Psikiyatrik Acillerde İntihara Yaklaşım
Özet
Psikiyatrik aciller ve intihar krizleri, bireyin işlevselliğini bozan ve kendine zarar verme riski taşıyan akut durumlardır. Dünya genelinde her yıl 800.000'den fazla insan intihar nedeniyle ölmektedir; bu doğrultuda Dünya Sağlık Örgütü intiharı küresel bir halk sağlığı krizi ilan etmiştir. Acil servislere yapılan tıbbi başvurularda gizli intihar düşüncesi oranının %11'i aşmasına karşın, sağlık çalışanlarının eğitim eksikliği ve intihar hakkında konuşmanın riskleri artıracağı yanılgısı gibi nedenlerle tarama ve sorgulama oranları oldukça düşüktür. İntihar girişimlerinde ilk olarak hayati önem taşıyan tıbbi müdahale sağlanmalı, ardından risk azaltıcı etkisi kanıtlanmış psikiyatri konsültasyonları planlanmalıdır. İntihar riskini kesin öngören bir araç bulunmamakla birlikte; geçmiş intihar girişimleri, psikiyatrik hastalıklar, alkol-madde kullanımı, kronik veya ağrılı tıbbi rahatsızlıklar ile travmatik yaşam olayları en güçlü risk faktörlerini oluşturur. Vakalar düşük, orta ve ciddi risk grupları olarak sınıflandırılarak yönetilmeli; hastaların durumuna uygun güvenlik planları oluşturulmalı ve ölümcül araçlara erişimleri mutlaka sınırlandırılmalıdır.
Psychiatric emergencies and suicidal crises are acute conditions that impair an individual's functioning and carry a risk of self-harm. Globally, more than 800,000 people die by suicide each year, leading the World Health Organization to declare suicide a global public health crisis. Although the rate of hidden suicidal ideation exceeds 11% in medical emergency presentations, screening and inquiry rates remain considerably low due to a lack of training among healthcare professionals and the misconception that discussing suicide increases risks. In suicide attempts, vital medical intervention must be provided first, followed by psychiatric consultations, which have a proven risk-reducing effect. While there is no tool to definitively predict suicide risk, prior suicide attempts, psychiatric disorders, alcohol-substance use, chronic or painful medical conditions, and traumatic life events constitute the strongest risk factors. Cases should be managed by classifying them into low, moderate, and severe risk groups, tailored safety plans must be developed for patients, and their access to lethal means must be strictly restricted.
Referanslar
Orum MH. Acil Servise Baaşvuran Psikiyatrik Olgular ve Konsültasyon Liyezon Psikiyatrisi. J ADEM. 2020;1(2):31–52.
Principles of preventive psychiatry. - PsycNET [Internet]. [cited 2022 Jul 22]. Available from: https://psycnet.apa.org/record/1965-02239-000
Williamson J. Crisis Admission Units and Emergency Psychiatric Services (Public Health in Europe 11) By J.E. COOPER. Published by W.H.O. Copenhagen. pp 118. Price Sw.fr.11: http://dx.doi.org/101177/002076408202800414 [Internet]. 2016 Jul 27 [cited 2022 Jul 22];28(4):319. Available from: https://journals.sagepub.com/doi/10.1177/002076408202800414
Özgüven HD. İntihar Girişimlerinde Krize Müdahale. Kriz Derg [Internet]. 2005;11(1):025–34. Available from: https://dergipark.org.tr/tr/doi/10.1501/Kriz_0000000187
Deniz İ, Ersöz DAG, İldeş N, Türkarslan DN. 1995 - 2000 Yılları Resmi Kayıtlarından Batman’da Gerçekleşen İntihar ve İntihar Girişimleri Üzerine Bir İnceleme. Sos Polit Çalışmaları Derg [Internet]. 2001 Mar 1 [cited 2022 Jul 22];4(4). Available from: https://dergipark.org.tr/tr/pub/spcd/issue/21118/227467
Harmer B, Lee S, Duong T vi H, Saadabadi A. Suicidal Ideation [Internet]. StatPearls. StatPearls Publishing; 2022 [cited 2022 Jul 15]. 415–420 p. Available from: https://www.ncbi.nlm.nih.gov/books/NBK565877/
Boudreaux ED, Larkin C, Kini N, Capoccia L, Allen MH, Goldstein Grumet J, et al. Predictive utility of an emergency department decision support tool in patients with active suicidal ideation. Psychol Serv [Internet]. 2018 Aug 1 [cited 2022 Jul 22];15(3):270–8. Available from: /pmc/articles/PMC6082179/
Betz ME, Sullivan AF, Manton AP, Espinola JA, Miller I, Camargo CA, et al. Knowledge, attitudes, and practices of emergency department providers in the care of suicidal patients. Depress Anxiety [Internet]. 2013 Oct [cited 2022 Jul 22];30(10):1005–12. Available from: /pmc/articles/PMC4350671/
Gündüz N. Aci̇l Servi̇ste Özkıyım Düşüncesi̇ ve Davranışının Değerlendi̇ri̇lmesi̇ ve Yöneti̇mi̇. In: Acil Yaklaşımlar. Akademisyen; 2019. p. 647–60.
