From Big Medical Encyclopedia

SUICIDE (suicidium) — intentional deprivation of of life.

The most often pathophysiological basis of S. as it was for the first time shown by I. P. Pavlov, braking or fading of one of the reflexes conducting for the person — a reflex of the purpose is that is followed by loss of interest in life, loss of its value and sense. In most cases braking of a reflex of the purpose happens short-term, seldom long. The analysis of cases of unfinished S. shows that made suicide attempt quite often regret deeds, ask for help, only sometimes again make an attempt to make S.

Chasto suicides are mentally sick (see) that is explained by sharp disturbance of perception of the world around at them, inability is correct to estimate the made acts, reality and degree of the danger arising at the same time. In the absence of due medical control of S. can be made the being able acute postoperative (narcotic) psychosis or an infectious delirium developing at a number of the diseases which are followed by high temperature and the expressed intoxication of an organism (malaria, flu, etc.). Much less often S. are made as the conscious act of a protest (a hunger strike, self-immolation, etc.).

Pages — an important social problem, especially in capitalist society, in Krom are S.'s reason socio-economic factors (unemployment, poverty, rise in price of life, etc.). Other reason promoting growth of number C. it is preferential among youth, crisis of bourgeois morals, prevalence of alcoholism, drug addiction, the crime leading people to moral exinanition, loss by them of ideals, perspectives and meaning of life are.

In the socialist countries of S. occurs preferential among mentally patients and persons suffering from an alcoholism. Reduction of number of cases of S. in the socialist countries is promoted by elimination of social and economic premises for S., existence at people of strong confidence in tomorrow and necessary conditions for harmonious development of the personality. The possibility of the choice of work on desire, the guaranteed public and free medical aid, accurately organized social security system, community of interests at all population, a possibility of creative self-expression, spiritual growth of each member of collective, education of youth to active living position — all this serves in aspiration to prevention of loss by the person of interest in life, braking and fading of a reflex of the purpose at it, so, and to S.'s prevention

Mental disorders as the reason of suicide

Mental disorders and S. do not correspond as cause and effect; between growth of number of mental diseases and S. there is no parallelism. Throughout last and current centuries the number C. sharply increased, and the number of mental diseases for the same period increased slightly. Among the making S. men always prevailed, the ratio of number of the men and women who made S. makes, according to Bertilyon (A. Bertillon, 1896), 4:1 and, according to Sharfetter (S. Scharfetter, 1973), 2,4: 1 while a ratio of mentally sick men and women always approximately equally, and such mental disorder as a depression most often accompanying S. occurs at women considerably more often than at men.

S.'s share made by persons with mental disorders increases throughout the current century. At the beginning of the century it made, according to JI. A. Prozorova (1911) and E. Krepelin (1912), 30%, by data A. D. Kotsovsky, 40%; in the 50th, according to Baryuk (H. Vagik, 1959), 70%; at the beginning of the 70th, according to Sharfetter (1973), 94% of total number of Page. S.'s growth among persons with mental disorders is connected with the same reasons, to-rye cause S.'s growth in general. In particular, matters the postareny population, i.e. increase in that group of people, among a cut S.'s frequency is the greatest.

At mental disorders three factors take part in S.'s genesis: 1) psychopathological disturbances; 2) the influences of the environment causing difficulties of fitness or exerting the direct psychoinjuring impact; 3) personal installations (suicide or antisui-tsidalny orientation). Value of each factor is unequal and is defined by degree and a form of mental disturbances. At the expressed mental disorders, first of all at psychoses (see. Mental diseases ), S. is preferential or is completely caused psikhopatol. disturbances. Than easier mental disorders, in particular when they are characterized by the symptoms inherent to borderline cases, that more S. is defined by influences of the environment and personal installations.

The page are rather seldom made by the patients suffering from the expressed mental disturbances, napr, being in a condition of psychosis since it would be interfered usually by the room of the patient in psychiatric.

The overwhelming number C. falls to the share of patients with lungs or the erased forms of a mental disease.

They are observed first of all during the period remissions (see), at the sluggish course of a disease, in the period of recovery, in particular in the nearest future after an extract of the patient from psychiatric-tsy, and also at the beginning of development of a mental disease. In the latter case S. or suicide attempt quite often is its first explicit manifestation. S.'s dominance at easy mental disturbances is confirmed also by such fact as existence among the made S. of a large number of persons with undetected mental disorders. In cases of the erased mental disturbances to predict S.'s possibility, proceeding only from features of psychopathology, extremely difficult.

