Características Proximales de Intentos Autolíticos: Estudio en un Hospital Público de España

RESUMEN Introducción: En el presente trabajo se describen distintos parámetros de las tentativas de suicidio atendidas desde la implementación del programa de Atención al Riesgo Suicida (ARSUIC) en 2012 en el Hospital Ramón y Cajal de la Comunidad de Madrid, España. Métodos: La muestra estuvo compuesta por 107 pacientes y la información se recogió a través de un cuestionario creado ad hoc con las siguientes variables: tipo de ideación suicida, consumo de tóxicos inmediatamente antes, método (en caso de sobreingesta medicamentosa: fármaco/s utilizado/s), ubicación, accesibilidad al rescate, planificación, intencionalidad, crítica y frenadores. Resultados: Se obtuvieron estadísticos descriptivos y se realizó una comparación por sexo a través de las pruebas de x2 y coeficientes de contingencia. Los datos del estudio longitudinal retrospectivo mostraron como perfil más frecuente el de pacientes con ideas de muerte no estructuradas, sin consumo previo de tóxicos, que se realizan en el domicilio familiar de manera no planificada y con intención autolítica o evitativa del malestar de una sobreingesta medicamentosa, especialmente con benzodiacepinas. Los pacientes tienden a solicitar auxilio posterior y realizar crítica del intento, y los potenciales frenadores con frecuencia no se recogen en el informe clínico. Respecto a las disimilitudes en función del sexo, se encontraron diferencias estadísticamente significativas en el consumo previo de alcohol, a favor de los hombres, y en el método sobreingesta, concretamente con benzodiacepinas, a favor de las mujeres. Conclusiones: Profundizar en las tipologías de los intentos autolíticos resulta fundamental para mejorar la prevención, la comprensión y el abordaje sanitario.

ABSTRACT Introduction: Different parameters of suicide attempts treated since the implementation of the Attention to Suicide Risk Program (ARSUIC) in 2012 at the Hospital Ramón y Cajal in Madrid Region are described in this paper. Method: The sample was composed of 107 patients and the information was collected through a questionnaire created ad hoc with the following variables: type of suicidal ideation; drug use immediately prior to the attempt; method (in case of drug overdosing: drug/s used); location; accessibility to rescue; planning; intentionality; criticism; and brakes. Results: Descriptive statistics were obtained and a comparison by gender was made through the x2 and contingency coefficients tests. The data from the retrospective longitudinal study showed that the most common profile was of patients with unstructured ideas of death and no previous drug use who took an unplanned drug overdose in the family home, with the intention of self-harm or avoidance of discomfort, especially with benzodiazepines. Patients tend to ask for help afterwards and criticise the attempt, but potential restraints are often not recorded in the clinical report. Regarding the dissimilarities based on gender, statistically significant differences were found in prior alcohol consumption, in favour of men and in the overdose method, specifically with benzodiazepines, in favour of women. Conclusions: Knowing the types of attempts at self-harm is essential for improving prevention, understanding and patient management.

Cuidado aos adolescentes com comportamentos suicidas e autolesivos: o olhar dos profissionais de uma rede de serviços intersetoriais / Caring for adolescents with suicidal and self-harm behaviors: the perspective from professionals of an intersectoral service network

Resumo Objetivou-se analisar como os profissionais de uma rede de serviços intersetoriais desenvolvem ações de cuidado aos adolescentes com comportamentos suicidas e autolesivos. Trata-se de um estudo descritivo e exploratório de abordagem qualitativa, realizado através de anotações no diário de campo e entrevistas semiestruturadas com 22 profissionais vinculados a serviços da assistência social, educação e saúde de um município de grande porte do nordeste brasileiro. A coleta de dados ocorreu no período de agosto a setembro de 2021. Os discursos foram submetidos à análise de conteúdo na modalidade temática indutiva, com suporte do software Nvivo 11 Pro. Diante disso, duas categorias emergiram: estratégias de cuidado da rede intersetorial e fragilidades no cuidado. Os profissionais percebem os adolescentes como sujeitos que necessitam de suporte para o sofrimento psíquico apresentado. Deste modo desenvolvem, como principais estratégias de cuidado, o acolhimento e as atividades de prevenção, estas de modo pontual. Contudo, a rede de cuidados mostra-se insuficiente, devido à escassez de políticas infantojuvenis e serviços especializados, além de dificuldades na prática da intersetorialidade. Conclui-se que o cuidado ofertado aos adolescentes é fragilizado e necessita do fortalecimento de políticas públicas transversais, ampliação dos serviços primários/especializados e do trabalho intersetorial.

Abstract It aimed to analyze how professionals from an intersectoral service network develop care actions for adolescents with suicidal and self-injurious behaviors. This is a descriptive and exploratory study with a qualitative approach, carried out through notes in the field diary and semi-structured interviews with 22 professionals linked to social assistance, education and health services in a large municipality in northeastern Brazil. Data collection took place from August to September 2021. The speeches were subjected to content analysis in the inductive thematic modality, with support from the Nvivo 11 Pro software. Given this, two categories emerged: intersectoral network care strategies and weaknesses in care. Professionals perceive adolescents as subjects who need support for their psychological suffering. In this way, they develop, as the main care strategies, reception and prevention activities, on a punctual basis. However, the care network appears to be insufficient, due to the scarcity of child and youth policies and specialized services, in addition to difficulties in practicing intersectorality. It is concluded that the care offered to adolescents is fragile and requires the strengthening of transversal public policies, expansion of primary/specialized services and intersectoral work.

