DEPARTMENT OF

HOMOEOPATHIC PSYCHIATRY

INTRODUCTION

An Emergency is defined as an

unforeseen combination of

circumstances which calls for an

immediate action.

A Psychiatric emergency is a

disturbance in thought, mood or

action which causes sudden stress

to the individual or sudden disability,

thus requiring immediate

management.

TYPES OF PSYCHIATRIC EMERGENCIES

A psychiatric emergency can be one or more of the following:

A new psychiatric disorder with an acute onset.

A chronic pschatric diorder with a relapse.

An organic psychiatric disorder.

An abnormal response to a stressful situation.

Iatrogenic emergencies.

Alcohol or drug dependence.

Deliberate harm to self or others.

SUICIDE

Suicide (Latin suicidium, from sui

caedere, "to kill oneself") is the act of

intentionally causing one's own death

Fatal act that represents the person’s wish to die.

Some plan for days and weeks before

acting it out while others take their lives

seemingly on impulse.

EPIDEMIOLOGY

Over 8,00,000 people die due to

suicide every year.

For every suicide there are many more

people who attempt suicide every

year. A prior suicide attempt is the

single most important risk factor for

suicide in the general population.

Suicide is the second leading cause of

death among 15–29-year-olds.

75% of global suicides occur in low-

and middle-income countries.

METHODS OF SUICIDE

Ingestion of pesticide, hanging and

firearms are among the most

common methods of suicide

globally.

RISK FACTORS

GENDER DIFFERENCES

AGE

RACE

RELIGION

MARITAL STATUS

OCCUPATION

CLIMATE

PHYSICAL HEALTH

MENTAL ILLNESS

PREVIOUS SUICIDAL BEHAVIOUR

GENDER DIFFERENCES

•Men commit suicide more than four times as often as women.

•But women attempt suicide or have suicidal thoughts three times as often as men.

AGE

•Suicide is rare before puberty.

•Most suicides now are among those aged 35 to 64.

RACE

•Suicide rates among white men and women are approximately two to three times high as for African American men and women.

RELIGION

•Muslims have much lower rates in comparison to other religions.

MARITAL STATUS

•Marriage lessens the risk of suicide significantly,especiallyif there are children in home.

•Divorce increases the suicide risk.

OCCUPATION

•The higher the person’s social status, the greater the risk of suicide.

PHYSICAL HEALTH

• A physical illness is estimated to be an important contributing factor in about half of all suicides.

• Certain drugs can produce depression which may lead to suicide in some cases.

• Among these drugs are reserpine, corticosteroids, antihypertensives and some anticancer agents.

MENTAL ILLNESS

• Almost 95% of all persons who commit suicide or attempt suicide have a mental disorder.

PREVIOUS SUICIDAL BEHAVIOUR

• A past suicide attempt is perhaps the best indicator that a patient is at increased risk of suicide.

• Studies show that about 40% of depressed patients who commit suicide have made a previous attempt.

ETIOLOGY

Sociological Factors

French Sociologist Emile Durkheim divided suicides into 3 social

categories:

Egoistic: Egoistic suicide applies to those who are not strongly

integrated to any social group.

Altruistic: Altruistic suicides applies to those susceptible to suicide

stemming from their excessive integration into a group.eg Soldiers

Anomic: Anomic suicide applies to persons whose integration into

society is disturbed so that they cannot follow customary norms of

behaviour.

Psychological Factors

Freud’s Theory

In his paper “Mourning and Melancholia,” Sigmund Freud stated his belief that

suicide represents aggression turned inward against an introjected, ambivalently

cathected love object.

Menninger’s Theory

Karl Menninger, in Man Against Himself, concieved of suicide as inverted

homicide because of a patient’s anger toward another person.

He also described three components of hostility in suicide:

The wish to kill

The wish to be killed and

The wish to die

Recent Theories

Suicidologists believe that much can be learned about the

psychodynamics of suicidal patients from their fantasies about what would

happen if they commit suicide.

