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Greenwood HT, French J, Ferrer M, Jandhyala N, Thio LL, Dlugos DJ, Park KL, Kanner AM. Prevalence of Suicidality in Adolescents With Newly Diagnosed Focal Epilepsy at Diagnosis and Over the Following 36 Months. Neurology 2024; 103:e209397. [PMID: 38833656 DOI: 10.1212/wnl.0000000000209397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Individuals with epilepsy have increased risk of suicidal ideation (SI) and behaviors when compared with the general population. This relationship has remained largely unexplored in adolescents. We investigated the prevalence of suicidality in adolescents with newly diagnosed focal epilepsy within 4 months of treatment initiation and over the following 36 months. METHODS This was a post hoc analysis of the enrollment and follow-up data from the Human Epilepsy Project, an international, multi-institutional study that enrolled participants between 2012 and 2017. Participants enrolled were 11-17 years of age within 4 months of treatment initiation for focal epilepsy. We used data from the Columbia Suicide Severity Rating Scale (C-SSRS), administered at enrollment and over the 36-month follow-up period, along with data from medical records. RESULTS A total of 66 adolescent participants were enrolled and completed the C-SSRS. At enrollment, 14 (21%) had any lifetime SI and 5 (8%) had any lifetime suicidal behaviors (SBs). Over the following 36 months, 6 adolescents reported new onset SI and 5 adolescents reported new onset SB. Thus, the lifetime prevalence of SI within this population increased from 21% to 30% (14-20 adolescents), and the lifetime prevalence of SB increased from 8% to 15% (5-10). DISCUSSION The prevalence of suicidality in adolescents with newly diagnosed focal epilepsy reported in our study is consistent with previous findings of significant suicidality observed in epilepsy. We identify adolescents as an at-risk population at the time of epilepsy diagnosis and in the following years.
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Affiliation(s)
- Hadley T Greenwood
- From the Department of Neurology (H.T.G., J.F., M.F., N.J.), and Department of Pediatrics (M.F.), NYU Grossman School of Medicine, New York; Department of Neurology (L.L.T.), Washington University in St. Louis School of Medicine, MO; Department of Pediatrics and Neurology (D.J.D.), Children's Hospital of Philadelphia, PA; Department of Pediatrics and Neurology (K.L.P.), University of Colorado School of Medicine, Aurora; and Department of Neurology (A.M.K.), Miller School of Medicine, University of Miami, FL
| | - Jacqueline French
- From the Department of Neurology (H.T.G., J.F., M.F., N.J.), and Department of Pediatrics (M.F.), NYU Grossman School of Medicine, New York; Department of Neurology (L.L.T.), Washington University in St. Louis School of Medicine, MO; Department of Pediatrics and Neurology (D.J.D.), Children's Hospital of Philadelphia, PA; Department of Pediatrics and Neurology (K.L.P.), University of Colorado School of Medicine, Aurora; and Department of Neurology (A.M.K.), Miller School of Medicine, University of Miami, FL
| | - Monica Ferrer
- From the Department of Neurology (H.T.G., J.F., M.F., N.J.), and Department of Pediatrics (M.F.), NYU Grossman School of Medicine, New York; Department of Neurology (L.L.T.), Washington University in St. Louis School of Medicine, MO; Department of Pediatrics and Neurology (D.J.D.), Children's Hospital of Philadelphia, PA; Department of Pediatrics and Neurology (K.L.P.), University of Colorado School of Medicine, Aurora; and Department of Neurology (A.M.K.), Miller School of Medicine, University of Miami, FL
| | - Nora Jandhyala
- From the Department of Neurology (H.T.G., J.F., M.F., N.J.), and Department of Pediatrics (M.F.), NYU Grossman School of Medicine, New York; Department of Neurology (L.L.T.), Washington University in St. Louis School of Medicine, MO; Department of Pediatrics and Neurology (D.J.D.), Children's Hospital of Philadelphia, PA; Department of Pediatrics and Neurology (K.L.P.), University of Colorado School of Medicine, Aurora; and Department of Neurology (A.M.K.), Miller School of Medicine, University of Miami, FL