Autolesiones no suicidas en estudiantes de medicina: frecuencia y factores asociados / Non-suicidal Self-injury in Medical Students: Frequency and Associated Factors

Introducción: la salud mental de los estudiantes de medicina ha sido ampliamente investigada, demostrando que forman parte de un grupo vulnerable al desarrollo de trastornos mentales. Objetivo: el objetivo de esta investigación fue determinar la frecuencia de NSSI y sus factores asociados en estudiantes de medicina del Paraguay. Metodología: este fue un estudio descriptivo y transversal. Se lanzó una encuesta online para evaluar depresión, ansiedad y autolesiones, se utilizaron las escalas PHQ-2, GAD-7 y SHQ, respectivamente. Resultados: recibimos respuestas de 330 estudiantes de medicina. De los participantes, el 71,2 % eran mujeres. Se identificó que el 46,4 % de los participantes padecía depresión (PHQ-2 ≥ 3) y el 37,3 % ansiedad (GAD-7 ≥10). La frecuencia de NSSI fue del 27 % (n = 89). Los principales factores asociados a NSSI fueron un diagnóstico previo de un trastorno mental (que aumentó la probabilidad de NSSI en 3,76 veces) y/o una historia de abuso físico o sexual (con un aumento de 3,75 veces). Conclusión: esta investigación encontró la presencia de NSSI en casi 3 de cada 10 de los estudiantes de medicina encuestados. Los principales factores asociados con la conducta autolesiva fueron un diagnóstico previo de un trastorno mental y/o antecedentes de abuso físico o sexual.

Introduction: the mental health of medical students has been extensively researched, showing that they are part of a group vulnerable to the development of mental disorders. Aim: the aim of this research was to determine the frequency of NSSI and its associated factors in medical students in Paraguay. Methodology: this was a descriptive and cross-sectional study. An online survey was launched to assess depression, anxiety, and self-harm, the PHQ-2, the GAD-7 and SHQ scales were used, respectively. Results: we received responses from 330 medical students. Of the participants, 71.2 % were female. 46.4% of the participants were identified as having depression (PHQ-2 ≥ 3) and 37.3 % as having anxiety (GAD-7 ≥10). The frequency of NSSI was 27 % (n = 89). The main factors associated with NSSI were a previous diagnosis of a mental disorder (which increased the likelihood of NSSI by 3.76 times) and/ or a history of physical or sexual abuse (with a 3.75-fold increase). Conclusion: this research found the presence of NSSI in almost 3 out of 10 of the medical students surveyed. The main factors associated with self-injurious behavior were a previous diagnosis of a mental disorder and/or a history of physical or sexual abuse.

Autolesiones no suicidas en estudiantes de medicina: frecuencia y factores asociados

Introducción: la salud mental de los estudiantes de medicina ha sido ampliamente investigada, demostrando que forman parte de un grupo vulnerable al desarrollo de trastornos mentales. Objetivo: el objetivo de esta investigación fue determinar la frecuencia de NSSI y sus factores asociados en estudiantes de medicina del Paraguay. Metodología: este fue un estudio descriptivo y transversal. Se lanzó una encuesta online para evaluar depresión, ansiedad y autolesiones, se utilizaron las escalas PHQ-2, GAD-7 y SHQ, respectivamente. Resultados: recibimos respuestas de 330 estudiantes de medicina. De los participantes, el 71,2 % eran mujeres. Se identificó que el 46,4 % de los participantes padecía depresión (PHQ-2 ≥ 3) y el 37,3 % ansiedad (GAD-7 ≥10). La frecuencia de NSSI fue del 27 % (n = 89). Los principales factores asociados a NSSI fueron un diagnóstico previo de un trastorno mental (que aumentó la probabilidad de NSSI en 3,76 veces) y/o una historia de abuso físico o sexual (con un aumento de 3,75 veces). Conclusión: esta investigación encontró la presencia de NSSI en casi 3 de cada 10 de los estudiantes de medicina encuestados. Los principales factores asociados con la conducta autolesiva fueron un diagnóstico previo de un trastorno mental y/o antecedentes de abuso físico o sexual.

Introduction: the mental health of medical students has been extensively researched, showing that they are part of a group vulnerable to the development of mental disorders. Aim: the aim of this research was to determine the frequency of NSSI and its associated factors in medical students in Paraguay. Methodology: this was a descriptive and cross-sectional study. An online survey was launched to assess depression, anxiety, and self-harm, the PHQ-2, the GAD-7 and SHQ scales were used, respectively. Results: we received responses from 330 medical students. Of the participants, 71.2 % were female. 46.4% of the participants were identified as having depression (PHQ-2 ≥ 3) and 37.3 % as having anxiety (GAD-7 ≥10). The frequency of NSSI was 27 % (n = 89). The main factors associated with NSSI were a previous diagnosis of a mental disorder (which increased the likelihood of NSSI by 3.76 times) and/ or a history of physical or sexual abuse (with a 3.75-fold increase). Conclusion: this research found the presence of NSSI in almost 3 out of 10 of the medical students surveyed. The main factors associated with self-injurious behavior were a previous diagnosis of a mental disorder and/or a history of physical or sexual abuse.

A retrospective study of attempted self-harm in a secondary care setting in rural India

Background: Suicides and non-suicidal self-injuries (NSSI) pose a serious public health problem, affecting communities all over the world. Adolescents and young adults are particularly vulnerable to commit self-harm (SH). SH causes serious emotional, physical, and economic repercussions, and leads to long-term health impacts. Methods: A retrospective study was conducted in a rural secondary care hospital from Feb 2020 to March 2022. Data regarding demographics, cause and type of SH, and treatment provided to 190 patients were analysed. Results: Majority of patients were in the 16-35 years age group. Poison consumption was the commonest method used. Pesticides and pills were the commonly-used agents. Agricultural activities and pre-existing illness in families facilitated access to these agents, as did the unregulated availability and unsafe storage. 31 patients disclosed the reason for SH, with the commonest reason being strained relationships. Emotional states described by the patients which pushed them to SH included dejection, hopelessness, anger, recklessness, altered mood, lack of purpose in life, cynicism and a sense of lack of support. 16% were discharged against medical advice. Conclusions: The study identified the need for methodical documentation, referral and follow-up of patients, with adequate psychiatric and counselling support. Access to care for SH patients is lacking especially in rural areas, and is at best available only for management of the SH event. SH should be considered not as a disease by itself, but as an outcome of stress due to socio-economic and other factors. Multi-stakeholder convergent approaches are needed to tackle this challenge in a holistic manner.