Most often S. is made by patients in a condition of a depression of various origin. Existence of suicide thoughts at a depression is pattern and expression of psychiatrists of the last century «melancholy — psychosis of suicides» is not disproved by time.

The second place on S.'s frequency is taken by patients, at to-rykh are observed psikhopatol. the symptoms inherent to psychopathies, neurosises and reactive states, and also patients with psychopatholike and neurosis-like frustration (see. Psychopathies , Psychogenias ). The high risk of S. is caused at these patients with their big exposure to influence of factors of the environment (especially mental injuries), and also that circumstance that very often listed forms of mental pathology are followed by a depression.

Among patients with the expressed depressions S.'s danger is highest at the alarming agitated depressions, including those from them, to-rye are followed by depressive nonsense of self-accusation, ruin, self-abasement (see. Depressive syndromes ), a Cotard delusion (see. Kotara syndrome ), melancholic depersonalization, especially, when that is shown in the form of anesthesia dolorosa psychica (see. Depersonalization ). Such depressions meet first of all at maniac-depressive psychosis (see), schizophrenia (see), presenile melancholy (see. Presenile psychoses ). S.'s risk at patients with a depressive and paranoid state is very high (see. Paranoid syndrome ), most often meeting at patients with schizophrenia. The page is able expressed dysphorias (see) are usually made by patients with epilepsy (see. Epilepsy ), schizophrenia, organic lesions of c. N of page, first of all traumatic genesis. When patients with the listed mental disorders timely would not be directed in psychiatric, perhaps expanded S. extending to children and (or) the marriage partner of the diseased.

When patients with depressions would be in psychiatric, S. or suicide attempt are made by them usually or in the second half of night or at daybreak, i.e. in the period of the greatest intensity of affect of melancholy. In the afternoon S. is made by the patients who are in a condition of a depression, preferential melancholic raptus (see. Depressive syndromes).

In acute crazy conditions of S. it is most often made at figurative nonsense (see. Nonsense ), in Krom the ideas of physical extermination of the patient, the expressed fear and motive excitement with impulsive actions (prevail at schizophrenia, alcoholic, reactive, epileptic paranoid).

At crazy psychoses with paranoiac and hallucinatory-dilision syndromes of S. patients with hypochiondrial and religious nonsense, and also with nonsense of marital infidelity make more often. In the latter case murder of the marriage partner can precede suicide of men. The religious nonsense can be expanded S.'s cause of a large number of people. Pages with paranoiac and hallucinatory-dilision syndromes occur at patients at schizophrenia, alcoholic psychoses (see), to paranoia (see), pathological development of the personality (see).

With hallucinatory frustration of S. most often occur among patients at verbal hallucinosis (see. Hallucinations ) the imperative, menacing and condemning contents, combined with melancholy, alarm, fear and hallucinatory nonsense; such hallucinosis meets at alcoholic gallyutsinoza (see. Alcoholic psychoses), schizophrenia, hallucinosis at syphilis of a brain, vascular and traumatic defeats of c. N

of page C. at patients with conditions of stupefaction (see) are observed at deliriums (see. Delirious syndrome ) and twilight stupefaction (see) i.e. when visual hallucinations (preferential frightening contents), fear and motive excitement prevail (intoksikatsionny psychoses, epilepsy, psychoses at a craniocereberal injury).

Occasionally S. are made by the patients who are in a condition of catatonic excitement (see. Catatonic syndrome). Thus, S. at patients meets with the expressed mental disorders at a combination various psikhopatol more often. the symptoms forming quite often big syndrome (see Psychopathology).

At lungs psikhopatol. S.'s disturbances are more often made in subdep-ressivny states. Their structure differs in a big variety. These are subdepressions with dominance of an oligothymia, morbid depression of supervaluable or persuasive character (see. Hypochiondrial syndrome), senesthopathias (see), vegetative disorders, easy manifestations of depersonalization (see), adynamias, a dysphoric component (see the Dysphoria); similar states meet at endogenous diseases (see Schizophrenia, Maniac-depressive psychosis), neurosises (see) and psychopathies (see), situational depressions (see. Reactive psychoses), neurosis-like and psychopatholike states at the most various mental diseases. Long subdepressions with «philosophic intoxication», the autistiche-ski-pessimistic outlook expressed by extraordinary burdensome disorders of thinking are especially characteristic of the patients with schizophrenia making S.

