Suicidal Thoughts / Attempts

Why Does The Patient Think Or Attempt Suicide?

• Patient could feel very depressed and feel the life as worthless.

• A feeling of persecution leading to contemplation of attempt at suicide.

• Patient could attempt suicide, acting on auditory hallucinations.

• Confused thoughts can drive them to seek relief through suicide.

• Attempt suicide impulsively.

Is the person contemplating Suicide?

A schizophrenia patient could be thinking of taking his life if he/she:

• Often talks / writes about ending life.

• Expresses a feeling of being worthless constantly.

• Facing major stresses in life such as failure in exams/marriage/job etc.

• Attempts suicide during relapse.

• While remitting from illness if the patient is confronted with major setbacks

• It is often not possible to anticipate suicide.

When There Is Persistent Talk Of Suicide:

• Do not ignore the persistent talk of suicide. Be alert to the patient's conversation, the sleep pattern and changes in behavior.

• Try to keep the patient calm through reassuring conversations.

• Inform the psychiatrist about the problem immediately.

• Contact the nearest GP to deal with the situation.

• If this is not possible, arrange to admit the patient in a hospital, as advised by your psychiatrist.

• Keep all medicines out of the patients' reach.

• Do not leave the patient alone.

If The Patient Has Attempted Suicide:

1. Rush the patient to the nearest hospital for first aid medical care.

2. Be sure to take the psychiatrist's prescription to the hospital along with you.

3. Inform your consultant psychiatrist and the social worker in charge of the patient.

Preventive Measures

• Ensure drug compliance through supervised medication.

• Maintain contact with the treating Psychiatrist and the social worker as often as possible.

• Engage the patient in all household activities.

• Motivate the patient to make him/her feel worthy.

• Reassure frequently and allow for regular interaction.

• Discuss with the treating psychiatrist the possible cause and the preventive measures to be adopted in future.

Relapse

A relapse occurs either when there is an increase in severity of existing symptoms in the patient or a recurrence of symptoms which have been under control. Previous symptoms may recur or there may be evidence of new problems. It may occur quite suddenly but can be triggered by gradual changes in relationship between the patient and the family.

What Causes a Relapse ?

• When the patient faces a stressful situation, something he can not cope with, for example: failure in exams, critical remarks from caregivers on the failure.

• Patient discontinuing medication, refusal to take medication.

• Care giver altering / discontinuing medication, ignoring the psychiatrist's advice.

• Patient moving to a stressful environment for eg. he has moved to a new place, which is not to his liking.

• Sometimes a relapse can occur despite adequate medication and with no precipitating factors.

How Does One Identify A Relapse ?

Symptoms under control may reappear, or worsen. New symptoms may occur. Some of these are:

• Restlessness, fear, complaints of difficulties in concentration.

• Changes in sleep pattern leading to sleeplessness.

• Changes in behaviour - patient becomes irritable and quarrelsome.

• Changes in mood - talks or laughs to himself, more frequently.

• Refuses to take medicines / food.

• Becomes quite excited / agitated / disturbed / depressed.

• Evidence of a change in behaviour: Eg: unusual mannerisms.

• Deteriorating personal hygiene (refusal to brush teeth, shave, groom the hair, etc.)

• Remaining in bed for long periods.

• Refusal to co operate in all matters (household activities / going to work etc.)

• Withdrawal from the company of friends and relatives, starts brooding.

• Wanders away from home.

• Expresses suicidal thoughts and ideas.

How To Deal With A Relapse?

• Learn to identify early symptoms of relapse. Usually, symptoms which were present in earlier episodes recur. At times new symptoms may occur.

• Ensure that the patient has not missed his/her dosage of medicines.

• If found that he/she is not taking medicines properly, begin supervising closely.

• Increase the dosage by immediately seeking psychiatric advice.

• If you are able to identify any stressful situations, make changes to defuse the crisis as soon as possible.

• If you have problems handling the patient, admit him/her in the nearest hospital. Keep the consultant psychiatrist/social worker informed.

How To Prevent The Occurrence Of A Relapse In Future

• Do not neglect the medication. Maintain the dosage and timing systematically. Discuss the need to review medications as or when the need is felt.

• Help the patient discuss freely and frankly about his/her discomforts in dealing with people/situations.

• Be kind but firm with the patient.

• Encourage the patient to undertake regular activities during the day; praise and motivate.

• Ensure a regular follow up with the psychiatrist and case manager.

Poor Compliance: Refusal to take Medication

Medicines are essential to control signs and symptoms of schizophrenia and may be required to be taken over long periods.

Realising that medicines have to be taken all through the life, a person suffering from schizophrenia could sometimes give up taking medicines. At times, he may adjust medication according to his convenience against medical advice. Sometimes, he may be very irregular with doses.

What Are The Reasons For This?

• Patient may feel better and decide that he does not need drugs any more.

• The patient becomes distressed by the side effects of the medicines.

• The patient tends to believe that medicines are in no way helpful.

• The patient may be forgetful and tends to skip the prescribed dosage.

• The patient cannot afford medicines.

• The patient feels that because of medicines his activities have slowed down.

• Lack of supervision by carer. Refills not timely.

How Would You Know That Patient Is Not Taking Drugs Or Is Irregular?

• Patient adamantly refuses drugs.

• Early signs and symptoms of relapse are seen.

• The patient may be throwing away drugs / spitting them out, without the carer’s knowledge.

• A surprise check on medicines may reveal the patient is not taking dosage as advised.

How Can You Deal With This Situation?

Medical Emergencies

Mentally ill patients can also suffer from other medical problems. Emergencies like appendicitis may warrant hospitalization and even surgery.

Should such a crisis arise, the caregiver must

• Inform the specialist about the mental illness and the medicines that the patient has been taking.

• Inform the psychiatrist and seek their opinion with reference to change in dosage.

• Ensure that psychiatric medicines are at no point of time discontinued but adjust the dosage as is convenient to facilitate continuation of treatment by seeking appropriate guidance from both the specialists.