Sodium nitrite (SN, NaNO2) is a water-soluble, white-yellow crystalline powder with broad applications in food preservation, automotive maintenance, and animal control. It is a strong oxidizing agent that can oxidize hemoglobin iron (Fe) to its oxidized state, leading to methemoglobin formation. An increasing trend of suicide cases by SN ingestion has been reported globally following its popularization in online suicide forums providing detailed instructions of its use solely or as part of a “suicide kit.” We report a case of a 21-year-old male who was found continuously vomiting, with blood per orem and cyanosis of the mouth and digits. Within minutes of the onset of symptoms, the patient lost consciousness and was pronounced dead on arrival at the nearest emergency room. Autopsy findings showed lip erosions, hemorrhage, and perioral and peripheral cyanosis. Internal examination showed characteristic bright red muscle discoloration, dark brown arterial blood, red-brown congested visceral organs, and hyperemic esophageal and gastric mucosa. Methemoglobin studies from sampled arterial blood showed elevated levels (17.5%). Further investigation of the decedent’s belongings, social media posts, and recent online purchases reinforced the intentional sodium nitrite ingestion. While there are plenty of reported SN poisoning in suicide cases internationally, limited reports have been published locally. Death by SN poisoning is preventable with Methylene blue. The role of forensic pathologists through autopsy may be the last chance to detect such cases. The lack of systemic death investigation, experts, and local laboratories to reliably detect the signs of SN poisoning may have affected the low detection rate of cases locally. Further reporting of cases can raise the awareness of medical professionals that is fundamental to the ultimate saving of lives.

Background: Suicide among adolescents is a critical global health problem. Identifying risk factors for suicide in adolescents is crucial because it is one of the most severe mental health issues and can result in loss of life. Risk factors serve as indicators that have the potential to bring life to an end. However, people around adolescents often display indifference and even tend to overlook the suicide risk factors experienced by them. Objective: This study aimed to explore the risk factors for suicide in adolescents in Indonesia. Methods: This study used qualitative descriptive research design conducted at State Vocational High Schools (SMKN) and Puskesmas. Data collection was done through Focus Group Discussion (FGD) of 10 students, and in-depth interviews of eight participants (two parents of adolescents who attempted suicide, two guidance counseling teachers, two adolescents who attempted suicide, and two mental nurses) The data were analyzed using thematic analysis. Results: The risk factors for suicide experienced by adolescents are biological, psychological, and social factors. These risk factors for suicide are stressors that contribute to adolescents engaging in suicidal behavior. Identifying the risk factors experienced by adolescents is crucial for suicide prevention. Conclusion The risk factors that lead to suicide in adolescents encompass biological, psychological, and social factors. A thorough understanding of suicide among parents, teachers, and peers can significantly assist in implementing suitable prevention measures and interventions for adolescent suicide.
Adolescent ; Risk Factors ; Biological Factors ; Psychology ; Social Factors ; Suicide

This paper summarizes a lecture on psychiatry and spirituality, which examined research onthe relationship between religion, spirituality and mental health, and discussed theimportance of addressing spiritual issues in psychotherapy. In this article, religion andspirituality are first differentiated from one another. Next, research on the relationshipbetween religion and mental health is examined. Third, a theoretical model is presentedexplaining how religious involvement may affect mental and social health. Fourth, a review of religious/spiritually-integrated psychotherapy is presented with a focus ondepression/anxiety, moral injury, and PTSD. Finally, further resources for more informationabout the topic is provided. Because many people in the Philippines are religious, and religionaffects mental health one way or the other, it cannot be ignored by psychiatrists who practicein this country.
Religion ; Spirituality ; Depression ; Anxiety ; Suicide ; Substance-Related Disorders ; Stress Disorders, Post-Traumatic ; Psychotherapy

OBJECTIVES: To explore the characteristics of postmortem examination, chemical examination and scene investigation of deaths caused by oral diphenidol hydrochloride poisoning, and so as to provide a reference for proper settlement and prevention of such deaths. METHODS: The data of 22 deaths caused by oral diphenidol hydrochloride poisoning in a city from January 2018 to August 2020 were collected, including case details, scene investigations, autopsies, chemical examinations and digital evidence. Thirty-one cases of deaths caused by oral diphenidol hydrochloride poisoning reported in previous literature were also collected. RESULTS: In the 53 oral diphenidol hydrochloride poisoning death cases, 50 cases were suicide, 2 cases were accidental, while 1 case was undetermined. Fifty-two cases were found in the medical records or crime scene investigation reports with doses ranging from 775 mg to 12 500 mg, and 23 deceased were detected with postmortem blood concentrations ranging from 2.71 mg/L to 83.1 mg/L. Clinical symptoms were recorded in 6 patients, including conscious disturbance and convulsion. Among the 45 cases which were performed with external examination, 23 cases autopsied. CONCLUSIONS Most of the deceased of oral diphenidol hydrochloride poisoning were suicide. No significant correlation was found between dose and blood concentration through the retrospective analysis of cases.
Humans ; Retrospective Studies ; Piperidines ; Autopsy ; Suicide ; Poisoning