Socio-demographic Correlation among Patients with Deliberate Self-harm

Background: Deliberate self-harm is a complex behavior of maladaptive response to acute and chronic stress, and likely to be suffering from mental health problems as well as co-morbid general medical conditions, including several non-suicidal intentions to suicide. Deliberate self-harm was previously included in suicide. Sir Thomas Browne first used the word ‘Suicide’ in 1642 in his religion Medici. The word suicide originated from SUI (of oneself) & CAEDES (murder). According to WHO ‘Suicide’ refers to the act of killing oneself intentionally, performed by the person with full knowledge or expectation of the fatal outcome. This study aimed to analyze the pattern of psychiatric disorders among patients with deliberate self-harm. This study aimed to analyze the socio-demographic correlation among patients with deliberate self-harm. Material & Methods: This descriptive cross-sectional study was conducted at the Department of Medicine; emergency & OPD, Rangpur Medical College, Rangpur, Bangladesh. The study duration was 1 year; July 2012- June 2013. A total of 116 deliberate self-harm cases were included in this study as per the inclusion criteria. A convenience sampling technique was undertaken in this study. Results: The correlation of age, sex, economic status, religion, educational status, occupation, marital status, family history of mental illness, previous H/O mental illness, previous H/O physical illness, nature of stress factors, and the total number of DSH was significant between psychiatric disorder and co-morbid general medical condition. Conclusion: There was a significant correlation between sociodemographic parameters among the patients with deliberate self-harm. Bangladesh is a country with a cultural heritage of thousands of years. Traditional values, and social and family bonding are the characteristics of the culture. Traditional value systems are being declined gradually due to the influence of western culture. The social structure is in a period of transition that is characterized by the waning of family ties and social support as well as an increase in urbanization and modernization. This factor together with psychiatric and co-morbid general medical conditions plays an important role in deliberate self-harm

A qualitative study on self-harm experience of adolescents with mental disorders under environmental function model / 中国实用护理杂志

Objective:To deeply understand the psychological experience of self-harm in adolescent patients with mental disorder under environmental function model, and to provide reference for the formulation of nursing intervention measures for adolescent patients with mental disorder.Methods:Descriptive phenomenology was used to conduct in-depth interviews with 14 adolescent patients with mental disorders in Wuhan Mental Health Center From February to May 2021. The interview data were analyzed by Colaizzi′s seven-step analysis method.Results:There were 4 themes and 12 sub-themes: cognitive bias of self-harming behavior; psychological and emotional complexity: self-denial and self-loathing, pain, despair, satisfaction and comfort, shame, stigma, guilt; the causes of self-harm: family factors, school factors, personality factors and psychiatric symptoms factors; insufficient self-management ability: insufficient emotional management ability, low medication compliance, low self-efficacy.Conclusions:The self-harm behavior of adolescent mental disorder patients is not optimistic, the psychological and emotional burden is heavy, and the self-management ability is insufficient, so the intervention and prevention of self-harm behavior should be further strengthened.

Mortalidad en estudiantes universitarios según causas de muerte (2004-2018) / College student mortality by causes of death (2004-2018)

Introduction: College students represent an important subpopulation of the United States, with over 19 million college students in the U.S. enrolled yearly. Methods: Descriptive analysis of the causes of death for all deceased students reported by the UW Dean of Students Office (DSO) between 2004 and 2018. We analyzed frequencies and yearly rates. Results: Our analysis shows that contrary to published data and national statistics for the relevant age groups, intentional by self-harm deaths lead causes of death in enrolled students from 2004 to 2018. Intentional by self-harm is the main cause of death in male students, younger students, and white students. "Other" causes of death is the main cause in female students, older students, and students of color. Conclusions: These results must be shared with different stakeholders across campus as well as with other universities in order to support and evaluate campus-wide prevention strategies for means restriction and environmental safety.

Introducción: Los estudiantes universitarios representan una subpoblación importante de los Estados Unidos, con más de 19 millones de matriculados anualmente. Sin embargo, hay pocos datos publicados sobre la mortalidad y causas de muerte en la población universitaria. El propósito de este estudio fue analizar las causas de muerte, basadas en datos de certificados de defunción, de estudiantes matriculados en University of Winconsin- Madison desde 2004 hasta 2018. Métodos: Análisis descriptivo de las causas oficiales de muerte de todos los estudiantes fallecidos reportados por la Oficina del Decano de Estudiantes entre 2004 y 2018. Se analizaron frecuencias y tasas anuales. Resultados: El análisis muestra que, contrariamente a los datos publicados y las estadísticas nacionales para los grupos de edad relevantes, las muertes intencionales por autolesión lideran las causas de muerte en los estudiantes matriculados entre esos años. Las autolesiones intencionales son la principal causa de muerte en los estudiantes varones, en los estudiantes más jóvenes y en los estudiantes blancos. Las causas incluidas en la categoría indicada como Otras son las principales en las estudiantes mujeres, en estudiantes mayores y en estudiantes de color. Conclusiones: Los resultados de este estudio deben compartirse con las diferentes áreas interesadas en todo el campus universitario y con otras instituciones universitarias, para apoyar y evaluar las estrategias de prevención, la aplicación de los medios de restricción y la seguridad ambiental.

