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Rehabilitation Practice and Science

Translated Title

高齡殘障者之自殺個案：病例報告及文獻回顧

Abstract

This is a case of 69-year-old male patient who suffered from cerebral infarction with right-sided hemiplegia, transient motor aphasia, suspected thalamic syndrome, impaired activity of daily living and partial dependence. There were no past history of D.M. psychosis or other significant diseases except mild hypertension under thiazide control, also no family history of suicide or other hereditary diseases.Post-stroke depression had developed progressively since March 1993 including insomnia, fatigue indifference, anorexia, moodiness. Major depression was impressed based upon the diagnostic criteria of DSM-III. Other causes of depression including iatrogenesis and metabolic diseases had been ruled out. Psychological test revealed high score in inferiority, introversion, self isolation, hypochondria-sis and ego strength. Ambivalence was also noted with desire for independence and good health. Antidepressant(Imipramine and Amitriptyline) had ever been prescribed for a certain period with some improvement but suicidal attempt still took place in the long run by means of antidepressant overdoses. The causes of death were severe ventricular arrhythmia, cardiac conduction block and heart failure eventually. According to literature review, the mechanism of post-stroke depression are rather complicated including various psychosocial factors and even brain damage itself. Risk factors of suicide following depression include male, old age, moody disturbance,chronic disability, unemployment and suicidal attempts. Very high rate of suicide does exist in those people of old disability (stroke, cancer or other chronic ill ness), so prevention of suicide becomes important although it is often far beyond prevention and prediction. Tricyclic antidepressant has become one of the commonly used drugs for suicidal attempt recently in review of medical reports because of its potential; cardiac toxicity and high consumption in medical practice for depression syndrome. The purpose of this casereport is to point out the underlying risks of suicide in rehabilitated patients especially those old disablely people during the remission period of depression.

Language

Traditional Chinese

First Page

113

Last Page

117

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