| | - Liu Lin Thio
- From the Department of Neurology (H.T.G., J.F., M.F., N.J.), and Department of Pediatrics (M.F.), NYU Grossman School of Medicine, New York; Department of Neurology (L.L.T.), Washington University in St. Louis School of Medicine, MO; Department of Pediatrics and Neurology (D.J.D.), Children's Hospital of Philadelphia, PA; Department of Pediatrics and Neurology (K.L.P.), University of Colorado School of Medicine, Aurora; and Department of Neurology (A.M.K.), Miller School of Medicine, University of Miami, FL
| | - Dennis J Dlugos
- From the Department of Neurology (H.T.G., J.F., M.F., N.J.), and Department of Pediatrics (M.F.), NYU Grossman School of Medicine, New York; Department of Neurology (L.L.T.), Washington University in St. Louis School of Medicine, MO; Department of Pediatrics and Neurology (D.J.D.), Children's Hospital of Philadelphia, PA; Department of Pediatrics and Neurology (K.L.P.), University of Colorado School of Medicine, Aurora; and Department of Neurology (A.M.K.), Miller School of Medicine, University of Miami, FL
| | - Kristen L Park
- From the Department of Neurology (H.T.G., J.F., M.F., N.J.), and Department of Pediatrics (M.F.), NYU Grossman School of Medicine, New York; Department of Neurology (L.L.T.), Washington University in St. Louis School of Medicine, MO; Department of Pediatrics and Neurology (D.J.D.), Children's Hospital of Philadelphia, PA; Department of Pediatrics and Neurology (K.L.P.), University of Colorado School of Medicine, Aurora; and Department of Neurology (A.M.K.), Miller School of Medicine, University of Miami, FL
| | - Andres M Kanner
- From the Department of Neurology (H.T.G., J.F., M.F., N.J.), and Department of Pediatrics (M.F.), NYU Grossman School of Medicine, New York; Department of Neurology (L.L.T.), Washington University in St. Louis School of Medicine, MO; Department of Pediatrics and Neurology (D.J.D.), Children's Hospital of Philadelphia, PA; Department of Pediatrics and Neurology (K.L.P.), University of Colorado School of Medicine, Aurora; and Department of Neurology (A.M.K.), Miller School of Medicine, University of Miami, FL
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Clapperton A, Spittal MJ, Dwyer J, Nicholas A, Pirkis J. Suicide within five years of hospital-treated self-harm: A data linkage cohort study. J Affect Disord 2024; 356:528-534. [PMID: 38657761 DOI: 10.1016/j.jad.2024.04.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 04/17/2024] [Accepted: 04/21/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Hospital-treated self-harm is a strong predictor of suicide and hospital contacts may include missed opportunities for suicide prevention. We conducted a data linkage study to identify factors associated with suicide in people treated in hospital for self-harm in Victoria, Australia. METHOD We undertook a cohort study following 14,307 people treated in hospital for an episode of self-harm (i.e., either admitted or non-admitted ED presentations) over the period 2011 and 2012 and used data from the Victorian Suicide Register to identify suicides within 5 years. We estimated unadjusted hazard ratios (HRs) for suicide using survival analysis for each exposure variable and then computed adjusted HRs using a multivariate model that included all exposure variables. RESULTS Among females, the risk of suicide was higher in those aged 50-74 years (HR 1.78; Cl: 1.02, 3.10), residing in areas of least disadvantage (HR 2.58; Cl: 1.21, 5.50), who used hanging as a method of self-harm (HR 5.17; Cl: 1.86, 14.35) and with organic disorders (HR 6.71; Cl: 2.61, 17.23) or disorders of adult personality and behaviour (HR 2.10; Cl: 1.03, 4.27). In males, the risk of suicide was higher in those who used motor vehicle exhaust gas (MVEG) as a method of self-harm (HR 3.48; Cl: 1.73, 7.01), and with disorders due to psychoactive substance abuse (HR 1.75; Cl: 1.14, 2.67). CONCLUSION Although all patients should be routinely assessed for risk and needs following hospital-treated self-harm including appropriate follow-up care, people who use MVEG or hanging as methods of self-harm are obvious candidates for close follow-up.