Bowers A, Meyer C, Hillier S, Blubaugh M, Roepke B, Farabough M, et al. Suicide risk assessment in the emergency department: Are there any tools in the pipeline? Am J Emerg Med [Internet]. 2018 Apr 1 [cited 2022 Jul 22];36(4):630–6. Available from: https://pubmed.ncbi.nlm.nih.gov/28970025/
Ahmedani BK, Simon GE, Stewart C, Beck A, Waitzfelder BE, Rossom R, et al. Health care contacts in the year before suicide death. J Gen Intern Med [Internet]. 2014 Jun 25 [cited 2022 Jul 22];29(6):870–7. Available from: https://pubmed.ncbi.nlm.nih.gov/24567199/
Saini P, Chantler K, Kapur N. General practitioners’ perspectives on primary care consultations for suicidal patients. Health Soc Care Community [Internet]. 2016 May 1 [cited 2022 Jul 22];24(3):260–9. Available from: https://pubmed.ncbi.nlm.nih.gov/25661202/
Feldman MD, Franks P, Duberstein PR, Vannoy S, Epstein R, Kravitz RL. Let’s not talk about it: suicide inquiry in primary care. Ann Fam Med [Internet]. 2007 Sep 1 [cited 2022 Jul 22];5(5):412–8. Available from: https://pubmed.ncbi.nlm.nih.gov/17893382/
Ata EE, Bayrak NG, Bahadır Yılmaz E. İntihar girişimi nedeniyle acil servise başvuran olguların incelenmesi: bir yıllık retrospektif bir çalışma. Cukurova Med J [Internet]. 2021 Dec 30 [cited 2022 Jul 22];46(4):1675–86. Available from: https://app.trdizin.gov.tr/makale/TkRZNE16STRPQT09/intihar-girisimi-nedeniyle-acil-servise-basvuran-olgularin-incelenmesi-bir-yillik-retrospektif-bir-calisma
Weber AN, Michail M, Thompson A, Fiedorowicz JG. Psychiatric Emergencies: Assessing and Managing Suicidal Ideation. Med Clin North Am [Internet]. 2017 May 1 [cited 2022 Jul 22];101(3):553–71. Available from: https://pubmed.ncbi.nlm.nih.gov/28372713/
Keten HS, Hakkoymaz H, Aslan Ü, Bahar Ş, Keten A, Sucaklı MH, et al. Acil Servise İntihar Girişimi Nedeniyle Başvuran Olguların İncelenmesi. J Contemp Med [Internet]. 2015 [cited 2022 Jul 23];5(2):102–5. Available from: https://www.readcube.com/articles/10.16899%2Fctd.18672
Son JM, Jeong J, Ro YS, Hong W, Hong KJ, Song K-J, et al. Effect of previous emergency psychiatric consultation on suicide re-attempts - A multi-center observational study. Am J Emerg Med [Internet]. 2020 Sep 1 [cited 2022 Jul 23];38(9):1743–7. Available from: https://pubmed.ncbi.nlm.nih.gov/32738470/
Pokorny AD. Prediction of suicide in psychiatric patients. Report of a prospective study. Arch Gen Psychiatry [Internet]. 1983 Mar 1 [cited 2022 Jul 23];40(3):249–57. Available from: https://pubmed.ncbi.nlm.nih.gov/6830404/
Betz ME, Boudreaux ED. Managing Suicidal Patients in the Emergency Department. Ann Emerg Med [Internet]. 2016 Feb 1 [cited 2022 Jul 23];67(2):276–82. Available from: https://pubmed.ncbi.nlm.nih.gov/26443554/
Dazzi T, Gribble R, Wessely S, Fear NT. Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence? Psychol Med [Internet]. 2014 Dec 7 [cited 2022 Jul 23];44(16):3361–3. Available from: https://pubmed.ncbi.nlm.nih.gov/24998511/
Öncü B. İntihar Eğilimi Olan Hastaya Acil Müdahale. Kriz Derg [Internet]. 2006;14(2):31–9. Available from: https://dergipark.org.tr/tr/doi/10.1501/Kriz_0000000277
