Clinical aspects

Suicidal behaviour refers to a range of behaviours that include - thinking about suicide (or ideation), planning for suicide, attempting suicide and suicide itself. It often develops in a stepwise manner with increasing and more specific ideation and planning overcoming ambivalence and the individual becoming more and more determined.

Once suicidal ideation becomes more specific, patients may develop “pre-suicidal syndrome” characterised by:

• feelings of hopelessness, self-blame, of being alone and misunderstood
• negative ruminations, self-pity
• inactivity and social withdrawal
• inhibited aggression turned toward the self (auto-aggression)
• suicidal fantasies and planning
• dysphoria
• somatic symptoms, sleep problems, fatigue, and loss of appetite

Presence of pre-suicidal syndrome should be a warning sign. However, this may be less so in children and adolescents in whom impulsive suicide is more common when compared to adults.

Once the person decides to commit suicide he/she may be less agitated, and show signs of being more stable. This may lead to clinicians underestimating the risk of suicide of that particular person (1).

Reference:

• (1) Rey JM. IACAPAP e-Textbook of Child and Adolescent Mental Health.  Geneva. International Association for Child and Adolescent Psychiatry and Allied Professions 2015