自殺企圖患者에 對한 臨床的 考察 = A CLINICAL STUDY OF SUICIDE ATTEMPT

다국어 초록 (Multilingual Abstract)

The author studied 84 suicide attempters hospitalized to the department of neuropsychiatry of Seoul National University Hospital, from 1975 to 1978.
Some of the clinical characteristics of the suicide attempters were as follows;
1. Females outnumbered males. Most common age bracket was from 29 to 30 years. About three fourths of them belonged to middle and lower social classes and a majority of them had education of high school and college. One third of them belonged to the diagnostic category of affective disorders, the other one third to schizophrenia, and the rest to neuroses, personality disorders and others.
2. Those who attempted suicide two times or more were 44% (37 cases) of the total attempters.
3. Drug was the most common method of the attempt (63%), and hyponsedative was the most common drug (42%). Seventeen % of the attempts were done by drugs prescribed by psychiatrists.
4. A majority of the suicide attempts occured after precipitating events, after an average period of 13 days, 91% of which occurred within 4 weeks.
5. The precipitating events were found in 55% of the attempters; those, in order of frequency, were frustrated love affair, family disharmony, and financial and personal loss. About half of the of the attempts were associated directly with psychiatric symptoms such as depression, delusion and auditory hallucination. The other half was motivated directly by attention seeking or inferiority resulting from conflictful interpersonal relationships such as frustrated love affair and family disharmony.
6. Direct or indirect communication of suicide intent was expressed in 73% or more of the subjects.
7. Fifty one percent of them were attempters with intermediate seriousness. Among the cases of "forced admission", there was no attempter with the lowest seriousness, but all of such case (11%) were those with intermediate and highest
seriousness. Remaining 86%, (72 case) of the attempters were admitted compliantly by advice.
8. The number of attempters discharged prematurely whithin 2 weeks was 24 (29%). Especially the number of patients with depressive neurosis, chronic alcoholism, and personality disorders discharged in less than 2 weeks was about 3 times as many as control patients with the same diagnoses. The mean duration of hospitalization of the attempters with alcoholism, and personality disorders was about 11 days, wherea that of the control patients with same diagnoses was 35 days.
9. The number of patients dischargedagainst discharged against medical advice was 32 (38%), and about half of them (15 cases) were discharged due to inadequate understanding of psychiatry on the part of the patients and their family.
10. Thirty one patients (37%) never entered in follow-up care recommended by their attending doctors. A majority of them (18 cases) were patients with depressive and hysterical neuroses, alcoholism and personality disorders.
A great majority (41 cases) of 49 cases who received follow-up care for one month or more were patients with schizophrenia and major affective disorders. The patients with depressive and hysterical neuroses hospitalized for suicide attempt were followed up in a small minority of them only ; follow up rate of the control group with the same diagnoses was much higher. All of the eight attempters (10%) with alcoholism and personality disorders failed to receive follow-up care.
Suicide attempters with underlying mental disorders including antisocial and other personality disorders, alcoholism, and depressive and hysterical neuroses seemed to have hostility in their basic personality make-up. Therapist is advised to have not only an understanding of this basic problem but also an insight into the possible countertransference feelings of the therapist himself. Furthermore, it is important that the family should be taught about the lethality of suicide attempt, and should be prepared to be more cooperative to the treatment and to be able to help the suicide attempters when hearing "the cry for help".
The author considered about some limitations of this study. In sampling control group, the attitudes of the subjects and their family toward psychiatry should have been considered. In addition, geographical and numerical limitation of the samples inevitably prevented the author from a generalization of the data into a premature conculusion applying to suicide attemrts in Korea.
We have still crude ability of predictation of or protection from the suicide. The author attempted to reach an understanding of and method of dealing with the underlying psychopathology of the suicide attempters who might happen to end their own lives.