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Abstract
BACKGROUND The life time risk of suicide among patients with long term psychosis is 5-15%. Suicide prevention in this group is a major clinical challenge. AIMS To capture specific characteristics of suicidal communication and critical events preceding suicide in patients with psychosis. METHODS Medical records were examined and a life event inventory applied to a one-year cohort of 21 cases of suicide in the clinical group in Stockholm county. RESULTS In most cases direct or indirect verbal communication of suicidal thoughts were documented before the suicide. Three months preceeding death, 20 of the 21 subjects had described one or more negative critical experiences, typically physical illness, loss of contact with an important other, loss of "home", and intolerable side effects of medication. In most cases the suicide appeared to be the culmination of prolonged suffering and suicidal deliberations. CONCLUSIONS Suicide prevention among patients with psychosis requires sensitivity, active listening, and responsiveness on the part of the care person to the patient's explicit suicidal communication and perceptions of care-related or other incidents or interactions, even when conveyed in an odd manner or with little emotion. To prevent suicide, attentive and long-term planning in collaboration with the patient is essential.
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Affiliation(s)
- Anne Stefenson
- 1 National Center for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - David Titelman
- 1 National Center for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
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Gramaglia C, Feggi A, Bergamasco P, Bert F, Gattoni E, Marangon D, Siliquini R, Torre E, Zeppegno P. Clinical Characteristics Associated with Suicide Attempts in Clinical Settings: A Comparison of Suicidal and Non-Suicidal Depressed Inpatients. Front Psychiatry 2016; 7:109. [PMID: 27378957 PMCID: PMC4913318 DOI: 10.3389/fpsyt.2016.00109] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 06/06/2016] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Both psychiatrists and psychiatric nurses are involved in the psychiatric management of suicidal inpatients. One-to-one observation by qualified nurses and the accommodation of the patient in a room close to the infirmary are usually recommended. Suicidal risk should be reassessed periodically to check response to treatment. AIM To compare the severity of depressive symptoms in depressed inpatients admitted after an attempted suicide and those admitted for any other reason and to assess the severity of suicide attempts and the management of suicidal risk in clinical settings. MATERIALS AND METHODS We divided the sample into two subgroups: patients with a diagnosis of depression admitted because of a recent suicide attempt and depressed patients with no recent history of attempted suicide. Socio-demographic and clinical data were gathered; assessments included the Montgomery-Asberg Depression Rating Scale and the Nurses' Global Assessment of Suicide Risk (NGASR). RESULTS Forty-six patients were recruited over a 1-year period: 20 were admitted to the hospital following a suicide attempt; the other 26 had not attempted suicide and were admitted for other depression-related reasons. Multivariate analysis revealed a correlation between use of antidepressants and recent attempted suicide. Attempting suicide was not related to the severity of depressive symptoms. In the recent suicide attempt subgroup, NGASR suicide risk levels were lower at discharge than at admission. Patients with a recent history of attempted suicide had a higher number of suicide attempts in their clinical history than patients with no recent history of attempted suicide. CONCLUSION There were no correlations between psychiatric diagnosis, severity of depressive symptoms, and recent suicide attempt. Antidepressant therapy protected against suicide attempts. History of suicide attempts was one of the best predictors of recent attempted suicide. A more thorough understanding of the complex phenomenon of suicide and the reasons for suicidal behavior is needed.