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Affiliation(s)
- Angela Clapperton
- Centre for Mental Health and Community Wellbeing, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
| | - Matthew J Spittal
- Centre for Mental Health and Community Wellbeing, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Jeremy Dwyer
- Coroners Prevention Unit, Coroners Court of Victoria, Melbourne, VIC, Australia
| | - Angela Nicholas
- Centre for Mental Health and Community Wellbeing, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Jane Pirkis
- Centre for Mental Health and Community Wellbeing, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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Mikula P, Timkova V, Vitkova M, Szilasiova J, Nagyova I. Suicidal ideation in people with multiple sclerosis and its association with coping self-efficacy. Mult Scler Relat Disord 2024; 87:105677. [PMID: 38728959 DOI: 10.1016/j.msard.2024.105677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/09/2023] [Accepted: 05/06/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Chronic neurological disease such as multiple sclerosis (MS), is a significant risk factor for psychological distress, which can result in suicidal behaviour. Suicidal ideation (SI) is considered a harbinger of suicide-related mortality. However, so far, little is known about the role of protective factors against SI in MS. OBJECTIVE This study aims to assess the association between coping self-efficacy and SI when controlled for sociodemographic variables, clinical variables, sleep-related problems, and depression. METHODS The study sample consisted of 162 people with MS, was predominantly female (75.9 %), the mean age was 40.9 ± 11.4 years, the mean disease duration was 11.7 ± 7.1 years, and the mean functional disability score was 3.55 ± 1.1. We used the Coping Self-Efficacy scale (CSE), the General Health Questionnaire-28 (GHQ-28), the Expanded Disability Status Scale (EDSS), the Hospital Anxiety and Depression Scale (HADS), the Pittsburgh Sleep Quality Index (PSQI), and the Multidimensional Fatigue Inventory (MFI). Multiple linear regressions were utilized to statistically analyse the data. RESULTS All assessed coping self-efficacy dimensions were significantly associated with SI in MS when controlled for sociodemographic variables, clinical variables, sleep-related problems, and depression. Furthermore, all assessed coping self-efficacy dimensions were able to alleviate the negative association between income, depression and SI. CONCLUSION People with MS may significantly benefit from psychological support aimed at promoting coping self-efficacy and utilization of various coping strategies. Problem-focused coping, coping focused on getting support, and coping focused on stopping unpleasant thoughts and feelings seem to have comparable associations with SI, and thus interventions aimed at empowering any of these dimensions may be beneficial in diminishing the severity of SI.
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Affiliation(s)
- Pavol Mikula
- Department of Social and Behavioural Medicine, Faculty of Medicine, PJ Safarik University in Kosice, Slovakia
| | - Vladimira Timkova
- Department of Social and Behavioural Medicine, Faculty of Medicine, PJ Safarik University in Kosice, Slovakia.
| | - Marianna Vitkova
- Department of Neurology, Faculty of Medicine, PJ Safarik University in Kosice, Slovakia
| | - Jarmila Szilasiova
- Department of Neurology, Faculty of Medicine, PJ Safarik University in Kosice, Slovakia
| | - Iveta Nagyova
- Department of Social and Behavioural Medicine, Faculty of Medicine, PJ Safarik University in Kosice, Slovakia
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Liu C, Ye J, He S, Ma Z, Luo F, Miao J, Li H, Cao P, Zhu J. Causal relationship between rheumatoid arthritis and epilepsy in a European population: a univariate and multivariate Mendelian randomization study. Front Immunol 2024; 15:1389549. [PMID: 38817604 PMCID: PMC11137193 DOI: 10.3389/fimmu.2024.1389549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/06/2024] [Indexed: 06/01/2024] Open
Abstract
Background Several previous studies have reported an association between rheumatoid arthritis (RA) and epilepsy, but the causal relationship is unclear. The aim of this study was to assess the connection between RA and epilepsy in a European population using Mendelian randomization (MR). Methods Genome-wide association study summary data on RA and epilepsy from European populations were included. Univariate MR (UVMR) and multivariate MR were used to investigate the causal relationship between the two conditions. Three analysis methods were applied: inverse variance weight (IVW), MR-Egger, and weighted median, with IVW being the primary method. Cochran Q statistics, MR-PRESSO, MR-Egger intercept, leave-one-out test, and MR-Steiger test were combined for the sensitivity analysis. Results UVMR showed a positive association between RA and epilepsy risk (OR=1.038, 95% CI=1.007-1.038, p=0.017) that was supported by sensitivity analysis. Further MVMR after harmonizing the three covariates of hypertension, alcohol consumption, and smoking, confirmed the causal relationship between RA and epilepsy (OR=1.049, 95% CI=1.011-1.087, p=0.010). Conclusion This study demonstrated that RA is associated with an increased risk of epilepsy. It has emphasized that the monitoring of epilepsy risk in patients diagnosed with RA should be strengthened in clinical practice, and further studies are needed in the future to explore the potential mechanism of action connecting the two conditions.
