He has just been chosen as the best psychiatrist in Spain in 2021 by the Doctoralia application. A huge anecdote in a giant resume. After his experience in prisons, psychiatric centers and legal medicine institutes, Alvaro Moleon He now works at the Juan Ramón Jiménez Hospital in Huelva and consults at clinics in Huelva and Seville, where suicide has become one of his specialties.
Question: What type of patient is the one that most recently enters your practice?
Answer: The last year in my practice I have observed an increase in patients with hypochondriacal ideation and also with an obsessive-compulsive disorder linked to pollution Yet the cleaning. In addition to the typical patient with depressive anxiety disorder, which is the most prevalent in psychiatry consultations. Without forgetting the patient with schizophrenia, bipolar disorder and autism, who do not cease to account for a significant percentage of the day-to-day work that we carry out as psychiatrists.
In these types of disorders suicidal behavior it is also linked and we have to treat it also within the mental disorder itself. It is important to assess the patient comprehensively and often also within a multidisciplinary approach including psychologists, neurologists or nursing. Working as a team gives us different perspectives of the same patient and it will surely make the results better
Q: Suicide has experienced record numbers in 2020, what could this increase be due to?
A: Indeed, in 2020 suicide has experienced record figures, almost reaching 4,000 suicides in a single year and also becoming the first year in history, since there are records on suicides dating back to 1906, in which suicide has exceeded one thousand deaths in women. This is mainly due to the Covid pandemic, unemployment, lack of social relationships, insecurity, uncertainty… All of this has contributed to an increase in mental disorders, which in the end are still 70% of the broth of culture in which a suicide is cemented.
Depressions, borderline personality disorders, obsessive-compulsive disorders… have worsened considerably during the year 2020 and that has caused suicidal behavior to skyrocket. We cannot forget the increase in suicides in the population under 49 years of age, where suicide has been a considerably higher cause of death than Covid. Precisely in the population of 15 to 29 years old has become the first cause of death in that age group far ahead of traffic accidents or cancer.
Every day we observe in hospital emergencies that more and more children and adolescents come for suicidal behavior: cuts, hanging attempts, taking pills… These are acts that are increasing considerably in recent years. Although we do not yet have data for 2021, based on my clinical experience and what I have discussed with other colleagues, suicide will continue to increase and will probably result in a new record that will be known in the coming months.
Q: Is there more suicide than appears in social figures?
A: Indeed, there are more suicides than those that appear in the official figures. We cannot forget that a significant number of car accidents are suicides, but cannot be proved. There are also other types of suicides that are also not quantified for reasons of stigma in the family or problems with the insurance company when the suicide has life insurance with the economic repercussions that it would obviously have for first-degree relatives. These reasons make the number of reported suicides much lower than the real one.
Q: How is suicide addressed in a practice like yours?
A: A query like mine, suicide, would be approached initially through a social intervention in addition to an intervention with psychotherapeutic guidelines with a cognitive behavioral approach and a Pharmacotherapy suitable. There are some drugs indicated especially for patients with suicidal risk, such as some
antidepressants such as voxtorsietin or sodium tianeptine, esketamine… or also for patients with schizophrenia and suicidal risk, clozapine.
If the patient persists in suicidal risk, the second step would be to go to what is known as transcranial magnetic stimulation. It is a technique that I practice regularly, we have already given nearly two thousand sessions between the clinics in Seville and Huelva, many of them in depressive patients with suicidal risk, in which very good results are observed in patients resistant to pharmacological treatments.
If, despite this, the patient persists with suicidal behavior, the next step would be to apply the Electroconvulsive therapy. It is a technique that was reviled by bad press in its day, mainly due to some films such as Some one flies over the cuco’s nidus or some press articles. But it really is very effective. The psychiatrists who use it know that it will surely be the technique with the best results in psychiatry for cases in which it is indicated, such as depressive patients with suicidal risk. It would be the third level because it is true that it produces secondary effects such as memory failures.
Q: And how should it be addressed at home?
A: At home suicide should be approached naturally. It is more than proven that suicide should be discussed with the subject who has suicidal ideas with total naturalnessdecisively… since many times the individual who has some thought of ending his life feels relieved when other people talk to him about the subject or even provide him with another type of advice.
tools that he may not have been aware of and that can help him get out of that suicidal crisis.
In addition, in a house where there is a subject at risk of suicide, it is important to make a suicide prevention plan or protection: a security plan. It consists of removing all kinds of instruments that could make the person with suicidal ideas carry out the act, such as medications, mainly psychoactive drugs or treatments for heart disease or hypertension; also the use of knives or other sharp objects; in rural environments, care should be taken with firearms or ropes.
In the event that a family member observes that a family member has suicidal thoughts or begins to isolate himself or does not feel like interacting with people or even sees some warning sign such as a comment on social networks or even a letter… It is essential to see a specialist urgently. You have to go with him to a hospital and report that you have noticed this situation. And if the patient does not cooperate, call the emergency service so that they can assess him and refer him to the hospital because the risk of suicide is one of the three options that are available in psychiatry to be able to enter a hospital. involuntary patienthaving to be ratified by a judge 72 hours later.
Q: Is suicide a problem more linked to mental health or to the social reality of each person?
A: Suicide, obviously, although in principle it can appear in subjects with extreme unhappiness and a
feeling of hopelessness unrelated to suffering from a mental illness, in most cases it is due to suffering from a mental illness. The 70% of suicides occur under a mental illness disorderl, mainly depression, although there are also other related mental disorders such as bipolar disorder, attention deficit hyperactivity disorder in the youth population, borderline personality disorder, schizophrenia, antisocial personality disorder… They are disorders closely linked to suicide and they are obviously much more linked to suicide than the reality of a person who may be unhappy.
Q: As a society, how should we deal with suicide?
A: As a society I think we should realize the magnitude of the problem, a problem that triples deaths from traffic accidents. We must destigmatize the issue, speak clearly as some are doing well influencers What Dani Martin, Simone Biles or Manuel Carrasco who have talked about their mental problems. It is a topic that should be discussed more naturally. Just as a person tells that he has cardiac or traumatological problems, let him talk about his psychiatric problems without any taboo problem.
Afterwards, it is also important that the subjects, when they have a problem, comment on it themselves without being afraid of being singled out. Another fundamental issue is that we must request greater investment from politicians both in the increase in the number of vacancies for psychiatrists and clinical psychologists in Spain.
We are at the bottom in the ratio of clinical psychologists. And there is also a need to create a national suicide prevention plan. It is unfortunate that in a country like ours, in which last year we had a record number of suicides, the ministry has recently stated that a national plan against suicide is not necessary, but rather that some epigraph is included in the new project that has been of mental health is enough and it is not.
An effort should be made, as was done in the year 2000 with traffic accidents, which gave such good results and lowered deaths so much. Only with the efforts of politicians and ourselves as a society can we ensure that this suicidal crisis that we are living decreases.
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