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Affiliation(s)
- Carla Gramaglia
- Department of Translational Medicine, Institute of Psychiatry, Università del Piemonte Orientale , Novara , Italy
| | - Alessandro Feggi
- Department of Translational Medicine, Institute of Psychiatry, Università del Piemonte Orientale , Novara , Italy
| | - Paola Bergamasco
- SC. Psichiatria, AOU Maggiore della Carità di Novara , Novara , Italy
| | - Fabrizio Bert
- Department of Public Health and Paediatric Sciences, Università degli Studi di Torino , Torino , Italy
| | - Eleonora Gattoni
- Department of Translational Medicine, Institute of Psychiatry, Università del Piemonte Orientale , Novara , Italy
| | - Debora Marangon
- SC. Psichiatria, AOU Maggiore della Carità di Novara , Novara , Italy
| | - Roberta Siliquini
- Department of Public Health and Paediatric Sciences, Università degli Studi di Torino , Torino , Italy
| | - Eugenio Torre
- Department of Translational Medicine, Institute of Psychiatry, Università del Piemonte Orientale, Novara, Italy; SC. Psichiatria, AOU Maggiore della Carità di Novara, Novara, Italy
| | - Patrizia Zeppegno
- SC. Psichiatria, AOU Maggiore della Carità di Novara , Novara , Italy
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Nielssen O, Dear BF, Staples LG, Dear R, Ryan K, Purtell C, Titov N. Procedures for risk management and a review of crisis referrals from the MindSpot Clinic, a national service for the remote assessment and treatment of anxiety and depression. BMC Psychiatry 2015; 15:304. [PMID: 26626712 PMCID: PMC4666146 DOI: 10.1186/s12888-015-0676-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 11/08/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The MindSpot Clinic (MindSpot) provides remote screening assessments and therapist-guided treatment for anxiety and depression to adult Australians. Most patients are self-referred. The purpose of this study was to report on the procedures followed to maintain the safety of patients and to examine the circumstances of urgent referrals to local services made by this remote mental health service. METHOD A description of the procedures used to manage risk, and an audit of case summaries of patients who were urgently referred for crisis intervention. The reported measures were scores on self-report scales of psychological distress (K-10) and depression (PHQ-9), the number reporting suicidal thoughts and plans, and the number of acute referrals. RESULTS A total of 9061 people completed assessments and consented for analysis of their data in the year from 1 July, 2013 to 30 June, 2014. Of these, 2599 enrolled in online treatment at MindSpot, and the remainder were supported to access local mental health services. Suicidal thoughts were reported by 2366 (26.1 %) and suicidal plans were reported by 213 (2.4 %). There were 51 acute referrals, of whom 19 (37.3 %) lived in regional or remote locations. The main reason for referral was the patients' self-report of imminent suicidal intent. The police were notified in three cases, and in another case an ambulance attended after the patient reported taking an overdose. For the remaining acute referrals, MindSpot therapists were able to identify a local mental health service or a general practitioner, confirm receipt of a written case summary, and confirm that the patient had been contacted, or that the local service intended to contact the patient. CONCLUSIONS Around 0.6 % of the people seeking assessment or treatment by MindSpot were referred to local mental health services for urgent face to face care. The procedures for identifying and managing those patients were satisfactory, and in every case, either emergency services or local mental health services were able to take over the patient's care. This review suggests that the uncertainty associated with taking responsibility for the remote treatment of patients who disclose active suicidal plans is not a major impediment to providing direct access online treatment for severe forms of anxiety and depression.
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Affiliation(s)
- Olav Nielssen
- MindSpot Clinic, 16 University Ave, North Ryde, NSW, 2019, Australia. .,University of Sydney, 92 Parramatta Road, Camperdown, NSW, 2050, Australia. .,University of New South Wales, Anzac Pde Kensington, NSW, 2033, Australia.
| | - Blake F. Dear
- MindSpot Clinic, 16 University Ave, North Ryde, NSW 2019 Australia ,Macquarie University, Balaclava Road, North Ryde, NSW 2019 Australia
| | - Lauren G. Staples
- MindSpot Clinic, 16 University Ave, North Ryde, NSW 2019 Australia ,Macquarie University, Balaclava Road, North Ryde, NSW 2019 Australia
| | - Rebecca Dear
- MindSpot Clinic, 16 University Ave, North Ryde, NSW, 2019, Australia.
| | - Kathryn Ryan
- MindSpot Clinic, 16 University Ave, North Ryde, NSW, 2019, Australia.
| | - Carol Purtell
- MindSpot Clinic, 16 University Ave, North Ryde, NSW, 2019, Australia.
| | - Nickolai Titov
- MindSpot Clinic, 16 University Ave, North Ryde, NSW, 2019, Australia. .,Macquarie University, Balaclava Road, North Ryde, NSW, 2019, Australia.
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Chapman CL, Large MM. Should clozapine be available to people with early schizophrenia and suicidal ideation? Aust N Z J Psychiatry 2015; 49:393. [PMID: 25526942 DOI: 10.1177/0004867414563193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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