Suicide Methods From the Internet

Mr. A was a 20-year-old man who was admitted to the hospital after his mother expressed her concerns about his suicidal thoughts. On his initial interview, he reported no symptoms of depression. He had been admitted previously after a suicide attempt in which he overdosed on codeine that was distilled from an acetaminophen-based product. He reported that he found this procedure on the Internet. He was treated with an antidepressant, a mood stabilizer, and a second-generation antipsychotic. He discontinued his medications after discharge and refused to come in for outpatient follow-up. Shortly after the current admission, he left the hospital without permission. During this absence, he purchased the necessary equipment to commit suicide by helium asphyxiation but returned to the hospital without attempting self-harm. He reported that he had identified this method of suicide on the Internet. He subsequently endorsed symptoms of depression and was treated with citalopram. Additionally, he was diagnosed with narcissistic personality disorder by myself, was noted to have a high IQ (superior range), and used a rigid interpretive style characterized by intellectualization and rationalization. He responded to pharmacotherapy but was difficult to engage in a psychotherapeutic relationship. He was discharged with follow-up by a psychiatrist who works extensively with young adults.