The suffering experienced by some patients at the end of their lives can lead to a wish to hasten death (WTHD). It is sometimes an existential suffering, refractory to palliative care even if well conducted, which leads to this desire. Since several years, in psychiatry, the rapid anti-suicidal effects of a single injection of ketamine have been proven. WTHD and suicidal ideation have similarities. The injection of a single dose of ketamine could have an efficiency on the desire to hasten death.
We report the case of a woman with advanced breast cancer expressing a WTHD, treated by ketamine.
A 78-year-old woman expressed a WTHD (request for euthanasia) because of existential suffering following a loss of autonomy related to cancer. The suicide item was 4 on the Montgomery-Åsberg Depression Rating Scale (MADRS). She had no associated pain or depression. A single dose of intravenous ketamine 1 mg/kg over 40 min plus 1 mg of midazolam was injected. She had no adverse effects. From D1 post-injection to D3, the WTHD disappeared completely with a MADRS suicide item at 0. At D5, the WTHD started to reappear, and at D6, the previous speech was completely back.
These results suggest an effect of ketamine on WTHD. This opens up the possibility of treating existential suffering at the end of life. The optimal dosage of this treatment would have to be determined as well as a maintenance of efficacy scheme.

Working with patients who end their lives through suicide is one of the greatest challenges and fears a clinician might face. This paper explores the experience of working with such patients in the course of psychiatric care and Jungian analysis. Jungian theory is used to explore a conceptual understanding of the dilemmas faced. Such theory points to an intractable conflict between Self and ego giving rise to unbearable distress, partly through difficulties arising in achieving individuation. The paper proposes that our difficulties in dealing with a patient\'s suicide might reflect a manifestation of relentless hope and, perhaps contentiously, these patients made a more considered decision in their final acts than prevailing clinical opinion suggests.
C’est l’un des plus grands défis et l’une des plus grandes peurs auxquels fait face un clinicien que de travailler avec des patients qui mettent fin à leur vie en se suicidant. Cet article explore l’expérience de travailler avec de tels patients durant le suivi psychiatrique et l’analyse Jungienne. La théorie Jungienne est utilisée pour explorer une compréhension conceptuelle des dilemmes rencontrés. Une telle théorie souligne le conflit inextricable entre le Soi et le moi, qui produit une détresse insoutenable, en partie du fait des difficultés qui se présentent pour accomplir l’individuation. L’article propose que nos difficultés à nous débrouiller du suicide d’un patient puissent refléter la manifestation d’un espoir implacable, alors que ces patients sont peut-être parvenus en conscience à une décision plus réfléchie sur leurs actions finales que l’opinion clinique prédominante ne le suggère.
Die Arbeit mit Patienten, die ihr Leben durch Suizid beenden, ist eine der größten Herausforderungen und Ängste, denen sich ein Kliniker stellen kann. Dieser Artikel untersucht die Erfahrung der Arbeit mit solchen Patienten im Rahmen der psychiatrischen Versorgung und der Jungianischen Analyse. Die Jungianische Theorie wird verwendet, um ein konzeptionelles Verständnis der Dilemmata zu erforschen, mit denen man konfrontiert ist. Eine solche Theorie weist auf einen hartnäckigen Konflikt zwischen dem Selbst und dem Ego hin, der zu unerträglichem Leid führt, teilweise durch Schwierigkeiten, die beim Erreichen der Individuation auftreten. Der Beitrag regt an, in unseren Schwierigkeiten im Umgang mit dem Selbstmord eines Patienten eine Manifestation unerbittlicher Hoffnung widergespiegelt zu sehen, und, vielleicht umstritten, daß diese Patienten in ihren letzten Handlungen eine überlegtere Entscheidung getroffen haben, als die vorherrschende klinische Meinung vermuten läßt.
Lavorare con pazienti che terminano la loro vita con il suicidio è una delle sfide e delle paure più grandi che un clinico possa affrontare. Questo articolo considera l’esperienza di lavoro con tali pazienti nel corso della cura psichiatrica e dell’analisi junghiana. La teoria junghiana viene utilizzata per esplorare una comprensione concettuale dei dilemmi affrontati. Questa teoria indica un conflitto intrattabile tra il Sé e l’Io che dà origine a un’angoscia insopportabile, in parte a causa delle difficoltà che sorgono nel raggiungimento dell’individuazione. Questo articolo propone che le nostre difficoltà nell’affrontare il suicidio di un paziente potrebbero riflettere una speranza implacabile e, forse polemicamente, questi pazienti hanno in realtà preso una decisione più ponderata nelle loro decisioni finali di quanto suggerisca l’opinione clinica prevalente.
Работа с пациентами, которые заканчивают жизнь самоубийством, относится к самым большим сложностям и страхам, с которыми может столкнуться клиницист. В данной статье исследуется опыт работы с подобными пациентами в парадигме психиатрической помощи и юнгианского анализа. Для концептуального объяснения возникающих дилемм используется юнгианская теория. Согласно этой теории, имеется неразрешимый конфликт между Самостью и эго, вследствие чего возникают невыносимые страдания, отчасти связанные с трудностями следования индивидуации. В статье предполагается, что наши сложности в связи с суицидом пациента могут быть выражением неустанной надежды - возможно, спорной - что решение этих пациентов относительно своих последних действиях является более взвешенным, чем полагает доминирующее клиническое мнение.
Trabajar con pacientes que terminan con su vida a través del suicidio es uno de los miedos y de los más grandes desafíos que un analista pueda confrontar. El presente trabajo explora la experiencia de trabajar con estos pacientes en la atención psiquiátrica y el análisis Junguiano. La teoría Junguiana es utilizada para explorar una comprensión teórica de los dilemas confrontados. Dicha teoría señala un conflicto irresoluble entre Self y ego que da lugar a un malestar intolerable, en parte a través de las dificultades que emergen en alcanzar la individuación. El trabajo propone que nuestras dificultades en tratar con el suicidio de un paciente podrían reflejar la manifestación de una esperanza inquebrantable, y quizás, controversialmente, estos pacientes realizan una decisión más considerada en sus actos finales que lo que sugiere la opinión clínica predominante.
自性、自我和自杀 与自杀病人工作是临床医生可能面临的最大挑战和恐惧之一。本文探讨了在精神科治疗和荣格分析过程中, 与这类病人工作的经验。荣格理论被用来探索如何对眼前的困境进行概念化的理解。这种理论指出, 在自性和自我之间发生了难以解决的冲突, 这引起了难以忍受的压力, 这困难产生的部分原因是来自于实现自性化的过程中出现的困难。本文提出, 我们在处理病人自杀时所遇到的困难, 可能反映出一种无情的希望, 而且, 也许是有争议的, 这些病人在他们采取最后的行为时, 是进行了深思熟虑的, 而这考虑要比普遍的临床意见考虑得更深。.