Owens C, Lambert H, Donovan J, Lloyd KR. A qualitative study of help seeking and primary care consultation prior to suicide. Br J Gen Pract [Internet]. 2005 Jul 7 [cited 2022 Jul 23];55(516):503–9. Available from: /pmc/articles/PMC1472785/
Fowler JC. Suicide risk assessment in clinical practice: pragmatic guidelines for imperfect assessments. Psychotherapy (Chic) [Internet]. 2012 Mar [cited 2022 Jul 23];49(1):81–90. Available from: https://pubmed.ncbi.nlm.nih.gov/22369082/
Baca-Garcia E, Perez-Rodriguez MM, Oquendo MA, Keyes KM, Hasin DS, Grant BF, et al. Estimating risk for suicide attempt: are we asking the right questions? Passive suicidal ideation as a marker for suicidal behavior. J Affect Disord [Internet]. 2011 Nov [cited 2022 Jul 24];134(1–3):327–32. Available from: /pmc/articles/PMC3172880/
Mann JJ, Waternaux C, Haas GL, Malone KM. Toward a clinical model of suicidal behavior in psychiatric patients. Am J Psychiatry [Internet]. 1999 Feb [cited 2022 Jul 24];156(2):181–9. Available from: https://pubmed.ncbi.nlm.nih.gov/9989552/
Kessler RC, Borges G, Walters EE. Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey. Arch Gen Psychiatry [Internet]. 1999 Jul 1 [cited 2022 Jul 24];56(7):617–26. Available from: https://pubmed.ncbi.nlm.nih.gov/10401507/
Patterson WM, Dohn HH, Bird J, Patterson GA. Evaluation of suicidal patients: the SAD PERSONS scale. Psychosomatics [Internet]. 1983 Apr [cited 2022 Jul 24];24(4):343–5, 348–9. Available from: https://pubmed.ncbi.nlm.nih.gov/6867245/
Allen MH, Abar BW, McCormick M, Barnes DH, Haukoos J, Garmel GM, et al. Screening for suicidal ideation and attempts among emergency department medical patients: instrument and results from the Psychiatric Emergency Research Collaboration. Suicide Life Threat Behav [Internet]. 2013 Jun [cited 2022 Jul 24];43(3):313–23. Available from: https://pubmed.ncbi.nlm.nih.gov/23413776/
Atay İM, Gündoğar D. İntihar Davranışında Risk Faktörleri: Bir Gözden Geçirme. Kriz Derg [Internet]. 2005 Sep 1 [cited 2022 Jul 24];12(3):039–52. Available from: https://dergipark.org.tr/tr/pub/kriz/issue/41072/496446
Maris RW. Suicide. Lancet (London, England) [Internet]. 2002 Jul 27 [cited 2022 Jul 24];360(9329):319–26. Available from: https://pubmed.ncbi.nlm.nih.gov/12147388/
Suokas J, Lönnqvist J. Outcome of attempted suicide and psychiatric consultation: risk factors and suicide mortality during a five-year follow-up. Acta Psychiatr Scand [Internet]. 1991 Dec [cited 2022 Jul 24];84(6):545–9. Available from: https://pubmed.ncbi.nlm.nih.gov/1792928/
Borges G, Nock MK, Haro Abad JM, Hwang I, Sampson NA, Alonso J, et al. Twelve-month prevalence of and risk factors for suicide attempts in the World Health Organization World Mental Health Surveys. J Clin Psychiatry [Internet]. 2010 Dec 15 [cited 2022 Jul 24];71(12):1617–28. Available from: https://pubmed.ncbi.nlm.nih.gov/20816034/
Ostamo A, Lönnqvist J. Excess mortality of suicide attempters. Soc Psychiatry Psychiatr Epidemiol [Internet]. 2001 Jan 12 [cited 2022 Jul 24];36(1):29–35. Available from: https://pubmed.ncbi.nlm.nih.gov/11320805/