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Affiliation(s)
- Chang Liu
- School of Acupuncture-Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- The Third Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Jiangnan Ye
- School of Acupuncture-Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Shixiu He
- Arthrology Department, Nanchong Gaoping District People’s Hospital, Nanchong, Sichuan, China
| | - Zhijun Ma
- School of Acupuncture-Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Fang Luo
- School of Acupuncture-Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Jintao Miao
- The Third Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Huinan Li
- The Third Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Puhua Cao
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Jun Zhu
- School of Acupuncture-Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- The Third Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
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Stephenson M, Ohlsson H, Lannoy S, Sundquist J, Sundquist K, Edwards AC. Clarifying the relationship between physical injuries and risk for suicide attempt in a Swedish national sample. Acta Psychiatr Scand 2024; 149:389-403. [PMID: 38414134 PMCID: PMC10987261 DOI: 10.1111/acps.13675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/09/2024] [Accepted: 02/14/2024] [Indexed: 02/29/2024]
Abstract
INTRODUCTION The Interpersonal-Psychological Theory of Suicide proposes that capability for suicide is acquired through exposure to painful and provocative events (PPEs). Although there is robust evidence for a positive association between aggregate measures of PPEs and risk for suicidal behavior, little is known about the contributions of physical injuries. The present study investigated the relationship between injuries and risk of subsequent suicide attempt (SA). METHODS Data were from Swedish population-based registers. All individuals born in Sweden between 1970 and 1990 were included (N = 1,011,725 females and 1,067,709 males). We used Cox regression models to test associations between 10 types of injuries (eye injury; fracture; dislocation/sprain/strain; injury to nerves and spinal cord; injury to blood vessels; intracranial injury; crushing injury; internal injury; traumatic amputation; and other or unspecified injuries) and risk for later SA. Analyses were stratified by sex and adjusted for year of birth and parental education. Additional models tested for differences in the pattern of associations based on age group and genetic liability for SA. In co-relative models, we tested the association between each injury type and risk for SA in relative pairs of varying genetic relatedness to control for unmeasured familial confounders. RESULTS All 10 injury types were associated with elevated risk for SA (hazard ratios [HRs] = 1.2-7.0). Associations were stronger in the first year following an injury (HRs = 1.8-7.0), but HRs remained above 1 more than 1 year after injury exposure (HRs = 1.2-2.6). The strength of associations varied across injury type, sex, age, and genetic liability for SA. For example, the magnitude of the association between crushing injury and risk for SA was larger in females than males, whereas other injuries showed a similar pattern of associations across sex. Moreover, there was evidence to support positive additive interaction effects between several injury types and aggregate genetic liability for SA (relative excess risk due to interaction [RERI] = 0.1-0.3), but the majority of these interactions became non-significant or changed direction after accounting for comorbid psychiatric and substance use disorders. In co-relative models, the pattern of associations differed by injury type, such that there was evidence to support a potential causal effect of eye injury, fracture, dislocation/sprain/strain, intracranial injury, and other and unspecified injuries on risk for SA. For the remaining injury types, HRs were not significantly different from 1 in monozygotic twins, which is consistent with confounding by familial factors. CONCLUSIONS Injuries are associated with increased risk for subsequent SA, particularly in the first year following an injury. While genetic and familial environmental factors may partly explain these associations, there is also evidence to support a potential causal effect of several injury types on future risk for SA.
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Affiliation(s)
- Mallory Stephenson
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Henrik Ohlsson
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Séverine Lannoy
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia, United States of America
- Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | | | - Alexis C. Edwards
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia, United States of America
- Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia, United States of America
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Szanto K, Szücs A, Kenneally LB, Galfalvy HC. Is Late-Onset Suicidal Behavior a Distinct Subtype? Am J Geriatr Psychiatry 2024; 32:622-629. [PMID: 38182486 PMCID: PMC11016379 DOI: 10.1016/j.jagp.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/20/2023] [Accepted: 12/10/2023] [Indexed: 01/07/2024]
Abstract
This clinical viewpoint article aims to draw attention to a yet unexplored factor influencing suicidal behavior: age of onset of suicidal behavior. To tackle the substantial heterogeneity among depressed older attempters, we suggest consideration of at least two distinct pathways to suicidal behavior in late life based on when the first suicidal crisis occurred. Specifically, we discuss the current state of research and the rationale behind the suggested early-late-onset categorization of late-life suicidal behavior. We summarize available evidence so far on early-onset and late-onset attempters, and the potential heterogeneity in the interplay of risk/precipitating factors. Certain risk factors for suicide, such as impulsivity and borderline traits, decrease with age, while memory and broader cognitive impairments increase with age. Research indicates that familial/social exposure to suicidal behavior, childhood trauma, impulsivity, maladaptive personality traits, longstanding interpersonal difficulties, and legal problems are found predominantly in attempters experiencing their first suicidal crisis between youth and early midlife. In contrast, dementia prodrome is one of the most promising but understudied candidates for late-onset suicide risk, especially in the context of other risk factors. Moreover, personality traits conferring increased vulnerability to late-onset suicidal behavior (such as high conscientiousness) are not the same as ones classically identified in younger attempters and in older suicide attempters who have early-onset suicidal behavior (such as neuroticism and Cluster B traits). We discuss methodological points about studying age of onset of suicidal behavior, outline clinical implications, share ideas for future directions, and call for research on this understudied topic.
