Understanding the Unique Characteristics of Suicide in China： National Psychological Autopsy Study

Objective To compare the characteristics of suicides in the four main demographic groups： urban males, urban females, rural males and rural females in order to help clarify the demographic pattern of suicides in China. Methods A detailed psychological autopsy survey instrument was independently administered to 895 suicide victims in family members and close associates from 23 geographically representative locations from around the country. Results Pesticide ingestion accounted for 58% （519） of all suicides and 61% （3181519） of deaths were due to unsuccessful medical resuscitation. A substantial proportion （37%） of suicide victims did not have a mental illness. Among the 563 victims with mental illness, only 13% （76/563） received psychiatric treatment. Compared to other demographic groups, young rural females who died from suicide had the highest rate of pesticide ingestion （79%）, the lowest prevalence of mental illness （39%）, and the highest acute stress from precipitating life events just prior to the suicide. Contusion Many suicides in China are impulsive acts of deliberate self-harm following acute interpersonal crises. Prevention of suicides in China must focus on improving awareness of psychological problems, improving mental health services, providing alternative social support networks for managing acute interpersonal conflicts, limiting access to pesticides, and improving the resuscitation skills of primary care providers.     

Clinical contact preceding suicide.

Of the 400 consecutive completed suicides investigated over a 5-year period, 114 (28.5%) who had consulted a doctor in the week preceding death were specifically reviewed and compared with those who did not. The study comprised an analysis of the medical history, the scene of death and a complete autopsy with histological and toxicological examination and the identification of features which occurred more frequently in this group when compared with other suicides not contacting their doctors. Suicide-associated factors include psychiatric illness (58.8%), deteriorating health (16.7%), and a loss of spouse (7.0%); all these features were manifested by this group of suicides more frequently than by those who made no clinical contact (P < 0.001). A pre-indication of suicidal intention was made by 45% of these patients. This feature, as with previous attempts, occurred more commonly in patients who consulted a doctor (P < 0.001). Drug overdose was the most common suicidal method chosen (50.9%) and anti-depressants predominated (35%); 78% of those who overdosed ingested prescribed drugs. Poisoning was more common in this group (P < 0.001). Half of the victims committed suicide within 24 hours following consultation; of these, 51% overdosed on drugs with 61% of them ingesting their prescribed drugs. Of these 114 cases, the final consultation in 43% was to collect more drugs. All suicidal threats should be taken seriously, and particular care should be taken in prescribing and dispensing medication which may be fatal in overdose.     

基于“气血水”学说探讨陈宝田教授运用桂枝芍药知母汤的合方思路

"气血水"学说由日本古方派医家吉益南涯提出,认为疾病为气毒、血毒、水毒之变。痹证气、血、水三毒夹杂,毒乘于气,则关节疼痛、发热、肌肉萎缩;毒乘于血,则疼痛固定,肌肤紫暗、结节;毒乘于水,关节肿胀变形,酸楚重着,病情缠绵。桂枝芍药知母汤以祛气、水二毒为主,祛血毒力度薄弱。陈宝田教授将此方与乌头汤、小续命汤合用,简称小乌桂汤。乌头汤加强祛气、水二毒之功,小续命汤善祛血毒,三方合用契合痹证病机。并附医案两则,以供参考。     

Suicide and family loading for affective disorders

All suicides were ascertained for a 100-year period (1880 to 1980) in a study of mental illness among the Old Order Amish. The majority (92%) of the 26 cases were diagnosed with a major affective disorder and were situated in multigenerational families with heavy loading for bipolar, unipolar, and other affective-spectrum illnesses. The suicides clustered in four primary pedigrees, and the role of inheritance was suggested by the way in which suicides followed the distribution of affective disorders in these kinship lines. We believe these extended pedigrees provide presumptive evidence of genetic factors in both suicides and affective disorders.     

