Management precautions for surviving patients after a ward suicide.
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Biomedical subjects
Publications and source records attributed to H S Olin.
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A hypothesis is proposed that the nonpsychotic patient in the presuicidal state may have impaired reality testing in which the act of suicide is perceived as not leading to injury or death. Impaired reality testing may be enhanced by intense affects, drugs, and sleep deprivation.
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The family physician can be of great help to the parents after a child dies. Practical points to keep in mind are: in acute mourning, denial of death is a common response; parental emotional "detachment" from the dead child takes six to 12 months; parents may be motivated to "replace" the child too quickly; parental relationships with the surviving children can be impaired by overprotectiveness, and the physician should be aware of his limitations in this situation.
A major issue in the psychotherapy of the chronically suicidal is the patient's avoidance of his responsibility. If the patient is not helped to recognize this avoidance, the therapist's efforts may be consigned to future attempts to either assume responsibility for the patient or to rescue him.
The authors studied the amount of understanding that 100 mental hospital patients had a voluntary admission application they signed upon entering the hospital. Only 8 patients were rated as being completely informed of terms of the contract at the time of admission; 15 of 33 patients reinterviewed about 10 days after admission showed increased understanding. Minimal differences were found between 81 state hospital patients and 19 private hospital patients. The finding that few voluntary patients are fully informed to give consent to hospitalization poses a dilemma because of the trend to give personal responsibility to the patient.
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