Such fantasies include:

• Wishes for revenge, power, control, punishment

• Escape

• Rescue, rebirth, reunion with the dead, or a new life.

Depressed persons may attempt suicide just as they appear to be

recovering from their depression.

A study of Aaron Beck showed that hopelessness was one of the most

accurate indicators of long term suicidal risk.

BIOLOGICAL FACTORS

A group at the Karolinska Institute in Sweden first noted that low

concentrations of the serotonin metabolite 5-hydroxyindoleacetic acid(5-

HIAA) in the lumbar cerebrospinal fluid(CSF) were associated with suicidal

behaviour.

Postmortem neurochemical studies have reported modest decreases in

5-HIAA

Low concentrations of 5-HIAA in CSF also predict future suicidal behaviour.

GENETIC FACTORS

Suicidal behaviour, as with other psychiatric disorders,

tends to run in families.

In psychiatric patients, a family history of suicide

increases the risk of attempted suicides and that of

completed suicides.

VARIABLES ENHANCING RISK OF

SUICIDE AMONG VULNERABLE GROUPS

Adolescence and late life

Criminal behaviour

Disposition of personal property

Divorced, separated or single

Early loss or seperation from parents

Family History of suicide

Hallucinations

Hopelessness

Hypochondriasis

Impulsivity

Increasing stress

Lack of future plans

Insomnia

Lethality of previous attempt

Living alone

Low self esteem

Physical illness or impairment

Recent childbirth

Recent loss

Severe psychiatric illness

Sexual abuse

Unemployment

VENN DIAGRAM SUMMARIZING SUICIDE DATA AND ITS RELATION TO MOOD

DISORDER AND SUICIDE ATTEMPTS

MOOD DISORDERSUICIDE ATTEMPTS

SUICIDE

15% of mood disorder

subsequently suicide

10% of suicide attempts subsequently

suicide within 10 years

Robin Williams

Robin McLaurin Williams (July 21, 1951 –

August 11, 2014) was an American actor

and comedian. Starting as a stand-up

comedian in San Francisco and Los

Angeles in the mid-1970s, he is credited

with leading San Francisco's comedy

renaissance.

During the late 1970s and early 1980s, Williams had an addiction to

cocaine. Williams turned to exercise and cycling to help alleviate his

depression shortly after friend's death.

In 2003, he started drinking alcohol again while working on a film in Alaska.

His publicist Mara Buxbaum commented that he was suffering from severe

depression prior to his death. Williams' wife Susan stated that in the period

before his death, he had been sober, but was diagnosed with early

stage Parkinson's disease, which was something he was "not yet ready to

share publicly.

Williams committed suicide on August 11, 2014 in his home in Paradise Cay,

California at the age of 63. In the initial report released on August 12, the

Marin County Sheriff's Office deputy coroner stated Williams had hanged

himself with a belt and died from asphyxiation.

The final autopsy report, released in November 2014, affirmed that Williams

had committed suicide as initially described. Neither alcohol nor illegal

drugs were involved, while any prescription drugs present in Williams' body

were at "therapeutic" levels.

The report also noted that Williams had been suffering "a recent increase in

paranoia.“ Williams' doctors reportedly believe that Lewy body dementia

"was the critical factor" that led to his suicide.

COMMON MISCONCEPTIONS ABOUT

SUICIDE

MISCONCEPTIONS FACTS

1. People who talk about suicide

don’t commit suicide.

Suicide happens without warning.

2. Suicidal persons are fully intent on

dying.

3. Once a person is suicidal, he is

suicidal forever.

4. All suicidal persons are mentally ill

or psychotic.

Nearly 80% of persons who commit

suicide, give definite warnings and

clues about their suicidal intentions.

Most suicidal persons are undecided

about dying or living.

Suicidal person is suicidal only for a

limited period of time.

Although the suicidal person is often

extremely unhappy, he is not

necessarily mentally ill.

