Challenges and Outcome in Parasuicides Managment D

Challenges and Outcome in Parasuicide Management : 

Challenges and Outcome in Parasuicide Management Dr.Ehab Ali Sorketti Psychiatrist .M.B.B.S,M.P.M-UM-Malaysia UMMC University Malay Malaysia

Holiday Destination : 

Holiday Destination

UMMC : 

UMMC

Introduction : 

Introduction Worldwide, nonfatal, deliberate self-harm is usually most common in young people, especially young females Platt S, Bille-Brahe U, Kerkhof A et al. (1992), Parasuicide in Europe: the WHO/EURO Multicentre Study on Parasuicide. Introduction and preliminary analysis for 1989. Acta Psychiatr Scand 85:97–104

Introduction : 

Introduction Examination of the motives (or intentions) and premeditation involved. Hjelmeland H, Hawton K, Nordvik H et al. (2002), Why people engage in parasuicide: a cross-cultural study of intentions. Suicide Life Threat Behav 32:380–394

Introduction : 

Introduction There is a need of information on the motives widen our understanding of the motives, will provide information that can assist helping agencies and those planning preventive initiatives.

Aims of the study : 

Aims of the study 1- To compare the sociodemographic profiles

Aims of the study : 

Aims of the study 2- To compare the clinical presentation

Aims of the study : 

Aims of the study 3-To compare the psychosocial stressors, motives and reasons for attempted suicide

Methods : 

Methods All hospital treated parasuicide patients in UMMC between January–April 2005, were selected for the study. All parasuicide patients admitted to medical,surgical or psychiatric ward were interviewed by the investigator to complete: a Questionnaire and a self-report

Slide 14: 

Questionnaire 1- UH.R.N: 2-AGE: 3-SEX: MALE FEMALE 4-RACE: MALAY CHINESE INDIAN OTHER ------ 5-RELEGION: MUSLIM CHIRISTIAN HINDO BUDDIST OTHER----- 6-MARITAL STATUS: SINGLE MARRIED SEPARATED 7-EDUCATION LEVEL: PRIMARY SCHOOL SECONDARY SCHOOL COLLEGE UNIVERSITY 8-WORK STATUS: WORKING UNEMPLOYED STUDENT 9-RESIDENCE: STAYING ALONE WITH FRIEND WITH PARENTS WITH WIFE/HUSBAND 10- METHOD OF SELF-HARM: SELF POISONERS: OVERDOSE POISONONING SELF CUTTERS: CUTTING WRIST SLASHING THROAT JUMPING FROM A BULDING HANGING STRANGULATION BURNING ELECTRCUTION 11-CURRENT PSYCHIATRY DIAGNOSES: -------------- 12- PAST HISTORY OF PARASUICIDE: YES NO 13- FAMILY HISTORY OF SELF-HARAM: YES NO 14-HISTORY OF MEDICAL ILLNESS: YES NO 15- HISTORY OF MENTAL ILLNESS: YES NO 16- FAMILY HISTORY OF MENTAL ILLNESS: YES NO 17- HISTORY OF ALCOHOL ABUSE: YES NO 18- HISTORY OF DRUG ABUSE: YES NO 19--psychosocial stressors: Intimate relationships problem with: the spouse husband/wife boyfriend/girlfriend. Relation with children with other relatives or family members Employment or work problem financial problem Housing problem legal problems Problem of loneliness problem of ill health

20- REASON OF SELF-HARM (self report) : 

20- REASON OF SELF-HARM (self report) -I wanted to show how desperate I was feeling -I wanted to die -I wanted to punish myself - I wanted to frighten someone - I wanted to get my own back on someone - I wanted to get relief from a terrible state of mind -I wanted to find out if someone really loved me -I wanted to get some attention The list was based on that used by Bancroft et al.1976, 1979, Bancroft J, Skrimshire AM, Simkin S (1976), The reasons people give for taking overdoses. Br J Psychiatry 128:538–548

Definition of self-harm : 

Definition of self-harm The criteria were based on the definition of self-harm used in the WHO/EURO Multi-centre Study of Suicidal Behavior. Platt S, Bille-Brahe U, Kerkhof A et al. (1992), Parasuicide in Europe: the WHO/EURO Multicentre Study on Parasuicide. Introduction and preliminary analysis for 1989. Acta Psychiatr Scand 85:97–104

Design and Procedures: : 

Design and Procedures: The study design was in keeping with the guidelines of the University of Malaya Medical Center ethical committee. It was approved by the UMMC Research Ethics Committee.

