Suicide: A Précis!

Abstract

Background: Suicide remains a psychiatric emergency, tragedy, a public health burden, and for those aged 15-29, is the second leading cause of death globally. Stigma attached to psychiatric disorders and suicide means many people feel unable to seek help. Aim of Work: We highlighted confusing nosology, psychopathology, neurobiological underpinnings, typology, and, risk factor pertinent to suicide. A road-map to the clinical assessment and management of suicide has also been provided. Last, but not least, we tried to dispel the long-held myths about suicide. Methods: EMBASE, Ovid MEDLINE, PubMed, Scopus, Web of Science, and Cochrane Database of Systemic Reviews were searched for all relevant studies up to date of Jan, 2020. Results: Suicide is self-inflicted death with evidence (explicit/implicit) of intention to die. Suicide reflects many disparate determinants release/relief, response-to the disordered thinking, religious, revenge, rebirth, reunification or rational. 5-HT deficiency appears central to the neurobiology of suicide. Durkheim proposed 4 types of suicide (egoistic, altruistic, anomic, fatalistic). Risk factors for suicide entail both static and dynamic factors. Dynamic factors encompass both clinical and situational variables. Shneidman's concepts of perturbation and psychache are very crucial to consider when assessing the risk. Suicide rating scales are only ancillary with the Modified high-risk construct scale balances vectors of suicidality versus survivality. Myths germane to suicide abound that need to be demystified. Psychiatric management capitalizes on determining a setting for treatment and supervision, attending to patient's safety, as well as working to establish a cooperative and collaborative physician-patient relationship. This entails both psychosocial 'package' and somatic treatments and the best outcomes mandate well-keeled combined approaches. Pharmacologic interventions aim chiefly at acute symptomatic relief. Recently, heaps of data accrue speaking to the idea of ground-breaking 'anti-suicidal' agents that might alleviate suicidal ideation (SI) Conclusion: Suicide continues to be a complex public health problem of global calibre. It is variably tied to a myriad of risk factors underscoring likely etiological heterogeneity. That said, suicides can, at least partially, be prevented by restricting access to means of suicide, by training primary care physicians and health workers to identify people at risk as well as to assess and manage respective crises, provide adequate follow-up care and address the way this is portrayed in the media. A host of psychotherapeutic, pharmacological, or neuromodulatory treatments of mental disorders are readily available that can alter this acrimonious trajectory.

Suicide ideation and psychotropic recreational drug use by adolescents: a systematic review and meta-analysis

“…118 Various policies, including firearm access restrictions, awareness of communication media on the importance of addressing the topic correctly, identification of people at risk, 13 and the provision of psychotherapeutic, pharmacological, or neuromodulatory treatment, and training of health professionals to identify people at risk for suicide and offer proper care, are essential for effective suicide prevention efforts. 119 Programs for drug use prevention targeting adolescent drug use should incorporate discussions on bullying (both practicing and being a victim) 9 and strategies for addressing associated problems, such as interpersonal conflicts, anxiety, loneliness, an intimidating environment, a lack of support from parents and close friends, sedentary behavior, 108 and drug use, as evidenced in the present systematic review. A systematic review and meta-analysis concluded that the development of interpersonal skills, emotional regulation, and alcohol and drug education significantly impacted mental health 120 .…”

“… 118 Various policies, including firearm access restrictions, awareness of communication media on the importance of addressing the topic correctly, identification of people at risk, 13 and the provision of psychotherapeutic, pharmacological, or neuromodulatory treatment, and training of health professionals to identify people at risk for suicide and offer proper care, are essential for effective suicide prevention efforts. 119 …”

Suicide in Global Mental Health

“…Suicidal thoughts are the consideration of or desire to end one’s life and range from passive ideation (e.g., thoughts of wanting to be dead) to active ideation (e.g., wanting to kill oneself) [ 14 ]. Suicidal behaviors include self-directed, potentially injurious behavior accompanied by intent to die [ 15 ]. Although the progression from ideation to behavior is not always linear, these have been traditionally theorized as taking place over a continuum from thoughts to attempt or death from suicide [ 16 ].…”

Voluntary assisted dying (VAD) in Australasia and ‘coup de grâce’ in Islam

“…2 Evidence for this position is commonplace in that almost all suicide attempters are subsequently grateful that they did not succeed. 3…”