. Br Med Bull. 2011;100:101-21..
• Hocaoğlu Ç. İki uçlu bozukluk ve intihar davranışı. Journal of Mood Disorders. 2013;3(5).
• Wiebenga JXM, Dickhoff J, Mérelle SYM, Eikelenboom M, Heering HD, Gilissen R, et al. Prevalence, course, and determinants of suicide ideation and attempts in patients with a depressive and/or anxiety disorder: A review of NESDA findings. J Affect Disord. 2021;283:267-277.
• Cavanagh JT, Carson AJ, Sharpe M, Lawrie SM. Psychological autopsy studies of suicide: a systematic review. Psychol Med. 2003;33(3):395-405.
• Baldessarini RJ, Tondo L, Pinna M, Nuñez N, Vázquez GH. Suicidal risk factors in major affective disorders. Br J Psychiatry. 2019:215:621-626.
• Bentley KH, Franklin JC, Ribeiro JD, Kleiman EM, Fox KR, Nock MK. Anxiety and its disorders as risk factors for suicidal thoughts and behaviors: A meta-analytic review. Clin Psychol Rev. 2016;43:30-46.
• Bolton JM, Pagura J, Enns MW, Grant B, Sareen J. A population-based longitudinal study of risk factors for suicide attempts in major depressive disorder. J Psychiatr Res. 2010;44(13):817-826.
• Henriksson MM, Aro HM, Marttunen MJ, Heikkinen ME, Isometsä ET, Kuoppasalmi KI, et al. Mental disorders and comorbidity in suicide. Am J Psychiatry. 1993;150(6):935-940.
• Marangell LB, Bauer MS, Dennehy EB, Wisniewski SR, Allen MH, Miklowitz DJ, et al. Prospective predictors of suicide and suicide attempts in 1,556 patients with bipolar disorders followed for up to 2 years. Bipolar Disord. 2006;8(5):566-575.
• Abreu LN, Lafer B, Baca-Garcia E, Oquendo MA. Suicidal ideation and suicide attempts in bipolar disorder type I: an update for the clinician. Braz J Psychiatry. 2009;31(3):271-280.
• Finseth PI, Morken G, Andreassen OA, Malt UF, Vaaler AE. Risk factors related to lifetime suicide attempts in acutely admitted bipolar disorder inpatients. Bipolar Disord. 2012;14(7):727-734.
• Bleuler E. Dementia Praecox: oder Gruppe der Schizophrenien. Franz Deuticke; Leipzig, Germany: 1911.
• Siris SG. Suicide and schizophrenia. J. Psychopharmacol. 2001;15:127-135.
• Popovic D, Benabarre A, Crespo JM, Goikolea JM, González-Pinto A, Gutiérrez-Rojas L, et al. Risk factors for suicide in schizophrenia: Systematic review and clinical recommendations. Acta Psychiatr Scand. 2014;130:418-426.
• Balhara YP, Verma R. Schizophrenia and suicide. East Asian Arch Psychiatry. 2012;22:126-133.
• Hettige NC, Bani-Fatemi A, Sakinofsky I, De Luca VA. Biopsychosocial evaluation of the risk for suicide in schizophrenia. CNS Spectr. 2018;23:253-263.
• Warshaw MG, Dolan RT, Keller MB. Suicidal behavior in patients with current or past panic disorder: five years of prospective data from the Harvard/Brown Anxiety Research Program. American Journal of Psychiatry. 2000;157(11):1876-1878.
• Kanwar A, Malik S, Prokop LJ, Sim LA, Feldstein D, Wang Z, et al. The association between anxiety disorders and suicidal behaviors: a systematic review and meta-analysis. Depress Anxiety. 2013;30(10):917-929.
• Henriksson MM, Isometsä ET, Kuoppasalmi KI, Heikkinen ME, Marttunen MJ, Lönnqvist JK. Panic disorder in completed suicide. J Clin Psychiatry. 1996;57(7):275-281
• Tezcan E, Ülkeroğlu F, Çulha F, Karabulut C. Panic disorder and suicide. Erciyes Tıp Dergisi 1996;18(1):7-10.
• Simon NM, Zalta AK, Otto MW, Ostacher MJ, Fischmann D, Chow CW, et al. The association of comorbid anxiety disorders with suicide attempts and suicidal ideation in outpatients with bipolar disorder. J Psychiatr Res. 2007;41(3-4):255-264.
• Fialko L, Freeman D, Bebbington PE, Kuipers E, Garety PA, Dunn G, et al. Understanding suicidal ideation in psychosis: findings from the Psychological Prevention of Relapse in Psychosis (PRP) trial. Acta Psychiatr Scand. 2006;114(3):177-186.
• Placidi GP, Oquendo MA, Malone KM, Brodsky B, Ellis SP, Mann JJ. Anxiety in major depression: relationship to suicide attempts. Am J Psychiatry. 2000;157(10):1614-1618.
• Gil S. The role of personality traits in the understanding of suicide attempt behavior among psychiatric patients. Arch Suicide Res. 2003;7(2):159-166.
• Mendlowicz MV, Stein MB. Quality of life in individuals with anxiety disorders. Am J Psychiatry. 2000;157(5):669-682.
• Pellegrini L, Maietti E, Rucci P, Casadei G, Maina G, Fineberg NA, et al. Suicide attempts and suicidal ideation in patients with obsessive-compulsive disorder: A systematic review and meta-analysis. J Affect Disord. 2020;276:1001-1021.
• Angelakis I, Gooding P, Tarrier N, Panagioti M. Suicidality in obsessive compulsive disorder (OCD): a systematic review and meta-analysis. Clin Psychol Rev. 2015;39:1-15.
