0

1

2

3

4

5

6

7

8

9

10

marriage divorce separated single

Marital Status

0

10

20

30

40

50

1 2 3 4 5 6 7 8 9 10 11 12

Starting Age of Psychiatric Treatment

0

10

20

30

40

50

60

70

1 2 3 4 5 6 7 8 9 10 11 12

Evolution of Treatment

Starting Age of Treatment Age at Death Years of Psychiatric Treatment

50%

33%

5% 6% 6%

Diagnoses mood disorders personality disorders somatoform disorder

eating disorder substance abuse

Family History 67%

No Family History

16%

Unspecified Family History

17%

FAMILY PSYCHIATRIC HISTORY

Consumption of Drugs 50%

No Consumption of Drugs 50%

DRUG USE

drug use 43% no

drug

use

57%

DRUG USE IN

WOMEN

drug use 60%

no drug use 40%

DRUG USE IN MEN

98

90 96

113

92 92

N/A

90 94 87

102 100

0

20

40

60

80

100

120

1 2 3 4 5 6 7 8 9 10 11 12

Intelligence Quotient

100%

83%

33%

67%

25%

75%

completesuicide

pastautoliticideation

currentautoliticideation

previoussuicide

attempts

presentsuicidal

behavior

pastsuicidal

behavior

Categories based on CSSRS

suicidal ideation

42% no suicidal

ideation in last visit 58%

STATE IN LAST VISIT

Introduction

Results

Conclusions

RISK FACTORS ASSOCIATED WITH SUICIDE Caroline Naya de Zayas

Director: Dr. Pilar de Castro Manglano

Facts • > 800,000 deaths worldwide per year • 2nd leading cause of death in 15-29 year olds globally in 2012. • There is 1 suicide for every 25 attempted suicides. •An estimated 1 million adults in U.S reported making a suicide attempt in the past year. Objectives •Identify common risk factors among patients who have committed suicide. •Create alerts to be used in the evaluation of patients at risk of suicide.

Methods

0

10

20

30

40

50

60

70

1 2 3 4 5 6 7 8 9 10 11 12

Age at Time of Suicide

42%

58%

Sex

male female

References

0%10%20%30%40%50%60%70%80%90%

100%

Categories based on MMPI

Family History Drug use Marital Status: Single Psychiatric Diagnosis: especially Mood Disorders, and Comorbidites with Personality Disorders Certain Personality Traits:

Impulsive Emotionally dependent Difficulty understanding social interactions Low distress tolerance Difficulty confronting and resolving problems Somatization Hopelessness Emptiness Insecure Hypersensitivity in relationships

Stress Factors Previous Suicide Attempts Previous Suicidal Behavior or Thoughts State in Last Visit

Especially after hospitalization for a suicidal attempt there is a higher risk of suicide. If now we see they are “stable” “no ideation” after a long evolution

•Beautrais AL. Risk factors for suicide and attempted suicide among young people. The Australian and New Zealand Journal of Psychiatry 2000 Jun;34(3):420-36. •Lewis, Melvin.; Martin, Andres; Volkmar, Fred R (2007), Lewis’s Child and Adolescent Psychiatry: A Comprehensive Textbook, 4th Edition. Suicidal Behavior in Children and Adolescents: Causes and Management. Lippincot Williams & Wilkins •Thomas Jans, Yesim Taneli & Andreas Warnke. (2012) International Association for Child and Adolescent Psychiatry and Allied Professions. Textbook of Child and Adolescent Mental Health Suicide and Self Harming Behaviour

•Selection of Cases Hospital’s psychiatric database of patients who had committed suicide in the past fifteen years. A total of twelve cases were selected for this study. •Analysis of Cases Using Excel several different categories were created .Categories were created based on the CSSRS, the MMPI, the IPDE, and the patient’s history. •Minnesota Multiphasic Personality Inventory (MMPI) 567 questions divided into ten different clinical scales: Hypochondriasis, Depression, Conversion Hysteria, Psychopathic Deviate, Masculinity-Feminity, Paranoia-, Psychasthenia, - Schizophrenia, Hypomania, Social Introversion •International Personality Disorder Examination (IPDE) Provides a uniform approach for assessing personality disorders •Columbia Suicide Severity Rating Scale (CSSRS) Instrument used in the evaluation of suicidal thoughts and suicidal behavior •Creation of Alerts/Risk Factors Using all of the information found in the study a new scale was created as a supplement to other suicidal evaluations

5 males and 7 females

The mean was 95.8 IQ. All presented average to above average intelligence in one of the cases.

2 cases married (cases 7 & 11) 1 case separated 9 single

Drug use was found in 50% of the cases. When divided by sexes drug use was found more in men (60%) than women (43%). The drugs used were mostly marihuana, alcohol, cocaine, and self-medication of psychiatric medicines.

67% of cases presented family psychiatric history, not necessarily of suicide. Family members presented depression, anxiety, drug abuse and 1 presented schizophrenia.

Majority began treatment between the ages of 10 and 25 (58%). The mean age of starting treatment was 24.6. The average age at time of suicide was 37.6 years. Mean years of treatment were 13.4 years.

90%: somatization, insecurity, hypersensitivity in relationships,stress factors 82%:emotional dependence, impulsive, low selfesteem, hopelessness, emptiness 73%: misinterpretation of social stimuli, low distress tolerance, difficulty adapting socially, guilt, difficulty confronting/resolving everyday problems 55%: unsatisfied, need approval of others 45%: avoids getting close to others 36%: looks for affection and acceptance, difficulty concentrating, irritabile. 27%: passive 18%:try to appear favorably or in control

Most common diagnoses were Mood Disorders (50%). Personality disorders were seen many times as co morbidities. There was 1 somatoform disorder and 1 patient with a co morbid eating disorder. Many consumed drugs but in the histories only 1 had a diagnosed substance abuse problem.

83%: past autolitic ideation 67% : previous suicide attempts Important to keep in mind past thoughts and behaviors in all future evaluations.

58% stable in last visit: •Occultation? •Need to evaluate more? •Missing information?