S.'s risk is higher at such forms of psychopathies as thymopathies, hysterical and excitable psychopathies. Besides, S.'s risk is higher at mosaic, but not at «nuclear» psychopathies. Absence complete the wedge, pictures of psychopathic frustration — constant property of psychopatholike states, at to-rykh S.'s risk is always considerable. At neurosises S.'s risk of subjects is higher, than are less created and more slowly included patol. forms of reaction — hysterical, obsessivno-phobic, somatovegetativny, etc. S.'s risk at the listed borderline cases increases in cases of their combination with subdepress ivny mood.

Data on S.'s frequency and suicide attempts at separate nosological forms bring in the basic concerning endogenous diseases. According to various researchers, from 6 to 66%, most often from 30 to 50% of all S. and suicide attempts fall to their share. At the same time patients with maniac-depressive psychosis, first of all a cyclotymia, make S. considerably more often than patients with schizophrenia. At the same time there is a point of view, according to a cut, S.'s frequency at schizophrenia is obviously underestimated. Most often at endogenous psychoses of S. are made in a condition of a depression — from 3%, according to Perris (S. by Perris, 1966), to 15%, according to P. Seinsbury, from all depressions. According to a large number of researchers, about 10% of patients with endogenous depressions make S. Chastota S. at endogenous diseases accrues along with increase in their duration. So, at schizophrenia after 8 years of a disease made S., according to Osmond and Hoffer (N. of Osmond, A. Hoffer, 1967), 1,8% of patients, and after 10 years of a disease, according to Peldnnger (W. Poldinger, 1968), 4% of patients. At endogenous diseases suicide attempts meet in 10 — 25% of cases, and their death at maniac-depressive psychosis and schizophrenia is observed considerably more often than at patients with other nosological forms. At the same patients also the greatest number of the repeated suicide attempts which are coming to an end with S. U of persons with boundary mental disorders it is observed considerably more often the numerous suicide attempts which are not coming to the end with Page meet.

At reactive psychoses of S. are most often made in conditions of situational depression; at the same time also the expanded Page can be observed. In rare instances S. at reactive psychoses extends at the same time to a large number of people, i.e. accepts character of epidemic. In the latter case S. is caused always by the serious social reasons, napr, the national accident accompanied with the crash of moral and political values. At S.'s epidemics along with a mental injury has value and a factor of mental induction. The last plays the leading role at expanded S. of members of religious sects.

S.'s risk at an alcoholism, toxicomanias is extremely high (see), especially a barbitura-tizm (see t. 5, additional materials), drug addiction (see). Among the men sick with an alcoholism, S.'s prevalence, according to Walton (H. J. Walton, 1958), in 60, and according to Kessel (N. KES-sel, 1965), are 85 times higher than S.'s prevalence among the population in general. Among suicides there are patients with an alcoholism, according to Akhte (To. Achte, 1969), make 10%, and according to Dorpet and Ripley (T. L. Dorpat, H. S. Ripley, 1962) — 27%. Men make S. in an ebrietas, women more often — during hungover frustration.

The complication of the main mental alcoholism disorder, especially chronic, always sharply increases risk of commission of Page.

At psychiatric inspection of persons with mental disturbances, in addition to definition of the mental status, it is necessary to pay attention to signs, the combination to-rykh allows to suspect a possibility of commission of S. K to them belong: 1) S.'s cases and suicide attempts relatives of patients (it is necessary to find out at the same time their age at the time of commission of such attempts since quite often family predisposition to S. is found in various generations of a proband) if in the ascending generation find S., have a risk that it will be made by the patient at younger age: 2) existence in the anamnesis of the diseased of suicide thoughts, considerings of methods of commission of S. and suicide attempts; 3) existence at the diseased in the past of the acts arising spontaneously or caused by the external reasons, as though psychologically clear, caused jump of its usual stereotype of life and (or) changes in professional activity; 4) acute reaction in the past on events in private and professional life; 5) existence in the past of depressive frustration; 6) existence (especially at elderly people) the chronic somatopathies causing physical sufferings and complicating adaptation; 7) single accommodation, especially elderly people; 8) combination of a mental disease to alcoholism.

Treatment and prevention Pages shall include measures psychiatric (in particular, the room in-tsu), psychotherapeutic and social character.