• Kim H, Seo J, Namkoong K, Hwang EH, Sohn SY, Kim SJ, et al. Alexithymia and perfectionism traits are associated with suicidal risk in patients with obsessive-compulsive disorder. J Affect Disord. 2016;192:50-55.
• Oncu B, Sakarya D. (2013). Suicidal Behavior in Eating Disorders. Current Approaches in Psychiatry. 2013;5(1):48-60.
• Udo T, Bitley S, Grilo CM. Suicide attempts in US adults with lifetime DSM-5 eating disorders. BMC Med. 2019;17(1):120. DOI: 10.1186/s12916-019-1352-3.
• Milos G, Spindler A, Schnyder U, Martz J, Hoek HW, Willi J. Incidence of severe anorexia nervosa in Switzerland: 40 years of development. Int J Eat Disord. 2004;36(1):118-119.
• Franko DL, Keel PK. Suicidality in eating disorders: occurrence, correlates, and clinical implications. Clin Psychol Rev. 2006;26:769-782.
• Franko DL, Keel PK, Dorer DJ, Blais MA, Delinsky SS, Eddy KT, et al. What predicts suicide attempts in women with eating disorders? Psychological medicine, 2004;34(5):843-853.
• Castillo-Carniglia A, Keyes KM, Hasin DS, Cerdá M. Psychiatric comorbidities in alcohol use disorder. Lancet Psychiatry. 2019;6(12):1068-1080.
• Berglund M. Suicide in alcoholism. Arch Gen Psychiatry. 1984;41:888-891.
• Holmstrand C, Bogren M, Mattisson C, Brådvik L. Long-term suicide risk in no, one or more mental disorders: the Lundby Study 1947-1997. Acta Psychiatr Scand. 2015;132(6):459-469.
• Oquendo MA, Currier D, Liu SM, Hasin DS, Grant BF, Blanco C. Increased risk for suicidal behavior in comorbid bipolar disorder and alcohol use disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). J Clin Psychiatry. 2010;71(7):902-909.
• Murphy GE, Wetzel RD, Robins E, McEvoy L. Multiple risk factors predict suicide in alcoholism. Arch Gen Psychiatry. 1992;49(6):459-463.
• Evren EC, Üstünsoy S, Can S, Başoğlu C, Çakmak D. Alkol/madde bağımlılarında özkıyım girişimi öyküsünün klinik belirtilerle ilişkisi. Klinik Psikiyatri Dergisi. 2003;6(2):86-94.
• Nery FG, Soares JC. Comorbid bipolar disorder and substance abuse: evidence-based options. Curr Psychiatry. 2018;10:57-67.
• Rodríguez-Cintas L, Daigre C, Braquehais MD, Palma-Alvarez RF, Grau-López L, Ros-Cucurull E, et al. Factors associated with lifetime suicidal ideation and suicide attempts in outpatients with substance use disorders. Psychiatry Res. 2018;262:440-445.
• Lynch FL, Peterson EL, Lu CY, Hu Y, Rossom RC, Waitzfelder BE, et al. Substance use disorders and risk of suicide in a general US population: a case control study. Addict Sci Clin Pract. 2020;15(1):14. DOI: 10.1186/s13722-020-0181-1.
• Ak M, Gülsün M, Özmenler KN. Özkıyım ve kişilik. Psikiyatride Güncel Yaklaşımlar. 2009;1:45-54.
• Schneider B, Wetterling T, Sargk D, Schneider F, Schnabel A, Maurer K, et al. Axis I disorders and personality disorders as risk factors for suicide. Eur Arch Psychiatry Clin Neurosci. 2006;256(1):17-27.
• Black DW, Blum N, Pfohl B, Hale N. Suicidal behavior in borderline personality disorder: prevalence, risk factors, prediction, and prevention. J Pers Disord. 2004;18(3):226-239.
• Paris J. Estimating the prevalence of personality disorders in the community. J Pers Disord. 2010;24(4):405-411.
• Isometsä ET, Henriksson MM, Heikkinen ME, Aro HM, Marttunen MJ, Kuoppasalmi KI, et al. Suicide among subjects with personality disorders. Am J Psychiatry. 1996;153(5):667-673.
• Yalvaç HD, Kaya B, Ünal S. İntihar girişimi ile başvuran bireylerde kişilik bozukluğu ve bazı klinik değişkenler. Anadolu Psikiyatri Derg. 2014;15:24-30.
• Ruggieri V. Autismo, depresión y riesgo de suicidio [Autism, depression and risk of suicide]. Medicina (B Aires). 2020;80(Suppl2):12-16.
• Motto JA, Bostrom AG. A randomized controlled trial of postcrisis suicide prevention. Psychiatric Services. 2001;52(6):828-833.
• Han B, Compton WM, Gfroerer J, McKeon R. Mental health treatment patterns among adults with recent suicide attempts in the United States. American Journal of Public Health. 2014;104(12):2359-2368.
• Hickey L, Hawton K, Fagg J, Weitzel H. Deliberate self-harm patients who leave the accident and emergency department without a psychiatric assessment: a neglected population at risk of suicide. J Psychosom Res. 2001;50(2):87-93.
• Ata EE, Bayrak NG, Yılmaz EB. İntihar girişimi nedeniyle acil servise başvuran olguların incelenmesi: bir yıllık retrospektif bir çalışma. Cukurova Medical Journal. 2021;46(4):1675-1686.
• Caring for Adult Patients with Suicide Risk. A Consensus Guide for Emergency Departments. Suicide Prevention Resource Center. Education Development Center; 2015.
• Crane EH. Patients with Drug-Related Emergency Department Visits Involving Suicide Attempts Who Left Against Medical Advice. In: The CBHSQ Report. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2013.