Shestakova M. Suicidal behavior with depressions in elderly patients (clinical-psychopathological characteristics and a system of prevention)

On the base of an integrated clinical-psychopathological, psychometric and pa-thopsychological investigation data on causes, phenomenology, peculiarities of forma-tion of a suicidal behavior in depressions in elderly persons were obtained, predictors of its development were identified, and principles of its prevention were worked out. This work was based on an integrated investigation of 98 elderly patients (55-65 years old) with depression with a suicidal behavior (58 patients had the diagnosis of moderate depressive episode - F 32.1 and 40 patients - moderate recurrence depres-sive episode - F 33.1), who had become the main group. The control group consisted of 62 elderly patients with diagnoses F 33.1 and F 33.2 (depressions in patients from the control group did not stipulate a presence of a suicidal behavior). In was found out that a clinical-psychopathological structure of depressions with a suicidal behavior in elderly patients was characterized with a prevalence of anxious (53.1 %), senesto-hypochondriac (25.5 %) and "melancholic" (10.2 %) depression. In the group of elderly patients with depressions without a suicidal behavior variants of apathic-adynamic (48.4 %), dysphoric (24.2 %) and somato-vegetative (12.9 %) depression were predominant (p<0.05). Studying forms of a suicidal behavior in elderly patients with depressions we revealed that 100 % of the patients had suicidal thoughts (active and passive) and fantasies, 8.2 % of the patients had suicidal decisions and intentions, 8.2 % of the patients had suicidal attempts (2.1 % had demonstrative and 6.1 % true ones). A gender analysis of the suicidal behavior demonstrated that the suicidal thoughts and fantasies were registered more often in female patients (53.1 %), and the decisions and attempts were noticed more often in male patients (6.1 % and 6.1 % respectively). An analysis of means for the suicidal attempts showed that 50 % of them were performed by means of poisoning (gas), 25 % by falling down under conveyance, and 25 % by means of self-cutting. The system of prevention of a suicidal behavior for elderly patients with depression, which was worked out by us, is more effective in comparison with the methods used traditionally (72.5 % and 34.1 % of recovered patients respectively; 15.7 % and 23.3 % of much improved patients; 11.8 % and 36.2 % of patients with no change; 0 % and 6.4 % of patients with worsening of mental conditions). Catamnestic investigations during next 2 years demonstrate a stability of the effect obtained. Key words: suicidal behavior, depressive disorders, predictors, psychotherapy, system of prevention, pharmacotherapy, antisuicidal barrier.