Substance abuse among first admissions to the psychiatric unit of a general hospital in Trinidad

Admissions for first episode of psychiatric illness provide information on service utilization which can be used to improve service delivery. The present study reviews the use of in-patient general psychiatric services in southern Trinidad using data from first admissions in one year, specifically to determine service utilization by substance-abusing patients. Case files of all admissions to the psychiatric unit of the San Fernando General Hospital in one year were reviewed and analyzed for demographic data, substance abuse, diagnosis and associated features of the admission. Significant rates of substance abuse were found among first admissions. Of 123 new patients, 43.1% were diagnosed with a substance abuse disorder, 56.6% of whom had a comorbid psychiatric disorder. Patients with substance abuse problems tended to be young males. The substance most commonly abused was alcohol (26.8%) and alcohol abusers were more likely to be of East Indian descent. Management within this mental health catchment area needs to address identification, early intervention and prevention of substance abuse among psychiatric patients. It is proposed that both hospital and community-based substance abuse interventions should be employed in the management of acute psychiatric patients.     

Maternal mortality and psychiatric morbidity in the perinatal period: challenges and opportunities for prevention in the Australian setting

Maternal mortality associated with psychiatric illness in the perinatal period (pregnancy to the end of the first year postpartum) has until recently been under-reported in Australia due to limitations in the scope of the data collection and methods of detection. The recent United Kingdom report Why mothers die 2000-2002 identified psychiatric illness as the leading cause of maternal death in the UK. Findings from the last three reports on maternal deaths in Australia (covering the period 1994-2002) suggest that maternal psychiatric illness is one of the leading causes of maternal death, with the majority of suicides occurring by violent means. Such findings strengthen the case for routine perinatal psychosocial screening programs, with clear referral guidelines and assertive perinatal treatment of significant maternal psychiatric morbidity. Data linkage studies are needed to measure the full extent of maternal mortality associated with psychiatric illness in Australia.     

A two year prospective study of maniac disorder and its symptomatology in northern Nigeria.

A prospective study of 38 manic patients (22 males and 16 females) was carried out. The average age of males and females were 31.2 and 29.4 years respectively. About 66% were Moslems while 33% were Christians. Fifteen patients were Hausa/Fulani, the largest ethnic group in Northern Nigeria. 17 patients were illiterates and were mainly Hausa-Fulani housewives. 35 out of the 38 patients were treated as in-patients and the duration of stay ranged from 14-42 days. 32 patients were followed-up for between 6 months to about 2 years. Only 3 cases relapsed during follow-up. Hypomanic affect, the commonest symptom was found in only 71% of the cases, a finding which compares favourably with a previous study. 15 cases (8 males and 7 females) had previous histories of mainly manic illness. 8 cases had associated drug abuse mainly alcohol and hemp. There was no positive family history of mental illness. 16 cases consulted traditional or religious healers before seeking orthodox psychiatric treatment. The main neuroleptic used was chlorpromazine with an average dose of 300 mg daily. ECT was used concurrently 6 times in 10 cases. Lithium prophylaxis was not used.     

海南省2015—2019年精神疾病合并结核病患者筛查及临床分析

目的 了解海南省精神疾病合并结核病情况 ,为海南省精神疾病合并结核病的预防和控制提供依据。 方法 精神疾病诊断和治疗按中国精神障碍分类与诊断标准第三版（精神障碍分类）执行,结核病诊断按《肺结核门诊诊疗规范（2012 年版 )》、《中华人民共和国卫生行业标准肺结核诊断标准（WS288-2017）》、《中国结核病防治规划实施工作指南(2020年版)》和《临床诊疗指南· 结核病分册》执行,以描述性流行病学分析方法收集海南省安宁医院2015年1月1日—2019年12月31日就诊精神疾病合并结核病患者的基本资料、流行病学特征以及院外监督治疗情况进行统计学分析。 结果 海南省安宁医院2015年1月1日—2019年12月31日共收就诊精神疾病患者15 426例,初筛疑似结核病患者59例,最终确诊合并结核病31例,合并结核病发生率为0.20%。31例精神疾病合并结核病患者中,男性18例,女性13例,年龄（43.8±11.2）岁。受教育时间为（6.5±5.2）年,家庭平均人口（4.5±1.6）人,精神疾病患病平均时间（5.5±2.3）年;未婚9例（29.0%）,现婚11例（35.5%）,离婚7例（22.6%）,丧偶4例（12.9%）;农民8例（25.8%）,无业23例（74.2%）。31例精神疾病合并结核病均按结核病督导和精神药物综合方案,经1年治疗干预,患者精神病评定量表（brief psychiatric rating scale,BPRS）总分为（29.08±1.98）,比治疗干预前（36.30±1.96）明显降低,精神病治疗效果明显（P<0.05）。14例涂阳结核病患者治愈7例,治愈率为50.0%,17例涂阴结核病患者完成治疗11例,规范治疗完成率为64.7%。结论 海南省精神疾病合并结核病患者发生率较高,且结核病治愈率低,应加强精神疾病专科医疗单位结核病筛查诊断能力培训,防止结核病误诊和漏诊,避免结核病在精神疾病院内传播,保护院内精神疾病患者治疗安全。     

Profile of in-patient suicides in two hospitals in Malaysia.

