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Journal of Experimental and Clinical
Medicine
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Home > Archives > Vol 30, No 4 (2013)
Vol 30, No 4 (2013)
Table of Contents
Editorial
First Page And Contents 1-9
Editorial 283-284
Author and Reviewer Index PDF
Basic Medical Sciences
Assessment of human thyroid function using radioimmunoassay and
enzyme-linkedimmuno- sorbent-assay
317-321
Mohamed Elfadil MOHAMED GAR-ELNAB, Reham Mohamed TAHA,
Mohammed Ahmed ALİOMER, Mohamed FARAHNA, Yahia M.
BUSHARA
Internal Medical Sciences
Evaluation of serum thiol levels in patients with non ST elevation acute
coronary syndrome
295-299
Fatih TANRIVERDİ, Havva ŞAHİN KAVAKLI, Gülhan KURTOĞLU
ÇELİK, Ferhat İÇME, Alp ŞENER, Onur KARAKAYALI, Sevilay VURAL
Levels of serum trace elements in ischemic stroke patients 301-304
Hayriye GÖNÜLLÜ, Sevdegül KARADAŞ, Aysel MİLANLİOĞLU, Edip
GÖNÜLLÜ, Celal KATI, Halit DEMİR
Diagnostic value of apparent diffusion coefficients to differentiate benign
and malignant breast lesions
305-310
Ahmet Veysel POLAT, Adile OZBAY, Ramazan AYDİN, Kerim ASLAN,
Ilkay Koray BAYRAK
The relationship between cigarette smoking and obesity 311-315
Aziz GÜMÜŞ, Servet KAYHAN, Halit CİNARKA, Serap BAYDUR,
Derya GIAKOUP, Ünal ŞAHİN
Epidemiological features of warfarin overdose and efficacy of
prothrombin complex concentrates
327-330
Mehmet Özgür ERDOĞAN, Harun AYHAN, Şahin ÇOLAK, Latif
DURAN, Yücel YAVUZ, Hızır Ufuk AKDEMİR, Fatma Burcu DOĞANÇ
Retrospective analysis of patients who admitted to the emergency
service with orthopedic injuries
335-338
Gokhan ERSUNAN, Mustafa USLU, Yavuz GEÇER, Yavuz KATIRCI,
Hayati KANDİS, Ozlem BİLİR, Ayhan SARITAS
Thorax computed tomography findings and mortality analysis of a
localized outbreak of H1N1 pneumonia in east Part of Turkey in 2013
339-344
Servet KAYHAN, Aziz GÜMÜŞ, Halit ÇINARKA, Sabri OĞULLAR, Ayşe
ERTÜRK, Ünal ŞAHİN
Assessment of central venous catheters applied in pediatric patients at
emergency department
345-348
Yılmaz ZENGİN, Mustafa İÇER, Ercan GÜNDÜZ, Recep DURSUN,
Hasan Mansur DURGUN, Cahfer GÜLOĞLU
The effect of zinc supplementation on cigarette smoke-induced
nephrotoxicity in rats
353-356
Arif DURAN, Zeynep OCAK, Tarık OCAK, Hakan Elcin TERZİ, Alim
Arif DURAN, Zeynep OCAK, Tarık OCAK, Hakan Elcin TERZİ, Alim
ERDEM, Ertuğrul Mevlüt KOCAMAN
Is electrocardiography sufficient for supraventricular tachycardia
treatment? A case report
357-359
Tarık OCAK, Arif DURAN, Alim ERDEM, Serkan ÖZTÜRK, Kemalettin
ERDEM
High dose aripiprazole induced double incontinence 361-362
Arif DURAN, Hüsnü ÖNDER, Tarık OCAK, Osman YILDIRIM, Şahin
ASLAN
An unusual presentation of methanol poisoning 367-368
Suha TURMEN, Umut ERYİĞİT, Aynur SAHİN, Seda MENTESE,
Abdulkadir GUNDUZ
Digital necrosis caused by a snake bite 377-379
Hasan KARA, Ahmet AK, Aysegul BAYIR, Murat AKINCI, Hamide
ALP, Selim DEĞİRMENCİ
Charcot’s foot 381-383
Hafize TİTİZ, Ayse GÜLER, Yavuz KATİRCİ, Hayati KANDİS, Gokhan
ERSUNAN, Ayhan SARİTAS
Valproic acid- induced early diagnosed encephalopathy 385-387
Recep DEMİR, Lütfi ÖZEL, İdris KOCATÜRK, Gökhan ÖZDEMİR, Hızır
ULVİ
Ocular hemorrhage due to warfarin: Five case reports 389-393
Sedat KOÇAK, Esma ERDEMİR, Birsen ERTEKİN, Başar CANDER,