OBJECTIVE: The aim was to study the correlates of depression, anxiety, self-esteem, and suicidal ideas in patients of COVID-associated mucormycosis (CAM) and effects of treatment.
METHODS: A cross-sectional, analytical study was performed in a tertiary care center in Western Maharashtra. By purposive sampling, 34 patients of CAM were included in the study with their informed consent and after obtaining ethical clearance. A self-made questionnaire to include demographic and clinical details was filled. Hospital Anxiety and Depression Scale (HADS), Rosenberg Self-Esteem Scale (RSES), and Suicidal Ideation Attributes Scale (SIDAS) were applied after initial diagnosis. The HADS, RSES, and SIDAS were reapplied after their operative treatment.
RESULTS: A significant reduction in anxiety and depression scores postoperatively was seen. No significant difference was found in self-esteem or suicidal ideas postoperatively in the study population. However, patients who underwent orbital exenteration showed a significant reduction in level of self-esteem with anxiety and depression postoperatively. No specific correlation was found between the computed tomography score, family history, intensive care unit admission, or orbital exenteration with anxiety, depression, self-esteem, and suicidal ideas.
CONCLUSIONS: Levels of anxiety and depression in patients of CAM reduced significantly after treatment, but self-esteem worsened in males more than females owing to disfigurement. There is a need of psychological counseling in patients of mucormycosis undergoing a debilitating surgery both pre- and postoperatively for a better outcome and recovery.

Suicide is a major public health problem throughout the world, occurring in over 800,000 people annually. Mood disorders are a common psychopathology and are a signficiant risk factor for suicidality. Lithium pharmacotherapy has been shown to reduce symptoms of suicidal behavior, especially in long-term patient interventions. Reasons for this remain unclear. Lithium treatment for individuals with affective disorders appears underutilized. Use of lithium is thought to reduce risk for suicidality, even if mood stabilization is not achieved and serum concentration is lower than the conventionally accepted therapeutic blood level ranges. In this article, the authors review the currently available literature on lithium\'s effect on suicidality and provide discussion on proposed mechanisms of action. This brief report serves as an important reminder to clinicians to include lithium pharmocotherapy in their armamentarium for treatment of affective disorders, especially when symptoms of suicidality are present.