Autolesiones no suicidas y trastorno límite de la personalidad en adolescentes: scoping review

Objetivo: Mapear la evidencia científica respecto de las autolesiones no suicidas y trastorno límite de la personalidad en adolescentes de muestras comunitarias o clínicas en el contexto internacional. Introducción: Las autolesiones no suicidas corresponden a un importante campo de investigación en el espectro de suicidio, no obstante, son diversas las perspectivas para su conceptualización. La literatura señala ampliamente la comorbilidad entre las autolesiones no suicidas y el trastorno límite de la personalidad. Métodos: Scoping review basada en la metodología propuesta por el Joanna Briggs Institute. Se utilizaron las bases de datos Ovid, Science Direct, Proquest, Biblioteca Virtual de Salud y Web of Science. La búsqueda fue realizada en fuentes publicadas del 2011 hasta noviembre de 2021 en idiomas español, inglés y portugués. Resultados: La muestra final estuvo conformada por 12 artículos extraídos que cumplieron con los criterios de inclusión. Se encontraron cuatro categorías: curso longitudinal de las autolesiones no suicidas y trastornos límite de la personalidad en adolescentes, marcadores neuronales-fisiológicos de las autolesiones no suicidas y trastornos límite de la personalidad en adolescentes y riesgos psicosociales asociados a las autolesiones no suicidas y trastornos límite de la personalidad. Conclusiones: Se requieren más estudios interdisciplinares en el campo de las autolesiones no suicidas y trastornos límite de la personalidad en adolescentes. Se evidencia la necesidad de estudiar el curso longitudinal, marcadores neuronales-fisiológicos y riesgos psicosociales para mejorar la especificad de las intervenciones en muestras clínicas.

Objective: To map the scientific evidence regarding non-suicidal self-harm and borderline personality disorder in adolescents from community or clinical samples in the international context. Introduction: Non-suicidal self-harm corresponds to an important field of research in the suicide spectrum; however, there are diverse perspectives for its conceptualization. The literature widely points out the comorbidity between non-suicidal self-harm and borderline personality disorder. Methods: Scoping review based on the methodology proposed by the Joanna Briggs Institute. The Ovid, Science Direct, Proquest, Virtual Health Library and Web of Science databases were used. The search was carried out in sources published from 2011 to November 2021 in Spanish, English and Portuguese languages. Results: The final sample consisted of 12 extracted articles that met the inclusion criteria. Four categories were found: longitudinal course of non-suicidal self-harm and borderline personality disorders in adolescents, neuronal-physiological markers of non-suicidal self-harm and borderline personality disorders in adolescents, and psychosocial risks associated with non-suicidal self-harm and borderline disorders. of personality. Conclusions: More interdisciplinary studies are required in the field of non-suicidal self-harm and borderline personality disorders in adolescents. The need to study the longitudinal course, neuronal-physiological markers and psychosocial risks is evident to improve the specificity of interventions in clinical samples.

Conductas Autolesivas en Estudiantes del Nivel Secundario de una Institución Educativa Pública / Self injurious Behaviors on students the Public Hight School / Comportamentos autolesivos em estudantes a nível do 2do Grau de uma Instituição Pública

Las autolesiones constituyen un fenómeno cuyos índices de prevalencia han ido en aumento en la población adolescente, por lo que se considera necesario conocer a profundidad los diferentes aspectos implicados en la ejecución de tales conductas. No obstante, las investigaciones que abordan dicha variable en el Perú, y sobre todo en la región Piura, son escasas. Por tanto, se buscó determinar los niveles de conductas autolesivas en estudiantes del nivel secundario de una institución educativa pública de la región. Se empleó la escala de autolesión de SHAGER, la cual fue aplicada de manera virtual a través de la plataforma Google, acompañada de una ficha sociodemográfica ad hoc. Estudio no experimental - descriptivo, N= 1057, n= 283. Se obtuvo que las funciones Autocastigo y Antisuicidio se ubican en niveles Alto y Promedio, respectivamente. Además, en cuanto a las características sociodemográficas, las estudiantes provienen de familias de tipo nuclear, con padres casados, son de religión católica y la mayoría de ellas no pertenece a algún grupo social. En conclusión, las alumnas se encuentran en el nivel Promedio de conductas autolesivas, puesto que existe un porcentaje significativo de ellas que se ubica en el nivel Alto.

Self-harm is a phenomenon whose prevalence rates have been increasing in the teenage population, so it is considered necessary to know in depth the different aspects involved in the execution of such behaviors. However, the research that broaches this variable in Peru, and especially in the Piura region, is scarce. Therefore it was sought to determine the levels of self-injurious behavior in hight school students of a public educational institution in the region. The SHAGER self-injury scale was used, which was applied virtually through the Google platform, along with an ad hoc sociodemographic card. Non-experimental - descriptive study, N= 1057, n= 283. It was found that the Self-punishment and Anti-suicide functions are located at High and Average levels, respectively. In addition, in terms of sociodemographic characteristics, the students come from nuclear families, with married parents, are of the Catholic religion and most of them do not belong to any social group. In conclusion, the students are at the Average level of self-injurious behavior, since there is a significant percentage of them that is located at the High level.

A autolesão um fenômeno cujas taxas de prevalência vêm aumentando na população adolescente, por isso considera-se necessário conhecer a fundo os diferentes aspectos envolvidos na execução de tais comportamentos. No entanto, a pesquisa que aborda essa variável no Peru, e especialmente na região de Piura, é escassa. O objetivo foi determinar os níveis de comportamento autolesivo em estudantes do 2do grau de uma instituição pública de ensino da região. Foi utilizada a escala de autolesão SHAGER, que foi aplicada virtualmente por meio da plataforma Google, acompanhada de uma ficha sociodemográfica ad hoc. Não experimental - estudo descritivo, N= 1057, n= 283. Constatou-se que as funções Autopunição e Anti-suicídio estão localizadas nos níveis Alto e Médio, respectivamente. Além disso, em termos de características sociodemográficas, os alunos são oriundos de famílias nucleares, com pais casados, são de religião católica e a maioria não pertence a nenhum grupo social. Em conclusão, os alunos estão no nível Médio de comportamento autolesivo, pois há uma porcentagem significativa deles que está localizada no nível Alto.