A study of completed in-patient suicides at the University Hospital Kuala Lumpur (UHKL) and Hospital Bahagia Ulu Kinta (HBUK) between 1st January 1967 to 31st December 1987 were conducted. Records of completed in-patient suicides during the period were exhaustively studied. Only 18 cases were from UHKL and 23 cases were from HBUK. It was found that the suicide patients were mainly young Chinese males from the lower socio economic group. The main reasons for suicide were interpersonal conflicts and physical illness. Alcohol was not an important factor unlike patients in the West.. Suicidal intent was also important. Many of the suicides were committed during the early hours of the morning and they usually occurred at inaccessible places. The method was strongly influenced by availability. To the best knowledge of the author, this is the first study of in-patient suicides in Malaysia.     

The pattern of completed suicides seen in Kuala Lumpur General Hospital 1999

A study was done on 76 suicide cases managed by the Forensic Pathology Department of Hospital Kuala Lumpur (HKL) from January till December 1999 to explore the pattern of suicide and psychiatric history. The Chinese contributed 52% (n=40) of cases followed by the Indians (29%, n=22) and the Malays (12%, n=9). After the age of sixty, 84.6% of the subjects were Chinese. The common methods of suicide were poisoning (39%), hanging (34%) and jumping from height (22%). Four out of 12 case-notes traced had documented psychiatric history i.e. schizophrenia. Conclusion: the suicide rate for Kuala Lumpur is estimated at 7.4 per 100,000. The Indians has the highest suicide rate of 21.1 per 100,000 in keeping with other local studies. The suicide rate for the Chinese is 8.6 per 100,000, but it increased to 23 per 100,000 among the elderly Chinese. The suicide rate for Malays is 2.6 per 100,000, higher than what was cited in previous local studies. The incidence of jumping from height as a suicide method had doubled over the last 2 decades.     

Suicide by aboriginal people in South Australia: comparison with suicide deaths in the total urban and rural populations

OBJECTIVE: To ascertain the number of recorded deaths by suicide of Aboriginal people and non-Aboriginals in South Australian urban and rural areas over the period 1981-1988. METHOD: The South Australian Coroner's records were examined by one of the authors and an Aboriginal research officer in consultation with members of the South Australian Aboriginal community (who identified Aboriginal suicides wrongly recorded as non-Aboriginal suicides). RESULTS: There was a major increase in suicide by Aboriginal people, both urban and rural, over that period, not marked by a similar increase for non-Aboriginal South Australians. CONCLUSIONS: A comparison can be drawn with reports of suicide by American Indians. It is possible that Aboriginal deaths by suicide can be ascribed to "anomie" (a concept first developed by Durkheim of social disintegration affecting tribal peoples under colonisation). The paper highlights the need for the development of successful intervention programmes in Aboriginal health.     

Psychiatric morbidity and referral rate among medical in-patients at Kenyatta National Hospital

Psychiatric morbidity among 200 medical in-patients at Kenyatta National Hospital was determined by a two-stage screening procedure, using the Self Reporting Questionnaire (SRQ) and standardized psychiatric interview (SPI). 44 (22%) of the total sample of 200 patients who were interviewed met the pre-established criteria for psychiatric morbidity; of these 59% comprised affective disorders. 4 (9%) of the psychiatric morbidity cases were referred for psychiatric evaluation. Referral seemed to be related to severity of illness and a previous history of psychiatric illness. There was no evidence in the notes that the psychiatric problems had been detected, treated or dealt with in any other way by the medical team in 34 patients out of 44 with psychiatric morbidity. Increase in the mental health input in the training of all health workers with emphasis on recognition and management of some of the commoner psychological problems is recommended.     