Beghi M, Rosenbaum JF, Cerri C, Cornaggia CM. Risk factors for fatal and nonfatal repetition of suicide attempts: a literature review. Neuropsychiatr Dis Treat [Internet]. 2013 Nov 8 [cited 2022 Jul 24];9:1725–36. Available from: https://pubmed.ncbi.nlm.nih.gov/24235836/
Olfson M, Wall M, Wang S, Crystal S, Gerhard T, Blanco C. Suicide Following Deliberate Self-Harm. Am J Psychiatry [Internet]. 2017 Aug 1 [cited 2022 Jul 25];174(8):765–74. Available from: https://pubmed.ncbi.nlm.nih.gov/28320225/
Rich CL, Runeson BS. Similarities in diagnostic comorbidity between suicide among young people in Sweden and the United States. Acta Psychiatr Scand [Internet]. 1992 Nov [cited 2022 Jul 25];86(5):335–9. Available from: https://pubmed.ncbi.nlm.nih.gov/1485522/
Stovall J, Domino FJ. Approaching the Suicidal Patient. Vol. 68, American Family Physician. 2003. p. 1814–8.
Mann JJ. A current perspective of suicide and attempted suicide. Ann Intern Med [Internet]. 2002 Feb 19 [cited 2022 Jul 25];136(4):302–11. Available from: https://pubmed.ncbi.nlm.nih.gov/11848728/
Foster T, Gillespie K, McClelland R. Mental disorders and suicide in Northern Ireland. Br J Psychiatry [Internet]. 1997 May 3 [cited 2022 Jul 25];170(5):447–52. Available from: https://pubmed.ncbi.nlm.nih.gov/9307695/
Sher L. Risk and Protective Factors for Suicide in Patients with Alcoholism. Sci World J [Internet]. 2006 Oct 31 [cited 2022 Jul 25];6:1405–11. Available from: https://pubmed.ncbi.nlm.nih.gov/17086346/
Murphy GE, Hawton K, van Heeringen K. Psychiatric aspects of suicidal behaviour: Substance abuse. Int Handb suicide attempted suicide. 2000 Jan 1;135–46.
Lukens TW, Wolf SJ, Edlow JA, Shahabuddin S, Allen MH, Currier GW, et al. Clinical policy: critical issues in the diagnosis and management of the adult psychiatric patient in the emergency department. Ann Emerg Med [Internet]. 2006 Jan [cited 2022 Jul 25];47(1):79–99. Available from: https://pubmed.ncbi.nlm.nih.gov/16387222/
Coshal S, Saunders J, Matorin AA, Shah AA. Evaluation of Depression and Suicidal Patients in the Emergency Room. Psychiatr Clin North Am [Internet]. 2017 Sep 1 [cited 2022 Jul 25];40(3):363–77. Available from: https://pubmed.ncbi.nlm.nih.gov/28800795/
Verona E, Sachs-Ericsson N, Joiner TE. Suicide attempts associated with externalizing psychopathology in an epidemiological sample. Am J Psychiatry [Internet]. 2004 Mar [cited 2022 Jul 25];161(3):444–51. Available from: https://pubmed.ncbi.nlm.nih.gov/14992969/
Tran T, Luo W, Phung D, Harvey R, Berk M, Kennedy RL, et al. Risk stratification using data from electronic medical records better predicts suicide risks than clinician assessments. BMC Psychiatry [Internet]. 2014 Mar 14 [cited 2022 Jul 25];14(1):76. Available from: https://pubmed.ncbi.nlm.nih.gov/24628849/
Henriksson MM, Isometsä ET, Hietanen PS, Aro HM, Lönnqvist JK. Mental disorders in cancer suicides. J Affect Disord [Internet]. 1995 Dec 24 [cited 2022 Jul 25];36(1–2):11–20. Available from: https://pubmed.ncbi.nlm.nih.gov/8988260/
Andreasen NC, Black DW. Introductory textbook of psychiatry. American Psychiatric Publishing Inc.; 2001. 834 p.