Mediating effect of depression in the relationship between mobile phone addiction and self-harm among senior high school students / 中华行为医学与脑科学杂志

Objective:To explore the relationship among mobile phone addiction, depression and self-harm in senior high school students.Methods:Totally 707 students were collected from two middle schools by cluster sampling method, and smartphone addiction scale(SAS), patient health questionnaire-9 (PHQ-9)and adolescents self-harm scale(ASHS) were used for investigation. SPSS 23.0 software was used for descriptive analysis, correlation analysis, and Mplus 8.3 was used to conduct structural equation modeling and Bootstrap mediated effect test.Results:The rate of self-harm was 33.38%.The scores of mobile phone addiction, depression and self-harm were(106.01±27.18), 5.00(1.00, 9.00)and 0(0, 3.00), respectively.Mobile phone addiction was positively correlated with depression and self-harm( r=0.33, 0.16, both P<0.01), and depression was positively correlated with self-harm( r=0.52, P<0.01). Depression played full mediating role in the relationship between mobile phone addiction and self-harm(effect value=0.16, 95% CI=0.12-0.21). Conclusion:This study indicates that depression exerts a mediating effect on the relationship between mobile phone addiction and self-harm.

"Em profundo sofrimento": a gestão estatal da automutilação entre crianças e adolescentes de 2017 a 2020 / "In profound suffering": state management of self-harm among children and adolescents from 2017 to 2020

Nesta dissertação, investiga-se políticas governamentais de prevenção à automutilação entre crianças e adolescentes, no período de 2017 a 2020. Parte-se da premissa que certos fenômenos em algum momento são identificados ou classificados como um problema social. As ações governamentais aqui analisadas representam uma legitimação e uma resposta à construção do fenômeno da automutilação como um problema a ser gerido pelo Estado. A partir do método da etnografia de documentos, são examinados arquivos públicos das políticas em questão. Tais materiais são reconhecidos como objetos privilegiados da burocracia estatal, explora-se seus efeitos de ocultamento ou de exibição de hierarquias, valores, emoções, práticas e agenciamentos, e a sua materialidade, circulação e estética. Três linhas de força que tecem a gestão da automutilação são discutidas: o enfoque na família como espaço privilegiado para o cuidado ao sofrimento de crianças e adolescentes; a percepção das redes sociais como espaços incitadores de violência contra o público infantojuvenil; e os programas de educação socioemocional como estratégias de prevenção da automutilação. Argumenta-se que, no baixo relevo, essas propostas cristalizam a posição das crianças e adolescentes como figuras vulneráveis; e silenciam as relações de violência no espaço doméstico e a dimensão social do sofrimento. Tais ações governamentais, fabricadas em um momento de avanço de um projeto antidemocrático e anti-igualitário no país, representam um entrelaçamento sutil entre o campo da saúde mental, a linguagem dos direitos humanos e o conservadorismo moral.

This thesis investigates government policies for the prevention of self-harm between children and adolescents, between 2017 and 2020. It starts from the premise that certain phenomena are eventually identified or classified as a social problem. The government actions assessed here represent both an answer and legitimation to the construction of the phenomena of self-harm as a state problem. Based on an ethnographic document analysis, the public archives from such policies are here examined. Such records are recognized as privileged objects of state bureaucracy; their effects on concealment or display of hierarchies, values, emotions, practices, and agency are explored, as well as it's materiality, circulation, and aesthetics. Three power lines of such management are discussed: the family as a privileged space in caring for the suffering of children and adolescents; the perception of social networks as places where violence against the youth is incited; and the socioemotional education programs as strategy to prevent self-harm. Subordinately, it is argued that these proposals crystallize children and adolescents as vulnerable figures; and suppress violence-based relationships in the domestic space and the social dimension of the suffering. Such government actions, delivered in a moment when a anti-democratic and anti-egalitarian project is on the rise in Brazil, represents a nuanced interlacing between the mental health field, human rights' discourse and conservative morality.

#automutilação: a expressão simbólica da autolesão não suicida / #automutilação: a expressão simbólica da autolesão não suicida / #automutilación: la expresión simbólica de la autolesión no suicida

A autolesão não suicida (ALNS) é um fenômeno de relevância crescente com altas taxas de prevalência em adolescentes e jovens adultos. Como método, foi realizada etnografia virtual em comunidade de autolesão no Facebook de modo a ampliar a compreensão dos aspectos simbólicos relacionados à prática. Em fevereiro de 2021, 133 publicações foram coletadas e divididas em três categorias de análise: autolesão, sofrimento e religião. A autolesão é compreendida como similar ao comportamento compulsivo por meio do qual praticantes buscam uma experiência de transcendência ainda que às custas de dor. Assemelha-se a uma dependência comportamental. O sofrimento descrito aponta processos depressivos e se caracteriza por solidão, dificuldade de expressão de sentimentos e necessidade de manutenção de uma persona funcional no cotidiano. Assim, a comunidade emerge como meio de expressão dos aspectos relegados à sombra no mundo offline.

Non-suicidal self-injury (NSSI) is a phenomenon of increasing relevance, with high prevalence rates in adolescents and young adults. NSSI is one of the main risk factors for future. The method of virtual ethnography was carried out in a self-injury community on Facebook in order to broaden the understanding of the symbolic aspects related to the practice. In February 2021, 133 publications were collected and divided into three categories of analysis: self-injury, suffering and religion. Self-injury was understood as a compulsive behavior through which practitioners seek an experience of transcendence at the expense of pain. It resembles an addict behavior. The suffering described refers to depressive processes and is characterized by loneliness, difficulty in expressing feelings and the need to maintain a functional persona in everyday life. Therefore, the group emerges as a means of expressing aspects relegated to the shadows in the offline world.

La autolesión no suicida (ALNS) es un fenómeno de creciente relevancia con altas tasas de prevalencia en adolescentes y adultos jóvenes. Como método, se realizó una etnografía virtual en una comunidad de autolesiones en Facebook con el fin de ampliar la comprensión de los aspectos simbólicos relacionados con la práctica. En febrero de 2021 se recopilaron 133 publicaciones y se dividieron em tres categorías de análisis: autolesiones, sufrimiento y religión. Se entiende que la autolesión es similar al comportamiento compulsivo por el cual los practicantes buscan una experiencia de trascendencia incluso a expensas del dolor. Se asemeja a una adicción conductual. El sufrimiento descrito apunta a procesos depresivos y se caracteriza por la soledad, la dificultad para expresar los sentimientos y la necesidad de mantener una personalidad funcional en la vida cotidiana. Así, la comunidad surge como medio de expresión de aspectos relegados a la sombra en el mundo offline.

