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FEATURES OF SUICIDAL BEHAVIOR IN PATIENTS OF GERONTOPSYCHIATRIC
DEPARTMENTS
Biktimirova Guzal Ravshanova
Samarkand regional mental health hospital, doctor psychiatrist, Samarkand, Republic of
Uzbekistan
Ochilov Ulug’bek Usmanovich
PhD Faculty of Postgraduate Education, Head of the Course of Psychiatry, Samarkand
State Medical University, Samarkand, Uzbekistan
Nortojiyev Jaxongir Muxammad o’g’li
Student of group 435 of the 2nd term medical faculty of Samarkand State Medical
University, Samarkand, Republic of Uzbekistan
https://doi.org/10.5281/zenodo.10613546
Abstract.
To date, the suicide movement is an important world-class problem of medical
and socio-economic importance. The sexual and age characteristics of suicide are important
factors in the distribution of suicide attempts, not just suicide.
Key words:
gerontopsychiatry, suicide, psychiatric care, nosological form.
ОСОБЕННОСТИ СУИЦИДАЛЬНОГО ПОВЕДЕНИЯ У ПАЦИЕНТОВ
ГЕРОНТОПСИХИАТРИЧЕСКИХ ОТДЕЛЕНИЙ
Аннотация.
На сегодняшний день суицидальное движение представляет собой
важную проблему мирового уровня, имеющую медицинское и социально-экономическое
значение. Половые и возрастные особенности суицида являются важными факторами
распределения суицидальных попыток, а не только суицида.
Ключевые слова:
геронтопсихиатрия, суицид, психиатрическая помощь,
нозологическая форма.
Introduction.
Suicide is one of the most important health problems in most countries of
the world. According to the WHO, more than one million people commit suicide each year. In
recent decades, our country has been characterized by high rates of death due to suicide, more than
20 cases per 100 thousand residents. According to the most severe forms of suicide behavior and
patients with a high risk of suicide, specialized psychiatric care should be provided in a 24-hour
hospital. Often, treatment is carried out with the help of mandatory restrictive measures, in which
the patient directly threatens the safety of his life and others [1-5]. Treatment aimed at eliminating
psychopathological symptoms should lead to an improvement in the mental state of patients and
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neutralization of suicidal thoughts. However, patients at high risk of suicide may attempt suicide
in the hospital, on treatment Leave, or in the early stages after discharge [6-9].
Throughout the history of the development of psychiatric care, there has been a gradual
improvement in the quality of life of patients, which has led to a reduction in the risk of suicide
behaviors and, ultimately, a decrease in mortality in psychiatric hospitals. If in the 9th century. the
functions of psychiatric institutions were reduced to seeing the mentally ill, then in the first half of
the 20th century.active methods of treatment and diagnosis of mental disorders, including
depressive disorders, have already appeared, a system of inpatient and non-inpatient forms of
psychiatric care has been created [10-16]. Therefore, unlike the situation in the VIII-IX centuries,
the mortality rate in psychiatric hospitals is much lower, but suicide continues among them [17-
19].
Cases of suicide and attempted suicide in a psychiatric hospital were not recorded in
statistical documents, part of the contingent of patients after the suicide attempt died in medical
institutions of somatic profile, part was recorded as accidents. Nevertheless, the prevalence rate of
suicidal behavior is an important criterion for the quality of psychiatric care provided by the
treatment institution [20-23]. For example, according to annual reports, about 10 percent of
inpatient suicide was committed by patients from psychiatric clinics, which accounted for 2.5
percent of all suicides in the general population [24]. Trials against psychiatric hospitals in cases
of suicide by relatives of suicide victims are common abroad. If one of the four outpatient suicides
causes relatives claims, every second case between inpatient suicides leads to a hearing. Courts
and juries view stationary units as having a higher level of patient control and thus more
responsible for preventing suicide. The incidence of suicide deaths in the United States is important
in the licensing of medical organizations by the Joint Commission on Accreditation of health
organizations (JCAHO). Suicide in psychiatric hospitals is called" signal events " because they
express the need for immediate response and investigation. The terms" Signal event "and" medical
error "are not synonymous; not all" signal " events are caused by error, and not all errors need
analysis and examination [25-28]. Despite the active development of suicide as a separate area of
Psychiatry in Russia and abroad in recent times, not enough attention has been paid to the problem
of diagnosing and preventing suicide behavior during treatment in a psychiatric hospital and in the
early stages after discharge [29-31.
In the elderly and elderly, the suicide rate is about three times higher than in young people
aged 15 to 24 years. This trend is characteristic of both sexes, but is more pronounced in men [32-
35].
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Late age is accompanied by the loss of loved ones, loss of social status, deterioration of
somatic health. Due to the decrease in adaptive abilities, older people find it difficult to adapt to
changes in the environment, get lost in the intensive flow of various information, accumulate
resentment and misunderstandings about the behavior of young people. The presence of depressive
disorders in older people determines suicidal activity with a higher mortality rate. These factors
confirm the need for further study of the problem of suicidal behavior in late life [36-40].
The purpose of the study
was to improve the provision of psychiatric care to patients at
the gerontopsychiatric Hospital who identify suicidal behaviors in various nosological forms of
mental pathology.
Materials and methods.