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Affiliation(s)
- Katalin Szanto
- Department of Psychiatry (KS), University of Pittsburgh, PA.
| | - Anna Szücs
- Department of Medicine (AS), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore; Faculty of Behavioural and Movement Sciences (AZ), Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | - Hanga C Galfalvy
- Department of Psychiatry (HCG), Vagelos College of Physicians and Surgeons, Columbia University, NY; Department of Biostatistics (HCG), Mailman School of Public Health, Columbia University, NY
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Müller A, Hebben F, Dillen K, Dunkl V, Goereci Y, Voltz R, Löcherbach P, Warnke C, Golla H. "So at least now I know how to deal with things myself, what I can do if it gets really bad again"-experiences with a long-term cross-sectoral advocacy care and case management for severe multiple sclerosis: a qualitative study. BMC Health Serv Res 2024; 24:453. [PMID: 38600493 PMCID: PMC11007872 DOI: 10.1186/s12913-024-10851-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/11/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Persons with severe Multiple Sclerosis (PwsMS) face complex needs and daily limitations that make it challenging to receive optimal care. The implementation and coordination of health care, social services, and support in financial affairs can be particularly time consuming and burdensome for both PwsMS and caregivers. Care and case management (CCM) helps ensure optimal individual care as well as care at a higher-level. The goal of the current qualitative study was to determine the experiences of PwsMS, caregivers and health care specialists (HCSs) with the CCM. METHODS In the current qualitative sub study, as part of a larger trial, in-depth semi-structured interviews with PwsMS, caregivers and HCSs who had been in contact with the CCM were conducted between 02/2022 and 01/2023. Data was transcribed, pseudonymized, tested for saturation and analyzed using structuring content analysis according to Kuckartz. Sociodemographic and interview characteristics were analyzed descriptively. RESULTS Thirteen PwsMS, 12 caregivers and 10 HCSs completed interviews. Main categories of CCM functions were derived deductively: (1) gatekeeper function, (2) broker function, (3) advocacy function, (4) outlook on CCM in standard care. Subcategories were then derived inductively from the interview material. 852 segments were coded. Participants appreciated the CCM as a continuous and objective contact person, a person of trust (92 codes), a competent source of information and advice (on MS) (68 codes) and comprehensive cross-insurance support (128 codes), relieving and supporting PwsMS, their caregivers and HCSs (67 codes). CONCLUSIONS Through the cross-sectoral continuous support in health-related, social, financial and everyday bureaucratic matters, the CCM provides comprehensive and overriding support and relief for PwsMS, caregivers and HCSs. This intervention bears the potential to be fine-tuned and applied to similar complex patient groups. TRIAL REGISTRATION The study was approved by the Ethics Committee of the University of Cologne (#20-1436), registered at the German Register for Clinical Studies (DRKS00022771) and in accordance with the Declaration of Helsinki.
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Affiliation(s)
- Anne Müller
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany.
| | - Fabian Hebben
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Kim Dillen
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Veronika Dunkl
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Yasemin Goereci
- Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Raymond Voltz
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), University of Cologne, Cologne, Germany
- Center for Health Services Research, University of Cologne, Cologne, Germany
| | - Peter Löcherbach
- German Society of Care and Case Management E.V. (DGCC), Münster, Germany
| | - Clemens Warnke
- Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Heidrun Golla
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
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Walsh CG, Ripperger MA, Novak L, Reale C, Anders S, Spann A, Kolli J, Robinson K, Chen Q, Isaacs D, Acosta LMY, Phibbs F, Fielstein E, Wilimitis D, Musacchio Schafer K, Hilton R, Albert D, Shelton J, Stroh J, Stead WW, Johnson KB. Randomized Controlled Comparative Effectiveness Trial of Risk Model-Guided Clinical Decision Support for Suicide Screening. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.14.24304318. [PMID: 38562678 PMCID: PMC10984050 DOI: 10.1101/2024.03.14.24304318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Suicide prevention requires risk identification, appropriate intervention, and follow-up. Traditional risk identification relies on patient self-reporting, support network reporting, or face-to-face screening with validated instruments or history and physical exam. In the last decade, statistical risk models have been studied and more recently deployed to augment clinical judgment. Models have generally been found to be low precision or problematic at scale due to low incidence. Few have been tested in clinical practice, and none have been tested in clinical trials to our knowledge. Methods We report the results of a pragmatic randomized controlled trial (RCT) in three outpatient adult Neurology clinic settings. This two-arm trial compared the effectiveness of Interruptive and Non-Interruptive Clinical Decision Support (CDS) to prompt further screening of suicidal ideation for those predicted to be high risk using a real-time, validated statistical risk model of suicide attempt risk, with the decision to screen as the primary end point. Secondary outcomes included rates of suicidal ideation and attempts in both arms. Manual chart review of every trial encounter was used to determine if suicide risk assessment was subsequently documented. Results From August 16, 2022, through February 16, 2023, our study randomized 596 patient encounters across 561 patients for providers to receive either Interruptive or Non-Interruptive CDS in a 1:1 ratio. Adjusting for provider cluster effects, Interruptive CDS led to significantly higher numbers of decisions to screen (42%=121/289 encounters) compared to Non-Interruptive CDS (4%=12/307) (odds ratio=17.7, p-value <0.001). Secondarily, no documented episodes of suicidal ideation or attempts occurred in either arm. While the proportion of documented assessments among those noting the decision to screen was higher for providers in the Non-Interruptive arm (92%=11/12) than in the Interruptive arm (52%=63/121), the interruptive CDS was associated with more frequent documentation of suicide risk assessment (63/289 encounters compared to 11/307, p-value<0.001). Conclusions In this pragmatic RCT of real-time predictive CDS to guide suicide risk assessment, Interruptive CDS led to higher numbers of decisions to screen and documented suicide risk assessments. Well-powered large-scale trials randomizing this type of CDS compared to standard of care are indicated to measure effectiveness in reducing suicidal self-harm. ClinicalTrials.gov Identifier: NCT05312437.