Perspectivas de estudio sobre el comportamiento suicida en niños y adolescentes: Una revision sistemática de la literatura utilizando la teoría de grafos / Perspectives on the Study of Suicidal Behavior in Children and Adolescents: A Systematic Review of the Literature Using Graph Theory

Resumen En las últimas décadas se ha incrementado el número de investigaciones sobre el comportamiento suicida en la infancia y la adolescencia, sin embargo, no existen trabajos en la actualidad que caractericen la producción científica en perspectivas de estudio. El objetivo de este artículo es realizar una revisión sistemática de las principales perspectivas de estudio sobre el comportamiento suicida en niños y adolescentes, poniendo énfasis en los principales factores de riesgo a nivel biopsicosocial, predictores clínicos y modelos explicativos. La búsqueda bibliográfica se efectuó en la base de datos Web of Science. Para el manejo de la información se emplearon las herramientas Sc12 Tool y Gephi. Se encontraron tres perspectivas dominantes de estudio, enfocadas a: (1) el análisis de los predictores psiquiátricos de la conducta suicida, (2) la relación entre autolesión no suicida y la conducta suicida y (3) el abuso infantil y su relación con la conducta suicida. Se espera que este estudio contribuya a la comprensión de las múltiples aristas investigativas sobre el comportamiento suicida en la infancia y la adolescencia. Al mismo tiempo, la metodología utilizada enriquece el campo de estudio al reflejar con precisión su situación actual a nivel investigativo.

Abstract In the last decades, the number of research on suicidal behavior in childhood and adolescence has increased, however, there are no studies at present that characterize the scientific production in research perspectives. The objective of this article is to perform a systematic review of the main perspectives of study on suicidal behavior in children and adolescents, emphasizing the main risk factors at the biopsychosocial level, clinical predictors, and explanatory models. The bibliographic search was carried out in the Web of Science database. For the management of the information, a citation and clustering analysis was undertaken by means of graph theory. The tools Sc12 Tool and Gephi were used. Three dominant research orientations focused on the analysis of psychiatric predictors of suicidal behavior (i), the relationship between non-suicidal self-injury and suicidal behavior (2), and child abuse and its relationship with suicidal behavior (3). It is hoped that this study will contribute to the understanding of the multiple research questions about suicidal behavior in childhood and adolescence. At the same time, the used methodology enriches the field of study by accurately reflecting its current status at the research level.

Por uma escuta sensível: a escarificação na adolescência como fenômeno multifacetado / For sensitive listening: the scarification in adolescence as a multifaceted phenomenon / Para una escucha sensible: la escarificación en la adolescencia como fenómeno multifacético / Pour une écoute sensible: la scarification à l'adolescence en tant que phénomène aux multiples facettes

Define-se a escarificação como o comportamento de machucar-se sem que haja intenção consciente de suicídio ou perversão sexual. Identificando-se um aumento recente de tais práticas bastante associadas à fase da adolescência, o presente artigo pretende contribuir com a leitura psicanalítica sobre autolesão na adolescência, buscando contemplar a metapsicologia do fenômeno e a especificidade da clínica psicanalítica para esses casos. Para tanto, foram utilizados trechos de entrevistas feitas com adolescentes que se cortam. Em geral, a prática de autolesão é sustentada por uma intricada cadeia associativa, na qual o sentido do corte frequentemente escapa a quem se corta. Notam-se importantes variações correspondentes à função do corte no corpo, frequentemente relacionado a dificuldades de simbolização de afetos decorrentes do traumatismo, a fragilidades narcísicas e identitárias, ao retorno pulsional da agressividade erotizada ao próprio corpo, ao "corte" do sofrimento, pela transformação deste em dor física, entre outras possibilidades. Para amenizar tais dificuldades, sugere-se que a intervenção clínica seja "feita sob medida" para cada adolescente atendido, com base na escuta sensível da psicodinâmica latente ao ato de se cortar.

The scarification is the ones behavior to hurt himself without a conscientious intention of committing suicide or performing a sexual perversion act. Recently, it has been identified the increscent of such habits, which are frequently associated to the adolescence period. This article aims to contribute to the psychoanalytical view about the self-injury on adolescence period, seeking to contemplate this phenomenon metapsychology and its clinical specificity. Therefore, we interviewed adolescents who cut themselves and used some interviews excerpts. In general, the practice of self-injury relates itself to an intricate associative chain, in which the meaning of the cut often eludes those who cut themselves. The cutting function is miscellaneous. Often, the self-injury relates itself to trauma affects and symbolization defects; to narcissus-identitary flaws; to the eroticized aggression drive breakthrough to the body; to the "cut" of suffering, by transforming it into physical pain; among other possibilities. In order to work with such issues, it is suggested that the clinical intervention be "made to measure" for each one attended, as it is recommended to the clinicians to be sensitive on their listening of the cutting psychodynamics and its latent meanings.

La escarificación es el comportamiento de una persona para lastimarse a sí mismo sin una intención consciente de suicidarse o realizar un acto de perversión sexual. Recientemente, se ha identificado el aumento de dichos hábitos, los cuales se asocian frecuentemente al período de la adolescencia. Este artículo tiene como objetivo contribuir a la visión psicoanalítica sobre la autolesión en el período de la adolescencia, buscando contemplar este fenómeno metapsicológico y su especificidad clínica. Por lo tanto, entrevistamos a adolescentes que se cortaron y usamos algunos extractos de entrevistas. En general, la práctica de la autolesión se relaciona con una intrincada cadena asociativa, en la que el significado del corte a menudo elude a quienes se cortan. La función de corte es diversa. A menudo, la autolesión se relaciona con afectos traumáticos y defectos de simbolización, a los defectos identitarios del narciso, a la agresión erotizada impulsa el avance hacia el cuerpo; al "corte" del sufrimiento, transformándolo en dolor físico, entre otras posibilidades. Para trabajar con estos temas, se sugiere que la intervención clínica sea "a medida" para cada uno de los atendidos, ya que se recomienda a los clínicos ser sensibles en su escucha de la psicodinámica cortante y sus significados latentes.

