Treatment of suicidal conditions. Suicidal thoughts: what to do?

Suicidal tendencies manifest themselves differently in different mental types of people, but there are a number of signs that are characteristic of most patients. The main cause of thoughts of suicide is depression, both chronic and acute. The formation of acute depression involves strong emotional experiences such as grief, grief, and frustration. Other mental disorders that lead to aggressive and impulsive behavior also play an important role.

Signs of suicidality are common among people who have experienced traumatic events in childhood. This could be the loss of family, high levels of stress at a young age, loss of home, or a difficult family situation. Often suicide is the final stage of auto-aggressive behavior, i.e. actions aimed at causing harm to oneself. This includes not only physical harm, but also deviant behavior, such as alcoholism or drug use. Auto-aggressive behavior in this case is formed as a reaction to an event that caused a strong emotional shock. Elderly people mostly resort to suicide due to a serious painful illness that they can no longer tolerate.

Symptoms of suicidal tendencies are very easy to notice for the patient’s relatives and friends. As we have already noted, excessive use of drugs and alcohol may indicate a person’s tendency towards self-destruction, but the danger of such tendencies is also that taking such substances negatively affects a person’s mood and increases impulsive impulses. About 50% of people who decide to commit suicide are in a state of intoxication immediately before the attempt, more than half of them resort to alcohol.

Independent struggle

To organize the most effective treatment of suicidal conditions, it is recommended to use the following methods:

1. Organize communication with new people. To radically change your lifestyle, it is important not only to eradicate bad habits, but also to expand your social circle. A new and fresh look at old problems will help improve your psychological state, as well as jointly organize an effective fight
2. A change of scenery. Traveling is one of the best types of self-therapy, allowing you to get new positive emotions, start an affair or communicate with new people.
3. Change your place of work. It is optimal to resolve this issue without material losses. Sometimes a person cannot really assess his own abilities and does not continue to develop himself
4. Change your place of residence. To start life with a new leaf, changing the city, region, region will also be beneficial. Although a person may experience stress as a result of moving, such a decision often has a beneficial effect
5. Self-hypnosis. This will require internal moral strength to set the right attitude for yourself. Training experts recommend fighting such emotional manifestations as anger, cruelty, and hatred.

However, such methods are, as a rule, additional methods that support the work of specialists or medication treatment.

Use of medications

If a person is unable to cope independently with the manifestations of a suicidal state, the following groups of drugs can be used:

1. Antidepressants. With their help, it is possible to block reactions to negative factors. Before choosing medications on your own, it is imperative to consult with a specialist. The most commonly used drugs are Afobazole and Mirtazapine.
2. Sedative group of drugs. Some medicines are made on an organic basis using medicinal herbs, while others are made using synthetic substances. For example, among the most popular are Glycine, Dormiplanta
3. Complex of vitamins. Often, suicidal thoughts arise as a result of a lack of important substances for the body. To replenish it, it is advisable to use Complivit, Daily Formula
4. Means of traditional therapy. A tincture based on peony will be effective. Therapy involves a weekly course, and adding 5 drops per day is sufficient.

Psychotherapy is an equally effective way to deal with suicidal thoughts. First of all, a specialist will help you find out what causes the condition. Depending on the severity, hypnosis, therapeutic techniques, and individual conversations may be used. As a rule, several tests are first used to determine the development of the pathological condition.

Suicide attempt and consequences

Before suicide, the patient has corresponding thoughts. He is preparing to commit suicide. That is why such people give away their things and put all their affairs in order. They say goodbye to their friends as if it was the last time. The patient considers his actions and chooses a method of suicide. Depending on it, medicines are purchased, weapons or poisonous substances are purchased.

Morally a person is ready for suicide. Therefore, if he survives a suicide attempt, he remains alive, then this leads to terrible depression. It seems to a person that he is so insignificant that he could not even commit suicide. In addition, the patient feels guilty. If help is not provided to him in a timely manner, he will repeat his suicide attempt.