城乡社区自杀死亡率前瞻性观察

目的：研究城乡社区人群的自杀死亡率及其在不同人群中的分布特征，探讨自杀死亡原因和自杀方式。方法：采用分层整群抽样方法，选择城乡8个观察区，自1988年至1992年对其自杀死亡状况进行5年前瞻性观察。结果：观察区5年间≥15岁人群中共自杀死亡423例，5年的逐年自杀死亡率分别为10万分之17．75，27．29，25．26，18．31和22．96。年平均自杀死亡率为10万分之22．32，主要自杀原因为家庭纠纷，失恋和精神疾病，主要自杀方式为服毒和自缢。结论：本观察区中的自杀死亡率，自杀原因和自杀方式与国内同类研究结果基本一致，与国外资料相比本观察区自杀死亡率处于中等或中等以上水平。     

对精神病患者监护人的干预在减少医疗纠纷中的作用

目的:探讨对精神病患者监护人的干预在减少医疗纠纷中的作用。方法:采用回顾性调查,统计32例医疗纠纷情况并分析原因。结果:产生医疗纠纷的原因中,22例与患者的监护人有较大关系。结论:通过对监护人的干预能减少精神病科的医疗纠纷。     

男性精神障碍患者肇事肇祸行为相关因素研究

背景　少数精神障碍患者的攻击行为容易演变为肇事肇祸行为，以男性患者为主，目前缺乏对该类患者发生肇事肇祸行为相关因素的分析研究。目的　探讨男性精神障碍患者发生肇事肇祸行为的相关因素，为预防肇事肇祸行为的发生提供帮助。方法　选取2014年3月-2016年1月在北京市安康医院司法鉴定中心进行司法精神病学鉴定的男性精神障碍患者96例纳入研究组，以及首都医科大学附属北京安定医院同期住院的男性精神障碍患者65例纳入对照组。本研究为病例对照研究，采用自编调查问卷，调查患者的一般资料，包括年龄、受教育年限、婚姻状况、民族、文化程度、居住地、职业；疾病史概况，包括首次发病年龄、治疗情况、颅脑疾病史、乙醇饮用史、吸烟史、自杀史、既往住院次数；个人成长史概况，包括是否童年家庭环境不良、是否曾遭父母虐待、是否曾被父母遗弃、父母健康状况、父母婚姻状况、父母有无因精神疾病住院、父母有无犯罪记录、父母有无乙醇或物质滥用、居住方式、家庭是否和睦、家庭月收入；家族史概况，包括有无家族犯罪史、有无家族精神疾病史。采用心理变态测评量表修订版（PCL-R）评价患者的人格特点；采用简明精神病评定量表（BPRS）评价患者的精神症状；采用修改版外显攻击行为量表（MOAS）评价患者的攻击行为。问卷在患者进行鉴定或入院当天由两名经过量表一致性培训的调查员询问患者及家属后填写。结果　司法鉴定结果显示发生肇事肇祸行为的精神障碍患者多为精神分裂症（82例，占85.4%）；研究组与对照组文化程度、居住地、职业，治疗情况、既往住院次数，家庭月收入比较，差异有统计学意义（P<0.05）；与对照组相比，研究组PCL-R的反社会因子得分高，BPRS的思维障碍、敌对性因子得分和总分高，MOAS的财产攻击、体力攻击条目加权分和加权总分高（P<0.05）；多因素Logistic回归分析结果显示，文化程度〔OR=8.732，95%CI（1.268，60.123）〕、治疗情况〔OR=45.846，95%CI（4.254，494.149）〕、财产攻击条目加权分〔OR=0.044，95%CI（0.006，0.321）〕、体力攻击条目加权分〔OR=0.035，95%CI（0.005，0.246）〕是男性精神障碍患者发生肇事肇祸行为的影响因素（P<0.05）。结论　发生肇事肇祸行为的男性精神障碍患者多为精神分裂症。文化程度低、未积极接受治疗、有财产攻击、体力攻击倾向是男性精神障碍患者发生肇事肇祸行为的危险因素。加强文化教育、积极的治疗手段有助于降低该类患者发生肇事肇祸行为。     