Data Analysis: : 

Data Analysis: The analysis was performed using SPSS version 12.0 (SPSS, 2004).

Results : 

Results

sex : 

sex The total numbers of patients included in the study were 77 patients, 20 male (26.0%) and 57 females (74.0%).

Ethnic group : 

Ethnic group 11(14.3%) Malay, 37(48.1%) Chinese 29(37.7) Indian,

Age : 

Age

Religion : 

Religion

METHOD OF SELF-HARM: : 

METHOD OF SELF-HARM: 52(67.5%) Self-Poisoners 25(32.5%) self-cutters

PSYCHIATRIC DIAGNOSES: : 

PSYCHIATRIC DIAGNOSES:

Psychosocial stressors: : 

Psychosocial stressors:

Table 1:Association between Sociodemographic profile and Methods of self-harm: : 

Table 1:Association between Sociodemographic profile and Methods of self-harm: Sociodemographic profile method of self-harm P-value Self-poisoners self-cutters Sex Male 11 9 0.13 Female 41 16 Race Malay 8 3 0.01 Chinese 19 18 Indian 25 4 Marital status Single 34 15 0.415 Married 18 10 Education primary 36 19 0.3 Tertiary 16 6 Religion Muslim/ 10 4 0.01 Christian 9 3 Hindu 19 1 Buddhist 14 7 Work working 27 9 0.14 Nonworking 25 16 Residence alone/parents 28 13 0.53 Friend/husband 24 12

Table 2: Association between Clinical domains and Methods of self-harm: : 

Table 2: Association between Clinical domains and Methods of self-harm: Clinical domains method of self-harm P-value Self-Poisoners self-cutters Diagnosis Adjustment disorder 33 5 0.001 Depression 13 11 Others 6 9 Past hist self-harm Yes 13 15 0.003 No 39 10 Hist of mental-illness Yes 13 16 0.001 No 39 9 FH self-harm Yes 3 0 0.302 NO 49 25 FH mental-illness Yes 2 3 0.19 NO 50 22 Medical illness yes 13 6 0.58 NO 39 19 Alcohol abuse Yes 11 5 0.58 No 41 20 Drug abuse Yes 3 4 0.15 No 49 21

Association between psychosocial Stressors and the Methods of Self-harm: : 

Association between psychosocial Stressors and the Methods of Self-harm: The odd ratio of some one with relationship problem to self –poisoning relatively is 2 times compare to some with other problems.

Table 4: Reasons and the Motives Chosen by Self-Cutters and Self-Poisoners to explain their episodes of deliberate Self-Harm; : 

Table 4: Reasons and the Motives Chosen by Self-Cutters and Self-Poisoners to explain their episodes of deliberate Self-Harm; Reasons and motives method of self-harm P Self-Cutters Self-Poisoners I wanted to show how desperate I was feeling 7(30.4%) 16(69.6%) 0.51 I wanted to die 17(56.7%) 13(43.3%) 0.001 I wanted to punish myself 8(66.7%) 4(33.3%) 0.009 I wanted to frighten someone 1(50.0%) 1(50.0%) 0.54 Iwanted to get my own back on someone 1(50.0%) 1(50.0%) 0.54 I wanted to get relief from a terrible state of mind 14(26.9%) 38(73.1%) 0.108 I wanted to find out if someone really loved me 1(7.7%) 12(92.3%) 0.03 I wanted to get some attention 3(13.0%) 20(87.0%) 0.01

Discussion : 

Discussion Previous investigations --- overdose This study we studied them both

Discussion : 

Discussion In this study significant socio-demographic factors. (Table 1), Age (17-26 Y ) Race Religion Ethnic group mostly Indian and they tend to harm themselves by self-poisoning P= 0.01

Discussion : 

Discussion Religion more Buddhist and Hindu tend to harm themselves than the Muslims and Christians P=0.01. This is similar to the findings by Raleigh et al, 1990 that Muslims had relatively lower rates of suicide than Hindus. Raleigh V S, Bulusu L & Balarajan R. Suicides among immigrants from the Indian Subcontinent. British Journal of Psychiatry 1990; 156: 46-50.