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Kanner AM, Shankar R, Margraf NG, Schmitz B, Ben-Menachem E, Sander JW. Mood disorders in adults with epilepsy: a review of unrecognized facts and common misconceptions. Ann Gen Psychiatry 2024; 23:11. [PMID: 38433207 PMCID: PMC10910742 DOI: 10.1186/s12991-024-00493-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 02/03/2024] [Indexed: 03/05/2024] Open
Abstract
Epilepsy is one of the most common neurologic conditions. Its clinical manifestations are not restricted to seizures but often include cognitive disturbances and psychiatric disorders. Prospective population-based studies have shown that people with epilepsy have an increased risk of developing mood disorders, and people with a primary mood disorder have an increased risk of developing epilepsy. The existence of common pathogenic mechanisms in epilepsy and mood disorders may explain the bidirectional relation between these two conditions. Recognition of a personal and family psychiatric history at the time of evaluation of people for a seizure disorder is critical in the selection of antiseizure medications: those with mood-stabilizing properties (e.g., lamotrigine, oxcarbazepine) should be favoured as a first option in those with a positive history while those with negative psychotropic properties (e.g., levetiracetam, topiramate) avoided. While mood disorders may be clinically identical in people with epilepsy, they often present with atypical manifestations that do not meet ICD or DSM diagnostic criteria. Failure to treat mood disorders in epilepsy may have a negative impact, increasing suicide risk and iatrogenic effects of antiseizure medications and worsening quality of life. Treating mood disorders in epilepsy is identical to those with primary mood disorders. Yet, there is a common misconception that antidepressants have proconvulsant properties. Most antidepressants are safe when prescribed at therapeutic doses. The incidence of seizures is lower in people randomized to antidepressants than placebo in multicenter randomized placebo-controlled trials of people treated for a primary mood disorder. Thus, there is no excuse not to prescribe antidepressant medications to people with epilepsy.
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Affiliation(s)
- Andres M Kanner
- Epilepsy Division and Department of Neurology, Miller School of Medicine, University of Miami, 1120 NW, 14th Street, Room 1324, Miami, FL, 33136, USA.
| | - Rohit Shankar
- University of Plymouth Peninsula School of Medicine, Truro, UK
- Cornwall Partnership NHS Foundation Trust, Truro, UK
| | - Nils G Margraf
- Department of Neurology, Christian-Albrechts University of Kiel and University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Bettina Schmitz
- Department of Neurology, Vivantes Humboldt-Klinikum, Berlin, Germany
| | - Elinor Ben-Menachem
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Josemir W Sander
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, 2103SW, The Netherlands
- Chalfont Centre for Epilepsy, Chalfont St Peter, UK
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
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10
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Vuotto SC, Wang M, Okcu MF, Bowers DC, Ullrich NJ, Ness KK, Li C, Srivastava DK, Howell RM, Gibson TM, Leisenring WM, Oeffinger KC, Robison LL, Armstrong GT, Krull KR, Brinkman TM. Neurologic morbidity and functional independence in adult survivors of childhood cancer. Ann Clin Transl Neurol 2024; 11:291-301. [PMID: 38013658 PMCID: PMC10863908 DOI: 10.1002/acn3.51951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 11/02/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVE To examine associations between neurologic late effects and attainment of independence in adult survivors of childhood cancer treated with central nervous system (CNS)-directed therapies. METHODS A total of 7881 survivors treated with cranial radiation therapy (n = 4051; CRT) and/or intrathecal methotrexate (n = 4193; IT MTX) ([CNS-treated]; median age [range] = 25.5 years [18-48]; time since diagnosis = 17.7 years [6.8-30.2]) and 8039 without CNS-directed therapy reported neurologic conditions including stroke, seizure, neurosensory deficits, focal neurologic dysfunction, and migraines/severe headaches. Functional independence was assessed using latent class analysis with multiple indicators (independent living, assistance with routine and personal care needs, ability to work/attend school, attainment of driver's license, marital/partner status). Multivariable regression models, adjusted for age, sex, race/ethnicity, and chronic health conditions, estimated