What to do to prevent suicide

In preventing suicide, understanding the motives of the person who decides to commit it plays a significant role. First of all, a deeply depressed person realizes that he is isolated. He feels helpless, abandoned, lonely and useless. It is these feelings that move him to part with the world. A person who has decided to commit suicide is sure that no one is able not only to understand his sadness and pain, but also to relieve it. He regards the attempt to stop his decision to commit suicide as a desire of those around him to prolong his suffering. Helping a person who has decided to make a radical decision should come down to the following principles:

1. Participation. The person who is trying to dissuade suicide, or the Rescuer, must first of all assure the suicide that he is completely on the side of the desperate and is able to understand the pain and hopelessness that the Victim feels. Such words are the only correct reaction to the feeling of isolation of a suicide. Limiting Rescuer tactics to just these beliefs is doomed to failure. You need to be so on the side of the Victim that you even agree with participation that death is really the only way out.
2. Inducement. After the Rescuer finds a point of contact with the suicide, you can move on to the next principle. It should be used carefully but firmly. First of all, the task is to prove to the Victim that the method he has chosen is wrong. The suicide should be told about what he may lose, what he is now blind and immune to. The most important thing is to explain that after a successful suicide there will be no way to return.

After suicide

In order to reduce the risk of a second suicide attempt, it is recommended to ensure the full support of family, friends and loved ones. Such patients are strictly prohibited from taking alcoholic beverages and drugs. Psychotherapists and relatives of the patient must do everything possible to ensure that the patient has contact with the outside world.

It is recommended to provide the patient with adequate sleep, the duration of which is 7-8 hours. Good results come from attending a self-help and support group. A person’s loved ones should hide all weapons, pills and other items that could cause harm to themselves. Relatives need to seek help from professionals who will develop an effective therapeutic regimen.

Suicidal thoughts. How to recognize and what to do?

According to the World Health Organization, approximately 800,000 people worldwide commit suicide every year. As noted by WHO Director General Tedros Adhanom Ghebreyesus, every 40 seconds in the world one person dies as a result of suicide. These are statistics from the latest WHO report, published less than a month ago, in early September. Moreover, these indicators do not take into account the number of attempts that did not end in death, which are approximately 20 times more, the authors of the document believe.

Russia is one of the top three countries in the number of suicides - 26.5 cases per 100 thousand people (which is more than twice the world average - 10.5 cases). Only South American Guyana (30.2 cases) and African Lesotho (28.9) are ahead of us. In 2021, there were 44 thousand suicides in our country - five people per hour.

Often people contemplating suicide cannot tell loved ones about the problem or are afraid to seek help. AIDS.CENTER has prepared material on how to recognize suicidal tendencies and how to help in this situation.

1. What signs can be used to understand that a person is thinking about suicide?

There are signals by which you can understand that a loved one is depressed and sees no other way out but suicide. Here are some of them.

• Directly says: “I’m going to kill myself,” “I wish I could die,” or “I wish I never existed.”
• Buys weapons or pills.
• Refuses to communicate and spends all his time alone.
• Feels trapped or thinks that everything is hopeless.
• Uncontrollably takes alcohol or drugs.
• Does risky and self-destructive things (such as using drugs or driving dangerously).
• He gives away things, writes a will, says goodbye to people as if he will never see them again.

Warning signs are not always obvious and can be different; in each case, you need to focus on what is not typical for this particular person.

There is a common belief that real suicides do not talk about their plans, but, as psychologists say, this is not so. Of course, there are situations when a person does not talk about his problems, is not depressed and suddenly commits suicide, in this case it is hardly possible to help. But if a loved one talks about their intention to commit suicide or you observe any of these signs, do not be afraid to talk to them.

Source: BBC Russian Service

2. How to talk to your loved one and help him?

The first rule is not to hush up the problem and not try to get around it, explains psychologist Tatyana Orlova. “If a person wants to commit suicide, then he needs to be told: “I see what is happening to you, and I have an assumption that you want to commit suicide. Let's talk about it". After this, you can ask why the person developed such a worldview, why the desire to commit suicide arose.”

As Orlova explains, usually these are circumstances that tell a person that the foundations of his life have been undermined, there is no way out, no one loves, there are no ways of development. The conversation itself will help a person understand that he is not alone. “At the same time, you can remember positive experiences, say that there have already been difficult situations in his life, and talk with him about how and due to what he coped then. Then look for resources. Let’s say a person can’t find a job for a year. What else can be done, who else can you talk to, what help can you offer him to correct this situation? - continues the psychologist.