La scarification est le comportement de celui qui se fait du mal sans intention consciencieuse de se suicider ou d'accomplir un acte de perversion sexuelle. Récemment, il a été identifié l'augmentation de ces habitudes, qui sont fréquemment associées à la période de l'adolescence. Cet article vise à contribuer à la vision psychanalytique de l'automutilation à l'adolescence, en cherchant à contempler ce phénomène métapsychologique et sa spécificité clinique. Par conséquent, nous avons interviewé des adolescents qui se coupaient et utilisé des extraits d'entretiens. En général, la pratique de l'automutilation se rapporte à une chaîne associative complexe, dans laquelle le sens de la coupure échappe souvent à ceux qui se coupent. La fonction de coupe est diverse. Souvent, l'automutilation se rapporte à des effets traumatiques et à des défauts de symbolisation ; aux défauts narcisse-identitaires ; à la percée érotisée agression motrice du corps ; à la « coupure ¼ de la souffrance, en la transformant en douleur physique; entre autres possibilités. Afin de travailler avec de telles problématiques, il est suggéré que l'intervention clinique soit « sur mesure ¼ pour chacun des participants, car il est recommandé aux cliniciens d'être sensibles à leur écoute de la psychodynamique coupante et de ses significations latentes.

Living frisbees: riesgos de patologías mentales en niños y niñas expuestos a thc durante su gestación / Living frisbees: risks of mental pathologies in boys and girls exposed to thc during their pregnancy

La Cannabis sativa es una planta que contiene componentes psicoactivos (principalmente tetrahidrocannabinol) y actualmente corresponde a la droga ilícita más consumida a nivel mundial. Además, desde el área de la salud mental, ha habido un creciente interés en evaluar la relación entre el consumo de marihuana y el desarrollo de trastornos mentales. En este contexto, considerando tanto este creciente aumento en su consumo a nivel mundial y el interés por conocer si está involucrada en la patogénesis de patologías de la esfera psiquiátrica, es clave analizar qué posibles riesgos de desarrollar patologías mentales presentan aquellos niños expuestos al tetrahidrocannabinol durante la gestación. A partir de esta situación, el objetivo de este FRISBEEs es determinar si los niños/as expuestos a THC durante su gestación tienen un mayor riesgo de patologías mentales, en comparación a aquellos niños no expuestos durante su gestación. Los materiales y métodos utilizados para responder esta pregunta fueron obtenidos a partir de una búsqueda bibliográfica en dos bases de datos, donde se analizó la evidencia disponible, y se seleccionó el estudio primario titulado "Maternal tobacco, cannabis and alcohol use during pregnancy and risk of adolescent psychotic symptoms in offspring", ya que era el que más se aproximaba a poder responder nuestra pregunta clínica. Este se analizó de forma crítica, llegando al resultado de que el estudio no fue concluyente en establecer una asociación entre el uso de cannabis y síntomas psicóticos. Como conclusión, dado que no se pudo llegar a establecer una asociación entre el uso de cannabis y el desarrollo de patologías mentales, se debería realizar más investigación sobre el tema dado la magnitud del consumo de cannabis a nivel mundial, para así poder llegar a conclusiones clínicas basadas en la evidencia y poder dar recomendaciones clínicas a las pacientes embarazadas.

Cannabis sativa is a plant that contains psychoactive components (mainly tetrahydrocannabinol) and currently corresponds to the most widely consumed illicit drug worldwide. In addition, from the area of mental health, there has been a growing interest in evaluating the relationship between marijuana use and the development of mental disorders. In this context, considering both this growing increase in its consumption worldwide and the interest in knowing if it is involved in the pathogenesis of pathologies in the psychiatric sphere, it is essential to analyze what possible risks of developing mental pathologies present those children exposed to tetrahydrocannabinol during gestation. Based on this situation, the objective of this FRISBEEs is to determine whether children exposed to THC during their pregnancy have a greater risk of mental pathologies, compared to those children not exposed during their pregnancy. The materials and methods used to answer this question were obtained from a bibliographic search in two databases, where the available evidence was analyzed, and the primary study entitled "Maternal tobacco, cannabis and alcohol use during pregnancy and risk of adolescent psychotic symptoms in offspring ", as he was the closest to answering our clinical question. This was critically analyzed, reaching the result that the study was not conclusive in establishing an association between the use of cannabis and psychotic symptoms. In conclusion, given that it was not possible to establish an association between the use of cannabis and the development of mental pathologies, more research should be carried out on the subject given the magnitude of cannabis use worldwide, in order to reach conclusions. evidence-based clinics and to be able to give clinical recommendations to pregnant patients

Self-harming adolescents: how do they perceive and explain this behavior? / Adolescentes que se autolesionam: como percebem e explicam tal comportamento? / Adolescentes que se autolesionan: ¿cómo perciben y explican este comportamiento?

Self-harm is a prevalent adolescence behavior, indicated as a public health problem. The objective was to understand how adolescents perceive and explain this behavior, considering family and school characteristics. It's a multiple case study, in which five self-harming adolescents participated, enrolled in a public school in Novo Hamburgo-RS, participated in the study. They answered the following instruments: Sociodemographic Data Sheet, Semi-Structured Interview, Family Support Perception Inventory, Youth Self-Reporting and Delaware School Climate Survey-Student. Each case was individually analyzed and cross-case synthesis was performed. Self-harm was indicated as a strategy to relief suffering and regulate emotions. Low familial support, lack of skills, and presence of internalizing and externalizing problems were evidenced, as well as negative evaluation of peer relations and student engagement. When faced with a complex phenomenon, it is important to contemplate individual and relational issues in interventions. (AU)