2013—2016年134例精神疾病患者死亡案例的回顾性分析

 目的 分析精神疾病患者死亡的法医学特征,为司法鉴定和临床关怀提供实践指导。 方法 收集上海市公安局虹口分局2013—2016年受理的精神疾病患者死亡案例,通过系统的案情调查、尸表检验,对所有死者的死亡原因、死亡方式及与相关因素进行统计学分析。 结果 2013—2016年间共有134例精神疾病患者死亡。男女比例为1∶1.23,平均年龄为(54.9±17.6)岁。89人(66.4%)精神病史超过3年,106人(79.1%)生前服用精神药物。抑郁症最常见(94例),其次为精神分裂症(35例)和焦虑症(5例)。死亡方式分别为自杀(117例)、猝死(16例)和意外(1例)。自杀案件以高坠最常见(79例,58.9%)。猝死案例较自杀案例具有更长的精神病史和用药史,多发生于住宅内。 结论 应重视精神疾病患者的精神和心理状况,同时注重预防和治疗其他躯体疾病。     

Suicide rate after the 1991-1995 War in Southwestern Croatia

BACKGROUND: The paper analyzed the impact of war, the most pernicious of social evils, taking into consideration intensity of change in rate of suicide in the southwestern region of Croatia during the war and including three distinctly specific intervals, two peacetime-one pre-war (1986-1990) and one post-war (1996-2000) as well as the period of the war itself (1991-1995). METHODS: From 853 cases of suicide committed during the period under review, age and gender of suicide victims, level of alcohol intoxication at suicide, means used in committing suicide, and suicide rate in years under review were analyzed. Quantitative characteristics of suicides were compared with other types of violent deaths, e.g., homicides and accidents. Frequencies of different features are shown graphically. Statistica 4.0 for Windows 98 was used in data processing. RESULTS: Of a total of 2,925 violent deaths in the period under review (1986-2000), 29.16% or 853 suicides (29.1%) were recorded. A total of 513 suicides were committed in the peace-time period--262 prior to the war (1986-1990) and 251 after the war (1996-2000)--while 340 suicides were recorded during the war (1991-1995). Means of committing suicide also changed drastically during the war, when 64 cases of firearm use were recorded compared with 18 cases during the pre-war interval and 36 cases in the post-war interval. CONCLUSIONS: Three parameters, namely, suicide rate, use of firearms, and intoxication, suffered the greatest changes in the war compared with the pre- and post-war period in the region under review.     

某精神医院急诊科重性精神疾病患者流行病学调查及特征分析

目的：：研究某精神病院急诊科重性精神病疾病流行病学情况,对精神疾病患者特征进行分析。方法：选取2011年3月至2015年3月期间某精神病医院急诊科收治的1641例精神疾病患者,对精神疾病患者进行流行病学调查,包括患者的性别、年龄、发病时间、住院次数、服药情况、临床表现、合并疾病以及处理方法等进行统计,分析患者发病特征。结果：共调查精神疾病患者1641例,患者年龄14~88岁,平均年龄(41.6±10.2)岁。其中首发重性精神疾病的患者583例,占35.53％;复发重性精神疾病的患者1058例,占64.47％。外伤患者138例,给予包扎止血处理;肌肉注射411例;静脉输液286例。所有患者在我院长期住院治疗,其中精神科1338例,外科91例,内科169例,妇科43例。治疗后出院1292例,转院113例,236例转精神科门诊治疗,无死亡病例。精神分裂、情感障碍以及精神发育迟滞在所有精神疾病中所占比例最高,分别为28.52％、23.28％以及20.48％。其中除感情障碍外,其他类型疾病男性发病率均略高于女性。精神疾病发病年龄段以18~60岁最多,共1232例(75.08％),其中多数患者为已婚患者,共1184例(72.15％),文化程度以初高中患者最多,共983例(59.90％),多数患者在家属陪同下来院就诊,共1397例(85.13％)。结论：对精神病患者的发病类型及患者临床特征进行分析有助于对精神疾病的诊断和针对性治疗,减少患者对社会的危害性,有助于社会的发展,对临床治疗具有重要意义。     

Suicides by prisoners

In a consecutive series of 44 deaths of male prisoners in Brisbane Prison, a maximum-security prison, in the 15-year period 1973-1987, 20 deaths were a result of suicide. More than half the suicides occurred within the first two months in custody. Prisoners on remand were more prone to commit suicide than were sentenced prisoners. A history of psychiatric disorder was frequent, and more than one-third of the prisoners previously had received psychiatric inpatient treatment. In 40% of cases suicide had been attempted previously. Hanging was the usual method of suicide. The application of preventive measures in the presence of risk factors for suicide at the present level of knowledge are discussed.