Suicide Attempt without a Mental Health Diagnosis.

INTRODUCTION: Suicide in people without a mental health diagnosis pose a clinical challenge that is still poorly understood by psychiatrists, generating the debate between respecting the patient's autonomy right or supporting involuntary admissions after a lethal gesture to rule out psychopathology. AIMS AND METHODS: The authors take a case of an 81-year-old man without mental health history who, after his first suicide attempt by ingesting floor cleaners, presented acute kidney failure that required to initiate haemodialysis to preserve his life. Despite being aware of the fatal outcome in case of rejecting it, he denied the dialysis and verbalize the persistence of suicide ideation. This publication complies with the agreements of the Declaration of Helsinki and the informed consent was obtained from his wife. RESULTS: It was finally considered that the patient maintained his capacity for judgment and no involuntary measures were taken, with family consent. Finally, he passed away ten days after carrying out the suicide attempt. DISCUSSION: He was evaluated up to three times by mental health professionals and, after deciding that he had preserved judgment, his decision was respected. The patient passed away ten days later. CONCLUSIONS: This approach could help psychiatrics better understand suicide behaviour in cases we don't make a mental health diagnosis.

Trajectories of children and adolescents attending a psychiatric emergency unit during the COVID-19 confinements: 2020-2022 longitudinal study.

INTRODUCTION: The prevalence of psychiatric disorders has not shifted widely through the COVID pandemic, except for some specific groups such as young people or women. Our objective is to examine prospectively the evolution of children and adolescents who consulted in a psychiatric emergency service during the COVID-19 confinements. METHOD: We collected prospective clinical information about 296 young people under 18 who visited a tertiary hospital for psychiatric reasons during the confinement periods in Spain. Clinical diagnoses, suicide attempts, hospital admissions, and pharmacological prescriptions were extracted from electronic health records through 2020, 2021, and 2022. Features of those who maintained psychiatric care and those who did not were compared. RESULTS: Three out of four children and adolescents who visited the psychiatric emergency department during the confinements continued psychiatric care at the end of 2022. Those who did not showed better premorbid adjustment at baseline. During follow-up, diagnoses of neurodevelopmental disorders and eating disorders, as well as the dosage of psychotropic drug prescriptions, increased. The diagnoses of major depressive disorder and eating disorder at baseline were associated with attempting suicide during follow-up. Patients with internalizing symptoms were admitted earlier than those with externalizing symptoms but no differences were found in terms of suicide attempts. CONCLUSIONS: The continuity of psychiatric care after an initial emergency visit during the confinements implied greater clinical severity, as reflected by changes in clinical diagnoses and pharmacological regimens. Emergent symptoms of depression or eating disorders after social distancing or isolation could predict subsequent suicidal behavior in young populations.