ABSTRACT
The author suggests that a new paradigm may be needed which holds that some suicides may be inevitable. The goal of this paradigm would be to diminish the sense of failure and inadequacy felt by many psychiatrists who experience the suicide of a patient and to increase understanding of the unique biopsychosocial profile of those whose suicides appear to be inevitable. The author stresses that this proposed paradigm should not be misconstrued as therapeutic nihilism but rather should serve to stimulate efforts to treat this patient population more effectively. Risk factors that place individuals at high risk for suicide are reviewed, including presence of a mental illness, genetic predisposition, and factors such as a history of abuse, divorce, unemployment, male gender, recent discharge from a psychiatric hospital, prior suicide attempts, alcohol or other substance abuse, a history of panic attacks, and persistent suicidal thoughts, especially if coupled with a plan. The author notes that, in those suicides that appear to have been inevitable, risk factors are not only numerous but at the extreme end of profound pathology. The example of Ernest Hemingway is used to illustrate how such a combination of risk factors may have contributed to his eventual suicide. Psychiatrists, like other doctors, may have to acknowledge that some psychiatric disorders are associated with a high mortality rate as a natural outcome. This could lead to heightened vigilance, a more realistic view of what can and cannot be achieved with therapy, and efforts to improve the quality of life of patients at high risk for suicide with the goal of reducing this risk and prolonging their lives. (Journal of Psychiatric Practice 2012;18:221-224).
Subject(s)
Professional-Patient Relations/ethics , Psychotherapy/ethics , Suicide/psychology , Famous Persons , Female , Genetic Predisposition to Disease , History, 20th Century , Humans , Male , Mental Disorders/epidemiology , Mental Disorders/genetics , Models, Psychological , Risk Factors , Suicide/history , United States , Suicide PreventionSubject(s)
Delusions/etiology , Hydrocephalus, Normal Pressure/complications , Spouses , Aged , Antipsychotic Agents , Cerebral Ventricles/pathology , Cholinesterase Inhibitors/therapeutic use , Cognition Disorders/diagnosis , Cognition Disorders/drug therapy , Corpus Callosum/pathology , Delusions/diagnosis , Delusions/drug therapy , Diagnosis, Differential , Donepezil , Female , Humans , Hydrocephalus, Normal Pressure/pathology , Hydrocephalus, Normal Pressure/surgery , Indans/therapeutic use , Magnetic Resonance Imaging , Memantine/therapeutic use , Piperidines/therapeutic use , Severity of Illness Index , Sexual Behavior/psychology , Ventriculoperitoneal ShuntABSTRACT
Esta é a 9 ed do Compêndio de psiquiatria. Desde que o livro foi lançado, há mais de 30 anos, foi atualizado e revisado continuamente para atender às necessidades de diversos grupos profissionais -- psiquiatras e médicos não-psiquiatras, estudantes de medicina, psicólogos, assistentes sociais, enfermeiros psiquiátricos e outras pessoas que trabalham e tratam de doentes mentais. Também é usado por leigos como um guia para ajudá-los a colaborar com os cuidados de um parente ou amigo com alguma doença mental. É um volume complementar ao Tratado de psiquiatria, caracterizado por sua compacidade, portabilidade e cobertura atualizada do campo. Evoluiu ao longo dos anos como um livro didático separado e independente, que tem a reputação de ser um compêndio denso, preciso, objetivo e confiável dos novos eventos no campo da psiquiatria