The psychologist also emphasizes that one should not devalue or condemn. “There is no need to deny and immediately try to cast doubt on all arguments. We must admit that it is difficult for a person to deal with this. You just need to say: “I hear you, I can be with you, let’s look for a way out together” and offer the help of a psychologist.”

In addition, psychologists advise making sure that the space is safe - removing from the house all means that a person can use for suicide. And also do not leave him alone or offer to call you if he has an irresistible desire to commit suicide.

3. In what cases should you call an ambulance for psychiatric help?

You cannot always help a person on your own; in this case, it is better to seek specialized help. “If your loved one said that he is going to commit suicide, and talks about how he would do it, or prepares for it (buying something for this, writing a will) and at the same time refuses to seek help, you should call an ambulance.” - says psychiatrist Sergei Divisenko.

Another case, in his opinion, when you need to immediately call an ambulance is if a person hurts himself. “Self-harm is not always a suicide attempt. In some cases, this may be due to the desire to drown out mental pain with physical pain, but sometimes self-harm can be dangerous to life and health,” Divisenko clarifies.

4. How can I help myself and what should I do?

Sometimes a person himself understands that his thoughts about suicide are destructive, and wants to help himself. For such cases, detailed instructions were written by Mayo Clinic doctors.

1. Remember that suicidal thoughts will pass.
2. Recognize that depression and thoughts of hopelessness distort your perception of reality and prevent you from making the right decisions.
3. Understand that suicidal feelings are the result of treatable problems.
4. Act as if you have other plans for your life, even if it is difficult to do so now.
5. Seek help from a psychologist or psychiatrist, or you can call the psychological help hotline.

At the same time, try to protect yourself.

• Stick to your treatment plan. Take your prescribed medications and do not miss appointments with your therapist.
• Keep on hand a list of contacts of people you can contact in a crisis situation.
• Get rid of items that could harm yourself.
• Create a weekly plan for activities that will support or delight you, and stick to it. This could be sports or art or any other hobby.
• Chat with friends and family. Try not to spend time alone.
• Join a support group if there is one in your area.
• Try not to use drugs and alcohol, they can increase suicidal thoughts.
• Keep a diary. Write down your thoughts and feelings about things that are important to you.

Suicidal thoughts

Suicidal thoughts appear in people during stressful situations and depression. A person has thoughts that he is in a situation from which there is no way out. A person is isolated from the outside world and does not make contact even with family and friends. When suicidal thoughts arise, people engage in risky behavior. They are careless when driving a car or operating a variety of serious machinery.

With suicidal thoughts, a person never has positive emotions. The patient strongly repents and develops pronounced self-criticism. With pathology, the appearance of depression, panic attacks, and mental disorders is observed. With suicidal thoughts, the patient's personality traits change. Such people are constantly excited, they are diagnosed with increased anxiety. With pathology, frequent mood swings are observed. The person is overly preoccupied with the topic of death. He experiences emotional pain that he cannot tolerate.

Increase in suicidal desires during therapy

The therapist must understand that short-term exacerbations of suicidal desires are possible during therapy. He should warn the patient about this, specifically stipulating that a sudden outbreak of suicidal impulses should not be interpreted as a sign of failure of therapy. Already in the early stages of treatment, it is necessary to present to the patient various strategies with which he could resist the sudden onset or intensification of suicidal impulses. The therapist may address the patient with the following words:

One important goal of therapy is to teach you effective ways to cope with suicidal impulses. You must be on alert all the time in order to notice in time the emergence or aggravation of these desires. At the first appearance of suicidal thoughts, you should follow a procedure aimed at eliminating them. This way you will learn to overcome these thoughts and desires. If you want, we can rehearse right now what you should do if suicidal desires arise.

The therapist must be alert to the effects of traumatic situations unrelated to therapy, which may lead to an exacerbation of suicidal desires. In our practice, there have been cases when a patient who had not previously shown suicidal intentions began to think about suicide already in the process of therapy under the influence of some unpleasant event. For example, one patient decided to commit suicide when her friend abandoned her. The therapist had to carefully analyze why the breakup with a friend led the patient to such a decision, and as a result of this analysis, a heap of irrational beliefs was revealed, for example: “I cannot live without love,” “If they don’t love me, then I’m worthless.”

