scholarly journals Attempted Suicide and Criminal Justice System in a Sample of Forensic Psychiatric Patients in Malaysia

Author(s):  
Johari Khamis ◽  
Ravivarma Rao Panirselvam ◽  
Norhameza Ahmad Badruddin ◽  
Farynna Hana Ab Rahman ◽  
Chan Lai Fong

Criminalization of suicide attempts is an archaic barrier to suicide prevention. Globally, clinical profiles of prosecuted suicide attempters are an under-researched area. This retrospective study aims to describe the clinical profiles of individuals who were charged for attempted suicide and subsequently sent for criminal responsibility and fitness to plead evaluation in a forensic psychiatric unit in Malaysia from January 1, 2008, to December 31, 2019. We identified 22 cases who were mostly adult males (90.9%). Seventy-three percent have a psychiatric disorder. Mood disorders were more prevalent (32%) followed by psychotic disorders and substance use disorders. For most of these individuals, this was the first contact with any form of mental health services and 41% defaulted their treatment before arrest. This sample illustrates a vulnerable group who has been disengaged with mental healthcare. Future research is warranted to further investigate mechanisms that are effective in addressing unmet needs of persons in suicidal crisis as opposed to utilizing the criminal justice pathway.

Crisis ◽  
1999 ◽  
Vol 20 (1) ◽  
pp. 41-48 ◽  
Author(s):  
Jérôme Ottino

This paper deals with an inpatient unit that recently opened in Geneva, specializing in the treatment of patients aged 16-21 years who had attempted suicide or felt the desire to commit suicide. This particular center was established because of the significant weaknesses found in the provision of care to adolescents who had attempted suicide. Despite the growing interest of health workers in this area of study over recent years, the frequency of suicide among the young has not decreased and there are numerous recurrences of the suicide attempts. Further, all efforts to improve the adolescents' compliance with psychiatric treatment have failed to date. The number of drop-outs from treatment is still very high. Thus, the objectives of our inpatient unit are as follows: (1) to overcome initial resistance to treatment and to improve long-term compliance; (2) to decrease the number of recurrent attempts as a consequence of the above, thus increasing life expectancy; (3) to offer the adolescents who have tried (or have contemplated) committing suicide an improved quality of life, after first helping them overcome the suicidal crisis. To achieve these goals, the therapeutic team of the unit proposes short stays during which the work with the adolescents consists of a very intensive psychoanalytic-oriented crisis intervention. Numerous practical aspects of our therapeutic approach in the inpatient unit are related here in detail, always with reference to our theoretical hypothesis.


1998 ◽  
Vol 43 (5) ◽  
pp. 491-495 ◽  
Author(s):  
Maurice M Ohayon ◽  
Anne Crocker ◽  
Bernard St-Onge ◽  
M Caulet

Objective: To compare the characteristics of individuals assessed for fitness to stand trial (FST) with those assessed for criminal responsibility (CR). Method: This study examines all the consecutive requests of FST or CR addressed to the only forensic psychiatric hospital in the province of Quebec and 2 prisons in the Montreal area over a 1-year period. Results: In all, 170 FST, 52 CR, and 29 both FST and CR assessment requests were received (251 subjects). Psychiatrists' recommendations and court verdicts of unfitness to stand trial or not criminally responsible on account of mental disorders were mostly related to the presence of a psychotic-spectrum disorder. There is generally a good agreement between psychiatric recommendations and verdicts of the court, with the exception of unfitness recommendations. Conclusions: Defendants referred for a FST or a CR assessment displayed similar characteristics. However, although subjects with psychotic disorders represented more than one-half of the unfit or not criminally responsible verdicts, most of the subjects with psychoses were found competent to stand trial or responsible.


2000 ◽  
Vol 34 (3) ◽  
pp. 437-445 ◽  
Author(s):  
Jacqualine Vajda ◽  
Kate Steinbeck

