How to move on?
30 yrs old male, lives with partner and 2 months old son.
Chef in restaurant.
Acute psychiatric unit: threatened to kill his wife and 1 month old son.
On admission: had blood over his face and hands. He had injured himself by whisky glass.
Medical history: 1st admission
“There is no privacy, we are always been watched. There are cameras, cables everywhere” “I didn’t want to kill them, I wanted them to leave
me, then it would have been easier for me to kill myself”
2000 14 days
Diagnosis:Moderate depression with somatic symptoms
Main complaints: sadness, palpitations, disturbed sleeping
“I wanted to try how it feels to be a soul. I have always been a black sheep in my family. My mum used to say, that first child always fails.
I don’t feel I am appreciated by anyone.”
Psychiatrist:emotionally instable, sensitive, reserved, takes time in answering questions.
no evidence of disorganised thoughts, no decrease in action productivity.
Previous suicide attempts:
1st 8yrs old,
2nd,3rd 10-12yrs old
4th, -5th current suicide attempt, arguments with his mother, no will to live, several times has imagined his funeral.
2nd admission in 2002
2002, 53 days
Suicide attempt: alone in a summer house, drunk, cutting veins because girlfriend left him.
Diagnosis: Current episode of moderate depression and Borderline Personality Disorder
“nothing cheers me up, nobody cares about me,nobody understands me. I have felt like this since I have remembered myself”
Obsessional thoughts to kill himself: “
I travelled around the world and wanted to go to Tunesia to poison myself there by rat poison which I had taken from my home. Poison got stolen and
therefore I had to return to home.”
”There might not be anything good after death, but here is nothing good either. I can decide about my life as nobody asked my opinion whether I
want to be born or not. I am sure I will succeed in the future”
Obsessional thoughts most intense in the evening before sleep. Suicidal ideation persistant after first suicide attempt, when read a book about life
2 alter identities:
“I feel like I have 2 selfs: one constantly thinks about suicide, other says it is not normal. I like to think about death, then I feel happy.”
Psychiatrist: face hypomimic, melanholic, slow movement, emotionally numb, lack of volition, resoneric speech, but no delusions, hallucinations and
disorganised thoughts.Currently a chef in restaurant, wants to quit that job.
Treatment in hospital: Escitalipram -> clomipramine 100mg, Risperidone 3mg. T.Sulpirid 200mg x2 (less obsessional thoughts, sleeps better, depressive
symptomes decreased, suicidal thoughts persist: collects fact sheets of different medicines to know how better commit a sucide.)
Psychoanalytic therapy was recommended by psychiatrist.
2002 november, 23 days
Diagnosis: Severe depression without psychotic symptoms. Borderline Personality Disorder
8th suiside attempt: visited friend, saw tablets and took them. In coma several days.
„I will kill myself anyway. I want/must kill myself! I cant do anything read a newspaper, watch Tv, the obsession is always there.There is 2
persons inside me: one says I need to live, need to refurbish my flat. Second person looks any opportunity to kill himself. I imagine how I will have
a car crash, bones broken, blood everywhere… second person likes that.”
No ambitions – seen and done everything. Doesn’t fight with his suicidal thoughts anymore, not feeling guilty about anything. Has list of
“Everything was so ok – suddenly my hand reached towards tablets. Half of my face was laughing when reaching tablets and I couldn’t
control it anymore.”
Psychiatrist: admits that suicide thoughts are his, sometimes has doubts about it. No formal thought disorders, no hallucinations.
Treatment: T.Sulpirid 300mg and T.Mirtazapine 30mg: mood stable, patient has many plans, wants to get back to work, wants to accept marriage proposal
from other patient, no time to think about suicide.
Diagnosis: Moderate depression, BPD
Problems: dunk driving, penalty 1000EUR, split up with partner, workplace go broke. Not feeling well in crowded places, avoids them.
In meantime 2 suicide attempts: tried to hang himself – cable was too long. Overdose with tablets, friend found him, told him off, John vomitted
Complaints: anxious, restless, sleeping problems, nightmares.
MMPI : hypomanic state, bipolar, borderline personality
October 2006, 24 days
Suicide attempt: tried to jump from 5th floor.
Diagnosis: F28 Other non psychotic disorder, BPD, F12.1 Harmful use of cannabinoids
2 weeks before that tried to injure himself by bottle.
edit on 30-12-2011 by Hithe Merinos because: (no reason given)