Conducta suicida en niños y adolescentes / Suicide behavior in children and adolescents

Existe un amplio rango de conductas suicidas, que representan un continuo de una dimensión común, con algunas diferencias cualitativas: 1) Planificación o pensamientos suicidas con intención de morir; 2) Amenaza, expresión verbal de intención suicida; 3) Gesto, amenaza suicida con los medios disponibles para intentarlo. Por ej.: tener las pastillas en la mano sin tomarlas; 4) Intentos de suicidio, conducta autodestructiva con intención suicida; 5) Suicidio logrado, muerte por suicidio comprobado. En los intentos de suicidio predominan las mujeres y el uso de métodos pasivos, menos letales como la autointoxicación. En los suicidios logrados predominan los hombres de todas las edades, y el uso de métodos más activos de autoeliminación. Muchos autores piensan que se trata de poblaciones distintas con intenciones distintas, y que estas personas pretenden llamar la atención y pedir ayuda, y no autoeliminarse. Sin embargo, el riesgo de suicido logrado aumenta en los sujetos que han efectuado intentos previos, el riesgo es mayor en los primeros meses, continuando hasta los 2 años posteriores. Por este motivo, las investigaciones se han centrado en comprender toda la gama de conductas suicidas, identificar las intervenciones terapéuticas más eficientes para los intentos de suicidio, mejorar el seguimiento de estos casos, e identificar los factores de riesgo para el suicidio logrado, con fines de prevención

Suicide attempt: one diagnosis, multiple disorders.

Patients who intentionally injure themselves are a varied group, ranging from those who are unthinkingly agitated to those who are calculatingly manipulative to those who are truly suicidal; these patients require very different forms of management. If a manipulator is able to exploit the hospital in trying to solve life's problems, he is likely to repeat such behavior when inevitable problems occur in the future. The truly suicidal patient, however, must be recognized and safeguarded while his underlying problems are treated. Suicidal behavior is the outcome of the dynamic interaction of the patient's personality, affective state, and social circumstances. The question commonly asked initially, "Will he try to hurt himself again?" addresses the wrong issue, as outcome is of little diagnostic relevance.

[Atenolol poisoning]. / Intoxikation mit Atenolol.

A 44-year-old obese female patient ingested 200 mg diazepam and 1000 mg atenolol with suicidal intent. On admission to the clinic 24 hours later she was in deep coma, with a body temperature of 28.9 degrees C. The blood level of atenolol was 250 mg/l (therapeutic range 0.2-0.5 mg/l); this is the highest level yet recorded. She was treated with gastric lavage, instillation of charcoal and with orciprenaline, dopamine and dobutamine. She survived the poisoning without any untoward sequelae.

[Primary polyuric kidney failure and acute yellow liver dystrophy following infusion of glucose substitutes in children]. / Primär polyurisches Nierenversagen und akute gelbe Leberdystrophie nach Infusion von Zuckeraustauschstoffen im Kindesalter.

Four children (aged 2 1/2-14 years) were given infusions of fructose, sorbitol and xylitol after sustaining head trauma (n = 3) or after attempted suicide with carbromal (n = 1). After transitory polyuria renal failure of varying severity set in three to five days after onset of the infusion treatment. Serum osmolality fell to 265-274 mosm/kg, haematocrit to 0.25-0.31, and hyponatraemia developed. Serum creatinine rose to maximally 256-930 mumol/l. Liver damage developed in parallel to the renal failure, two children dying with acute yellow liver atrophy. Two children--given symptomatic treatment with balanced equalization of the hyponatraemia, administration of frusemide and adjusted carbohydrate substitution--were discharged after four to eight weeks with normal renal and hepatic functions. Dialysis was not required. The hepatic and renal abnormalities must have been due to the high amounts of fructose, sorbitol and xylitol, to a total of 7.1-23.0 g/kg on the first day, well above recommended levels.