Objective: To determine potential risk factors associated with repeat suicide attempts among adolescents. Method: Retrospective medical record review of all patients aged 13–20 years who presented to the emergency department at an inner city tertiary hospital after attempted suicide between 1994 and 1996. Subjects were identified using the International Classification of Diseases (ICD-9) codes E950.0 to E959.9 for attempted suicide. Study variables included demographic parameters, chronic medical conditions/illnesses, psychiatric and substance abuse disorders, history of sexual abuse and previous and subsequent suicide attempts. Variables univariately associated with repetition at p < 0.25 were entered into a multiple regression analysis. Results: Eighty seven per cent of patients presented with a drug overdose. Seventy-six per cent of all subjects attempted suicide in the context of a dispute or relationship break-up. At least one psychiatric disorder was present in 76% of subjects at the index attempt. The most frequently diagnosed disorders were depression (45.5%) and drug (34%) and alcohol abuse (27%). Variables predicting repetition within 12 months were drug (OR = 3.891, p = 0.02) and alcohol abuse (OR = 3.56, p = 0.05), non-affective psychotic disorders (OR = 3.81, p = 0.04), and chronic medical conditions/illness (OR = 3.29, p = 0.03). A history of sexual abuse was almost significant (OR = 3.03, p = 0.06). Conclusions: Adolescents most likely to re-attempt suicide with 12 months present with either substance abuse, non-affective psychotic disorders, chronic medical conditions, or a history of sexual abuse. All adolescents with a possible suicide attempt should receive a comprehensive mental health and psychosocial assessment. Closer scrutiny of the role of chronic illnesses and sexual abuse in both future research and clinical management is urged. A broad based, multidisciplinary intervention approach is recommended.


Psichologija ◽  
2012 ◽  
Vol 45 ◽  
pp. 55-69
Author(s):  
Jurgita Rimkevičienė ◽  
Danutė Gailienė

Suicidologijoje stokojama duomenų apie psichoaktyvių medžiagų vartojimo vaidmenį savižudybės procese bei impulsyvių ir neimpulsyvių mėginimų nusižudyti skirtumus. Šiame tyrime atlikta 15 vartojančių alkoholį arba narkotikus asmenų, per paskutinius metus mėginusių nusižudyti, kokybinių interviu teminė analizė. Tyrimas leido išskirti ne du, kaip aprašoma literatūroje, o tris mėginimų nusižudyti tipus, būdingus vartojantiems psichoaktyvias medžiagas: planuoti, neplanuoti ir mėginimai nusižudyti „aptemus sąmonei“, ir aprašyti visiems jiems būdingus bruožus. Nepaisant kai kurių ribotumų, šis tyrimas gali pasiūlyti vertingų įžvalgų vertinant vartojančių psichoaktyvias medžiagas asmenų suicidinę riziką.Pagrindiniai žodžiai: mėginimas nusižudyti, savižudybės procesas, psichoaktyvios medžiagos, alkoholis, narkotikai.THE TYPES OF SUICIDE PROCESS AMONG PSYCHOACTIVE SUBSTANCE USERS Jurgita Rimkevičienė, Danutė Gailienė Summary Research regarding the role of psychoactive substance use in the process of suicide is lacking in current sui­cidology. In addition to this, evidence shows that im­pulsive suicide attempts are common among substance users. However there is no clear understanding of the impulsive suicide process. That makes it difficult to combine results of different studies and create clear guidelines for impulsive suicide risk evaluation. The purpose of this research is to depict the impulsive and non-impulsive process of suicide among psychoactive substance users. The participants of the study were 15 psycho­active substance (10 – alcohol, 5 – drug) users, who had attempted suicide during the last year. 8 of them attempted once, 4 – two or three times, other 3 – more than 5 times. All participants – 4 women and 11 men were patients from Vilnius Centre for Addictive Disorders and Vilnius Mental Health Centre. Quali­tative interviews based on Suicide Intent Scale were conducted about the suicide attempt or attempts. A thematic analysis of the interviews was used to depict the process of suicide. This study led to distinguishing 3 different types of attempted suicide – planned, unplanned and suicide attempts during a “blackout” – which are typical for psychoactive substance users. Both unplanned suicide attempts and suicide attempts during a “blackout” can be called impulsive, though the latter diverged by their hastiness, aggressiveness, inability to control one’s behaviour, intensive feeling of anger, serious danger caused to health and wellbeing, as well as a follo­wing amnesia of a major part of the suicide attempt. Intensive emotions, especially anger and stressors in interpersonal relationships, had a major impact for the respondents in the process of suicide. According to the participants of the survey, substance use had intensified their suicidal crisis having a clear effect on their emotional, relationship and other difficulties. In addition, alcohol and drug use was considered as one of the suicide methods. Despite several restrictions of the research, the study results provide some valuable insight in the suicide risk evaluation among psycho­active substance users. Key words: suicide attempt, suicide process, psychoactive substances, alcohol, drugs.


