الفهرس 
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Abstract
sUD is defined as the long-term, recurrent use of substances at high dosages and/or frequencies that results in a separate, diagnosable illness that impairs health and function and may necessitate special treatment. SUDs may cause; social functioning impairment, accidents, diseases induced or worsened by substance use medical or psychiatric ailments, disability, and mortality, as well as higher rates of suicide.
Synthetic Cannabinoids (SCs) recently started to be used recreationally, especially by young adults, although SC drugs mimic the psychotropic effects of cannabis, their undesired effects are unpredictable and more severe than those associated with cannabis. Opioid addiction is an epidemic challenging health across the world. Over dosage, accidents, injuries, AIDS, violence, and other medical issues are all possible side effects of opioid use disorder. The Egyptian society faces a serious problem of illicit drug addiction; particularly among young adult males. Tramadol dependence is more common among skilled workers and employees in Egypt.
Suicide is defined as death caused by self-directed injurious behavior with the intent to die as a result of the behavior. Suicide is a complex global public health issue that claims the lives every day. Suicidal behavior is a leading cause of mortality and disability around the world. SUD is reported in a high percentage of suicide victims. Impulsivity is likely to play a role in the relation between substance use and suicidal ideation and behavior.
Self-mutilation is defined as intentionally self-directed destruction or alteration of bodily tissue for non-social or culturally sanctioned causes rather than with the intent of committing suicide. Self-punishment can either be a mental or a physical act. Mental punishments can manifest as feelings of prolonged guilt over past experiences or actions. Physical punishments can range from simply skipping a meal to more direct and severe actions, such as cutting yourself, burning yourself, pulling out hair, or hitting yourself with the intention of feeling pain. Prior to suicide behavior, self-mutilation acts as “gateway” behavior, reducing inhibition through self-injury habituation. Suicide risk has been proven to rise when the frequency and intensity of self-mutilation increases.
This thesis was designed aiming to; (1) evaluate the risk of suicide and self-mutilation in male patients using opioids and male patients using SCs, (2) to compare and detect if there a difference in the risk of suicide, self-mutilation between patients using opioids and patients using SCs, and (3) to assess any correlation between (self-mutilation and suicide) and addiction severity. The present study evaluated 120 patients (60 used SCs as their main substance and 60 used opioids) within the period between; October 2019 till December 2020 and carried out at the Institute of Psychiatry; Ain Shams University and Masr El Gedida (El Matar) psychiatric hospital outpatient clinics. We obtained an informed written consent and inclusion criteria were insured before the study was conducted which included age between 18-45 years, only males are invited to participate in this study.
The tools were precisely selected to fulfill the purpose of the study, that included Semi-Structured Questionnaire to collect data (including Full history taking, personal history, history of present illness, past history, psychiatric history as well as medical history) based on the Institute of Psychiatry, Ain Shams University sheet, Mini-International Neuropsychiatric Interview (M.I.N.I.) ICD10, Addiction Severity Index (ASI), Colombia Suicide Severity Rating Scale, Self-Punishment Questionnaire and National Drugs Observatory File. All data gathered were recorded, tabulated and transferred on Statistical Package for Social Sciences (SPSS) using personal computer and the suitable statistical parameters. Results were displayed to fulfill the purpose of the study.
On socio-demographic characteristics, this study demonstrated that the mean age of SCs group ranged from 18 to 45 years with mean (SD) age 26.75 (7.72) years, while the age of opioids group ranged from 19 to 43 years with mean (SD) age 31.9 (6.90). The study revealed that (60%) of SCs group were in age stratum (18 to 27 years), while (27%) of opioids group were in age stratum (18 to 27 years). No further statically significant differences were found between both studied groups as regard marital status, education or work.
On clinical characteristics, an overall 58% of SCs group reported family history of substance use, while 45% of opioids group reported family history of substance use. All subjects of both studied groups were nicotine smokers. Mean (SD) age of onset of nicotine smoking at SCs group was 13.5(2.51) years, while was 14.8 (3.11) at opioids group. The Mean (SD) age of onset of substance use at SCs group was 20.37(4.56) years, while was 23.12 (7.01) years at opioids group. Patients of both studied groups were using another substances, where (41.7%) of SCs group were using cannabinoids (Hash) as another substance, (10%) used alcohol and (6.7%) used pregabalin; as most common other substances. In the opioids group, the most common other substances were pregabalin (25%), cannabinoids (20%), and alcohol (16.7%). No further statically significant differences were found between both studied groups as regard previous medical help seeking or admission number.