PREVENTION AND CONTROL

Suicides are preventable. There are a number of measures

that can be taken at population, sub-population and

individual levels to prevent suicide and suicide attempts.

These include:

Reducing access to the means of suicide (e.G. Pesticides,

firearms, certain medications)

Introducing alcohol policies to reduce the harmful use of

alcohol.

Early identification, treatment and care of people with

mental and substance use disorders, chronic pain and

acute emotional distress.

Training of non-specialized health workers in the

assessment and management of suicidal behaviour.

Follow-up care for people who attempted suicide and

provision of community support.

GOALS TO REDUCE SUICIDE

Promote awareness that suicide is a public health problem that is preventable.

Develop broad base support for suicide prevention.

Develop and implement strategies to reduce the stigma associated with being a consumer of mental health, substance abuse and suicide prevention service.

Develop and implement suicide prevention

program.

Implement training for recognition of at-risk

behaviour and delivery of effective treatment.

Develop and promote effective clinical and

professional practices.

Improve access to, and community linkages

with, mental health and substance abuse

services.

Improve reporting and portrayals of suicidal

behaviour, mental illness and sustance abuse in

the entertainment and news media.

Promote and support research on suicide and

suicide prevention.

Improve and expand surveillance systems.

WHO RESPONSE

WHO recognizes suicide as a public health

priority. The first WHO World Suicide Report

“Preventing suicide: A global imperative”

published in 2014, aims to increase the

awareness of the public health significance

of suicide and suicide attempts and to

make suicide prevention a high priority on

the global public health agenda.

It also aims to encourage and

support countries to develop or

strengthen comprehensive suicide

prevention strategies in a

multisectoral public health

approach.

Suicide is one of the priority conditions in the

WHO Mental Health Gap Action Programme

(mhGAP) launched in 2008, which provides

evidence-based technical guidance to

scale up service provision and care in

countries for mental, neurological and

substance use disorders.

In the WHO Mental Health Action Plan 2013-

2020, WHO Member States have committed

themselves to working towards the global

target of reducing the suicide rate in

countries by 10% by 2020.

World Suicide Prevention Day (WSPD)

World Suicide Prevention Day (WSPD), on 10 September,

is organized by the International Association for Suicide

Prevention (IASP). The purpose of this day is to raise

awareness around the globe that suicide can be

prevented.

In past years, over 300 activities in around 70 countries

were reported to IASP, including educational and

commemorative events, press briefings and

conferences, as well as Facebook and Twitter coverage.

HOMOEOPATHIC MANAGEMENT

SYPHILIS

This miasm is held to be responsible for

many psychological disorders, including

alcoholism, depression, suicidal impulses,

insanity.

Syphilitic people have tendency to destruction, destruction at every single

moment, and it delight them.

An even religious syphilitic person destroy by the name of god. They kill

people in different religion.

The syphilitic’s person anger is more violent, explosive anger that scares the

people around them.

The syphilitic person’s sadness and joy are also tendency to be destructive.

Anyone losing his senses on a happy occasion is syphilitic miasm.

A strong desire to put an end to one’s life (Suicide or Murder) is syphilitic

miasm. Generally, the syphilitic person does not experience joy.

Destructiveness is the predominant physical feature such as an ulcer

(destructive process). There is destruction of shape, structure of the tissue.

DR.HAHNEMANN ON SUICIDE

In the Allgemeine Anzeiger der Deutschen,

1819, Hahnemann published a short article on "Uncharitableness

Towards Suicides." He mentions the epidemic prevalence of suicide,

maintains that it is a form of insanity and says : (Lesser Writings," New

York, p. 695.)

"This most unnatural of all human purposes, this

disorder of the mind that renders them weary, of life, might always

be with certainty cured if the medicinal powers of pure gold for the

cure of this sad condition were known. The smallest dose of

pulverized gold attenuated to the billionth degree, or the smallest

part of a drop of an equally diluted solution of pure gold, which may be mixed in his drink without his knowledge, immediately and

permanently removes this fearful state of the (body and) mind, and

the unfortunate being is saved."

