The phenomenology of self-mutilation in a general hospital setting

Comparison of a series of twenty-four wrist-cutters with a control group of self-poisoners showed a number of significant differences. The wrist-cutters were younger and their acts were regarded as being of low lethality; they are no more likely to have made previous suicide attempts; they complain less often of depression, and more frequently of 'emptiness' and tension as primary complaints. Sudden, unpredictable mood swings are common and there is a greater tendency for their physicians to diagnose personality disorders, often in pejorative terms. They frequently have substantial medical interests and paramedical occupations. A high proportion complain of dysorectic symptoms (anorexia or overeating or combinations of both), use drugs and/or alcohol in excess; show sexual disturbance and distress, and also promiscuity. They more frequently have a negative reaction to menarche and menstruation; have come from broken homes and have experienced parental deprivation. A proportion of the group exhibit difficulty in verbal communication, and absconding from hospital was more common in the group of cutters. Painless cutting after a period of depersonalization, followed by relaxation and repersonalization after bleeding, was the typical pattern.

A study of attempted suicides in urban versus rural areas, with a follow-up

The group of subjects consisted of 44 patients (attempters) who were admitted to hospital for treatment because of attempted suicide during a 3-month period in Norther Savo (in Eastern Finland), another 44 patients (non-attempters) admitted to hospital in the same period for other reasons serving as controls. The number of women was the same in both groups, and so was, in consequence, the number of men. The study compared the attempters with the non-attempters and, in addition, the patients coming from urban areas with those coming from rural areas, the ratio of the urban to the rural patients being the same in both groups. The study was based on personal psychiatric interviews with the patients, which took place in each case both immediately following the patient's admission and precisely 3 months afterwards. The results showed that schizophrenia was significantly more frequent in the rural than in the urban attempter group. By contrast, alcoholism and alcohol abuse were more frequent in the urban than in the rural attempter group. Compared with the urban patients, the rural patients tended to be physically more seriously desordered. Poisoning by drugs was a significantly more frequent means of attempted suicide in the urban than in th rural group. The patients in the latter group, again, had resorted oftener to the so-called "active" methods of attempted suicide. Of the attempters, 25% attempted suicide anew during the 3-month follow-up period, the corresponding figure for the non-attempter group being only 6%. During the follow-up period, a greater number of suicidal attempts was made by the patients in the rural group than by those in the urban group, and, as regards the intent to succeed, the attempts of the former were more serious than those of the latter. The so-called "active" methods were used more often by rural than by urban patients also during the follow-up period. All in all, the self-destructive behaviour exhibited during the follow-up period was graver in the rural than in the urban group.

Self-poisoning and self-injury in the Oxford area. Epidemiological aspects 1969-73

A prospective study of self-poisoning and self-injury in the Oxford area for 1972-73 and a retrospective study for 1969 has shown the following: (a) The number of admissions to a general hospital following self-poisoning and self-injury has increased by approximately 45% in 3 1/2 years. The increase is more marked in women than in men. (b) When compared with a previous study the incidence in Oxford city has quadrupled in ten years. (c) A total of 74% of men and 67% of women, aged 16 years and over, harming themselves in this way are under the age of 35 years. The repetitiveness is increasing and the proportion of those repeating the attempt was 10% within three months, and 15% within six months. (d) The rates are exceptionally high for teenage wives and single, widowed, and divorced women aged between 24-35 years. Single men show exceptionally high rates in the 35-45 year age group. (e) With the exception of married women aged between 25 and 34 years and women over 60, the rates were higher in urban than in rural areas. (f) In men the rates were higher among personal service workers, semi-skilled manual and unskilled manual workers. In women the rates were highest among non-manual, ancillary to professional (especially nurses), and semi-skilled manual workers. Male students had rates much lower than those of their age group, while female students had rates about the same as their age group. The lowest rates were among professional and 'own account' workers.

Death in young alcoholics

Homicide, accidents and heart disease were the leading causes of death among young alcoholics treated at an outpatient alcoholism clinic over a 3-year period. Ways of preventing early death in alcoholics are suggested.

Psychiatric morbidity in a sample of a London coroner's open verdicts

One hundred and thirty-four deaths recorded as open verdicts in the Inner West London Coroner's District during 1969 and 1970 have been surveyed for evidence of mental illness. For 110 (82 per cent) of these deaths the probable verdicts were suicide or accident and they were reclassified as undetermined deaths. Of these deaths 73 per cent were diagnosed as mentally ill, 54 per cent were receiving medical treatment for psychological symptoms before death, 42 per cent had a history of psychiatric care and 24 per cent had made a previous suicide attempt. In these respects undetermined deaths and suicide deaths resemble each other; both are drawn predominantly from the mentally ill.

Attempted suicide and suicide in functional psychoses

A total of 2,243 first admissions to Gaustad Hospital between 1938 and 1961 diagnosed as functional psychotics were either followed up to the time of their death within 5 years, or observed over a period of 5 years, and then reexamined. Of these patients, 325 had attempted suicide prior to their admission. The frequency of attempted suicide was equal in both sexes. Men appeared to use more dangerous methods, and to have more serious intentions. The psychosis appears to have been of importance when considering whether, but not how the suicide should be attempted. The greatest risk of attempted suicide was to be found amongst patients with psychoses of a depressive nature. Twenty-eight of the 2,243 patients in this study committed suicide within 5 years following their discharge, and a further 20 took their own lives prior to the reexamination. A certain connection can be seen between attempted suicide and psychotic symptoms.