62 patients between the ages of 55 and 75 who were admitted to
the Smolensk regional clinical psychiatric hospital were examined. Patient registration was carried
out no later than 48 hours after admission, which, in the event of a suicide attempt, coincided with
the early postsocial period. Suicide behaviors were evaluated using the suicide reasoning scale
(SSI) and the Pierce suicide intent scale (PSIS). The Montgomery-Asberg scale (Mads) and the
Beck Depression survey (BDI) have been used to investigate Affective Disorders.
Results and their discussion.
As part of the study, the clinical and psychopathological
characteristics of internal forms of suicide behavior were studied, the factors and extent of suicide
risk were found to be related to the corresponding spectrum of mental disorders. The
gerontopsychiatric branch concluded that the psychological portrait of a suicidal person was made
taking into account the dynamics of the development of suicidal behavior in the pre - and post-
suicidal periods.
An analysis of psychometric scales found the presence of symptoms of anxiety-depressive
syndrome. The MADS score of 20 to 39 accounted for 64,5 percent of suicides, corresponding to
clinically significant moderate or severe depression. Objective symptoms of depression were
observed in 90.3% and only 54,8 of the respondents% depression is subjective. Nearly half of the
respondents had difficulty actively participating. Each second person recorded internal tension and
had trouble sleeping, and ⅔ a contingent of patients occasionally or continuously expressed
pessimistic and suicidal thoughts. 58% of patients were found to have anxiety, confirming the
predominance of anxiety-depressive symptoms. These data, according to the authors, should be
considered depressive, depressive-hypochondriacal, depressive-paranoid and high – risk of
suicide-disturbing-depressive. This indicates that Affective Disorders in older suicides primarily
need psychopharmacotherapy and psychocorrection, taking into account the features of the
structure and course of depression to prevent recurrence of suicidal behavior. Thus, the main
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strategy for Suicide Prevention among the elderly is to effectively treat depression using
pharmacological and psychological techniques together.
The score of 10 to 25,8 corresponding to the average and high suicide risk on the SSI scale,
was 64,5% of suicides. 38.7% of patients experienced a desire to attempt suicide. The beck scale
(suicide clause) found that 74,2% of patients had visited suicidal thoughts they did not intend to
commit, and 16% wanted to commit suicide. An analysis of the results of Pierce's suicide intention
scale showed that more than half (64,5%) of respondents were convinced of the death of the
attempted method.
The study of suicide attempt methods found a statically significant (p<0,005) advantage of
self-poisoning as a suicide attempt method (fig. 1) and 35.49%. Self-heating and electrical damage
are rarely selected (5,9%, respectively). Intermediate positions took over lifesaving techniques
such as self-cutting (25,8%), self-discovery (19.3%), and self-scarring in the form of height drops
(13%).
The choice of suicide attempt method had gender differences. In half of all cases, women resorted
to self-poisoning (50.4%), usually medication.
Men with approximately the same frequency performed self-poisoning (23,4%), self-
injection (23,5%) and sapoporesis (29,4%). Falling from a height as a suicide attempt method was
chosen by 21,4% of women and only 5,9% of men. Electrical damage and spontaneous floods have
only been recorded in men. In general, men chose more brutal and traumatic methods of suicide,
which often led to a complex postsocial period and required medical care in a general somatic
hospital.
Most suicide attempts occurred in the evening and at night (71%), which is most likely due to
increased symptoms of anxiety and depression in the afternoon, Affective Disorders of exogenous
organic and vascular nature.
Thus, detailed information about the method of suicide makes it possible to predict the
dynamics and severity of the risk of suicide. The reasons for attempted suicide were distributed as
follows: protest or retaliation acted as a motive for attempted suicide in 13% of cases, calling or
seeking mercy in 35,5%, avoiding suffering or punishment in 9,7%, and giving up life in 32,2%
of cases. Both men and women critically evaluated suicide attempts. While half of the cases
contain critical and manipulative types of postsuscide, gender analysis of the remaining cases has
revealed some differences. In 22,6% of women, a manipulative variant of the postsuscide was
observed, which often led to repeated suicide attempts.
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During the study, the importance of anxiety-depressive symptoms in suicide was confirmed, the
role and severity of depressive disorders were found, and the risk of suicide in the elderly with
mental disorders was moderate and increased. Factors affecting the long and chronic development
of suicidal behavior have been identified. Typical manifestations of suicide attempt methods and
internal forms of suicide behavior are described in the form of suicidal thoughts, plans, and a desire
to attempt suicide.
The risk of the appearance, development and recurrence of suicidal behavior, variants of
the postsocial period in the elderly mentally ill were analyzed.
Conclusions.
The results made it possible to increase the effectiveness of psychiatric
profile geriatric units in providing suicide care for elderly patients.
Thus, although elderly suicidal behaviors are equally common in men and women, and
independent of habitat, men have a significantly higher risk of suicide. Factors that increase its
level include severe somatic pathology and alcohol dependence syndrome. Among the mental
pathologies of old age, the most suicidal risk can be called organic mental and Affective Disorders.
Of particular importance in the structure of affective disorders are symptoms of depression and
anxiety. The latter, a feeling of internal tension and discomfort, combined with an increase in
dissomnia, can be the trigger for the transfer of internal forms of suicide to the act of suicide. The
increased risk of suicide in elderly mental patients is associated with a higher percentage of suicidal
confidence in the death of the suicide method and the desire to attempt suicide. The findings make
it possible to improve the prevention and diagnosis of suicide behavior in the age group studied.
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