Sucide Attempt in Acute Psychoic Conditions from Biopsychosicial Management Review

Acute psychotic and transient disorders have annually increased, especially in developing countries. The highest prevalence for acute Psychotic disorders is currently in three developing countries, namely Ibadan, Nigeria, and India. Reported the most causes by psychosocial factors and biological factors. Acute and Transient Psychotic disorders have an annual incidence rate of about 3.9% to 9.6% of the 100.000 population. The reported prevalence range from 10% to 50% mostly in the first year. We aim to report a case of Acute and Transient Psychotic Disorders accompanied by suicide attempts to increase cases so that psychiatrists should be able to make a diagnosis quickly and precisely because it is included in the emergency psychiatric. Acute and Transient Psychotic Disorders often cause symptoms in the form of acts of self harm or others, in the form of committing suicide, which is a very important social phenomenon and requires attention not only from a psychiatrist but also the general public. The phenomenon of suicide has spread to almost all parts of the world, both in countries with advanced technology and in developing countries. Integrated management of this case is clinically oriented to a biopsychosocial model that is used as a basic principle in the clinical practice of a doctor in building relationships with patients. In this case, we reported a 24 – year old male, the first attack, occurring within one week, and accompanied by suicidal thoughts. So it is necessary to take a biopsychosocial approach that aims for comprehensive and sustainable interventions.


INTRODUCTION
Acute and transient psychotic disorders can be seen from diagnostic criteria in the form of acute onset, short duration, and recovery occur within 2-3 months [1]. The most common cause that we encounter, is due to experiencing a life event that is full of pressure, especially for people who are vulnerable to psychological problems. In some studies that focus on this disorder, which involves in terms of domain aspects of clinical psychopathology that is used as an interesting key variable in terms of determining a risk assessment, seen from the onset and also from the journey of mental illness itself, especially in the productive age (young age), especially those that have genetic factors [2].
The psychopathology domain can be used as a sign of symptoms that exist in this disorder and can be used in terms of distinguishing other psychotic disorders [3]. If there are risk factors with the onset of the first disorder, early age, male sex, and more extended hospital stays, this will increase the risk of future schizophrenia. Several national studies in the UK and Denmark have reported around 1,0000 cases annually with the range of 3.9 to 9.6%, while prevalence studies are reported to range from 5.9% to 20% in clinical-based hospitals [4].
Suicidal behavior is reported to be quite high at around 36-55%, especially in the acute polymorphic phase, which is usually with unstable mood [5]. In 2017, the United States amount to as high as 100-200 attempts per suicide in adolescents 15-24 years old [6]. Onset Younger has a high risk of attempting suicide. Patients with depressive symptoms of comorbidity have a family history of suicide including being at high risk who need special attention [7]. A person who has the risk of endangering himself or endangering others is an important condition in this case. According to Dr. George Engel, 1980 in his book on Biopsychosocial Formulations, in terms of risk assessment, doctors must know terms of knowing biological, psychological, and social risk factors. So it will be easier in terms of collecting data to assess risk factors that exist in patients. Fostering good relationships with patients, digging as much data as possible can be obtained from interviews directly with patients or from families so that practical approaches using biopsychosocial formulations can be fulfilled [8]. It is also inseparable from our knowledge and understanding of the psychodynamic formulations of patients, starting from the difficulties they face in everyday life, starting from a history of growth and development, parenting, childhood experiences to adulthood [9].
One of the theories of children's mental development "Sigmund Freud", discusses the main development patterns as the basic capital of individuals who focus on the theme of psychoanalysis / psychosexual starting from the age of 0-1 years, known as the oral phase, wherein this phase infants need a good stimulus, especially from his mother. Ages 1-3 years are called the anal phase, ages 3-6 years, are called the phallic/oedipal phase, ages 6-11 years, are called the latent phase, and ages 11-18 years, are called the genital phase. As a doctor, we must be able to explore the difficulties that are being experienced by patients, build trust so that patients want to tell about what he is feeling right now, maybe in terms of difficulties to control themselves, difficulties in terms of selfesteem, or difficulties in building relationships with people other. This theory was created to overcome psychological vulnerability for those who experienced trauma during childhood as we are familiar with "conflict". If the conflict is Therefore, psychotic is considered as a collection of symptoms, where someone who has a mental disorder, affective, ability to recognize reality, how to communicate, and relate to other people is disturbed [11].
Some studies are mostly related to social and cultural factors. Most reportedly came from developing countries. The highest prevalence in migrant populations, where they move from their original area to another region, such conditions require adaptation in new places, so that such conditions may make them more and more under pressure so that they can become new stressors. This temporary acute psychotic disorder has a consistent state of polymorphic type, where there are various symptoms (such as temporary, delusional, mood instability, agitation behavior, and accompanied by fluctuating anxiety symptoms, and some negative symptoms) which we can distinguish from the symptoms of schizophrenia or schizoaffective [4].