2013 ◽  
Vol 19 (1) ◽  
pp. 4 ◽  
Author(s):  
Paul Sussman ◽  
Carla Kotze

<p><strong>Background.</strong> In the absence of medical literature reporting on homicide-unsuccessful-suicide (HUS) cases in which the perpetrator is referred for forensic psychiatric observation present an opportunity to explore psychiatric features pertaining to the event.</p><p><strong>Objective.</strong> To identify possible contributing psychiatric features in HUS cases.</p><p><strong>Method.</strong> A retrospective, single-centre, descriptive study was conducted, in which were reviewed clinical records of HUS subjects referred for observation to Weskoppies Hospital from December 2005 to January 2011. Socio-demographic and psychiatric information was obtained.</p><p><strong> Results.</strong> Nine cases were reviewed. The median age of the subjects was 29 years and 7 subjects were male. Five cases involved family members. Cases involving couples demonstrated male subjects and cases involving filicide demonstrated female subjects. Only 1 case involved the use of a firearm. At the time of the incident, 4 of the cases had no psychiatric diagnosis but notable interpersonal difficulties. Psychotic disorders were diagnosed in 3 subjects, a depressive disorder in 1 subject and a depressive and anxiety disorder in 1 subject.</p><p><strong>Conclusion.</strong> Subjects commonly used less lethal methods than shooting. The high rate of psychiatric disorders diagnosed is in keeping with court referrals occurring when a mental illness is suspected. Some cases may require specialised probing before psychosis becomes apparent. Identification of psychosocial stressors and failure of coping mechanisms during periods of strife within an intimate relationship may be a focus of future research in homicide-suicide cases. Separation should possibly be investigated as an independent factor which promotes the interpersonal difficulty associated with homicide-suicide.</p>


BJPsych Open ◽  
2018 ◽  
Vol 4 (1) ◽  
pp. 18-28 ◽  
Author(s):  
A. Dorina Denzel ◽  
Joke M. Harte ◽  
Mattis van den Bergh ◽  
Erik J. A. Scherder

BackgroundBlack and minority ethnic (BME) groups are known to have higher prevalences of psychotic disorders and are over-represented in western penitentiaries and forensic psychiatric institutions. Research from regular mental healthcare settings suggests that they could show different and more severe psychotic symptoms.AimsTo explore ethnic variations in severity of symptomatology of BME and non-BME detainees with psychotic disorders.MethodIn this study, 824 patients with psychotic disorders from seven different ethnic groups, imprisoned in a penitentiary psychiatric centre in the Netherlands, were compared on symptom severity and symptom representation using the BPRS-E clinical interview. Data were analysed by means of a multilevel analysis.ResultsBME patients with psychotic disorders are over-represented in forensic psychiatry, and symptom profiles of prisoners with psychotic disorders vary by ethnicity. Additionally, severity levels of overall psychopathology differ between ethnic groups: patients with an ethnic majority status show more severe levels of psychopathology compared with BME patients.ConclusionsThere are differences in symptom severity and symptom profiles between BME patients and non-BME patients. Disregarding these differences could have an adverse effect on the outcome of the treatment. Possible explanations and clinical impact are discussed.Declaration of interestNone.


2007 ◽  
Vol 22 (3) ◽  
pp. 188-194 ◽  
Author(s):  
Philippe Huguelet ◽  
Sylvia Mohr ◽  
Valérie Jung ◽  
Christiane Gillieron ◽  
Pierre-Yves Brandt ◽  
...  

AbstractLittle is known of the relations between psychosis, religion and suicide. One hundred and fifteen outpatients with schizophrenia or schizo-affective disorder and 30 inpatients without psychotic symptoms were studied using a semi-structured interview assessing religiousness/spirituality. Their past suicide attempts were examined. Additionally, they were asked about the role (protective or incentive) of religion in their decision to commit suicide. Forty-three percent of the patients with psychosis had previously attempted suicide. Religiousness was not associated with the rate of patients who attempted suicide. Twenty-five percent of all subjects acknowledged a protective role of religion, mostly through ethical condemnation of suicide and religious coping. One out of ten patients reported an incentive role of religion, not only due to negatively connotated issues but also to the hope for something better after death. There were no differences between groups (i.e. psychotic vs. non-psychotic patients). Religion may play a specific role in the decisions patients make about suicide, both in psychotic and non-psychotic patients. This role may be protective, a finding particularly important for patients with psychosis who are known to be at high risk of severe suicide attempts. Interventions aiming to lower the number of suicide attempts in patients with schizophrenia should take these data into account.


