Suicide is a Latin word (sui= self, cide = kill).

The term SUICIDE is used to describe any deliberate act of self-harm, which results in death. By contrast ATTEMPTED SUICIDE includes any deliberate act of self–harm, which does not result in death.

Attempted suicide includes two categories of acts:

1. Deliberate self poisoning (or "overdose"),
2. Deliberate self-injury.

Deliberate self-poisoning describes the intentional ingestion of more than the prescribed amount of medical substances or ingestion of substances never intended for human consumption (e.g. insecticides, pesticides) irrespective of the intended outcome of the act. Deliberate self-injury describes intentional self-inflicted injury, slashing veins at the wrists etc again irrespective of the intended outcome.

Highly significant psychiatric factors in suicide include Depressive Disorder. Schizophrenic Disorder, Drug abuse and other mental disorders. 95% of the persons who commit or attempt suicide have diagnosable and treatable mental disorder. Depressive Disorder is detected in 75% cases and schizophrenic disorder in another 10% cases. The persons who have a history of impulsive behavior or violent acts are also at high risks.

Most commonly suicide seems to arise from a depressed person’s feeling that life is so unbearable that death is the only way out from great pain, financial loss, loss of self-esteem, terminal illness and other such circumstances. A suicidal person experiences hopelessness and helplessness: ambivalent conflicts between life and unending stress; and no apparent possibilities for change or improvement. These feelings and attitudes are distress signals. The next step is intentional self-inflicted death.

CLINICAL<

It is not necessary that all the persons who have suicidal ideation will express them. Therefore, whenever suicidal ideation are suspected it is obligatory on the part of the interviewer to ask the person about it directly. It is a myth that by asking the person about suicidal ideation, one may implant such ideas in his mind.

Suicidal ideation frequently follow the experience of some emotionally painful event like

• failure in love affair
• failure or poor academic performance
• quarrel with significant family member
• quarrel with friends
• loss in business
• rape.

People, who have experienced stressful life events which involve loss of self esteem or loss of social status are at a higher risk of suicidal attempt.

If any of the family or friends have attempted suicide, following factors suggest serious intent:

1. Act carried out in isolation
2. Act timed so that interventions by others is unlikely
3. Precautions taken to avoid discovery.
4. Preparation made in anticipation of death (making out a will).
5. Active planning done for the attempt.
6. Failing to inform potential helpers after the act.
7. Leaving a suicidal note.
8. Admission of suicidal intent.
9. Patient found in an unconscious state.

A common and serious mistake is to assume that the degree of suicidal intent can be gauged from the physical danger of the act. This assumption can be very misleading especially with overdoses, because many people have a little idea of what effect particular tablet or substance might have. Thus a person with serious suicidal intent might take small overdose of sleeping tablets, another with no thoughts of actual suicide might impulsively consume all the tablets in a large bottle.

It is necessary to dispel the myth that talkers would not attempt suicide and that talking can resolve all the problems of suicide.

MANAGEMENT

Some patients will require in patient psychiatric treatment particularly those judged to be at considerable risk of further immediate suicide.

Depending on psychiatric diagnosis, medication (antidepressants, antipsychotics) is given.

Electro-convulsive therapy (ECT) becomes a life saving measure in certain cases. The medication requires 2 to 4 weeks to show therapeutic effects whereas with ECT similar benefits are achieved within a week, ECT does not produce any brain damage.

Outpatient care will be appropriate for other cases. These include patients who are facing social, interpersonal and occupational difficulties.

Medication may be needed for these cases. Psychotherapy is required. The psychotherapy involves enabling the patient to make his own decisions or adaptation to the challenges, which he faces.