Acute and transient psychotic disorders prevalence was
reported for about 104 cases and varies around 5.8% to 19.0% with the greatest number of events in low and middle-income countries, where the location is reported to have an earlier age earlier than in high-income countries. Gender-based incidents are more common in women and the appearance of more than two subtypes with symptoms such as acute schizophrenia [12].
We report a case report of attempted suicide caused by acute and transient psychotic disorders with a biopsychosocial model approach management.

CASE REPORTED
A man 24-year-old was brought by the family to the emergency department of Dr. Soetomo hospital, with the chief complaint of wandering about his job at that he has been felt for four days ago. He looks older than his age, lean, Javanese, working as a parking supervisor in a private company, already married, and has two children. The patient feels his friends at the office do not like him, and feel his mind can be read and known by others. Also, patients complain of difficulty sleeping, especially at night, only sleep about 2 to 3 hours a day, Emotions are often unstable in the form of anger for no apparent reason. Be not excited when going to the office. The patient also complained of hearing voices from both ears, like male voices, many people, that mocked him by saying he was not a bad person, many who did not like the patient. The sound made it so uncomfortable that the patient banged his head several times on the wall of the office room, hoping that the sounds would disappear from his hearing.
According to the wife, the patient has begun to experience behavioral changes for one week before submitted to the hospital. Frequently speaking wandering about work issues, feel uncomfortable at the office because many colleagues seem to be jealous of his current position at the office. And the problem of the patient's discomfort with their superiors. Besides, patients also feel scared and feel guilty for lending money to one of the office friends using cash belonging to the office. This is all according to the wife that keeps the patient in mind. Patients who have not worked for one year in this company have been trusted to be parking supervisors and hold finance at the office. But the wife once tried to confirm this problem directly to the office by asking many colleagues from the office and they all denied that no one felt jealous of the patient. Besides, other complaints from this patient according to his wife are that he often smiles, his uncontrolled emotions, that is angry for no apparent reason, more smoking and indeed the patient has difficulty falling asleep until the new body can sleep. This week the patient has felt lazy to go to the office, eating and drinking decreased slightly. The patient also tells his wife about the voices that are heard suddenly when he is not doing activities, such as sitting in an office chair. The sounds made him uncomfortable which make so the patient does banging his head against the wall several times. The patient also once again attempted suicide, suddenly climbed onto the roof of the house to jump down, but when it did not happen because it was assisted by relatives who were finally able to calm down patients to get down from the roof of the house. Following the existing activities in the ward such as occupational therapy, and for eight days the patient was treated with conditions getting better so that he was allowed to go home. Psychopharmacology is continued and is provided with education both to the patient himself and his family.

DISCUSSION
In this case, as an initial process of learning students can begin by using a biopsychosocial approach. and reduce stigma against him. All of this is useful in terms of reducing the risk of suicide. Family intervention is also needed, in terms of reducing the risk of suicide. The conclusion can be drawn that such an intervention is necessary in the handling of cases with psychotic disorders [15]. So that the prognosis, in this case, is still good.

Acute and transient psychotic disorders reported about
104 cases about prevalence to vary around 5.8% to 19.0% with the greatest number of events in low and middle-income countries, where the location is reported to have an earlier age earlier than in high-income countries. Gender-based incidents are more common in women and the appearance of more than two subtypes with symptoms of symptoms such as acute schizophrenia [12].

CONCLUSION
Using a biopsychosocial approach to carry out a systematic and comprehensive assessment can help us to formulate the symptoms that appear in a patient and understand the origin of the patient's predicament. Judging from the diagnostic criteria for acute and transient psychotic Jurnal Psikiatri Surabaya disorders with acute onset, short duration, and recovery period of 2 -3 months with stressful life events especially prone to psychological problems. Also, it is seen from the risk factors with the onset of the first disorder, early or productive age, gender, and most important genetic factors, which will increase the risk of developing schizophrenia in the future.
Suicidal behavior is reported to be quite high, especially in acute conditions.
From a psychological aspect, the family intervention has an important role in supporting and increasing patient confidence. Likewise with social interventions, which play a very important role in reducing stigma in society, thereby restoring self-confidence and continuing daily activities as they were before the illness.