Suicide, attempted

Recurrent thoughts of death or suicide (or suicide attempt)... 

The lymphocytes from 31 patients exposed to various organophosphate pesticides were examined for chromosomal aberrations (Van Bao et al. 1974). Five of the patients were exposed to methyl parathion only. Blood samples were taken 3-6 days after exposure and again at 30 and 180 days. A significant (p<0.05) increase was noted in the frequency of stable chromosomal aberrations in acutely intoxicated persons (although such cells are eventually lost from the cell population). Two of the methyl parathion-exposed persons had taken large doses orally in suicide attempts. The study limitations include small sample size, absence of a control group, lack of quantification of exposure levels, and possible... 

In a similar study, the lymphoeytes from live patients who ingested methyl parathion (Wofatox) in suicide attempts were examined for aneuploidy, chromatid aberrations, and ehromosome aberrations (Czeizel 1994). No significant differences from the 15 control patients were seen in these end points. 

Suicidal or history of frequent suicide attempts Clozapine ... 

One extremely important outcome in the treatment of major depressive disorder is the prevention of suicidal attempts. 

The obvious goal of therapy for the depressed patient is the resolution of depressive symptoms and a return to euthymia. Once symptoms have resolved, then the purpose of ongoing therapy is to prevent relapse and recurrence of depressive symptoms. One extremely important outcome in the treatment of MDD is the prevention of suicidal attempts. Other essential outcomes include improvement of the patient s quality of life, normalization of functioning in areas such as work and relationships, avoidance or minimization of adverse effects, and reduction of health care costs.15... 

The mean age of onset of bipolar disorder is 20, although onset may occur in early childhood to the mid-40s.1 If the onset of symptoms occurs after 60 years of age, the condition is probably secondary to medical causes. Early onset of bipolar disorder is associated with greater comorbidities, more mood episodes, a greater proportion of days depressed, and greater lifetime risk of suicide attempts, compared to bipolar disorder with a later onset. Substance abuse and anxiety disorders are more common in patients with an early onset. Patients with bipolar disorder also have higher rates of suicidal thinking, suicidal attempts, and completed suicides. 

Patients with bipolar disorder have a high risk of suicide. Factors that increase that risk are early age at disease onset, high number of depressive episodes, comorbid alcohol abuse, personal history of antidepressant-induced mania, and family history of suicidal behavior.15 In those with bipolar disorder, 1 of 5 suicide attempts are lethal, in contrast to 1 of 10 to 1 of 20 in the general population. 

Assess for the safety of others and potential for violence. If accompanied by friends or family with whom the patient is living, ask them to remove from the home all guns, caustic chemicals, medications, and objects the person might use to harm self or others. Risk factors for suicide include severity of depression, feelings of hopelessness, comorbid personality disorder, and a history of a previous suicide attempt.19... 

Finally, all of the trials in the FDA data set included the same measure of depression, a physician-rated scale called the Hamilton Rating Scale for Depression (HRSD). The Hamilton scale is completed by doctors based on interviews and observations of patients. The doctor rates the patient s mood, thoughts about suicide, sleep disturbances and other symptoms of depression. For example, one point is given if the patient feels that life is not worth living, and four points are scored if the person has made a serious suicide attempt. The result is a numerical score that can range from o to 51. 

Fergusson, Dean, Steve Doucette, Kathleen Cranley Glass, Stan Shapiro, David Healy, Hebert Paul and Brian Hutton, Association between Suicide Attempts and Selective Serotonin Reuptake Inhibitors Systematic Review of Randomised Controlled Trials , British Medical Journal 330 (2005) 396-99... 

In the past several decades there has been increased incidence of depression, which motivated Gerald Klerman to describe this era as the age of melancholia [5], The lifetime prevalence of depression in the U.S. is higher in women (21.3%) than in men (12.7%). Although the rates of major depression vary across the world, data from fifty countries support the notion that this disease is the fourth leading cause of disability worldwide (second in developed countries) [3]. Longitudinal studies verify that the typical course of the disease is recurrent, with periods of recovery and periods of depression symptoms however, approximately 17% of patients have a chronic unremitting disease [6], Depression is the major cause of suicidal behavior and the rate of suicidal attempts has been estimated to be around 56% in depressed patients [7]. 