Crisis ◽  
2016 ◽  
Vol 37 (2) ◽  
pp. 155-160 ◽  
Author(s):  
Jin Kim ◽  
Han Joon Kim ◽  
Soo Hyun Kim ◽  
Sang Hoon Oh ◽  
Kyu Nam Park

Abstract. Background: Previous suicide attempts increase the risk of a completed suicide. However, a large proportion of patients with deliberate self-wrist cutting (DSWC) are often discharged without undergoing a psychiatric interview. Aims: The aims of this study were to investigate the differences in the characteristics and outcomes of patients with DSWC and those with deliberate self-poisoning (DSP) episodes. The results of this study may be used to improve the efficacy of treatment for DSWC patients. Method: We retrospectively reviewed the medical records of 598 patients with DSWC and DSP who were treated at the emergency department of Seoul Saint Mary's Hospital between 2008 and 2013. We assessed sociodemographic information, clinical variables, the reasons for the suicide attempts, and the severity of the suicide attempts. Results: A total of 141 (23.6%) patients were included in the DSWC group, and 457 (76.4%) were included in the DSP group. A significantly greater number of patients in the DSWC group had previously attempted suicide (p = .014). A total of 63 patients (44.7%) in the DSWC group and 409 patients (89.5%) in the DSP group underwent psychiatric interviews. Conclusion: More DSWC patients had previously attempted suicide, but fewer of them underwent psychiatric interviews compared with the DSP patients.


Crisis ◽  
2009 ◽  
Vol 30 (3) ◽  
pp. 115-119 ◽  
Author(s):  
Stephanie De Munck ◽  
Gwendolyn Portzky ◽  
Kees Van Heeringen

Background: Notwithstanding the epidemiological studies indicating an increased risk of attempted suicide among adolescents and young adults, there is a scarcity of international studies that examine long-term epidemiological trends in rates and characteristics of this vulnerable group. Aims: This article describes the results of a 9-year monitoring study of suicide attempts in adolescents and young adults referred to the Accident and Emergency Department of the Gent University Hospital (Belgium). Methods: Between January 1996 and December 2004, trends, sociodemographic, and methodrelated characteristics of suicide attempts were assessed by a psychiatrist on data sheets. Results: Attempted suicide rates declined from 1996 to 2001 and then rose until 2004, but did not exceed previous rates. During the 9 years of monitoring, there was a preponderance of female suicide attempters, except for 1997. Rates of attempts and of fatal suicide were negatively correlated. Significantly more males than females deliberately injured themselves. Younger attempters, especially females, significantly more often poisoned themselves with analgesics. In nearly one in five attempts, alcohol was used in combination with other methods, and alcohol intake was more commonly observed in older suicide attempters. Nearly half of the adolescents were identified as repeaters. Conclusions: The results of this study warrant further monitoring of trends and characteristics of young suicide attempters.


Crisis ◽  
2014 ◽  
Vol 35 (1) ◽  
pp. 60-66 ◽  
Author(s):  
Amanda Venta ◽  
Carla Sharp

Background: Identifying risk factors for suicide-related thoughts and behaviors (SRTB) is essential among adolescents in whom SRTB remain a leading cause of death. Although many risk factors have already been identified, influential theories now suggest that the domain of interpersonal relationships may play a critical role in the emergence of SRTB. Because attachment has long been seen as the foundation of interpersonal functioning, we suggest that attachment insecurity warrants attention as a risk factor for SRTB. Aims: This study sought to explore relations between attachment organization and suicidal ideation, suicide attempts, and self-harm in an inpatient adolescent sample, controlling for demographic and psychopathological covariates. Method: We recruited 194 adolescents from an inpatient unit and assigned them to one of four attachment groups (secure, preoccupied, dismissing, or disorganized attachment). Interview and self-report measures were used to create four variables reflecting the presence or absence of suicidal ideation in the last year, single lifetime suicide attempt, multiple lifetime suicide attempts, and lifetime self-harm. Results: Chi-square and regression analyses did not reveal significant relations between attachment organization and SRTB, although findings did confirm previously established relations between psychopathology and SRTB, such that internalizing disorder was associated with increased self-harm, suicide ideation, and suicide attempt and externalizing disorder was associated with increased self-harm. Conclusion: The severity of this sample and methodological differences from previous studies may explain the nonsignificant findings. Nonsignificant findings may indicate that the relation between attachment organization and SRTB is moderated by other factors that should be explored in future research.


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