Erlangsen A, Vach W, Jeune B. The effect of hospitalization with medical illnesses on the suicide risk in the oldest old: a population-based register study. J Am Geriatr Soc [Internet]. 2005 May [cited 2022 Jul 25];53(5):771–6. Available from: https://pubmed.ncbi.nlm.nih.gov/15877551/
Cohen A, Chapman BP, Gilman SE, Delmerico AM, Wieczorek W, Duberstein PR, et al. Social inequalities in the occurrence of suicidal ideation among older primary care patients. Am J Geriatr Psychiatry [Internet]. 2010 Dec [cited 2022 Jul 25];18(12):1146–54. Available from: https://pubmed.ncbi.nlm.nih.gov/20808098/
Devries KM, Mak JY, Bacchus LJ, Child JC, Falder G, Petzold M, et al. Intimate partner violence and incident depressive symptoms and suicide attempts: a systematic review of longitudinal studies. Tsai AC, editor. PLoS Med [Internet]. 2013 May 7 [cited 2022 Jul 25];10(5):e1001439. Available from: https://pubmed.ncbi.nlm.nih.gov/23671407/
Kazan D, Calear AL, Batterham PJ. The impact of intimate partner relationships on suicidal thoughts and behaviours: A systematic review. J Affect Disord [Internet]. 2016 Jan 15 [cited 2022 Jul 25];190:585–98. Available from: https://pubmed.ncbi.nlm.nih.gov/26583348/
Gray BP, Dihigo SK. Suicide risk assessment in high-risk adolescents. Nurse Pract [Internet]. 2015 Sep 13 [cited 2022 Jul 25];40(9):30–7; quiz 37–8. Available from: https://pubmed.ncbi.nlm.nih.gov/26262455/
Beautrais AL, Joyce PR, Mulder RT. Precipitating factors and life events in serious suicide attempts among youths aged 13 through 24 years. J Am Acad Child Adolesc Psychiatry [Internet]. 1997 Nov [cited 2022 Jul 25];36(11):1543–51. Available from: https://pubmed.ncbi.nlm.nih.gov/9394939/
Ramirez J. Suicide: Across the Life Span. Nurs Clin North Am [Internet]. 2016 Jun 1 [cited 2022 Jul 25];51(2):275–86. Available from: https://pubmed.ncbi.nlm.nih.gov/27229281/
Menon V. Suicide risk assessment and formulation: an update. Asian J Psychiatr [Internet]. 2013 Oct [cited 2022 Jul 25];6(5):430–5. Available from: https://pubmed.ncbi.nlm.nih.gov/24011694/
Dervic K, Oquendo MA, Grunebaum MF, Ellis S, Burke AK, Mann JJ. Religious affiliation and suicide attempt. Am J Psychiatry [Internet]. 2004 Dec [cited 2022 Aug 3];161(12):2303–8. Available from: https://pubmed.ncbi.nlm.nih.gov/15569904/
Devrimci-Ozguven H, Sayil I. Suicide attempts in Turkey: results of the WHO-EURO Multicentre Study on Suicidal Behaviour. Can J Psychiatry [Internet]. 2003 Jun 1 [cited 2022 Aug 3];48(5):324–9. Available from: https://pubmed.ncbi.nlm.nih.gov/12866338/
Donald M, Dower J, Correa-Velez I, Jones M. Risk and protective factors for medically serious suicide attempts: a comparison of hospital-based with population-based samples of young adults. Aust N Z J Psychiatry [Internet]. 2006 Jan 26 [cited 2022 Aug 3];40(1):87–96. Available from: https://pubmed.ncbi.nlm.nih.gov/16403044/
Chu C, Klein KM, Buchman-Schmitt JM, Hom MA, Hagan CR, Joiner TE. Routinized Assessment of Suicide Risk in Clinical Practice: An Empirically Informed Update. J Clin Psychol [Internet]. 2015 Dec 1 [cited 2022 Jul 25];71(12):1186–200. Available from: https://pubmed.ncbi.nlm.nih.gov/26287362/