The risk of exacerbation of suicidal desires is especially high in patients who have attempted suicide before starting therapy; in this case, even minor everyday troubles can lead to an exacerbation of auto-aggressive intentions. Some patients become despondent when they notice a resumption of suicidal thoughts and conclude that therapy is ineffective. The therapist should explain to the patient that this event contains more positive than negative, because the patient gains the opportunity to “work through” his suicidal desires in a therapeutic situation.

Treatment of child suicide anonymously in Moscow

For suicidal tendencies in children, it is recommended to seek professional medical help. By providing timely psychological assistance, suicide is prevented and the child’s life is preserved. The Moscow clinic employs highly qualified psychologists and psychotherapists who initially diagnose the child’s condition. Thanks to the use of special techniques, they find out the causes of suicidal tendencies and develop an effective treatment regimen that is aimed at eliminating them.

During the diagnosis, neuropsychic disorders, mental disorders and psychosomatic diseases are determined, against the background of which suicidal thoughts appear. Their treatment requires taking medications and using psychocorrection.

Treatment of children is carried out in a hospital setting, which eliminates the possibility of suicide. The clinic employs qualified and communicative staff who provide 24-hour patient support. To treat a child, universal psychocorrectional techniques, individual and group lessons are used. If necessary, drug therapy is used. The choice of treatment method is made by the doctor in accordance with the individual characteristics of the patient and the severity of the pathology.

Causes

Psychiatrists distinguish two groups of causes of thoughts of suicide: mental disorders and the reaction of a healthy psyche to severe traumatic events or experiences.

Suicidal thoughts can be passive, when a person talks about his unwillingness to live or imagines that he has died, and active, when a person plans and looks for ways to die.

Risk of suicide with suicidal thoughts

Most people with suicidal ideation do not attempt suicide, but suicidal ideation is considered a high risk factor for suicide.

At some point in their lives, many people contemplate death, when it may seem that there is no way to solve their problems and suicide is the only way to end the pain.

A person may experience the following feelings at this moment:

• hopelessness, as if there is no point in living
• filled with negative thoughts
• unbearable pain, the end of which is impossible to imagine
• uselessness, a feeling of not being used by others
• despair, as if there is no other choice
• the feeling that everyone would be better off without you
• romanticization of death and the desire to die “beautifully”

What to do?

It is important to remember that these feelings are temporary and will not always be with you. In this article, I want to talk about some techniques that can help right now and protect you from a rash step:

1.Don't make a decision today

You don't need to act and fulfill your intentions right now. The possibility of suicide will not go away. You can make this decision tomorrow, next week or next month if you want. Try to focus only on getting through today, don't think about what awaits you tomorrow.

Make a crisis plan

It can be compiled with the help of a medical professional, psychologist, or independently. Keep this plan in an accessible place and update it as needed.

Be aware of your triggers

Triggers are things that can make you feel worse. Triggers are different for everyone, and you may find that certain music, photos or movies make you feel worse emotionally. Try to stay away from them.

Avoid drugs and alcohol

Psychoactive substances provide relief only at first. Once their effects wear off, you will inevitably feel worse. Drinking alcohol can increase the likelihood of suicidal thoughts. Drugs cause changes in consciousness and increase the chances of committing suicide while taking them.

Try to find a safe place

Go where you feel safe. This could be any place - your apartment or your parents' house, a temple, a museum or a schoolyard.

6. Stay away from things that could harm yourself.

Do not handle razor blades, knives or pills. If you have a lot of medication, you may want to ask someone to hold it for you until you regain control of your feelings.

Talk to other people

You need to talk to someone about your feelings. You can discuss your condition with friends, family or your GP. If you don't want to talk to people you know, you can call an emotional support line or helpline.

Be around other people

You may find it difficult to talk to anyone at the moment. This is fine. Just try not to spend too much time alone. You can go to a shopping center, gym, cafe or park. Being around people can help you stay safe, even if they don't know how you feel.

Make a list of important things

Make a list of all the positive things in your life. It may be hard to think about it now, but give it a try. Think about your strengths and all the good things in your life.

