| Abstract | Suicid je važan psihopatološki entitet i jedna od najzahtjevnijih kliničkih situacija s kojom se psihijatri suočavaju u svakodnevnom radu, a definira se kao dobrovoljno i svjesno oduzimanje vlastitog života. Suicidalnost je iznimno složena u svojoj pojavnosti te u kontinuumu autodestruktivnih ponašanja seže od nesuicidalnih samoozljeđivanja do izvršenja suicida. Hrvatska pripada zemljama relativno visokog rizika za suicidalno ponašanje, što se temelji na službenim stopama suicida. Jedan od najvažnijih i najzahtjevnijih zadataka psihijatra u svakodnevnoj kliničkoj praksi jest procjena suicidalnog rizika. U tu svrhu koriste se razni alati te osim kliničkog intervjua, koji predstavlja polazišnu točku u evaluaciji suicidalnog rizika, postoje i psihometrijske ljestvice među kojima valja istaknuti Columbia ocjensku ljestvicu ozbiljnosti suicidalnosti (Columbia-suicide severity rating scale, C-SSRS) kao jednu od novijih metoda procjene suicidalnog rizika. Nastavno na inicijalnu procjenu, potrebno je definirati najpogodniju razinu intervencije prema kategoriji suicidalnog rizika, koja uobičajeno uključuje one visoke, srednje i niske opasnosti. Suicidalni bolesnik predstavlja paradigmu hitnoga psihijatrijskog bolesnika. Aktivna suicidalnost (otvoreno iznošenje suicidalnih ideja) predstavlja indikaciju za prisilno psihijatrijsko liječenje. Akutno suicidalno stanje visokog rizika apsolutna je i jasna indikacija za hospitalizaciju, iako hospitalizacija ne predstavlja liječenje u užem smislu već osiguravanje sigurnosnih uvjeta potrebitih za provođenje liječenja onog poremećaja koji se nalazi u podlozi suicidalnosti. U prevenciji i liječenju suicidalnosti primjenjuju se farmakološke i nefarmakološke metode liječenja. Prije svega treba naglasiti kako se liječenje suicidalnosti odnosi na liječenje poremećaja koji je u podlozi suicidalnosti. U farmakološke metode liječenja suicidalnosti ubrajaju se anksiolitici, antidepresivi, antipsihotici i stabilizatori raspoloženja. Lijekovima se pokušava djelovati na akutne simptome poput agitacije, izražene tjeskobe i panike, nesanice te na psihički poremećaj koji se može nalaziti u osnovi prezentiranog ponašanja. Trenutačne farmakoterapijske opcije s pouzdanim dokazima o antisuicidalnim učincima uključuju litij, klozapin i ketamin. Od nefarmakoloških metoda liječenja učinkovitost pokazuju drugi biološki oblici liječenja poput elektrokonvulzivne terapije i transkranijalne magnetske stimulacije te psihoterapijsko i socioterapijsko liječenje gdje najbolje rezultate pokazuje kognitivno-bihevioralna terapija (KBT) i kolaborativni pristup liječenju suicidalnosti (engl. Collaborative Approach to Management of Suicidality, CAMS). Što se tiče prevencije suicidalnosti, Svjetska zdravstvena organizacija 2021. godine opisuje četiri učinkovite intervencije utemeljene na dokazima za sprječavanje samoubojstva, a to su: ograničavanje pristupa sredstvima samoubojstva, kao što su opasni pesticidi i vatreno oružje; interakcija s medijima u svrhu odgovornog izvještavanja o samoubojstvu; poticanje socijalnih i emocionalnih životnih vještina kod adolescenata; rano prepoznavanje, procjena, intervencija i praćenje svakoga tko je pogođen suicidalnim ponašanjem. |
| Abstract (english) | Suicide is an important psychopathological entity and one of the most demanding clinical situations that psychiatrists face in clinical practice. It is defined as voluntary and conscious taking of one's own life. Suicidality is extremely complex in its appearance, and in the continuum of self-destructive behaviors it ranges from non-suicidal self-harm to committing suicide. Croatia belongs to countries with a relatively high risk for suicidal behavior based on official suicide rates. One of the most important and demanding tasks of a psychiatrist in daily clinical practice is the assessment of suicidal risk. For this purpose, various tools are used, and in addition to the clinical interview, which represents the starting point in the evaluation of suicidal risk, there are also psychometric scales, among which the Columbia-suicide severity rating scale (C-SSRS) should be highlighted as one of newer methods of suicidal risk assessment. Following the initial assessment, it is necessary to define the most suitable level of intervention according to the category of suicidal risk, which usually includes those of high, medium and low risk. A suicidal patient is a paradigm of an emergency psychiatric patient. Active suicidality (open presentation of suicidal ideas) is an indication for involuntary psychiatric treatment. A high-risk acute suicidal state is an absolute and clear indication for hospitalization, although hospitalization alone does not represent treatment in the narrower sense, but the provision of safety conditions necessary for the treatment of the disorder underlying suicidality. In the prevention and treatment of suicidality, pharmacological and non-pharmacological methods of treatment are applied. It should be emphasized that the treatment of suicidality refers to the treatment of the underlying disorder of suicidality. Pharmacological methods of treating suicidality include anxiolytics, antidepressants, antipsychotics and mood stabilizers. Medications are used to treat acute symptoms such as agitation, severe anxiety and panic, insomnia, and psychological disorders that may be at the root of the presented behavior. Current pharmacotherapeutic options with reliable evidence of antisuicidal effects include lithium, clozapine, and ketamine. In non-pharmacological methods of treatment, other biological forms of treatment such as electroconvulsive therapy and transcranial magnetic stimulation, as well as psychotherapeutic and sociotherapeutic treatment, where the best results are shown by cognitive-behavioral therapy (CBT) and a collaborative approach to the management of suicidality (Collaborative Approach to Management of Suicidality, CAMS) show effectiveness. In terms of suicide prevention, the World Health Organization describes four effective evidence-based interventions for suicide prevention in 2021, namely: limiting access to means of suicide, such as dangerous pesticides and firearms; interaction with the media for the purpose of responsible suicide reporting; encouraging social and emotional life skills in adolescents; early identification, assessment, intervention and follow-up of anyone affected by suicidal behavior. |