Fiedorowicz JG, Weldon K, Bergus G. Determining suicide risk (hint: a screen is not enough). J Fam Pract [Internet]. 2010 May [cited 2022 Jul 25];59(5):256–60. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20544044
Betz ME, Wintersteen M, Boudreaux ED, Brown G, Capoccia L, Currier G, et al. Reducing Suicide Risk: Challenges and Opportunities in the Emergency Department. Ann Emerg Med [Internet]. 2016 Dec 1 [cited 2022 Jul 25];68(6):758–65. Available from: https://pubmed.ncbi.nlm.nih.gov/27451339/
Detecting and treating suicide ideation in all settings. Sentin event alert [Internet]. 2016 Feb 24 [cited 2022 Jul 25];(56):1–7. Available from: https://pubmed.ncbi.nlm.nih.gov/26915165/
Gispert M, Davis MS, Marsh L, Wheeler K. Predictive factors in repeated suicide attempts by adolescents. Hosp Community Psychiatry [Internet]. 1987 Apr [cited 2022 Jul 25];38(4):390–3. Available from: https://pubmed.ncbi.nlm.nih.gov/3570186/
Malone KM, Oquendo MA, Haas GL, Ellis SP, Li S, Mann JJ. Protective factors against suicidal acts in major depression: reasons for living. Am J Psychiatry [Internet]. 2000 Jul [cited 2022 Jul 25];157(7):1084–8. Available from: https://pubmed.ncbi.nlm.nih.gov/10873915/
Kroll J. Use of no-suicide contracts by psychiatrists in Minnesota. Am J Psychiatry [Internet]. 2000 Oct;157(10):1684–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11007726
Stanley B, Brown GK, Brenner LA, Galfalvy HC, Currier GW, Knox KL, et al. Comparison of the Safety Planning Intervention With Follow-up vs Usual Care of Suicidal Patients Treated in the Emergency Department. JAMA psychiatry [Internet]. 2018 Sep 1 [cited 2022 Jul 26];75(9):894–900. Available from: https://pubmed.ncbi.nlm.nih.gov/29998307/
Delibaş DH, Erdoğan E. Sociodemographic and Clinical Characteristics of Patients with Suicide Attempt to a Training and Research Hospital Emergency Department; A Retrospective Study. Van Med J [Internet]. 2018 [cited 2022 Jul 26];25(4):514–9. Available from: https://app.trdizin.gov.tr/makale/TXpJMU5USTNOdz09/sociodemographic-and-clinical-characteristics-of-patients-with-suicide-attempt-to-a-training-and-research-hospital-emergency-department-a-retrospective-study
Mann JJ, Apter A, Bertolote J, Beautrais A, Currier D, Haas A, et al. Suicide prevention strategies: a systematic review. JAMA [Internet]. 2005 Oct 26 [cited 2022 Jul 26];294(16):2064–74. Available from: https://pubmed.ncbi.nlm.nih.gov/16249421/
Jena AB, Prasad V. Primary care physicians’ role in counseling about gun safety. Am Fam Physician [Internet]. 2014 Nov 1 [cited 2022 Jul 26];90(9):619–20. Available from: https://pubmed.ncbi.nlm.nih.gov/25368919/
Green JD, Kearns JC, Rosen RC, Keane TM, Marx BP. Evaluating the Effectiveness of Safety Plans for Military Veterans: Do Safety Plans Tailored to Veteran Characteristics Decrease Suicide Risk? Behav Ther [Internet]. 2018 Nov 1 [cited 2022 Jul 26];49(6):931–8. Available from: https://pubmed.ncbi.nlm.nih.gov/30316491/
Grant CL, Lusk JL. A multidisciplinary approach to therapeutic risk management of the suicidal patient. J Multidiscip Healthc [Internet]. 2015 Jun 24 [cited 2022 Jul 26];8:291–8. Available from: https://pubmed.ncbi.nlm.nih.gov/26150725/