odds ratios (OR) or relative risks (RR) for associations between neurologic morbidity, functional independence, and emotional distress. RESULTS Among CNS-treated survivors, three classes of independence were identified: (1) moderately independent, never married, and non-independent living (78.7%); (2) moderately independent, unable to drive (15.6%); and (3) non-independent (5.7%). In contrast to 50% of non-CNS-treated survivors and 60% of siblings, a fourth fully independent class of CNS-treated survivors was not identified. History of stroke (OR = 2.50, 95% CI: 1.70-3.68), seizure (OR = 9.70, 95% CI: 7.37-12.8), neurosensory deficits (OR = 2.67, 95% CI: 2.16-3.31), and focal neurologic dysfunction (OR = 3.05, 95% CI: 2.40-3.88) were associated with non-independence among CNS-treated survivors. Non-independence was associated with emotional distress symptoms. INTERPRETATION CNS-treated survivors do not attain full independence comparable to non-CNS-treated survivors or siblings. Interventions to promote independence may be beneficial for survivors with treatment-related neurological sequalae.
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Affiliation(s)
| | - Mingjuan Wang
- Department of BiostatisticsSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - M. Fatih Okcu
- Texas Children's Hospital, Baylor College of MedicineHoustonTexasUSA
| | | | - Nicole J. Ullrich
- Dana‐Farber/Boston Children's Cancer and Blood Disorders CenterBostonMassachusettsUSA
| | - Kirsten K. Ness
- Department of Epidemiology and Cancer ControlSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Chenghong Li
- Department of BiostatisticsSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Deo Kumar Srivastava
- Department of BiostatisticsSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | | | - Todd M. Gibson
- National Cancer InstituteDivision of Cancer Epidemiology & GeneticsBethesdaMarylandUSA
| | | | - Kevin C. Oeffinger
- Duke Univeristy School of MedicineDuke Cancer InstituteDurhamNorth CarolinaUSA
| | - Leslie L. Robison
- Department of Epidemiology and Cancer ControlSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Gregory T. Armstrong
- Department of Epidemiology and Cancer ControlSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Kevin R. Krull
- Department of Psychology & Biobehavioral SciencesSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Tara M. Brinkman
- Department of Epidemiology and Cancer ControlSt. Jude Children's Research HospitalMemphisTennesseeUSA
- Department of Psychology & Biobehavioral SciencesSt. Jude Children's Research HospitalMemphisTennesseeUSA
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11
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Talaslahti T, Ginters M, Palm A, Kautiainen H, Vataja R, Elonheimo H, Suvisaari J, Koponen H, Lindberg N. Suicides in degenerative neurocognitive disorders and traumatic brain injuries. Eur Psychiatry 2024; 67:e10. [PMID: 38228325 PMCID: PMC10897829 DOI: 10.1192/j.eurpsy.2024.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 12/20/2023] [Accepted: 12/29/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Neuropsychiatric symptoms in major neurocognitive disorders have been strongly associated with suicidality. METHODS The objectives were to explore suicide rates in degenerative neurocognitive disorders (DNDs), alcohol-related neurocognitive disorders (ARNDs), and traumatic brain injuries (TBIs). Patients who received these diagnoses between 1998 and 2015 (N = 231,817) were identified from nationwide registers, and their mortality was followed up until December 31, 2018. We calculated incidences of suicides per 100,000 person-years, types of suicides, and suicide rates compared with the general population (standardized mortality ratio [SMR]). RESULTS During the follow-up, 0.3% (95% confidence interval [95% CI]: 0.2-0.5) of patients with DNDs, 1.1% (0.7-1.8) with ARNDs, and 1.0% (0.7-1.3) with TBIs committed suicide. Suicide mortality rate was higher in men (58.9, 51.3, to 67.4 per 100,000) than in women (9.8, 7.5, to 12.5 per 100,000). The highest suicide rate was in ARNDs (98.8, 65.1, to 143.8 per 100,000), followed by TBIs (82.0, 62.4, to 105.8 per 100,000), and DNDs (21.2, 18.3, to 24.5 per 100,000). The SMRs (95% CI) were 3.69 (2.53-5.38), 2.99 (2.31-3.86), and 1.31 (1.13-1.51), respectively, and no sex difference emerged. The most common cause of death was self-inflicted injury by hanging or drowning (12.4, 10.3, to 14.8 per 100,000). CONCLUSIONS Suicide rates were higher in all three patient groups than the general population. Suicide risk remained elevated for more than 10 years after diagnosis. The suicide methods were mostly violent.