Humans ; Scopolamine ; Phenobarbital ; Suicide

Humans ; Suicide ; Forensic Pathology

OBJECTIVES: To investigate the differences in non-suicidal self-injury (NSSI) behaviors between only-child and non-only-child adolescents with mood disorders. METHODS: A three-stage sampling method was used to perform a cross-sectional survey of 529 adolescents, aged 12-18 years, who had mood disorders and NSSI behaviors. These adolescents were sampled from the outpatient service of 20 mental hospitals in 9 provinces of China from August to November 2020. A self-made questionnaire was used to collect general demographic data. The Functional Assessment of Self-Mutilation, Beck Scale for Suicide Ideation, Kessler Psychological Distress Scale, Stress Mindset Measure-General, Multidimensional Scale of Perceived Social Support, Multidimensional Students' Life Satisfaction Scales, and Rosenberg Self-Esteem Scale were used to collect the information on self-injury behaviors and psychological factors in these adolescents. RESULTS: A total of 529 adolescents with mood disorders and NSSI behaviors were surveyed, among whom 375 were only-child adolescents and 154 were non-only-child adolescents. Compared with the non-only-child group, the only-child group had a significantly higher total score of Functional Assessment of Self-Mutilation (P<0.05) .The type and frequency of self-injury in the only-child group were significantly higher than those in the non-only-child group (P<0.05). Psychological analysis showed that compared with the non-only-child group, the only-child group had a significantly lower score of self-esteem (P<0.05) and significantly higher scores of psychological distress and depressive symptoms (P<0.05). The multiple linear regression analysis showed that the score of suicidal ideation was positively correlated with the frequency of NSSI behaviors in both only-child and non-only-child adolescents with mood disorders (P<0.05); in the only-child adolescents, the level of self-esteem was negatively correlated with the frequency of NSSI behaviors (P<0.05), and the score of stress perception was positively correlated with the frequency of NSSI behaviors (P<0.05); in the non-only-child adolescents, the score of anxious emotion was positively correlated with the frequency of NSSI behaviors (P<0.05). CONCLUSIONS Among the adolescents with mood disorders and NSSI behaviors, the only-child adolescents tend to have a higher frequency of self-injury and poorer mental health, and therefore, the only-child adolescents with mood disorders and NSSI behaviors need more attention.
Adolescent ; Cross-Sectional Studies ; Humans ; Mood Disorders ; Risk Factors ; Self Mutilation ; Self-Injurious Behavior/psychology* ; Suicide, Attempted/psychology*

The patient is a 36-year-old- male who was bullied by peers and was emotionally abused by his father for being effeminate and preferring to play with dolls. These adverse childhood experiences made him vulnerable to depression. He told himself that he could no longer rely on anyone else but himself and took pride in his independence. He gave his best with his endeavors and did not settle for mediocrity, frequently reviewing his work. During the pandemic, he experienced several hardships such as disruption of activities, inability to meet the financial needs of his family and unemployment. He found himself struggling but surviving. While in a work-from-home arrangement, he was so frustrated about his internet connection that he complained on social media. The internet company then threatened him of possible legal charges and felt stuck in a hopeless situation. This affected his day-to-day activities until he felt so overwhelmed that he attempted suicide by ingesting multiple medications. He was then brought to the emergency room and was admitted. He was diagnosed to have Major Depressive Disorder and was started on antidepressants. Psychotherapy focused on identifying stressors and strengthening adaptive coping mechanisms while he was admitted at an isolation facility. He then followed up at the outpatient department of a tertiary government hospital in Mindanao with noted improvement in mood and functionality overtime. During admission, he was also diagnosed to have Diabetes Mellitus and COVID-19, which added to his burden as these were the biologic factors that were correlated to his depression. The case highlighted the interplay between the effects of multiple traumatic experiences in a vulnerable individual and thus necessitating a holistic management.
Depressive Disorder, Major ; Psychiatry ; Suicide

The burden of suicide increases globally in ages 15-19 as they are more vulnerable to risky behaviors [8]. The Young Adult Fertility and Sexuality Study of 2013 (YAFS4) suggests further analysis and accounting for other related variables to determine if a true relationship between educational attainment and suicide is reflected. An analytic cross-sectional study was employed using secondary data from the YAFS4. The proportion of suicide attempt among the different education levels and its confounders was determined using point and interval estimates, whereas the association between educational attainment and suicide attempt was determined through multiple logistic regression analysis. Results revealed a high prevalence of suicide attempt among those with 'No schooling/Elementary' (38.36%), who have used alcohol (36.15%) and drugs (50.82%), and identified as 'bisexual' or with an 'identity crisis' (52.00%). Overall, there was an association between educational attainment and suicide attempt. The odds of suicide attempt was 1.69 times higher among those with “No schooling/Elementary” as compared to those “College Graduates or Higher”, and was the only group found to be statistically significant even after controlling for socioeconomic status. An association exists between educational attainment and suicide attempt, wherein having a lower level of education has higher odds of suicide attempt. The study suggests that interventions start as early as elementary school and focus on the out-of-school youth. Additionally, future research may also look further into the confounding effects of socioeconomic status and the mechanisms involved.
Educational Status ; Suicide, Attempted ; Adolescent

OBJECTIVES: To explore the influencing factors of the horizontal distance of bodies in the high falling scene and the feasibility of inferring the falling mode based on it. METHODS: A total of 614 high falling deaths and 15 cases of corpse dumping from high altitudes were collected. The relationship between the horizontal distance and the falling height, as well as the sex, age and manner of death (suicide, accident and corpse dumping) were observed. RESULTS: The horizontal distance increased with the increase of falling height, and the difference among the height groups was statistically significant. The horizontal distance decreased with the increase of the age of the deceased, in each height group, the difference between the group over 60 years old and other age groups was statistically significant (P<0.05). The horizontal distance of male deceased was (1.99±0.27) m, which was greater than that of female deceased (1.88±0.19) m, and the difference was statistically significant in partial height groups (P<0.05). Roof falls had a greater horizontal movement distance than window falls. Except for the >20-30 m group, there was no significant difference in horizontal distance between suicide high falls and accidental high falls in other height groups. CONCLUSIONS The horizontal distance is affected by the falling height, the sex and age of the victim, and the spatial characteristics of the falling starting point.
Body Height ; Cadaver ; Female ; Homicide ; Humans ; Male ; Middle Aged ; Suicide