Causes of suicide:
uIndividual Psychiatric causes:
u Depressive disorder
u Alcohol dependence
u Substance dependence or abuse
u Schizophrenia
u Organic mental disorder
u Personality disorder
Social factors associated with suicide:
High unemployment
u Poverty
u Divorce
uSocial fragmentation
uMedia coverage of suicide
q Biological causes:1) family history of suicide is present
2)Decreased activity of 5-HT pathways.
q Psychological causes:
1)Feeling of hopelessness
2) Problem-solving deficit
3) Negative cognition
Care of suicidal patients:
uSafe ward environment
uAn adequate number of well-trained staff
uGood relationships between staff and patients.
On Admission:
1) Assess risk
2) Observation of the patients
3) Remove objects which might be used in suicide
4) Discuss with patients.
5) Regular review the risks.
6)The patient should not be allowed to leave the ward without notice or permission.
7) Prescribe medication
Prevention of suicide:
uBetter and more available psychiatric services
uRestricting the means of suicide
uEncouraging responsible reporting
uImproved care for high risk groups.
uCrisis centers and “hot lines”.
uEducational program.
Antidepressant drugs:
uTricyclic antidepressants: 1)Tertiary amines- amitriptyline, clomipramine, imipramine.
2)Secondary amines-desipramine, lofepramine, nortriptyline.
Side effects- Cardiotoxic
Anticholenergic side effects
Cognitive impairment
Weight gain in long-term Treatment:
Indication of antidepressant drugs
uDepressive episode
uMDD
uChild Psychiatric Disorder Enuresis, School phobia, separation anxiety disorder, Night terror.
uOther psychiatric disorders Panic attack, Agoraphobia, social phobia, OCD,GAD, PTSD etc.
uMedical conditions- Migraine, Chronic pain, Irritable Bowel Syndrome.
Oral doses:
uTricyclic tertiary amines Imipramine, Clomipramine, Amitriptyline, Tri-imipramine, Doxepine.
Oral dose 75-300mg
q Secondary amines Nortriptyline, desipramine
Dose-75-200mg
SSRIs- Fluoxetine10-60mg
Paroxetine 10-40mg
Fluvoxamine- 50-300mg
Sertraline 50-200mg
Citalopram10-40mg
Escitalopram- 10-20mg
uSerotonin- Nor epinephrine Reuptake Inhibitors (SNRI) 75-375mg
uNoradrenergic and specific serotonergic antidepressant (NASSA) Mirtazepine 15-45mg
uNoradrenergic Reuptake Inhibitors (NARI)
Reboxetine 8-10mg.
Organic
Mental Disorders:http://organicmentaldisorders.blogspot.com/
