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(cycling between gleeful and gloomy utterances).The patient repeatedly told a nurse that they wanted to die because they could not bear the hallucinations and other psychiatric symptoms, and because of the self-disgust they felt from when the symptoms worsened.The patient booked a period of leave, but on the day before the event, they expressed second thoughts. Noticing that the patient had not left their room since then, the nurse entered the room. The patient remained silent and pensive for 15 minutes, before declaring that they had something to say. The patient then admitted that they had reserved the period of leave out of a desire to die.On the day of the event, the patient, without returning to the ward, made a silent phone call to the hospital. The staff returned the call and the patient answered. When asked for their location, the patient said that they did not want to give it and that they no longer needed any food as they were about to die. a)The patient complained of loneliness and a sense of not fitting in anywhere. The patient also mentioned poor marital relationships.The patient experienced a sudden deterioration in schizophrenic symptoms. An entry in the nursing record made on the day before the event reads thus: ‘The patient is making no sense’. It also means that the patient’s condition had become worse.On the day of the event, the patient was taken to a seclusion room and told that her bra would need to be removed. On hearing this, the patient gave a grudging grimace.The patient tried to hide when they were called by the principal doctor, and drew back during temperature tests. b)Sub-categoryBehaviourMajor categorySigns emanating from the patientSymptomsSigns gleaned through engagementVerbal informationNonverbal informationTable 2　Objective signs of imminent suicide risk (Analysis 3)ExampleSub-sub-categorySuicide attemptSelf-injuryMorbid behaviourAccesses means of suicideDesire to leaveReticenceSudden deteriorationThe patient’s schizophrenic symptoms suddenly deteriorated.Symptoms The patient had no social relationships. Ten days prior to their death, the aggravated by patient discussed their anxiety about the upcoming discharge. Subsequently, discharge anxietythe patient experienced an escalation in anxiety, dread, and dissociation. Unstable symptomsThe patient experienced intra-day fluctuations in depressive disorder Talks about suicidal ideationTalks about suicidal ideation due to proactive communicationDeclares suicidal intentionComplains of lonelinessCommunication difficultiesReluctant expressionsEvasivenessPoor treatment motivationResists treatmentFails to understand the importance of treatmentTwelve days before the event, the patient attempted suicide by swallowing rat poison.On the day before the event, the patient hurt their right wrist with their fingernail.The patient repeatedly recited Buddhist sutras beginning five days before their suicide.The patient tried to open a window in the closed ward.On the day of the event, the patient tried to escape from the closed ward.During the patient’s last several days, they repeatedly applied for temporary leave, only to cancel it.The patient discussed their suicidal ideation in the past, but never mentioned a desire to die in their last four days.The patient had no desire to get better.Lacking awareness of the fact that they were ill, the patient denied experiencing psychiatric symptoms or suicidal ideation and repeatedly refused treatment, while demanding to be discharged.The patient failed to recognise that they were admitted because they had attempted suicide, and that they had failed to comprehend the importance of treatment.265