Treatment of persons who have attempted suicide in hospital

If a patient has attempted suicide, the hospital provides him with step-by-step psychological assistance. Initially, the psychotherapist establishes emotional contact with the patient and gives him the opportunity to talk about everything that is on his soul. After suicide, most patients talk about their failures, after which they calm down.

At the next stage, the specialist determines the reasons for suicide, which led to a deep psychological crisis. At this stage, the psychotherapist does everything possible to distract the patient from thoughts of suicide. He helps a person find a way out of the situation. For serious psychological problems and severe emotional states, drug therapy is used along with psychocorrectional techniques. After the patient realizes that he can overcome all the problems in life, the psychotherapist develops measures that will prevent a crisis situation.

Dealing with feelings of hopelessness

When asked what causes the desire to commit suicide, suicidal patients usually give the following answers. 1. Life has no meaning. I have nothing to expect from life. 2. I can't live anymore. I'll never be happy. 3. This is the only way to end suffering. 4. I have become a burden to the family. They will be better off without me.

Please note that all of these statements are somehow associated with a feeling of hopelessness. A person does not see a way out of a situation that is unbearable for him and believes that only suicide will free him from the burden of “unsolvable” problems.

In cases where the core of suicidal desire is a feeling of hopelessness, the therapist, using various methods, must show the patient: a) that his current life situation allows for other, less gloomy interpretations and b) that he has the opportunity to solve his problems in another way. The following very prosaic story can serve as an illustration of maladaptive behavior. A girl, driven to despair by the fact that her lover has not called her for several days, begins to contemplate suicide. When the therapist asks what she could do instead of sitting by the phone and waiting for the call, the girl replies, “I could call him myself.”

We try to identify feelings of hopelessness during the first interview. Subsequently, we try to bring the patient to an awareness of how this feeling is related to errors in thinking and perception. We have developed the Hopelessness Scale, which is a useful aid in assessing the degree of suicidal risk (Beck et al., 1974). A high score on this scale almost always indicates the presence of suicidal thoughts. Because the questionnaire only takes a few minutes to complete, it can be given to the patient before each session.

If clinical and psychometric studies show high levels of hopelessness and associated suicidal desires, the therapist must immediately begin to address this problem. In this case, waiting tactics is an unacceptable luxury; The therapist has no right to wait for suicidal thoughts and desires to express themselves loudly. The patient may simply not live to see the next session. Moreover, we recommend maintaining telephone contact with the patient between sessions until the suicidal crisis has passed. Sometimes it is useful to inform the patient’s relatives about the problem.

The therapeutic strategy used to deal with feelings of hopelessness stems from the concept that the thinking and perception of a depressed patient are constrained by preconceived conclusions. It does not occur to the patient to question his preconceptions. The therapist's task is to arouse the patient's interest in exploring negative prejudices. The therapist points out to the patient facts that contradict his conclusions, and, thus creating “cognitive dissonance,” encourages the patient to reconsider his position.

The patient experienced a strong desire to die after her divorce from her second husband. When asked by the therapist why she considered suicide the only possible way out of the current situation, the woman replied: “I can’t live without Peter.” Subsequent questioning yielded the following answer: “I can’t live without a man.”

The therapist asked whether she always needed the presence of a man for a normal existence, and it was this question that played the role of a “cognitive key.” The woman thought for a moment and then suddenly admitted: “You know, the happiest time for me was the period when I lived alone. My first husband was serving in the army at the time. I worked and lived alone." The realization that she had once lived well without a man allowed the patient to understand that she was not as helpless as she thought. Gradually, the patient gained a sense of independence and autonomy and stopped thinking about suicide.

Another illustration of how a therapist can lead a patient to recognize the logical inconsistencies in a belief system is the following conversation. A 25-year-old patient continued to think about suicide after a failed suicide attempt. Driven to despair by her husband’s infidelities, she considered her life “over.” The therapist structured the conversation in such a way as to obtain information from the patient that contradicts this conclusion and to encourage the patient to think more logically.

Therapist. Why do you want to commit suicide?

Patient. Without Raymond I am nothing... I will never be happy without him... But I cannot save our marriage.

T. Was your married life happy?

P. No, everything went wrong for us from the very beginning... Raymond always cheated on me... In the last five years I have hardly seen him.