Slide 34: 

In a study UMMC1989 Parasuicide study in Singapore Penang General Hospital young females. Indian Self-poisoning. Diagnosis of adjustment disorder Habil MH, Ganesvaran T, Agnes LS.Attempted suicide in Kuala Lumpur. Department of Psychological Medicine, Faculty of Medicine, University of Malaya. Asia Pac J Public Health. 1992-93;6(2):5-7. Fathelrahman AI, Ab Rahman AF, Mohd Zain Z Clinical Pharmacy Program, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Minden, Pulau Pinang, Malaysia.demographic features of drug and chemical poisoning in northern Malaysia..Clin Toxicol (Phila). 2005; 43(2):89-94. PMID: 15822759.

In term of Association between Clinical domains and methods of self-harm: : 

In term of Association between Clinical domains and methods of self-harm: (33patients) are diagnosed as adjustment disorder compared to only 5 self cutters P=0.001 (31%) who attempted suicide had major depressive disorder (MDD), no much difference between self-poisoners(13 ) and self cutters(11)

History of deliberate self harm : 

History of deliberate self harm In the first year after DSH the average rate of repetition of nonfatal DSH has been reported to be 17 % As in this study 13 patient of the Self-poisoners had a history of previous self-harm compared to 15 patient of self-cutters. p=0.003 Schmidtke, A, Bille-Brahe, U, DeLeo, D, Attempted suicide in Europe: Rates, trends, and sociodemographic characteristics of suicide attempters during the period 1989-1992. Results of the WHO/EURO Multicentre Study on Parasuicide Acta Psychiatrica Scandinavica, 93, 327-338.

Reasons and the Motives : 

Reasons and the Motives In common with the findings of hospital-based studies by Hawton et al. in 1982 and Boegers et al. the reasons most frequently reported by the patients in this study was to get relief from a terrible state of mind 38(73.1%) of Self-Poisoners and 14(26.9%) of the Self-Cutters Hawton K, Cole D, O’Grady J, Osborn M (1982a), Motivational aspects of deliberate self-poisoning in adolescents. Br J Psychiatry 141:286–291 Boegers J, Spirito A, Donaldson D (1998), Reasons for adolescent suicide attempts: associations with psychological functioning. J Am Acad Child Adolesc Psychiatry 37:1287–1293

Relationship problems : 

Relationship problems many used deliberate self-harm to cope with distress especially most common among those who have relationship problem in this study the odd ratio was found to be 2.0 for relationship problems compared to other reasons

wished to die : 

wished to die 17(56.7%) Self-Cutters wish to die compared to13 (43.3%) Self-Poisoners,, p=0.001 More self- cutters compared to self- poisoners indicated that they wanted to die,

Wished to die : 

Wished to die self-cutting often being associated with tension reduction It is much easier to engage in self-cutting on the spur of the moment using whatever is at hand, while taking an overdose requires a certain amount of planning.

Get some Attention : 

Get some Attention In this study (87.0%) of Self-Poisoners reported that wanted to get some attention compared to (13.0%) of Self-Cutters P=0.01

Conclusion : 

Conclusion The reasons for overdose : wanted to find out if someone really loved them (92.3%) wanted to get some attention (87.0%) To get relief from a terrible state of mind (73.1%) To show how desperate they were feeling (69.6%).

Conclusion : 

Conclusion The reasons for Self-cutting: Wanted to punish themselves(66.7%) Wanted to die (56.7%)

Prevention should focus on: : 

Prevention should focus on: Reducing the problems that lead to thoughts of self-harm Helping young people acquire alternative methods of problem-solving Recognizing sources of help.

Clinical Implications: : 

Clinical Implications: This is something that could be implemented in: - schools, colleges and universities - through discussion or mental health awareness educational programs. - It might also be promoted through the media

Clinical Implications: : 

Clinical Implications: For the clinician assessing self-harmers after overdoses or deliberate self-injury, The findings of this study highlight the need to include exploration of motives for self-harm.

Clinical Implications: : 

Clinical Implications: Gaining an understanding of the motivation provide a full picture of the nature of self-harm Help in addressing prevention of future episodes.

THANK YOU : 

THANK YOU