Clinical Analysis of 16 Cases of Hospitalized Mentally Ill Patients Who Committed Suicide
Time, but after this article, three cases of patients with depression are mentioned. In one case, the patient committed suicide 45 days after being hospitalized. At that time, the depression had almost subsided, and there was partial restoration of insight. The staff let their guard down, which led to a successful suicide. In two cases, the suicides occurred within 20 days of admission. From an outward perspective, these patients appeared to have alleviated depression, as evidenced by their willingness to engage in medical treatment, talking and laughing in the ward, and even helping workers with routine health tasks. In reality, the patients were麻痹ing the staff, causing them to lower their vigilance while carefully planning a suicide. If they found an opportunity to commit suicide, they had a very high success rate.
3. In another group of patients, one patient suffered from paranoid psychosis. Suicidal delusions began to collapse when there was partial restoration of insight around New Year's Day. Their families requested to take them home for the holidays, but the suicide occurred at home.
4. Proposals on how to more effectively prevent suicide:
① Doctors should enhance their sensitivity to depression. Depression is not unique to depressive symptoms; schizophrenia can also exhibit depressive symptoms after partial restoration of insight. The authors believe that after treating mental illness-related depression, it can be approached from the following aspects: First, appropriately reduce antipsychotic medication and add antidepressants. Secondly, use ECT treatment when necessary, along with appropriate psychological treatment. For significant suicidal ideation and depression, acute ECT treatment is the preferred choice, followed by active antidepressant treatment with sufficient dosage. Reviewing this group, only one case underwent ECT, and the dose of amitriptyline antidepressants was only an average of 175mg/day. Sulpiride was selected as an antidepressant, which was actually incorrect. During the recovery period, besides continuing antidepressant treatment, the authors believe it is necessary to strengthen psychological treatment so as to consolidate the therapeutic effect and reduce the incidence of suicide.
② Doctors should fully understand drug-induced anxiety. All kinds of antipsychotic drugs can cause anxiety, especially when high doses of high-titer drugs are used. In this group, three cases of drug-induced anxiety were due to perphenazine, and timely handling was required. Timely processing of akathisia phenomena, such as reducing the amount, adding antipsychotic drugs, or trying propranolol, is also important.
③ Doctors should pay attention to psychotic symptoms, particularly command auditory hallucinations like hearing voices, homicidal delusions, and physical impact delusions. These symptoms can also affect the patient’s mood and behavior leading to suicide. In this group, one case dominated by hallucinatory delusions committed suicide and should be given active treatment, such as rapid drug treatment. If necessary, ECT should also be considered.
④ Regarding the issue of false discharge, strict standards should be adhered to. Patients with suicidal ideation should not be allowed to leave or be discharged unless absolutely necessary. If they must leave or be discharged, family members should be informed about strict management, medication, and suicide prevention measures.