Cesareddin DİKMETAŞ
Is the flumazenil administration diagnosis or treatment? Two case
reports
395-397
Türker YARDAN, Ethem ACAR, Hızır Ufuk AKDEMIR, Ahmet BAYDIN,
Latif DURAN
Surgery Medical Sciences
Management of spinal trauma in emergency department 285-289
Hızır Ufuk AKDEMİR, Celal KATI, Latif DURAN, Enis KURUOĞLU
Mean platelet volume in diagnosis of gestational diabetes 291-294
Erçin Erdem ÇELİKEL, Sefa KURT, Emrah TÖZ, Azra ARICI
YURTKUL, Tutku GÜRBÜZ, Abdullah TAŞYURT
Comparison of pediatric and adult patients with thoracic trauma in
emergency department
323-326
Sevdegül KARADAŞ, Hayriye GÖNÜLLÜ, Ufuk ÇOBANOĞLU, Fatih
SELVİ, Recep DURSUN, Savaş GÜNER
Determinaton of eligibility for laparoscopic cholecystectomy of elective
patients
331-334
Erdem KARADENİZ, Bünyami ÖZOĞUL, Mehmet İlhan YILDIRGAN,
Abdullah KISAOĞLU, Sabri Selçuk ATAMANALP
Analysis of pleural amylase levels in a chest disease clinic 349-352
Suna TÜRKELİ, Atilla Güven ATICI, Servet KAYHAN, Yasemin Arı
YILMAZ
A different suicide attempt in an elderly patient: A case report 363-365
Gülhan KURTOĞLU ÇELİK, Gülhan PAMUKÇU GÜNAYDIN,
Hüsamettin AKKÜÇÜK, Yunsur ÇEVİK, Nurettin Özgür DOĞAN
Pneumomediastinum and subcutaneous emphysema after unilateral
salpingo-oophorectomy: A case report
369-371
Gülhan KURTOĞLU ÇELİK, Tolga ÖZOĞUL, Güllü ERCAN HAYDAR,
Havva ŞAHİN KAVAKLI, Ferhat İÇME, Ugur OZKULA
Retrobulbar hemorrhage associated with subarachnoid hemorrhage 373-375
Şahin ÇOLAK, Mehmet Özgür ERDOĞAN, Latif DURAN, Celal
KATIRCI, Ahmet ŞENEL
Ocular injury related with airbag deployment: A case report 399-401
Fatih ÇALIŞKAN, Hızır Ufuk AKDEMİR, Latif DURAN, Celal KATIRCI,
Yücel YAVUZ, Şahin ÇOLAK
Unusual a cause of quadriparesis: Hypokalemia; A case report 403-404
Seyit Kağan BAŞARSLAN, Ali KARAKUŞ, Murat ÇEVİK
ISSN: 1309-5129
Journal of Experimental and Clinical Medicine
1. Introduction
The elderly population has increased in the world population
and parallel to this increase psychiatric disorders and suicide
has gained importance. In the prevention of suicide in the
elderly, treatment of psychiatric disorders, particularly
including depressive disorder, the resolution of crisis
situations and the prevention of social isolation in old age are
important (Turan, 2008).
Elderly individuals, have biological, psychological and
social problems and changes which interact with each other.
These changes may lead to mental disorders in the elderly
individuals when they are not properly managed. Major
depression is one of the most common disorders (Huuhka and
Leinenon, 2011).
Symptoms of depression in the elderly are different from
the young population, especially the physical and cognitive
symptoms observed in the forefront (Cinar and Kartal,
2008). The incidence of depression among the elderly
population is 1-4%. Although the exact incidence of suicide
in elderly patients is not known, many of these patients have
severe depression may not be diagnosed and unfortunately
suicide is the most important complication in this group
(Huuhka and Leinonen, 2011). Penetrating injuries are rarely
encountered as a method of suicide. Approximately 10.5% of
penetrating injuries are due to suicide. Unfortunately there is
suicide in the literature (Ashraf et al., 1996).
