Dedić Gordana, Djurdjević Slavisa, Golubović Boris
Military Medical Academy, Clinic for Psychiatry, Department for Mental Health and Military Psychology, Belgrade, Serbia.
Vojnosanit Pregl. 2010 Feb;67(2):151-8. doi: 10.2298/vsp1002151d.
BACKGROUND/AIM: Urgent psychiatric help and effective psychotherapeutic treatments are required soon after revival of a person after suicide attempt by self-poisoning. The aim of this article was to define an assessment of actual psychological characteristics of a person after suicide attempt by self-poisoning in order to apply psychotherapeutic crisis intervention after suicide attempt, as well as to show an approach to the treatment guided by the assessment that uses a psychodynamic model of suicidal crisis intervention based on our clinical experience.
Hamilton Depression Rating Scale (HAMD), Center for Epidemiological Studies-Depression Scale (CES-D), Defensive Questionnaire Scale (DSQ-40), Scaling of Life Events (Paykel), and Pierce Suicide Intent Scale (SIS) were applied in 30 hospitalized persons following suicide attempt by self-poisoning and in 30 patients who had asked for psychiatric examination at the outpatient clinic due to various life crises not resulting in suicide attempt. The examinees of both groups were matched by sex, age, and education, professional and marital status. Comparison of the patient groups was done by the t-test. Logistic regression analysis was used for suicidal risk assessment.
The suicide attempters were depressed (HAMD = 22.60 +/- 5.93, CES-D = 29.67 +/- 7.99), with medium suicide risk factor (SIS = 4.5 +/- 4.17), using immature (projection, dissociation, devaluation, acting-out) and neurotic (altruism) defense mechanisms. The most important motives for suicide attempt were separation problems, problems with parents and a problem of loneliness. The commonest feelings and thoughts of a subject preceding suicide attempt were a wish to escape an unbearable situation, loss of control, desire to show love for a partner and wish to be helped. After a suicide attempt, 90% of the persons felt relief because the attempt failed, although almost half of them intend to repeat it. The risk of repeated suicide attempt was 1.8 (90% CI = 0.09-37.70, p < 0.001) times higher if values on the SIS Total Score were increased and 1.62 (90% CI = 0.03-81.39, p < 0.001) times higher if values on the SIS 1 (Circumstances Score) subscale were increased, too.
Before starting with psychotherapy for persons after suicide attempt by self-poisoning it is very important to define psychological assessment of a person, choose the treatment (out-patient clinic or inpatient/hospital), assess indications for pharmacotherapy and psychotherapy that also must include a selection of patients for application of this therapeutic method. Assessment of conscientious and unconscientious conflicts leading to a suicide attempt represents initial basis for a therapist's work with a patient after suicide attempt and for application of psychotherapeutic crisis intervention.
背景/目的：在因自我中毒自杀未遂者复苏后，需要尽快提供紧急的精神科帮助和有效的心理治疗。本文的目的是确定对因自我中毒自杀未遂者实际心理特征的评估，以便在自杀未遂后应用心理治疗危机干预，并基于我们的临床经验展示一种以评估为指导的治疗方法，该评估使用自杀危机干预的心理动力学模型。
对30例因自我中毒自杀未遂而住院的患者以及30例因各种生活危机但未导致自杀未遂而在门诊寻求精神科检查的患者，应用汉密尔顿抑郁量表（HAMD）、流行病学研究中心抑郁量表（CES-D）、防御问卷量表（DSQ-40）、生活事件量表（佩克尔）和皮尔斯自杀意图量表（SIS）。两组受试者在性别、年龄、教育程度、职业和婚姻状况方面进行匹配。通过t检验对患者组进行比较。使用逻辑回归分析进行自杀风险评估。
自杀未遂者存在抑郁（HAMD = 22.60 ± 5.93，CES-D = 29.67 ± 7.99），具有中等自杀风险因素（SIS = 4.5 ± 4.17），使用不成熟（投射、解离、贬低、付诸行动）和神经质（利他主义）防御机制。自杀未遂的最重要动机是分离问题、与父母的问题和孤独问题。自杀未遂前受试者最常见的感受和想法是希望逃离无法忍受的处境、失去控制、渴望向伴侣表达爱意以及希望得到帮助。自杀未遂后，90%的人因未遂而感到宽慰，尽管其中几乎一半人打算再次尝试。如果SIS总分值增加，再次自杀未遂的风险高1.8倍（90%可信区间 = 0.09 - 37.70，p < 0.001）；如果SIS 1（情况评分）子量表分值增加，再次自杀未遂的风险也高1.62倍（90%可信区间 = 0.03 - 81.39，p < 0.001）。
在对因自我中毒自杀未遂者开始心理治疗之前，确定对该人的心理评估、选择治疗方式（门诊或住院/医院）、评估药物治疗和心理治疗的适应症非常重要，这还必须包括选择适用这种治疗方法的患者。评估导致自杀未遂的有意识和无意识冲突是治疗师在自杀未遂后与患者合作以及应用心理治疗危机干预的初始基础。
