Isolated jejunal necrosis following corrosive acid poisoning

Corrosive acid poisoning is common in Asian countries, and most of the time, it is of suicidal intent in adults. Commonly they lead to extensive injuries of the upper gastrointestinal tract, and isolated involvement of the lower gastrointestinal tract is rare. We present a 35-year-old male who presented to us with a history of corrosive acid ingestion mixed with alcohol. Imaging did not demonstrate any pneumoperitoneum. The patient underwent exploratory laparotomy and found to have isolated jejunal necrosis without any evidence of injury to the stomach and duodenum. Segmental resection and end-to-end anastomosis were done.

Suicidal Intent in Young Adults Attending the Suicide Prevention Clinic at a Tertiary Care Centre in Kerala, India

BACKGROUND Suicide attempts in young adults in the age group 18 - 25 years have grown exponentially across the globe in the last three decades. Suicide is the third leading cause of death among young adults worldwide and is the second leading cause of death in 15 – 29-year-olds. The studies on the factors affecting suicidal intent among young adult suicide attempters are few from the Indian context and young adult group is of utmost importance. So, this study was done to estimate the suicidal intent among young adult suicide attempters and to assess the various factors associated with suicidal intent among young adults. METHODS The study was an analytical cross-sectional study, which was carried out at the Suicide Prevention Clinic of the Department of Psychiatry at a Tertiary Care Centre in Kerala, India over a period of 1 year from October 2015 to September 2016. The consecutive 160 young adult suicide attempters were interviewed. Beck’s suicide intent scale was used to assess the severity of suicide attempts. Statistical significance of socio-demographic factors and suicidal intent score was assessed by independent student t test and one way analysis of variance (ANOVA). RESULTS Out of the 160 participants, 50 (31.2 %) had low suicidal intent, 71 (44.4 %) had medium suicidal intent and 39 (24.4 %) had high suicidal intent. The study showed significant association between marital status (t = 2.515, P = 0.011), Occupation (F = 7.991, P < 0.001), previous suicide attempt (t = - 2.586, P = 0.011), mode of attempt (F = 7.228, P < 0.001) and psychiatric disorder (F = 11.218, P < 0.001) with the suicidal intent score. The study has found a significant association between the caregiver and suicidal intent score (F = 4.339, P = 0.006) which needs to be researched further. CONCLUSIONS Our study showed significant association between the socio-demographic variables like occupation, marital status, caregiver, mode of attempt, previous attempt and psychiatric diagnosis with the suicidal intent scores of young adult suicide attempters attending the suicide prevention clinic. This finding throws light to the factors contributing to high suicidal intent among young adults. The suicidal rates among the young adults are on the rise and we as the health professionals should be aware of these factors which will help in preventing young adult suicides. KEYWORDS Suicidal Intent, Young Adults, Suicide Prevention Clinic, Suicidal Behaviour, Kerala

Sociodemographic, Circumstantial, and Psychopathological Predictors of Involuntary Admission of Patients with Acute Psychosis

Studies have consistently determined that patients with acute psychosis are more likely to be involuntarily admitted, although few studies examine specific risk factors of involuntary admission (IA) among this patient group. Data from all patients presenting in the psychiatric emergency department (PED) over a period of one year were extracted. Acute psychosis was identified using specific diagnostic criteria. Predictors of IA were determined using logistic regression analysis. Out of 2533 emergency consultations, 597 patients presented with symptoms of acute psychosis, of whom 118 were involuntarily admitted (19.8%). Involuntarily admitted patients were more likely to arrive via police escort (odds ratio (OR) 10.94) or ambulance (OR 2.95), live in a psychiatric residency/nursing home (OR 2.76), report non-adherence to medication (OR 2.39), and were less likely to suffer from (comorbid) substance abuse (OR 0.53). Use of mechanical restraint was significantly associated with IA (OR 13.31). Among psychopathological aspects, aggressiveness was related to the highest risk of IA (OR 6.18), followed by suicidal intent (OR 5.54), disorientation (OR 4.66), tangential thinking (OR 3.95), and suspiciousness (OR 2.80). Patients stating fears were less likely to be involuntarily admitted (OR 0.25). By understanding the surrounding influencing factors, patient care can be improved with the aim of reducing the use of coercion.

