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การฆ่าตัวตาย PowerPoint PPT Presentation


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การฆ่าตัวตาย. วิทยากร พ.ญ.กมลเนตร วรรณเสวก 26 ธ.ค.2549. การฆ่าตัวตายหรือพยายามฆ่าตัวตายเป็นปัญหาสาธารณสุขที่สำคัญของไทยซึ่งมีแนวโน้มสูงขึ้น จากสถิติผู้ที่พยายามฆ่าตัวตายและฆ่าตัวตายสำเร็จรวมกัน ที่มารับบริการ ณ สถานบริการสาธารณสุขช่วงปีพ.ศ.2540-2544 เพิ่มจาก 27.4 เป็น 36.4 ต่อประชากรแสนคน.

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26 ..2549


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  • ..2540-2544 27.4 36.4


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    • 20-40 ,


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  • 6 (WHO 2000)


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5


4 100 5 200

4,100-5,200

?


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  • 2549 7.7


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()

  • .

  • .

  • ,


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()


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Risk factors for suicide

Risk factors for suicide

  • ,

  • ,

  • /


Risk factors for suicide1

Risk factors for suicide


Common suicide risk factors across diagnosis

Common suicide risk factors across diagnosis

  • Depression: present in all diagnoses

  • Anxiety/agitation/panic attacks : respond rapidly to targeted treatment

  • Alcohol/substance abuse

  • Hopelessness : severity is important


Management

Management

  • Pre-suicidal attempt

    • warning sign

    • Management in suicidal crisis

  • Post-suicidal attempt


Suicide warning signs

Suicide Warning Signs

  • , ,


Suicide warning signs1

()Suicide Warning Signs

  • /


Suicidal crisis

(suicidal crisis)

  • Recognize the clues to suicide

  • Trust your own judgement

  • Tell others

  • Stay with a suicidal person

  • Listen

  • Urge professional help

  • Be supportive


Suicidal crisis1

(suicidal crisis)


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  • acute risk of suicide


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  • Rule of Thumb:

    , admit

  • ,


Sad persons scale

SAD PERSONSscale

  • Sex

  • Age

  • Depression

  • Previous attempt

  • Ethanol attempt

  • Rational thinking loss

  • Social support deficit

  • Organized plan

  • No spouse

  • Sickness


Scores

Scores

  • 0-2 Low risk

  • 3-4

  • 5-6

  • 7-10 High risk


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    • Risk-rescue ratio ..

    • Level of planning ..


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  • social support


7 seven steps for helping

7 Seven Steps for Helping

  • /


7 seven steps for helping1

7 Seven Steps for Helping

5.

6.

7.


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  • Stabilization of medical conditions.

  • Protection from self-harm

    • Complete evaluation before disposition

    • Potential means for self-harm must be removed


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Protection from self-harm

  • Appropriate supervision and restraint must be provided.

    • Frequent supervision

    • Constant one-to-one supervision

    • Physical restraint


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    • Crisis intervention


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  • Choice of disposition : suicidal risk ,

    • Admission to a medical floor with psychiatric consultation

    • Voluntary admission to a psychiatric unit

    • Involuntary commitment to a psychiatric unit


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  • social supports


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  • Poor social network

  • Active substance abuse

  • ,


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  • 40% attempter attempt

  • F/U 13-35% attempter 2


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  • attempter

    • alcohol,

    • sociopathy,

    • ,

    • ,

    • attempt


Prevention

Prevention

  • primary prevention secondary prevention

  • primary prevention attempt

    • Samaritan attempter 2% attempt


Prevention1

Prevention

  • attempt suicide Samaritan

  • attempter emergency service attempt


Prevention2

Prevention

  • attempt suicide impulsive

  • . education

    . suicide


Prevention3

Prevention

.

.

. coping skill


Prevention4

Prevention

  • secondary prevention re-attempt suicide rate


Suicide prevention a study of patients views

Suicide prevention: a study of patients views.

Helpful Factors

  • Psychiatric services

  • Social networks

  • Religious beliefs and activites


Suicide prevention a study of patients views1

Suicide prevention: a study of patients views.

Unhelpful factors

  • Stigmatisation of people with mental illness is common

  • Employment was not protective against suicidal ideation


Suicide prevention a study of patients views2

Suicide prevention: a study of patients views

  • Efforts to improve contact with psychiatric services are more likely to be helpful than changes to those services

  • Patients social and religious support networks are highly valued and should be fostered.

  • Efforts to decrease the stigma attached to mental illnesses should continue.


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