Suicide prevention in psychiatric patients

IF 2.8 3区 医学 Q2 PSYCHIATRY Asia‐Pacific Psychiatry Pub Date : 2021-02-18 DOI:10.1111/appy.12450
Danuta Wasserman MD, PhD, Vladimir Carli MD, PhD, Miriam Iosue MPsych, Afzal Javed MD, PhD, Helen Herrman MD, PhD
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引用次数: 20

Abstract

An increased risk of suicide has been reported for psychiatric patients. In several world regions, an underlying psychiatric disorder is reported in up to 90% of people who die from suicide, though this rate seems to be considerably lower in low- and middle-income countries. Major psychiatric conditions associated with suicidality are mood disorders, alcohol and substance use disorders, borderline personality disorder, and schizophrenia. Comorbidity between different disorders is frequently associated with a higher suicide risk. A history of suicide attempts, feelings of hopelessness, impulsivity and aggression, adverse childhood experiences, severe psychopathology, and somatic disorders are common risk factors for suicide among psychiatric patients. Stressful life events and interpersonal problems, including interpersonal violence, are often triggers. A comprehensive and repeated suicide risk assessment represents the first step for effective suicide prevention. Particular attention should be paid during and after hospitalization, with the first days and weeks after discharge representing the most critical period. Pharmacological treatment of mood disorders and schizophrenia has been shown to have an anti-suicidal effect. A significant reduction of suicidal thoughts and behavior has been reported for cognitive behavioral therapy and dialectical behavior therapy. Brief interventions, including psychoeducation and follow-ups, are associated with a decrease in suicide deaths. Further development of suicide prevention in psychiatric patients will require a better understanding of additional risk and protective factors, such as the role of a person's decision-making capacity and social support, the role of spiritual and religious interventions, and the reduction of the treatment gap in mental health care.

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精神病患者的自杀预防
据报道,精神病患者自杀的风险增加。在世界上一些地区,据报告高达90%的自杀死亡者患有潜在的精神疾病,尽管这一比率在低收入和中等收入国家似乎要低得多。与自杀相关的主要精神疾病有情绪障碍、酒精和物质使用障碍、边缘型人格障碍和精神分裂症。不同疾病之间的共病通常与较高的自杀风险相关。自杀企图史、绝望感、冲动和攻击性、不良的童年经历、严重的精神病理和躯体疾病是精神病患者自杀的常见危险因素。紧张的生活事件和人际关系问题,包括人际暴力,通常是触发因素。全面和反复的自杀风险评估是有效预防自杀的第一步。在住院期间和住院后应特别注意,出院后的头几天和几周是最关键的时期。情绪障碍和精神分裂症的药物治疗已被证明具有抗自杀效果。据报道,认知行为疗法和辩证行为疗法显著减少了自杀念头和行为。包括心理教育和随访在内的简短干预与自杀死亡的减少有关。精神病患者自杀预防的进一步发展将需要更好地了解额外的风险和保护因素,例如一个人的决策能力和社会支持的作用,精神和宗教干预的作用,以及缩小精神卫生保健的治疗差距。
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来源期刊
CiteScore
7.80
自引率
0.00%
发文量
17
审稿时长
>12 weeks
期刊介绍: Asia-Pacific Psychiatry is an international psychiatric journal focused on the Asia and Pacific Rim region, and is the official journal of the Pacific Rim College of Psychiatrics. Asia-Pacific Psychiatry enables psychiatric and other mental health professionals in the region to share their research, education programs and clinical experience with a larger international readership. The journal offers a venue for high quality research for and from the region in the face of minimal international publication availability for authors concerned with the region. This includes findings highlighting the diversity in psychiatric behaviour, treatment and outcome related to social, ethnic, cultural and economic differences of the region. The journal publishes peer-reviewed articles and reviews, as well as clinically and educationally focused papers on regional best practices. Images, videos, a young psychiatrist''s corner, meeting reports, a journal club and contextual commentaries differentiate this journal from existing main stream psychiatry journals that are focused on other regions, or nationally focused within countries of Asia and the Pacific Rim.
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