Lethal Over the Counter Cardioselective Drugs: Urgent Call For Policy Makers

Drug overdose is a common presentation in emergency departments, and overdose of cardioselective agents warrants special attention, given its association with high mortality and morbidity. This study reports a case of cardioselective overdose with suicidal intent. We shed light on the accessibility in Saudi Arabia of these life-threatening drugs, and explore the nature of public health intervention to reduce to reduce the risk of misuse.

Investigating the relationship between childhood sexual abuse, self-harm repetition and suicidal intent: mixed-methods study

Background Research into the association between childhood sexual abuse (CSA) and self-harm repetition is limited. Aims We aimed to examine the association between self-harm repetition, mental health conditions, suicidal intent and CSA experiences among people who frequently self-harm. Method A mixed-methods study was conducted including consecutive patients aged ≥18 years, with five or more self-harm presentations, in three Irish hospitals. Information was extracted from psychiatric records and patients were invited to participate in a semi-structured interview. Data was collected and analysed with a mixed-methods, convergent parallel design. In tandem, the association between CSA and self-harm repetition, suicidal intent and mental health conditions was examined with logistic regression models and independent sample t-test, with psychiatric records data. Thematic analysis was conducted with interview data, to explore CSA experiences and self-harm repetition. Results Between March 2016 and July 2019, information was obtained on 188 consecutive participants, with 36 participants completing an interview. CSA was recorded in 42% of the total sample and 72.2% of those interviewed. CSA was positively associated with self-harm repetition (odds ratio 6.26, 95% CI 3.94−9.94, P = 0.00). Three themes emerged when exploring participants’ CSA experiences: CSA as a precipitating factor for self-harm, secrecy of CSA accentuating shame, and loss experiences linked to CSA and self-harm. Conclusions CSA was frequently reported among people who frequently self-harm, and associated with self-harm repetition. Identification of patients at risk of repetition is key for suicide prevention. This is an at-risk group with particular characteristics that must be considered; comprehensive patient histories can help inform and tailor treatment pathways.

Physical health impairment, disability and suicidal intent among self-harm survivors in South India

Background: Suicide is major public health concern in India. There are limited data examining the relationship between health impairment, disability and severity of suicidal intent. The aim of the study was to examine the associations of health impairment and disability with severity of suicidal intent among survivors following an act of self-harm.Methods: A pilot exploratory study of 453 self-harm survivors from a specialist hospital in South India. Socio-demographics, physical health impairment, disability (WHO Disability Schedule-II), suicidal intent, (Pierce suicide intent scale) and mental disorders were studied.Results: Arthritis was the most common physical impairment among self-harm survivors followed by gastrointestinal, sensory impairment and difficulty with mobilization. Nearly 10% of participants had some degree of functional impairment, with 38% experiencing severe physical pain in the week prior to self-harm. Past history of depression treatment, age, education and occupation influenced positively PSIS scores. There were significant associations between suicidal intent and disability.Conclusions: Indian self-harm survivors indicated complex relationships between physical health, disability and suicidal intent. Understanding these associations may help to develop suicide prevention strategies. Our findings suggest a need for integrating a comprehensive of physical health assessment in self harm survivors.

Higher Suicide Intent in Patients Attempting Suicide With Violent Methods Versus Self-Poisoning

Background: Suicidal intent for patients attempting suicide using violent methods (VMs) is assumed to be higher than for those using self-poisoning (SP), which may explain the higher mortality observed in follow-up studies. However, this has not been studied prospectively. Aims: We aimed to compare patients attempting suicide using VMs with those using SP regarding suicidal intent, suicidal ideation, depression, and hopelessness during hospital stay and after 1 year. Methods: Patients hospitalized after suicide attempt by VMs ( n = 80) or SP ( n = 81) completed the Beck scales for Suicide Intent, Suicide Ideation, Depression Inventory, and Hopelessness on admission and at the 12-month follow-up. Results: On admission, those using VMs had higher suicidal intent than those using SP ( M = 16.2 vs. 13.3, p < .001), but lower depression scores ( M = 22.2 vs. 26.8, p < .05). No significant differences were found in suicidal ideation ( M = 20.1 vs. 23.1) or hopelessness ( M = 10.1 vs. 11.9). At 12-month follow-up, depression scores decreased significantly for both groups, while hopelessness decreased only for the SP group. Limitations: The statistical power achieved was lower than intended. Conclusion: The higher levels of suicidal intent, but lower levels of depression, may indicate more impulsivity among people attempting suicide using VMs. Suicidal ideation was relatively stable.