Relapse rate was higher in opioids group than in SCs group, where 18.3% of opioids group relapsed with mean (SD) 2.86 (1.73). While 10 % in SCs group had relapsed with mean (SD) 2.10 (1.45) times. Forty percent of opioids group in our study were (HCV) positive, 13% were HIV positive, while 20% of SCs group were HCV positive, 8% HIV positive. About 31.7% of opioids group (Tramadol) had seizures, while 15% percent of SCs group had seizures, where. Our study found no further statically significant differences between both studied groups as regard past medical history or current psychopharmacological agents, except for antipsychotics which were prescribed to 12% of SCs group.
The Addiction Severity Index showed that; the most affected dimensions in SCs group were; substance use, employment, medical, and psychological areas. Meanwhile the most affected dimensions in opioids group were: substance use, employment, psychological and medical areas. By comparison our study found that patients of both groups had experienced problems in (medical, employment, legal, substance use, family-social, psychological) areas with no statically significant difference between both groups, except for alcohol problem it was shown that percent of patients who had severe degree of alcohol problem was higher in SCs group than in opioids group.
According to CSSR’s assessment of suicide ideation and suicide behavior; 78% of SCs group had suicide ideation, 45% had suicide behavior and 7 % had actual attempt (non-fatal), while 60% of opioids group had suicide ideation, 28% had suicide behavior with no statically significant difference.
According to Self-Punishment Questionnaire, our study showed that; opioids group had mild self-punishment more than SCs group, while SCs group had severe self-punishment more than opioids group. Where, at SCs group 13.3% had mild self-punishment, 33.4% had moderate self-punishment and 53.3% had severe self-punishment and no patients with very severe self-punishment. While at opioids group; 33.3% had mild self-punishment, 35% had moderate self-punishment, 31.7% had severe and no patients had very severe self-punishment. According to the main four domains of self-punishment questionnaire; the physical and affective punishment domains were statically significantly higher in SCs group than in opioids group as mean (SD) of physical punishment at SCs group was 21.12(7.2), while at opioids group was 15.48(8.99), affective punishment mean (SD) was 18.58(7.39) at SCs group, while at opioids group was 13.37(7.83).
All patients in our study were diagnosed as SUD according to (M.I.N.I.) ICD10, also our findings showed that; 8.33% of SCs group had major depressive episode, 65% had suicide, 3.33% had panic disorder, 5% had social phobia, 6.67% had Posttraumatic Stress Disorder (PTSD), 3.33% had Generalized Anxiety Disorder (GAD), and 20% had Antisocial Personality Disorder (ASPD). Meanwhile 13.33% of opioids group had major depressive episode, 50% suicide, 5% panic disorder, 8.3% social phobia, 5% (PTSD), 6.67% (GAD) and 30% (ASPD).
Our study found that, self-punishment was positively correlated to (suicide ideation and suicide behavior) in both studied groups. Correlations between (suicide ideation and suicide behavior) and socio-demographic data in both studied groups could not be found, except for education in opioids group which was negatively correlated with suicide ideation. There was no statically significant correlation between self-punishment and socio-demographic data in both studied groups. Also, there was no statically significant correlation between (suicide ideation and suicide behavior) with ASI in SCs group, except for substance use problem which was positively correlated to suicidal behavior in SCs group.
There was no statically significant correlation between suicide ideation and ASI in opioids group, except for employment problem which was highly statically significant correlated to suicide ideation. There was no statically significant correlation between suicide behavior and ASI in opioids group, except for medical problem there was statically significant positive correlation. So, patients who had medical problem in opioids group were more likely to have suicide behavior than others. Also, it had been found that suicide behavior was strongly correlated to family-social problem in opioids group. So, patients who had family-social problem in opioids group were more likely to have suicide behavior than others.
Our findings about correlations between Self- punishment and ASI found that; self- punishment was positively correlated with medical, substance use, family-social and psychological problems in SCs group. So, patients in SCs group who had medical, family-social, psychological problems and severe substance use problem were more likely to have self-punishment than others. Although correlations were not strong, they indicate the serious hazards of SCs usage. There were no significant correlations found between self-punishment and employment, alcohol or legal problems in SCs group. Self-punishment in opioids group was positively correlated to employment, medical, legal and psychological problems. These correlations might indicate the serious effects of opioids use and indicate that self-punishment more expected in those who had employment, medical, legal and psychological problems. But there was no further significant correlation founded between self- punishment and substance use, alcohol or family-social problems in opioids group.
Public health policy, research, and clinical attention should focus on self-mutilation and suicide prevention and reduction of the morbidity and mortality associated with suicidal behavior especially among SUD patients.