Atención psiquiátrica en el cuarto de urgencia del Complejo Hospitalario Metropolitano de la Caja de Seguro Social / Psychiatric care in an emergency room of the Complejo Hospitalario Metropolitano de la Caja de Seguro Social

El presente trabajo tiene como objetivo primordial poner en evidencia la variada patología psiquiátrica que presentaron novecientos setenta y dos (972) pacientes atendidos por los médicos residentes de Psiquiatría durante el período comprendido entre el 1 de junio de 1983 y el 31 de mayo de 1984. Se puso en evidencia que los trastornos psicóticos del tipo de la Esquizofrenia, fueron la principal causa de atención, trescientos ocho (308) casos. Los intentos de suicidio ocuparon el segundo lugar, ciento veintiseis (126) pacientes, mientras que los problemas asociados con el abuso de drogas no fueron notorios (1%). Hubo predominio de mujeres en el grupo estudiado, con mayor frecuencia de atención a pacientes de edades jóvenes (10 a 29 años). El mayor porcentaje de pacientes (41.6%) fue referido a la Consulta Externa de Psiquiatría, 38.7% de los pacientes fueron admitidos a la Sala de Observaciones del Cuarto de Urgencias y 4.2% de los pacientes fueron trasladados a otras instituciones

[Acute poisonings in Barcelona. Epidemiology and therapeutic considerations (author's transl)]. / Intoxicación aguda en Barcelona. Epidemiología y consideraciones sobre su terapéutica.

During the first semester of 1977, 330 patients were admitted with acute intoxication to a general hospital in Barcelona, representing 1.8% of the total admissions through the Emergency Room during that time. The patients with acute intoxication were distributed as follows: 48.2%, voluntary intoxication; 39.1%, household accidents; and 11.8%, acute alcoholic intoxication. While most household accidents occurred in children less than 5 years of age (87.5%), suicidal attempts were seen mostly between ages 13 and 30. Regarding sex distribution, 68.6% of suicidal attempts occurred in females, while males accounted for 82.1% of admissions for acute alcoholism. No seasonal distribution of the different types of intoxication could be detected. Concerning the type of toxic compound implicated, household accidents were due principally to drug ingestion (47.7%) followed by ingestion of caustics, detergents, and other cleansing products (37.1%), while most (88.8%) suicidal attempts were due to drug ingestion. In both cases the drugs more frequently utilized were, in this order, barbiturates, benzodiazepines, alcohol, analgesics, and antidepressants. As far as it regards gravity of intoxication, benzodiazepines offered the greatest margins of security. It was observed that gastric cleansing was carried out independently of the age and level of consciousness of the patient and without regards to the time elapsed between ingestion of the offending agent and first evaluation. It was also noted that diuresis was enhanced in 40% of cases without pharmacological justification. Finally, therapeutic plans are discussed and measures to rationalize them are proposed.

[The burden of a general medical clinic with patients after suicide attempts]. / Die Belastung einer internmedizinischen Klinik durch Patienten nach Suizidversuchen

All 125 patients who entered the "suicide ward" of the Medical Department of a large public hospital during 1974 were analyzed according to age and sex distribution, duration of hospital stay, motivation and method of committing suicide and fate after recovering from the acute phase of intoxication. Motivation to commit suicide was mainly due to conflicting interpersonal relations. Suicide attempts were 3 times more frequent in women than in men. 49% of all suicide attempts were considered to be of the "cry for help" variety and 29% were classified as obviously ineffective but serious attempts of self-killing. The remaining 22% of patients wanted to mark a "caesura" in their lives. Since the early phase of recovery is of utmost importance for the patient's future, medical and nursing staff have to be trained and experienced in coping with the suicide patient's numerous problems. The permanent collaboration of an experienced psychiatrist within the staff of larger acute-phase hospitals is highly desirable in order to analyze the underlying social and medical problems, assess the danger of a renewed suicide attempt, start early and appropriate therapy and train hospital staff and nurses.