Medical Psychiatry Channel
Editor’s note: Last week we posted an article “Behind the fall of genius teenagers are 70 million people with major depression”. Some of the data in the article made me shocked and distressed, so I really want to do something for people with mental disorders, including depression. This article by Professor Mei Qiyi tells us some truth and gives us some suggestions, which is the first step we did, and we will follow up with some related articles and research. So what else can our platform do for psychiatrists and patients? We hope you will leave a message in the background to tell us!
Author: Mei Qiyi Guangji Hospital, Suzhou University
Editor: d Editor
Source: Medical Psychiatry Channel
Suicide is the action of intentionally or deliberately harming one’s own life. Psychologists have long had many analyses and guidelines for suicide attempts, many of which are insightful. The growing recognition by social groups that suicide requires intervention has also given many helpful social supports to patients. However, the most important step in suicide prevention is psychiatric diagnosis and treatment, and any intentional or unintentional neglect of the critical role of psychiatry in suicide prevention and treatment of the illness may result in irreparable damage to the suicidal person and family. The reason is very simple, namely, more than 90% of suicides suffer from mental illness, and most suicides are closely related to mental illness.
I. Mental disorders are a major risk factor for suicide-related problems
Although most patients with mental illness do not die by suicide, data from the National Institute of Mental Health (NIMH) survey indicate that more than 90% of people who commit suicide may have suffered from some kind of mental disorder, the most common of which is depression; and bipolar disorder, schizophrenia, substance abuse and anxiety disorders are all mental illnesses that increase the risk of suicide. In the UK, a diagnosis of mental illness existed at the time of suicide or before in 50% of suicide cases. The lifetime risk of suicide for patients with mood disorders (mainly depression) is 6 to 15 percent, while the lifetime risk of suicide for patients with schizophrenia is 4 to 10 percent. A UK-wide audit found that a quarter of successful suicides had been receiving mental health services in the 12 months prior to their death. Of these, 16% were psychiatric inpatients and 24% were recently discharged psychiatric patients in the last three months, with mental illness being the leading cause of suicide.
The association between suicide and mental disorders was also revealed in the results of the mainland China survey conducted by Professor Phillips. Analysis of the data showed that 70% of the study sample met the current diagnostic indicators for mental disorders, of which 63% had affective disorders, 15% had anxiety disorders, 11% had psychotic disorders, and 4% had substance abuse.
A survey of the current state of mental disorders in Kunming, China, found that the incidence of suicidal ideation, suicidal planning, and suicidal behavior in the general population (95% CI) were 5.89% (5.24% – 6.54%), 1.71% (1.35% – 2.06%), and 0.96% (0.52% – 1.00%). Mental disorders affecting suicide-related behavior were higher in bipolar disorder, schizophrenia, pain disorder, specific terror, and alcohol dependence. The prevalence of suicidal ideation and suicidal behavior in the population is high, with psychiatric disorders being the main risk factor for the development of suicide-related problems.
Recent surveys have found that bipolar disorder is a psychiatric disorder with a high risk of suicide, with patients at 10 times the risk of suicide than the general population. 25%-50% of patients have experienced suicidal behavior, and 11%-19% have died by suicide. Some of the suicides were talented but died young during their lifetime. If we look at history, we can find similar events in the past and present, and many of those crazy geniuses fully meet the diagnostic criteria of bipolar disorder. A correct diagnosis is a prerequisite for reasonable treatment, and the significance of reducing the risk of suicide cannot be overstated.
Second, severe depression is not suitable for psychotherapy alone
Major depressive disorder is a disease, and there is no doubt that the leading treatment should be the doctor. Although we welcome the participation of counselors and social workers together, and psychotherapy is also commonly used as an adjunctive modality to intervene with suicidal patients, there is no doubt about the dominance of psychiatry, and many suicidal problems are not addressed in a timely manner by neglecting medical treatment.
Some depressed patients believe that although their illness is serious, they can be treated by self-adjustment or by talking to a counselor and do not need medication. This is a very dangerous idea!
The American Psychiatric Association (APA) guidelines for the treatment of depression clearly state that severe depression is not amenable to psychotherapy alone.
Most psychiatrists will combine medication with psychotherapy focused on depression. Some patients may also be treated with electrotherapy or transcranial magnetic stimulation, while psychotherapy alone is not appropriate for patients with severe depression. Psychotherapy can play a major role in preventing suicide in depression, but should only be used as an adjunct to medication, otherwise it is extremely risky. Some people say that psychiatrists just prescribe some medication, which is a lack of understanding of psychiatry. Psychiatry has never emphasized medication alone, and clinical practice is not likely to be about just shoving some pills in a patient’s mouth.
Some people also say that depressed patients do not want to admit that they are depressed and do not want to wear the hat of mental illness so they do not seek psychiatrists, which is a subjective speculation about depressed patients. Practice has shown that it is no less difficult for depressed patients to find a counselor than it is to find a psychiatrist. It is unlikely that the claim that depressed patients are afraid to seek treatment for their illnesses and that they are afraid of wearing the mental illness label originated from patients with major depressive disorder; it is almost always reasoned by the imagination of our friends who are happy with their leisure. Since the best option for major depression is to see a psychiatrist, why can’t you just come to a psychiatric clinic? I have worked as a clinical psychiatrist for many years and like other doctors have saved countless patients with major depression and bipolar disorder and other mental disorders who have attempted suicide.
Most patients with psychiatric disorders can recover after receiving the correct diagnosis and reasonable treatment from psychiatry, and the clinical cure and recovery rates are well documented. Psychiatry is very concerned about the long-term prognosis of patients, and this is really not the exclusive domain of psychologists.
Lastly, suicide prevention must be considered with psychiatric diagnosis and treatment!
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