A suicide attempt, not taking but saving a life

Suicide is the primary emergency for psychiatrists and it is a major public health problem. According to the numbers given by TUIK, 3225 people died in our country by suicide in 2012. Suicide accounts for a significant part of the excess mortality that is usually found in schizophrenia. Twenty to forty percent of patients with schizophrenia will make a suicide attempt sometime during their illness. Both in periods of psychotic aggravation-especially in which paranoid delusions are prominent-, and in periods of remission, when patients develop an insight for their illness and fear of their mental deterioration, suicide risk in this population seem to increase. Patients with schizophrenia, who attempt suicide, tend to use more lethal means in their attempts, have a strong intent to die and make multiple attempts. In accordance with these facts, we will present a schizophrenic patient who attempted suicide and diagnosed with myocardial infarction (MI), unrelated with his suicide attempt, by emergency department. Our patient was a 32-year-old male suffering from schizophrenia for ten years. He came to hospital with his relatives and he was accepted to the emergency department. He attempted suicide by taking multiple drugs and cutting his left wrist with a knife. His cuts were superficial and he had no life-threatening risk due to intoxication. He was consulted to psychiatry. Patient’s hospitalization in psychiatry service was planned after his general medical examination and monitorization due to intoxication was completed. However, in his routine blood samples troponin levels were found elevated. After his cardiac examination, he was diagnosed with NON-ST elevated MI. He was hospitalized in the cardiac intensive care unit. In his coronary angiography, 95% stenosis was detected in his intermediate coronary artery in which a stent was placed subsequently. He was followed up in intensive care unit for three days. Then he was transferred to psychiatry service. In his psychiatric examination, he had ideas of reference and delusions of persecution; as well as auditory hallucinations. Anti-psychotic medication was initiated and he was followed up 14 days in psychiatry service. In our case, there might be a poor relation between multiple drug intakes and patient’s heart attack. As mentioned before, he has been suffering from schizophrenia and he lacked of insight. Moreover, if he had not attempted suicide; he might have had a heart attack in a close future and probably he would not have come to hospital. Suicidal attempts in schizophrenia are very frequent. Nevertheless, this attempt, which saved our patient’s life, is different from other attempts. Furthermore, this case shows us that performing detailed general medical examination for psychotic patients in emergency services could be lifesaving.