Suicide in the medicolegal relation

In all cases of S. a corpse is subject obligatory court. - to a medical research, in process to-rogo establish a cause of death, character and the mechanism of formation of the found damages, a possibility of their causing by the victim, his ability to active purposeful actions in the presence of these damages. The page can be carried out as by direct violent action by means of firearms, toxic agents, etc., and by starvation, overcooling, etc. The most often found way C. — hanging (see). In most cases alcohol intoxication at the time of S. Neredko's commission at inspection of the scene or a research of clothes of a corpse comes to light find the letters, notes left by the suicide with a statement of motives of S. Sleduyet to consider a possibility of commission of pair S. or even S. by a group of persons by previous concert. In case of S. mentally sick the corpse can be located in the affected, elaborate pose. Imitation of murder or accident can also take place.

In the judicial and investigative relation establishment of a prizhiznennost or posmertnost of bruises (see Damages, in the medicolegal relation), their roles in a thanatogenesis (see) and bonds with a proximate cause of death is important (see Death, in the medicolegal relation). Found on a body of the injured damage can be caused shortly before death out of communication with it or in the agonal period during spasms at blows about close located objects, and also can be put with the suicide or the murderer trying to imitate S. or accident for the purpose of concealment of a crime (see Murder). It must be kept in mind that ability to action of persons with deadly damages allows commission of the so-called combined S. when after causing himself deadly damage the suicide puts himself repeated damages.

S.'s establishment as sorts of violent death (see) the court does not enter competence. - the medical expert, since it cannot be carried out only on the basis of data of medical character, and is a prerogative of judicial investigating authorities. However sou of - the medical expert can state the judgment, considering the nature of damages, their features and localization, about an opportunity or impossibility of causing these damages by the victim to himself.

In all cases, when court. - the medical expert or the doctor who is involved in inspection of the scene finds at the victim at least the minimum signs of life, he is obliged to start immediately holding resuscitation actions and to provide the fastest delivery of the victim in to lay down. establishment.

In some cases at investigation of cases of S. there is a need for psychiatric survey attempting upon S. or in carrying out according to case papers of posthumous psychiatric examination. At the same time the important role is given to the data characterizing the identity of the suicide (his tendencies, behavior in life, at work and in a family), and also by reflecting diseases transferred it, especially mental and craniocereberal injuries. For examination diaries, suicide notes and other data have essential value, to-rye can characterize a mental condition of the victim right in front of the Village.

Bibliography: Urgent problems of a suicidology, under the editorship of A. A. Portnov, page 6, 28, M., 1978; Cheltsov-Benut about in M. A. and H e l c about in and N. V. Conducting examination in the Soviet criminal trial, M., 1954; Avery D. Winokur G. Suicide, attempted suicide and relapse rates in depression, Arch, gen. Psychiat., v. 35, p. 749, 1978; In i e-n e r K. Drogen-und Selbstmordwertung, Nervenarzt, Bd 47, S. 398, 1976; B i r t with h-nell J. Alarcon J. Depression and attempted suicide, Brit. J. Psychiat., v. 118, p. 289, 1971; In r a u-t i g a m W. Reactionen, Neurosen, Psy-chopathien, Stuttgart, 1969; Kula-w i k H. Zur Psychopathologie der Suizi-dalitat, Psychiat. Neurol, med. Psychol. (Lpz.), Bd 29, S. 257, 1977; M o t t about J. A. The psychopathology of suicide, Amer. J. Psychiat., v. 136, p. 516, 1979; M about u-r e n M. - C. et. S o u 1 and at about 1 R. Suicide et depression, Ann. med. - psychol., t. 136, p. 1147, 1978; Murphy G. E. a. o. Suicide and alcoholism, Arch. gen. Psychiat., v. 36, p. 65, 1979; M y e r s D. H. a. Neal C. D. Suicide in psychiatric patients, Brit. J. Psychiat., v. 133, p. 38, 1978; Parasuicide, ed. by N. Kreitman, L. — N. Y., 1977; P 1 a-nansky K. Johnston R. Clinical setting and motivation in suicidal attempts of schizophrenics, Acta psychiat. scand., v. 49, p. 680, 1973; Suicidology, contemporary developments, ed. by E. S. Shneidman, N. Y., 1976; V i r k k u-n e n M. Attitude to psychiatric treatment before suicide in schizophrenia and paranoid psychoses, Brit. J. Psychiat., v. 128, p. 47, 1976.

Century of H. Hooks, I. V. Buromsky; A. G. Ambrumova, G.V. Morozov, N. G. Shumsky (psikhiat.).