HOMOEOPATHIC THERAPEUTICS

REMEDIES ACCORDING TO DIFFERENT

WAYS OF ATTEMPTING SUICIDE

Drowning

• Antim Crude

• Belladonna

• Drosera

• Helleborus

• Hyoscyamus

• Pulsatilla

• Rhus Tox

• Secal Cor

• Silicea

• VeratrumAlb

Hanging

• Arsenic

• Belladonna

Poison

• Lilium Tig

Shooting

• Antim Crude

• Aurum Met

• Carbo Veg

• Hepar Sulph

• Nat. Sulph

• Nux Vomica

• Pulsatilla

Throwing himself from

Height

• Aurum Met

• Belladonna

• Crotalus

• Nux Vomica

• Stramonium

Patient is constantly sad.

Desire to cut his throat but

fears death.

Impulse when he sees sharp

instuments or blood.

Impulse to kill himself.

Mental symptoms < in

morning

Alumina

Anacardium

Tendency towards

suicide by shooting.

Imagines he hears

voices of people

who are far away.

Antimonium Crudum

Ecstasy and exalted

love with great anxiety

about his fate and

inclination to shoot

himself.

Life seems a burden.

Arsenicum Album

Thoughts of death

and incurability of his

complaints.

Suicidal tendency

especially by hanging.

Aurum Mettalicum

Melancholy with inquietude and

desire to die.

Irresistible desire to weep.

Sees obstacles everywhere.

Hopeless, suicidal, inclined to

jump of heights.

Feels life is not desirable and

thought of death alone gives

pleasure.

Great anguish which even induces a disposition to suicide.

Belladonna

Patient wishes others to

destroy him.

Will beg physicians and

attendants to do so

Wishes to suicide by

drowning.

Capsicum

Almost overwhelmed by

persistent thoughts of suicide.

He does not want to kill himself.

He resist the thought and yet

they persists and he is

tormented by these thoughts.

Homesickness

Cinchona

Fixed ideas that he is

unhappy.

Full of fear at night.

Wants to commit

suicide but lack

courage.

Cimicifuga

Suspicious of

everything.

Taciturn, takes no

interest in anything

Suicidal mood but

fears death.

Mania from business

failure or disappointed

love

Lachesis

Meditates upon suicide and

finally settles back into an

apathetic state in which

there is an aversion to

everything , to work and

even to think.

Hysterical symptoms,

weeping, mental prostration.

NATRUM SULPH

Sadness, inclined to weep, melancholy

with periodical attack of mania.

Satiety of life, Suicidal- Has to use all self

control to prevent shooting himself.

Mental troubles < from jar or knock on

the head or a fall about the head.

PSORINUM

Religious melancholia, full of

fears and evil forebodings

Very depressed, sad

Suicidal thoughts, fear of falling

in business, wishes to die inspite

of the best hopes.

RHUS TOX

Anxiety and timidity <at twilight

Wants to drown himself yet he has

fear of death.

SPIGELIA

Great fear of

pointed things,

pins, moroseness to

the extent of

suicidal mania.

HEPAR SULPH

Patient is sad, low spirited

Terrific visions of dead persons

Impulse to suicide

< in evening

ZINC MET

Sadness

>Evening.

Feels calm when

thinking of suicide.

BIBLIOGRAPHY

Kaplan & Sadock’s; 2007; Synopsis of Psychiatry ;10th Edition; NewDelhi: India Wolters

Kluwer Pvt Ltd.

Ahuja Neeraj, 2011; A short textbook of Psychiatry;11TH Edition; NewDelhi: India

Jaypee brothers Medical Publishers(P) Ltd.

Boericke William; 2010; Homoeopathic Materia Medica; 3rd Revised Augmented

Edition; NewDelhi: India B.Jain publisher(p) LTD.

Lilienthal Samuel. 1925 ; Homoeopathic Therapeutics; 5nd Edition; NewDelhi: India

B.Jain publisher(p) LTD.

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