Suicide in children and adolescents

Suicide figures are generally underestimated, more so for children and adolescents than for adults. Yet suicide among adolescents has shown the greates rise for any age group. Every youngster who attempts or threatens suicide should have a thorough psychiatric evaluation. Most of them require intense therapy, either individually or in a group.

Intentional isoniazid overdosage among southwestern American Indians

A 30-month study explored the degree to which self-destructive behavior compromised tuberculosis therapy and prophylaxis among southwestern American Indians. The frequency of isoniazid (INH) overdosage paralleled the extent of INH usage in each tribe and the entent to which INH was perscribed for each tuberculosis category. The authors recommend the careful selection of patients for INH prophylaxis, the dispensing of small amounts at short intervals, the close monitoring of patient compliance with the prescribed drug regimen, and, possiblly, the dispensing of individually wrapped tablets to inhibit the impulsive ingestion of massive amounts of the drug.

"Suicidal behaviour" in New South Wales

For about fifteen years now a tradition has been evolving in the psychiatric literature towards a taxonomic separation of suicides and attempted suicides, on the assumption that they involve distinct psychogenic factors (Stengel and Cook, 1958; Farberow and Schneidman, 1961). However, even the originator of the distinction agreed that a better understanding of attempted suicide could be gained if it is regarded as conveying a degree of uncertainty that the attempt will succeed or fail (Stengel, 1958), and that the separation of ‘… suicide and attempted suicide … is artificial (as) … it is possible to view suicidal acts as a whole and irrespective of outcome’ (Stengel, 1969, p. 121). The latter view has been reflected in the recent introduction and usage of the term ‘suicidal behaviour’ which includes both suicides and attempted suicides (Hetzel, 1971).

[Suicidal trends in urban and rural districts of Brandenburg]

Statistic methods are used to investigate the discrepancy in the occurrence of suicides and attempted suicides in the urban and rural districts of Brandenburg. Although the socilolgical structures of the rural districts are much like those of the town, there exist obvious discrepancies in the incidence rate. The suicide rate is paradoxically in contrast with what may be expected when one has read the literature. The rate is higher in the rural districts than in the town. The possible causes of this phenomenon are discussed indetail. It is considered recommendable for the planning of preventive measures that not only the figures for actual suicides be taken as a representative rate and starting point, but also the figures for suicidal acts (suicides and attempted suicides).

The urban distribution of non-fatal deliberate self-harm

1. The incidence of non-fatal deliberate self-harm throughout the City of Bristol during 1972 and 1973 was assessed by means of a survey of patients presenting to Accident and Emergency Departments of hospitals in the area. Fatal or repeated acts of self-harm were not included in the survey. 2. The rates for females exceeded those for males at all ages, with peak incidence of 645 per 100,000 females (age group 15-29 years) and 334 per 100,000 males (age group 25-29 years). Ninety-three per cent had taken a drug overdose of some kind. 3. The problem was found in all electoral wards of tE CITY, THOUGH ITS DISTRIBUTION WAS MARKEDLY CENTRIPETAL, WITH A CENTRAL AREA HAVING MORBIDITY RATES UP TO 2-8 TIMES THAT FOR THE CITY AS A WHOLE. 4. The socio-economic correlates of deliberate self-harm were examined by reference both to a series of 368 patients interviewed soon after the event and to the pattern of its distribution throughout the city. A significant positive association was found with areas of overcrowding, lack of exclusive domestic amenities and high proportion of foreign born residents, but there was no correlation with the proportion of persons living alone nor with the type of accommodation. 5. The central high rate area was found to be heterogeneous in socio-economic terms, ranging from a student and young professionals' bed-sitter area to one with a high proportion of unskilled manual labourers and New Commonwealth immigrants. 6. The aetiological implications of the ecological findings for deliberate self-harm throughout the city are discussed.

Poisoning and overdosage

Admissions to Waikato Hospital during 1973 for poisoning and drug overdosage are compared with the figures for 1963, with allowances for population growth. The figures are analysed on the basis of age, sex, race and residential area. A real reduction is shown in poisoning of children, but a large increase has occured in adults, especially young adults and particularly in drug overdosage. Some possible factors in this are discussed.

Personality disorder: a challenge for the future

Young persons with life long pattern of maladaptive behaviour present to the health and social services with multiple disabilities. These include suicidal behaviours, drug abuse (alcohol and opiates), VA, motorvehicle accidents, repeated failure of close personal relationship (including marriage), job failure, repeated delinquency, criminal violence (including battering babies), and failure to cooperate with medical care. Conspicuous parental discord is the major causal influence, thus explaining transmission to successive generations. Regarding marital disharmony as a major public health hazard may diminish expensive human misery and reduce crime.

Demographic characteristics of emergency room admissions of acute drug reactions

This study investigated a sample of persons treated for acute drug reactions (overdoses) in a hospital emergency room setting to determine the general characteristics of these drug abusers and the incidence of drugs responsible for their admission. Detailed information is provided on the race and sex composition of these drug-abusing patients and comparisons are made with the general population of the area serviced by the hospital. The sample consisted of 506 persons who entered Jackson Memorial Hospital, Miami, Dade County, Florida during January-June 1972. A profile of the typical admission for emergency care of a nonfatal overdose reveals a White female who is 18-24 hears old and who has overdosed on a single legally manufactured and distributed substance, usually a sedative.