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

Öz

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.

Anahtar Kelimeler

• intihar
• acil servis
• psikiyatrik hastalıklar
• komorbidite

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

Öz

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.

Anahtar Kelimeler

• Suicide
• emergency service
• psychiatric diseases
• comorbidity

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