Electronic Letters to:
|
|
eLetters: Electronic letters published:
-
![[Read eLetter]](/icons/misc/sectionDOWN.gif)
Impulsivity and suicide risk
- Sudhir Kumar (26 August 2003)
-
Suicide: Is it still unexplored fully?
- Dr.Naseem A. Qureshi (26 August 2003)
|
|
|||
|
Sudhir Kumar, Consultant Neurologist, Department of Neurological Sciences Christian Medical College Hospital, Vellore, India-632004
Send letter to journal:
drsudhirkumar{at}yahoo.com Sudhir Kumar
|
Sir,I read with interest the recent article by Hunt et al (2003). Based on a well-conducted study, they conclude that schizophrenia and affective disorders are common psychiatric disorders in those committing suicide. Social risk factors such as alcohol and drug misuse/abuse, unemployment, unmarried status and living alone have also been highlighted. The purpose of this letter is to highlight another risk factor- impulsive behaviour. Suicidal attempts are considered to be impulsive if the patient committing suicide spends less than five minutes between decision to attempt suicide and the actual attempt (Simon et al, 2001). Simon et al (2001) found 24% of suicidal attempts to be impulsive. Impulsive behaviour was more common in those engaged in physical fight as compared to those who were depressed. In a study of deliberate self-burning in Iran, 62% had an impulsive ideation (Zarghami et al, 2002). The commonest underlying diagnosis was adjustment disorder (95% of cases) and the major motive for suicidal attempt was marital conflict. Presence of impulsive traits in patients with depressive disorders increases the risk of suicide attempts (Lecrubier, 2001). Among psychiatric inpatients, impulsive behaviour was significantly more common among suicidal patients as compared with nonsuicidal patients (Horesh et al, 1997). In conclusion, impulsive behaviour in the presence or absence of schizophrenia, depression or other mental disorders is associated with a higher risk of suicide. Therefore, impulsivity should be assessed in patients attending our practice. References Horesh N, Rolnick T, Iancu I, et al (1997) Anger, impulsivity and suicide risk. Psychother Psychosom; 66: 92-6. Hunt IM, Robinson J, Bickley H, et al (2003) Suicides in ethnic minorities within 12 months of contact with mental health services. National clinical survey. Br J Psychiatry; 183: 155-60 Lecrubier Y. (2001) The influence of comorbidity on the prevalence of suicidal behaviour. Eur Psychiatry; 16: 395-9. Simon OR, Swann AC, Powell KE, Potter LB, Kresnow MJ, O'Carroll PW. (2001) Characteristics of impulsive suicide attempts and attempters. Suicide Life Threat Behav; 32(1 Suppl): 49-59. Zarghami M, Khalilian A. (2002) Deliberate self-burning in Mazandaran, Iran. Burns; 28: 115-9. |
|||
|
|
|||
|
Dr.Naseem A. Qureshi, Consultant Psychiatrist Buraidah Mental Health Hospital, Saudi Arabia
Send letter to journal:
qureshinaseem{at}hotmail.com Dr.Naseem A. Qureshi
|
Hunt and associates study makes for very interesting reading. However, at the same time, a retrospective recollection of huge amounts of available data derived from research conducted on biopsychosociology of suicide across cultures - minorities or otherwise, largely makes this study superfluous. Although this is a first national survey of suicides in minorities living in UK, the team of researchers comletely failed to find any new findings and moreover reported results are nothing but replication of previously reported findings. Since the most influential description of suicide by Durkheim, there are hundred of books and innumerable published peer- reviewed papers on suicide and attempted self-harm covering multiple issues including epidemiology, etiology, pattern, treatment and prevention, yet the prevalence of suicide is not declining steadily worldwide. I as a mental health professional ask myself, why is it so? The answer lies in the fact that the mental health professionals have inappropriately addressed the issue of suicide, in particular the sociocultural dynamics of suicide, and no major efforts have been directed towards its prevention. Indeed, suicide is a social curse and by and large this curse is preventable. Further, sociocultural factors are comparatively most important determinants of suicide. Therefore, it is high time that the mental health professionals, state governmental authorities and social organizations should indiscriminately provide basic physical, mental, sociocultural and economic services not only to patients with mild to severe mental illnesses but normal people at large. In the first place, these are the normal people who during unusual, adverse, social circumstances tend to develop from neurotic to psychotic breakdowns. For example, kill the poverty, suicide rate will decrease considerably. Further, provide suitable employment to all people irrespective of race, suicide will decrease a lot. And provide easy access to mental health services to all, suicide rate will decline meaningfully. Remove stigma against mental illnesses and mental patients, suicide will also decrease. And finally provide viable milieu with good family bonds, suicide rate will come down to nearly zero. We are taught and have known these real facts about suicide for a long time but nothing useful is done to prevent suicide. National surveys like the one conducted by Hunt et al are nothing but simple reminders for relevant authorities to take concrete measures for preventing suicide not only among minorities but also majorities. |
|||