T. You said that you would never be happy without Raymond... And now, with Raymond, are you happy?

P. No. When we meet, we immediately start arguing. This is not life.

T. Then why do you think that you cannot live without Raymond?

P. Because without him I am nothing.

T. Could you say that again?

P. Without Raymond I am nothing.

T. What do you think of this idea?

P. ...Well, if you think about it, this is not entirely true.

T. You said that without Raymond you are “nothing.” And before you met Raymond, did you also feel like “nothing”?

P. No. I knew I was something.

T: Doesn’t it follow from this that you can be “someone” without Raymond?

P. Well, yes, probably. Yes I can.

T. If you felt like a person before meeting Raymond, do you need him now to feel like a person?

P. (puzzled). Hm…

T. I assume you meant that your life would be different without Raymond.

P. Yes. I just don't believe I can find anyone to replace Raymond for me.

T. Did you have any male friends before you met Raymond?

P. Yes. I was successful with men then.

T. If I understand correctly, before you met Raymond, you fell in love with other men and they fell in love with you. So?

P. Uh-huh.

T. Why do you think that you won’t be able to find a man now?

P. I'm not as attractive as before.

T. Since you got married, have any men shown interest in you? P. Yes, many tried to court me, but I ignored them.

T. Do you admit that if you were not married, men would be more persistent in their advances, knowing that you are single?

P. Maybe.

T. Do you admit that among them there may be a man more permanent than Raymond?

P. I don’t know... Perhaps.

T. Do you think there are any men around you as good as Raymond?

P. I think there are better men than Raymond. Raymond doesn't love me.

T. You said that you do not allow the thought of divorcing Raymond. Is it true that in the last five years you have hardly seen your husband?

P. Yes, that's true. He has been living elsewhere for a long time.

T. Is there even the slightest chance that you will start living together again?

P. No... he has another woman. He doesn't need me.

T. In that case, what do you have to lose if you divorce him?

P. I don’t know.

T. Do you not admit that your health might improve if you end this marriage?

P. It's hard to say.

T. Can your marriage be called real?

P. (Crying.) Probably not.

T. Can we assume that you will find another man?

P. I understand what you are getting at, and I know that you are right. In fact, I thought about this myself... Why cling to Raymond if he doesn’t want me. I think we need to put an end to our relationship.

P. Do you think that if you finally break up with Raymond, you will be able to love another man?

P. But I’ve fallen in love before.

T. So do you think you can love another?

P. Yes, I think I can.

At this moment, it became obvious that the patient was no longer as depressed as before and was able to find a way out of the current situation. The therapist structured the conversation in such a way as to show the patient that she had nothing to lose if she divorced Raymond (since their relationship had long since ended), and that divorce, on the contrary, opened up a lot of other opportunities for her.

After this conversation, the patient’s mood improved, and it could be considered that the suicidal crisis had passed. In a subsequent interview, the patient admitted that the turning point in that conversation was when the therapist questioned her idea that without Raymond she was “nothing.” In fact, how could this be true if even before meeting Raymond she felt like an accomplished person and was quite satisfied with her life? After replaying the conversation with the therapist several times in her mind, the patient made a firm decision to file for divorce.

So, in this case, the objectives of the survey were the following misconceptions of the patient: a) that she cannot be happy without her husband; b) that her marriage is viable; c) that divorce would mean an irreversible loss for her; d) that she cannot live without her husband. The patient was able to admit her misconceptions and realize the destructive consequences of an overly categorical way of thinking.

Forced treatment

In accordance with the current legislation of our country, compulsory treatment is allowed after a suicide attempt. if relatives try, they are advised to call an ambulance. The patient is hospitalized in a hospital. He is undergoing treatment in the psychosomatic department.

During the first few days, relatives and friends are not allowed to see the patient. After the patient regains consciousness and recovers a little, he can be visited in the presence of a medical professional. First, the doctor gives recommendations to relatives on how to behave with the patient. After a certain time, the clinic staff will establish contact with the patient and instill in him a desire for life, thanks to the use of special psychotherapeutic techniques. Compulsory treatment after suicide is recommended to be carried out without fail, which will eliminate the possibility of relapse.