A autolesão é prevalente na adolescência e indicada como um problema de saúde pública. Objetivou-se compreender como adolescentes percebem e explicam esse comportamento, considerando características de seu contexto familiar e escolar. Trata-se de um estudo de casos múltiplos, do qual participaram cinco adolescentes que se autolesionavam, matriculados em uma escola pública de Novo Hamburgo-RS, que responderam aos instrumentos: Ficha de Dados Sociodemográficos, Entrevista Semiestruturada, Inventário de Percepção de Suporte Familiar, Inventário de Comportamentos Autorreferidos para Jovens de 11 a 18 Anos e Delaware School Climate Survey-Student. Analisou-se individualmente cada caso e realizou-se a síntese de casos cruzados. A autolesão foi indicada como uma estratégia para aliviar sofrimento. Evidenciou-se baixo suporte familiar, carência de competências e presença de indicadores de problemas internalizantes e externalizantes, assim como avaliação negativa das relações entre pares e do engajamento estudantil. Frente a um fenômeno complexo, faz-se importante contemplar questões individuais e relacionais nas intervenções. (AU)

La autolesión es frecuente en adolescencia y se indica como un problema de salud pública. El objetivo era comprender cómo adolescentes perciben y explican este comportamiento, considerando características de su contexto familiar y escolar. Es un estudio de caso múltiple, en el participaron cinco adolescentes con autolesión, matriculados en escuela pública en Novo Hamburgo-RS, que respondieron a los instrumentos: Hoja de Datos Sociodemográficos, Entrevista Semiestructurada, Inventario de Percepción de Apoyo Familiar, Auto informe para Jóvenes de 11 a 18 años y Delaware School Climate Survey-Student. Cada caso se analizó individualmente y se realizó una síntesis cruzada de casos. La autolesión se indicó como estrategia para aliviar el sufrimiento. Se evidenció poco apoyo familiar, falta de habilidades y presencia de indicadores de problemas de internalización y externalización, así como una evaluación negativa de las relaciones con los compañeros y la participación de los estudiantes. Ante un fenómeno complejo, es importante contemplar problemas individuales y relacionales en las intervenciones. (AU)

¡Corte! Una nueva epidemia: autolesiones en la adolescencia / ¡Cut! A new epidemic: self-harm in adolescence

El siguiente trabajo pretende abordar una problemática que, a pesar de ser muy frecuente, no deja de ser llamativa: las autolesiones en los adolescentes. La pregunta que orientará el escrito tendrá que ver con lograr una cabal comprensión de por qué la población adolescente se muestra tan vulnerables a esta práctica. Para ello, se enumerarán y analizarán los distintos trabajos psíquicos que el adolescente deberá realizar en esta etapa, para así enlazarlo con la función que el corte en el propio cuerpo pudiera tener. En particular, se focalizará en el vínculo con los padres, en la construcción de la propia identidad, así como en la inscripción psíquica de un nuevo cuerpo, para lo cual será fundamental el sostén que solo podrá proveer el grupo de pares, aun cuando esto podría conllevar ciertos riesgos. Por último, se abre lugar a formas de intervención en esta problemática y a las particularidades que la clínica con adolescentes nos presenta

The following work aims to address a problem as frecuent as it is striking: self-harming in adolescents. The question that will guide the work will have to do with achieving a full understanding of why the adolescent population are so vulnerable to this practice. For this, the different psychic works that the adolescent must carry out at this stage will be listed and analyzed, in order to link it with the function that self-harm (cutting) in the body itself could have. In particular, it will focus on the bond with the parents, on the construction of their own identity, as well as on the psychic inscription of a new body, for which the support that only the peer group will be able to provide will be essential, even when this could carry certain risks. Finally, there is an opening possibility for intervening this problem and its particularities that the adolescent clinic presents to us

A Study on the Patterns of Psychiatric Referrals in a Tertiary Care Hospital in the North-Eastern Part of India.

Consultation-liaison psychiatry holds a special place, especially in general hospital setting. We wanted to study the socio-demographic variables, reasons for referral, and clinical correlates of psychiatric referrals from different wards in a tertiary care hospital. MethodsThis was a retrospective chart-review study carried out in the Gauhati Medical College Hospital, Guwahati, for a period of one month (May 2019). Demographic data of the participants was collected. Their primary medical / surgical diagnoses were noted along with the department where they were admitted. The reason for psychiatric consultation as well as the psychiatric diagnoses were analysed by descriptive statistics with the use of GraphPad InStat. ResultsMost of the sample was men (men: women: 106:72), mostly between 11 to 30 years (44.38%) and Hindus (Hindu: Muslim: 140:38). Majority of the consultations was from the Department of Medicine (47.19%), followed by Orthopaedics (15.17%) and Surgery (14.61%). Among the surgical/medical illnesses, most of them had fractures (ten), closely followed by neurological conditions like cerebrovascular accident (five) and head injury (four). Deliberate self-harm was the most common reason for psychiatric liaison (56), that constituted a high number with poisoning (45) as well as hanging (six) and cut neck (five). Psychiatric consultation was asked for use of alcohol in a substantial number of patients (45). ConclusionsAddressing the psychiatric comorbidity while continuing treatment for the surgical/medical illnesses gives a holistic approach towards our patients that can influence not only the course but also the quality of life of them.

A Case Report of Tension Pneumoperitoneum Secondary to Self-harm

Introduction: Tension Pneumoperitoneum is a rare andfatal form of abdominal compartment syndrome. It causesan abrupt rise of intra-abdominal pressure and leads tohemodynamic instability and multi-organ failure. Tensionpneumoperitoneum can be caused generally by sepsis, severeabdominal trauma, and gastric perforation. it is extremelyrare to see this tension pneumoperitoneum in a case ofself-harm.Case report: We present a case report of a 37-year-old malewith abdominal injury with intend to self-harm. He presentedto the emergency department in AL-Sader teaching hospital inAl Najaf city in Iraq, with hemodynamic instability. He waspromptly diagnosed with tension pneumoperitoneum withthe aid of x rays and clinical judgment. After decompression,patient was successfully treated with laparotomy, bowelresection and stoma formation.Conclusion: Although it is rare to see tensionpneumoperitoneum due to self-harm, early diagnosis andmanagement are vital to prevent mortality and morbidity insimilar cases.