Case Report doi: 10.5835/jecm.omu.30.04.018
A different suicide attempt in an elderly patient: A case report
aabcd*
a Department of Emergency Medicine, Atatürk Training and Research Hospital, Ankara, Turkey
b Department of Emergency Medicine, Alanya State Hospital, Antalya, Turkey
c Department of Emergency Medicine, Keçiören Training and Research Hospital, Ankara, Turkey
d Department of Emergency Medicine, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey
ARTICLE INFO ABSTRACT
Article History
Received 17 / 05 / 2012
Accepted 06 / 07 / 2012
quality of life. Suicidal behavior in the elderly varies in a wide spectrum from wish to die
to completed suicide. In elderly severe depression may not be diagnosed and unfortunately
suicide is the most important complication in this group. The incidence of suicides varies
behavior. The strong association between depression and suicide attempts in the elderly
has been pointed out in many works. The risk of suicide increases with age, regardless of
the gender and physical health. Penetrating injuries are more rarely observed than other
suicide methods. In this case report, we present an elderly patient with depression who
tried a different method of suicide.
J. Exp. Clin. Med., 2013; 30:363-365
© 2013 OMU
* Correspondence to:
Department of Emergency Medicine,
Faculty of Medicine,
Kocaeli University,
Kocaeli, Turkey
e-mail: nurettinozgurdogan@gmail.com
Keywords:
Depression
Elderly suicide
Geriatrics
Self-stabbing
364
2. Case report
A 85-year-old male patient was brought to the emergency
department by his relatives after stabbing himself. The
patient told that he had taken knife from his own home in the
evening, then he had gone to a park in the neighbourhood and
tried to stab himself. He could not succeed because he had
not enough strength in the right hand. Then he held the knife
in his left hand and tried to drive the knife in through lateral
archus costa in the left hemithorax with help of a brick with
his right hand and injured himself. The patient had history of
ischemic stroke and major depression and he was on warfarin
On the physical examination, vital signs were stable and
the knife was penetrated into the skin and under skin (Fig. 1).
General surgery and cardiovascular surgery were consulted.
The knife was removed after local wound exploration. It is
seen that the knife had penetrated in 5-6 cm laterally through
arcus costa and didn’t penetrated thorax or abdominal
cavity. INR level of the patient was 2.8. Thoracoabdominal
computed tomography scan revealed no active bleeding
or hemopneumothorax. The patient was discharged after
primarily sutured.
3. Discussion
Suicide and suicide attempts are important problems in
place in young deaths. Suicide and suicide attempts cause
a great deal of physical and psychological damage and
emergency doctor’s knowledge of the phenomena may be
helpful for the patients and relatives to obtain psychological
help after emergency treatment and to reduce deaths due
to suicide. Eliminating the risk factors due to biological,
sociological and psychological aspects of suicide is crucial
The patients with suicidal ideation or the ones who
attempted suicide are frequently encountered in emergency
to differentiate whether the patient with suicidal ideation
is serious or he/she might take those thoughts into action
(Kekec et al., 2000).
In our country suicides are most frequent in the range of
15-24 and 25-34 years of age. Women constitute the majority
of the suicides under 15 years of age and in 15-24 years of
age, whereas the number of men in other age groups is higher
than of all ages (Ucan, 2005). According to the results of
another study, suicide rates increased with age. The rate of
completed attempts increases in men after 45 years of age
whereas the rate of completed suicides increases in women
after 55 years of age. Suicide attempts are more common
in younger patients whereas completed suicides are more
frequent in elderly patients. Despite the fact that the elderly
constitute 10% of the total population, the rate of suicides
are 25% more frequent in this age group. The rate of suicides
increases three-fold over the age of 75 (Ozsoy and Esel,
2003).
In a study conducted by Pavia et al. (2005) in Italy, the
ratio of suicides was 23.7% in the 45-64 years of age, and
42% above 65 years of age. Yavuz et al. (2006) study, the
ratio of suicide was 29.6% in the 45-64 years of age group
which is similar to Europe and America, and 78% of the
patients were men, the rate of suicides over the age of 65 was
7.4% which is in accordance with the average of Turkey. The
lower rate of suicide among elderly population in our country
cultural structure of our country. Another reason for the lower
rates of suicide among elderly is the lower rate of the elderly
in general population of Turkey in comparison to Europe and
America (Yavuz et al., 2006).