Chen, Y. W. and Dilsaver, S. C. Lifetime rates of suicide attempts among subjects with bipolar and unipolar disorders relative to subjects with other Axis I disorders. Biol. Psych. 39 896-899,1996. 

Delusions, hallucinations, and suicide attempts are more common in bipolar depression than in unipolar depression. 

Suicide attempts occur in up to 50% of patients with bipolar disorder, and approximately 10% to 19% of individuals with bipolar I disorder commit suicide. Bipolar II patients may be more likely than bipolar I patients to attempt suicide. 

Suicidal ideation or attempts (suicide completion rates with bipolar I disorder are 10-15% suicide attempts are primarily associated with depressive episodes, mixed episodes with severe depression or presence of psychosis)... 

Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide... 

If a person is having suicidal thoughts presently, then you should assess for any plans that he or she may have for carrying out a suicidal act. One way to be attuned to clients preferred plans is to ask them about means used in past suicide attempts or parasuicidal behavior. For example, if a person tells you that he attempted suicide by swallowing a handful of pills in the past, then you can ask if that idea has reoccurred to him recendy or if a client tells you she has burned herself in the past with a cigarette, you can ask if she has been thinking about doing that recendy. You also want to look for how specific the plan is to determine its... 

Berman, A. F., Shepherd, G., Silverman, M. M. (2003). The FSARS-II Fethal-ity of Suicide Attempt Rating Scale — Updated. Suicide and Life Threatening Behaviors, 33, 261-276. 

Smith, K., Conroy, R. W., Ehler, B. D. (1984). Lethality of Suicide Attempt Rating Scale. Suicide and Life Threatening Behaviors, 14, 215-242. 

Ingestion of 12 g of endrin (dissolved in aromatic hydrocarbons) by a 49-year-old man in a suicide attempt caused convulsions persisting for 4 days death occurred after 11 days (Runhaar et al. 1985). Death occurred in 11 other cases following ingestion of endrin the time from administration to death ranged from 1 to 6 hours. In cases where endrin ingestion occurred with milk or alcohol, death occurred more rapidly (within 1-2 hours) presumably as the result of enhanced absorption that increased toxicity (Tewari and Sharma 1978). 

Musculoskeletal Effects. Muscular rigidity was observed in humans after acute cyanide poisoning (Grandas et al. 1989) and rhabdomyolysis, a clinical syndrome characterized by skeletal muscle injury, was observed in a man who ingested 0.57 mg CNVkg in a suicide attempt (Saincher et al. 1994). 

Renal Effects. Information regarding renal effects of cyanide in humans is limited to one report. Albuminuria was found in a man during the first 2 days after ingestion of 15 mg CN /kg as potassium cyanide in a suicide attempt (Liebowitz and Schwartz 1948). 

There are two case reports of death in humans following oral administration of 1,2-dibromoethane in suicide attempts. 

No studies were located in humans regarding the oral absorption of 1,2-dibromoethane. However, there is evidence to suggest that oral absorption occurs in humans. Death and poisoning resulting from suicide attempts (Olmstead 1960 Saraswat et al. 1986) and from consumption of contaminated fruits, grains, and drinking water (ERA 1983), indicate that absorption occurred. 

One of the most carefully worked out dose-response relationships is that for carbon monoxide poisoning. Based on controlled studies of exposure in humans at low levels and on observations in humans who have suffered high level exposures because of their occupation or because of accidents or suicide attempts, the relationship between blood levels of carboxyhemoglobin (COHb) and toxicity is understood as follows ... 

Quite withdrawn and ruminative at times, he would suddenly come to life and enter into the ongoing discussion. During one interchange, he revealed he had once made a suicide attempt, which he had not mentioned during the pre-drug interview. His description of such experiences lacked much emotion. 

---