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Chapter 15

PSYC 208 Chapter 15: Chapter 15 - Suicide

6 Pages
77 Views
Summer 2012

Department
Psychology
Course Code
PSYC 208
Professor
Paul Wehr
Chapter
15

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Chapter 15 - Suicide 05:11
Suicide
-Parasuicide: attempts not meant to end life
Intention is not to die, but action is the same.
Can lead to accidental death.
May lose fear of death and engage in more and more risky behaviours.
-Hard vs. Soft suicide: gunshot vs. overdose: more males vs. more females
-Suicide ideation: thoughts of suicide, often triggered by hopelessness and social isolation.
-There are different stages leading to suicide, but can also be impulsive with few signs.
-Stages:
Intense suffering leading to thoughts of suicide
Feelings of ambivalence (Wants suffering to end, but doesn’t want to die)
Narrowing of perceived alternatives (“Suicide is the only way to go.”)
Final decision made
Epidemiology
-2001, prevalence is 850,000 worldwide
-Europe: 25 per 100,000
-Canada: 11.5 per 100,000
Males: 17.4 per 100,000
Females: 5.3 per 100,000
Peaks in the 40s
-Higher in high social status and after losing status.
-Rate in teenagers tripled since 1960’s.
-Parasuicidal behaviours are 10-20 times higher.
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Risk Factors
-Emotion: aggression, impulsivity, humiliation, shame, hopelessness, anhedonia.
-Trauma: childhood trauma, sexual abuse, recent trauma.
-Marital: widowhood, divorce, bad marriage
-Aging: physical illness, chronic insomnia
-Social: lack of social support, negative family relations
-Neglectful parenting for females
-Psychiatric disorders
90% of suicide are associated with diagnosable disorder
affective disorder, substance dependence, schizophrenia, cluster B (dramatic)
50% of Borderline Personality Disorder attempt suicide
-Suicide genes are independent of with psychiatric disorders genes!
Pathophysiological Mechanisms
-Reduced serotonin activity
Low 5-HIAA (a metabolite of serotonin) in the cerebral-spinal fluid  Low serotonin 
Increased aggression and suicide
Two gene polymorphism  Low serotonin  High risk behaviours
Low cholesterol blood level  Low serotonin  High risk behaviours
oNot eating enough fatty foods  Sends signal to brain saying needs to take more risk
to find food  Brain responds by lowering serotonin (supposedly an evolved
psychological mechanism)
-Possible hyperactive HPA pathway activation and cortisol activity (mixed evidence)
Outcome & Treatment
-Risk of successful suicide after unsuccessful attempt:
First year: 0.5 – 2%
Nine years: 5%
Lifetime: 30%
-Protective factors: social support, children in home, life satisfaction, problem-solving abilities
-Treatment:
Primary & secondary prevention: reduced access to means, hotlines, public awareness
(debatable if they’re helpful or not)
oPrimary: preventing initial attempt
oSecondary: preventing subsequent attempts
Individual assessment for intent, ideation, and plan.
Hospitalization for high-risk individuals.
-
-
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Description
Chapter 15 - Suicide 05:11 Suicide - Parasuicide: attempts not meant to end life  Intention is not to die, but action is the same.  Can lead to accidental death.  May lose fear of death and engage in more and more risky behaviours. - Hard vs. Soft suicide: gunshot vs. overdose: more males vs. more females - Suicide ideation: thoughts of suicide, often triggered by hopelessness and social isolation. - There are different stages leading to suicide, but can also be impulsive with few signs. - Stages:  Intense suffering leading to thoughts of suicide  Feelings of ambivalence (Wants suffering to end, but doesn’t want to die)  Narrowing of perceived alternatives (“Suicide is the only way to go.”)  Final decision made Epidemiology - 2001, prevalence is 850,000 worldwide - Europe: 25 per 100,000 - Canada: 11.5 per 100,000  Males: 17.4 per 100,000  Females: 5.3 per 100,000  Peaks in the 40s - Higher in high social status and after losing status. - Rate in teenagers tripled since 1960’s. - Parasuicidal behaviours are 10-20 times higher. Risk Factors - Emotion: aggression, impulsivity, humiliation, shame, hopelessness, anhedonia. - Trauma: childhood trauma, sexual abuse, recent trauma. - Marital: widowhood, divorce, bad marriage - Aging: physical illness, chronic insomnia - Social: lack of social support, negative family relations - Neglectful parenting for females - Psychiatric disorders  90% of suicide are associated with diagnosable disorder  affective disorder, substance dependence, schizophrenia, cluster B (dramatic)  50% of Borderline Personality Disorder attempt suicide - Suicide genes are independent of with psychiatric disorders genes! Pathophysiological Mechanisms - Reduced serotonin activity  Low 5-HIAA (a metabolite of serotonin) in the cerebral-spinal fluid  Low serotonin  Increased aggression and suicide  Two gene polymorphism  Low serotonin  High risk behaviours  Low cholesterol blood level  Low serotonin  High risk behaviours o Not eating enough fatty foods  Sends signal to brain saying needs to take more risk to find food  Brain responds by lowering serotonin (supposedly an evolved psychological mechanism) - Possible hyperactive HPA pathway activation and cortisol activity (mixed evidence) Outcome & Treatment - Risk of successful suicide after unsuccessful attempt:  First year: 0.5 – 2%  Nine years: 5%  Lifetime: 30% - Protective factors: social support, children in home, life satisfaction, problem-solving abilities - Treatment:  Primary & secondary prevention: reduced access to means, hotlines, public awareness (debatable if they’re helpful or not) o Primary: preventing initial attempt o Secondary: preventing subsequent attempts Individual assessment for intent, ideation, and plan. Hospitalization for high-risk individuals. - - Chapter 15 - Suicide 05:11 Evolutionary Synthesis Chapter 15 - Suicide
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