The incidence of suicides varies among societies and
suicidal behavior. The strong association between depression
and suicide attempts in the elderly has been pointed out in
of suicide increases with age, regardless of the gender and
physical health. Situations such as delirium, dementia, stroke
history, polypharmacy and major depression may cause
suicidal tendencies in old age (Sun et al., 2012). In a study
conducted in Turkey with elderly patients with depression, in
which the incidence of suicidal ideation, suicide attempts and
the desire to die and the relation between these and certain
factors constituting risk for depression (socio-demographic
characteristics, living alone, negative living conditions,
income level) were investigated, it is demonstrated that
suicide attempts or suicidal ideation are rare whereas
supports the assumption that the presence to wish to die is
a sign of depression in the elderly population. The desire to
die in elderly depression is important for assessing the risk
common among men whereas suicidal ideation and attempts
are more common among women. Studies reveal that suicidal
attempts ending in death are threefold more in men than
women and suicide attempts are four times higher in women
Wannan and Fombonne (1998) in a study investigating
predisposing factors in suicide attempters admitted to
emergency departments observed that 79% of patients were
women and 21% were men and although women were
To explain this contradiction he suggests that men are more
determined, and they consider expressing that they needed
help as a weakness. In our case the efforts of our patient who
Fig. 1. Stabbed knife at the left hemithorax
Journal of Experimental and Clinical Medicine 30 (2013) 363-365
365
REFERENCES
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chest: Sixteen years’ experience. J. Roy. Coll. Surg. Edinb. 41, 379-381.
Cinar, I.O., Kartal, A., 2008. Signs of depression in the elderly relationship between depression and sociodemographic characteristics. TAF. Prev.
Med. Bull. 7, 399-404.
Huuhka, M., Leinonen, E., 2011. Severe and psychotic depression in an elderly person. Duodecim. 127, 390-396.
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Nguyen, T.V., Dalman, C., Le T.C., Nguyen, T.V., Tran, N.V., Allebeck, P., 2010. Suicide attempt in a rural area of Vietnam: Incidence, methods
used and access to mental health care. Int. J. Ment. Health Syst. 4, 3.
Ozsoy, S.D., Esel, E., 2003. Suicide. Anadolu Psikiyatri Dergisi. 4, 175-185.
Pavia, M., Nicotera, G., Scaramuzz,a G., Angelillo, I.F., and The Collaborative Group, 2005. Suicide mortality in Southern Italy: 1998-2002.
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Sun, W.J., Xu L., Chan, W.M., Lam, T.H., Schooling C.M., 2012. Depressive symptoms and suicide in 56.000 older Chinese: A cohort study in
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Turan, E., 2008. Suicide in particular groups: Elderly suicide. Turkiye Klinikleri J. Psychiatry- Special Topics. 1, 34-39.
Ucan, O., 2005. A study bibliography for publications dealing with suicide in Turkey. Kriz Dergisi 13, 15-26.
Wannan, G., Fombonne, E., 1998. Gender differences in rates and correlates of suicidal behaviour amongst child psychiatric outpatients. J.
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tried to stab himself with help of a brick because he could not
succeed by his own power shows his determination to die.
Nguyen et al. (2010) in their study observed that study
Vietnam 99% of cases of suicide were performed by taking
drugs and 1% by using a sharp object. Penetrating patients
with the diagnosis of chronic disease and psychiatric illness
and their relatives should be warned against the risk of
suicide.
Men commonly prefer shotguns, hanging or jumping from
height whereas women usually prefer taking high doses of
medicine, poisoning or cutting wrists. Men are seen to be more
effective in committing suicide by using lethal methods. On
the other hand women are commonly unsuccessful to reach
a conclusion although they thought committing suicide and
even they attempted to (Ozsoy and Esel, 2003). The reasons
for using drugs as a method of suicide include the drugs being
easy to reach and its being a cheap and painless method. In
addition, given that the aim of the majority of suicide attempts
is not death but to draw attention, we can understand why
using drugs is a preferred method of committing suicide.
Provision of preventive health services and adequate
social support for the elderly may reduce the risk of suicide
which increase with age. Elderly patients with the diagnosis
of chronic disease and psychiatric illness and their relatives
should be warned against the risk of suicide.
