suicide

Anmerkungen:

• -teenagers most at risk -older people more successful -75% leave warning before  committing suicide -those who attempted once never try again

1. BIO-PSYCHO-SOCIAL MODEL
   1. predisposing risk factors

      Anmerkungen:

      • genetic/family history biological factors personality traits (impulsivity)
      1. risk factors

         Anmerkungen:

         • psychiatric diagnosis + suicide exposure and other envtal influences VULNERABILITY IS CREATED*
         1. protective factors

            Anmerkungen:

            • -cognitive flexibility -strong social support -hopefulness -treatment of personality or psychiatric disorder
            1. precipitating factors

               Anmerkungen:

               • -availability of method -humiliating precipitating life event **THRESHOLD IS REACHED
               1. suicidal behaviour
2. psychodynamic explanation
   1. FREUD
      1. collapse of ego defense mechanisms
         1. use our defenses too much
            1. takes up too many resources
               1. helplessness
                  1. suicide
      2. overdeveloped superego

         Anmerkungen:

         • superego= what we've internalized from society
      3. regression to fixation to developmental stage

         Anmerkungen:

         • if we don't develop as we should through the psychosexual stages might mean we can't cope ==> may lead us to commit suicide
      4. thanatos in the driving seat
      5. ego ideal

         Anmerkungen:

         • perfectionism hides our insecurities and our ability to cope ==>we can't keep up with the expectations we placed on ourselves ==> anxiety then SUICIDE
3. BIOLOGICAL FACTORS
   1. 19x higher concordance rate in mono twins
   2. STUDY: Maternal suicidality

      Anmerkungen:

      • y axis: cumulative incidence of suicidal attempts *controlled for depression, anxiety and alcohol use
      1. moms with suicidal IDEATION
         1. kids had INCREASED RISK
      2. maternal suicidal attempts
         1. kids 5x more likely to have suicidal ideation
         2. 9x more likely to attempt suicide themselves
      3. no maternal suicidality
   3. mood disorders
      1. suicidality

         Anmerkungen:

         • mood disorders contribute to suicidality BUT suicidality is inherited INDEPENDENTLY from mood disorders
         1. inherited independently from mood disorders
      2. "completers"
   4. SEROTONIN

      Anmerkungen:

      • MAJOR BIOLOGICAL RISK FACTOR
      1. STUDY: metabolite 5HIAA

         Anmerkungen:

         • -we looked at depressed patients and the level of 5HIAA in their CSF  (procedure= lumbar tap) 5HIAA: what serotonin breaks down into results: 40% of people in LOW METABOLITE GROUP had attempted suicide versus only 7% in the HIGH METABOLITE GROUP
         1. low levels of 5HIAA
            1. ppl who attempt
            2. ppl who succeed
            3. ppl who choose lethal ways
      2. suicidality
      3. STUDY: receptor gene 5HT2a

         Anmerkungen:

         • looked at patients and controls -used HAMILTON RATING SCALE FOR DEPRESSION --> looked at ITEM 3 which measures suicidality 
         1. post-synaptic
            1. high levels of receptor gene= low serotonin
               1. HOMOZYGOUS FOR GENE
                  1. highest suicidality
      4. POST-MORTEM STUDY: TRANSPORTER GENE 5HTTLPR

         Anmerkungen:

         • looked at history of depression, substance abuse and aggression
         1. 220 brains
            1. 82 committed suicide
               1. OFC + vmPFC involved in suicidality
            2. 128 had not
               1. lower binding but in different areas
         2. low transporter= LOW SEROTONIN
   5. STUDY: patients with 1 suicide attempt + lethality
      1. BECK MEDICAL LETHALITY SCALE

         Anmerkungen:

         • Scores range from zero to 8 8= fatal  low attempters: less than 3 high attempters: greater than 4 (you require hospitalization)
      2. HIGH LETHALITY GROUP
         1. PFC HYPOFUNCTION
         2. older
         3. less impulsive
         4. higher suicide intent
         5. anterior cingulate, right superior frontal, right medial frontal gyri
   6. HPA AXIS

      Anmerkungen:

      • Hypothalamic pituitary adrenal axis **When the hypothalamus and the anterior pituitary sense that there is too much gluco-corticoid, they ram down production and DECREASE the levels of cortisol
      1. stressor in the environment
         1. hypothalamus releases CRH
            1. anterior pituitary releases ACTH
               1. adrenal cortex releases CORTICAL STEROIDS

                  Anmerkungen:

                  • CORTICAL STEROIDS: helps us adapt to stressor
      2. controls

         Anmerkungen:

         • cease cortisol production when too much is detected
      3. patients with suicidality
         1. hyperactivity of HPA AXIS
      4. modulates the physiological response to stress
      5. dexamethazone

         Anmerkungen:

         • cortical steroid
         1. Healthy HPA AXIS will reduce the amount of cortisol to prevent excess
4. SOCIAL LEARNING THEORY
   1. characteristics of behaviour
      1. more likely imitate peers
   2. consequences of behaviour
   3. modeling

      Anmerkungen:

      • more likely to imitate PEERS than parents
      1. social contagion
      2. suicide clusters
5. media coverage
   1. longer the coverage= increase suicide
6. SOCIO-CULTURAL PERSPECTIVE
   1. DURKHEIM
      1. egoistic

         Anmerkungen:

         • NO SHARED GROUP IDENTITY
         1. isolated
      2. altruistic

         Anmerkungen:

         • minimal distinction between individual and group 
         1. ex. CULT
      3. anomic
         1. normlessness
            1. winning lottery
7. peaks over holidays
8. TRYPTOPHAN
   1. STUDY: tryptophan in blood

      Anmerkungen:

      • 26 healthy volunteers, sample blood over 1 year period tryptophan: precursor to serotonin
      1. high tryptophan
         1. LOW suicide rates
   2. LOW in the spring
      1. suicide high
9. attempters

   Anmerkungen:

   • dysthymia + BORDERLINE PERSONALITY DISORDER
   1. often female
      1. *except in CHINA

         Anmerkungen:

         • 66% of all women in the WORLD who commit suicide are from CHINA **particularly in rural areas and in elderly high lethality= pesticides -big gap between rich and poor -more marital infedelity -high drug abuse -gambling elderly==> high cost of health care
         1. high lethality
            1. pesticides
   2. low lethality
   3. borderline personality disorder
      1. treatment= DBT

         Anmerkungen:

         • dialectical behavioural therapy
10. completers

    Anmerkungen:

    • MOOD DISORDER, SCHIZOPHRENIA, SUBSTANCE ABUSE
    1. male
       1. elders
    2. high lethality
    3. 60-90% suffer from mental disorder
    4. STUDY: aboriginals
       1. 2 x more likely
          1. INUIT: 6-11 times more
       2. males especially
       3. ELDERS LESS LIKELY
11. parasuicide

    Anmerkungen:

    • attempted suicide ==> 23x higher than suicide
12. STUDY: antidepresants + black box warning

    Anmerkungen:

    • suicide rates INCREASED when people STOPPED taking their anti-depressants **decrease in mortality in patients using anti-depressants *LOWER CHANCE OF DYING if you take medication
13. Beck Hopelessness Scale
    1. hopelessness
       1. cognitive rigidity
14. STUDY: job,relationship, education
    1. job, were married, high education
       1. more likely