Psychological pain lies at the heart of human experience. However, it may also be abnormally intense and/or prolonged in pathological states, with negative outcomes. A simple and reliable measure of psychological pain for clinical use would be useful. In this study, we present a preliminary validation of a simple visual analog scale jointly measuring psychological and physical pain.
Two samples of adult (non elderly) depressed patients and healthy controls were independently recruited in two locations in Canada and the USA (N = 46/48 and 200/20, respectively). Six dimensions were successively scored on a paper visual analog scale measuring current, mean and worst pain over the last 15 days, for physical then psychological pain.
All physical and psychological pain dimensions discriminated depressed from non-depressed subjects. Among depressed patients, psychological pain scores were higher than physical pain scores for a given period of assessment. Moreover, correlations between dimensions from the same pain category (physical or psychological) were higher than between different pain categories. Psychological pain was mainly correlated with depression and hopelessness scales while physical pain was mainly correlated with anxiety scales. Secondary analyses showed that psychological (and some physical) pain measures were correlated with suicidal ideas in one location, but no difference in pain scores was found between patients with vs. without a history of suicidal acts in both samples. Childhood trauma positively correlated with several pain dimensions.
The PPP-VAS appears to be a valid tool in terms of discriminative capacities and convergent-divergent validities. Validation in different samples, including adolescents and elderly, and in various psychiatric and medical conditions will have to be conducted, in addition to the assessment of concurrent and predictive validities, and the confirmation of sensitivity to change. The role of psychological pain in the suicidal process needs to be further elucidated.

UNASSIGNED: Academically typically achieving adolescents were compared with students having academic difficulty on stress and suicidal ideas.
UNASSIGNED: In a cross-sectional study, 75 academically typically achieving adolescents were compared with 105 students with academic difficulty and 52 students with specific learning disability (SLD). Academic functioning was assessed using teacher\'s screening instrument, intelligence quotient, and National Institute of Mental Health and Neurosciences index for SLD. Stress and suicidal ideas were assessed using general health questionnaire, suicide risk-11, and Mooney Problem Checklist (MPC). Appropriate statistical methods were applied.
UNASSIGNED: Three groups were comparable on age, gender, mother\'s working status, being only child, nuclear family, self-reported academic decline, and type of school. About half of adolescents reported psychological problems on General Health Questionnaire (mean score >3 in all the groups). Academically typically achieving adolescents showed higher stressors in peer relationships, planning for future and suicidal ideation compared to adolescents with academic difficulty. Adolescents face stress regarding worry about examinations, family not understanding what child has to do in school, unfair tests, too much work in some subjects, afraid of failure in school work, not spending enough time in studies, parental expectations, wanting to be more popular, worried about a family member, planning for the future, and fear of the future. Significant positive correlation was seen between General Health Questionnaire scores and all four subscales of MPC. Suicidal ideas showed a negative correlation with MPC.
UNASSIGNED: Adolescents experience considerable stress in multiple areas irrespective of their academic ability and performance. Hence, assessment and management of stress among adolescents must extend beyond academic difficulties.

Despite increased ethnic diversity in more economically developed countries it is unclear whether residential concentration of ethnic minority people (ethnic density) is detrimental or protective for mental health. This is the first systematic review and meta-analysis covering the international literature, assessing ethnic density associations with mental health outcomes.
We systematically searched Medline, PsychINFO, Sociological Abstracts, Web of Science from inception to 31 March 2016. We obtained additional data from study authors. We conducted random-effects meta-analysis taking into account clustering of estimates within datasets. Meta-regression assessed heterogeneity in studies due to ethnicity, country, generation, and area-level deprivation. Our main exposure was ethnic density, defined as the residential concentration of own racial/ethnic minority group. Outcomes included depression, anxiety and the common mental disorders (CMD), suicide, suicidality, psychotic experiences, and psychosis.
We included 41 studies in the review, with meta-analysis of 12 studies. In the meta-analyses, we found a large reduction in relative odds of psychotic experiences [odds ratio (OR) 0.82 (95% confidence interval (CI) 0.76-0.89)] and suicidal ideation [OR 0.88 (95% CI 0.79-0.98)] for each 10 percentage-point increase in own ethnic density. For CMD, depression, and anxiety, associations were indicative of protective effects of own ethnic density; however, results were not statistically significant. Findings from narrative review were consistent with those of the meta-analysis.
The findings support consistent protective ethnic density associations across countries and racial/ethnic minority populations as well as mental health outcomes. This may suggest the importance of the social environment in patterning detrimental mental health outcomes in marginalized and excluded population groups.

Many people use religious beliefs and practices to cope with stressful life events and derive peace of mind and purpose in life. The goal of this paper was to systematically review the recent psychological literature to assess the role of religion in mental health outcomes. A comprehensive literature search was conducted using medical and psychological databases on the relationship between religiosity and mental health. Seventy-four articles in the English and Arabic languages published between January 2000 and March 2012 were chosen. Despite the controversial relationship between religion and psychiatry, psychology, and medical care, there has been an increasing interest in the role which spirituality and religion play in mental health. The findings of past research showed that religion could play an important role in many situations, as religious convictions and rules influence the believer\'s life and health care. Most of the past literature in this area reported that there is a significant connection between religious beliefs and practices and mental health.