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Affiliation(s)
- Tiina Talaslahti
- Department of Psychiatry, University of Helsinki, Helsinki, Finland
| | - Milena Ginters
- Department of Psychiatry, University of Helsinki, Helsinki, Finland
| | - Anniina Palm
- Department of Psychiatry, University of Helsinki, Helsinki, Finland
| | - Hannu Kautiainen
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
- Department of Biostatistics, Folkhälsan Research Center, Helsinki, Finland
| | - Risto Vataja
- Department of Psychiatry, University of Helsinki, Helsinki, Finland
| | - Henrik Elonheimo
- The Department of Government Services, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jaana Suvisaari
- Mental Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Hannu Koponen
- Department of Psychiatry, University of Helsinki, Helsinki, Finland
| | - Nina Lindberg
- Department of Psychiatry, University of Helsinki, Helsinki, Finland
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12
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Suokas K, Kurkela O, Nevalainen J, Suvisaari J, Hakulinen C, Kampman O, Pirkola S. Geographical variation in treated psychotic and other mental disorders in Finland by region and urbanicity. Soc Psychiatry Psychiatr Epidemiol 2024; 59:37-49. [PMID: 37308692 PMCID: PMC10799825 DOI: 10.1007/s00127-023-02516-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/06/2023] [Indexed: 06/14/2023]
Abstract
PURPOSE In Finland, prevalence of schizophrenia is higher in the eastern and northern regions and co-occurs with the distribution of schizophrenia polygenic risk scores. Both genetic and environmental factors have been hypothesized to contribute to this variation. We aimed to examine the prevalence of psychotic and other mental disorders by region and degree of urbanicity, and the impacts of socio-economic adjustments on these associations. METHODS Nationwide population registers from 2011 to 2017 and healthcare registers from 1975 to 2017. We used 19 administrative and three aggregate regions based on the distribution of schizophrenia polygenic risk scores, and a seven-level urban-rural classification. Prevalence ratios (PRs) were calculated by Poisson regression models and adjusted for gender, age, and calendar year (basic adjustments), and Finnish origin, residential history, urbanicity, household income, economic activity, and physical comorbidity (additional adjustments) on an individual level. Average marginal effects were used to visualize interaction effects between region and urbanicity. RESULTS A total of 5,898,180 individuals were observed. All mental disorders were slightly more prevalent (PR 1.03 [95% CI, 1.02-1.03]), and psychotic disorders (1.11 [1.10-1.12]) and schizophrenia (1.19 [1.17-1.21]) considerably more prevalent in eastern and northern than in western coastal regions. After the additional adjustments, however, the PRs were 0.95 (0.95-0.96), 1.00 (0.99-1.01), and 1.03 (1.02-1.04), respectively. Urban residence was associated with increased prevalence of psychotic disorders across all regions (adjusted PR 1.21 [1.20-1.22]). CONCLUSION After adjusting for socioeconomic and sociodemographic factors, the within-country distribution of mental disorders no longer followed the traditional east-west gradient. Urban-rural differences, on the other hand, persisted after the adjustments.
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Affiliation(s)
- Kimmo Suokas
- Faculty of Social Sciences, Tampere University, Tampere, Finland, Arvo Ylpön katu 34 (Arvo 1), 33014.
| | - Olli Kurkela
- Faculty of Social Sciences, Tampere University, Tampere, Finland, Arvo Ylpön katu 34 (Arvo 1), 33014
- National Institute for Health and Welfare, Helsinki, Finland
- Laurea University of Applied Sciences, Vantaa, Finland
| | - Jaakko Nevalainen
- Faculty of Social Sciences, Tampere University, Tampere, Finland, Arvo Ylpön katu 34 (Arvo 1), 33014
| | - Jaana Suvisaari
- National Institute for Health and Welfare, Helsinki, Finland
| | - Christian Hakulinen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Health and Social Care Systems, National Institute for Health and Welfare, Helsinki, Finland
| | - Olli Kampman
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Psychiatry, The Pirkanmaa Wellbeing Services County, Tampere, Finland
- Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden
- Faculty of Medicine, Department of Clinical Medicine (Psychiatry), University of Turku, Turku, Finland
- Department of Psychiatry, The Wellbeing Services County of Ostrobothnia, Seinäjoki, Finland
| | - Sami Pirkola
- Faculty of Social Sciences, Tampere University, Tampere, Finland, Arvo Ylpön katu 34 (Arvo 1), 33014
- Tampere University Hospital, Tampere, Finland
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13
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Butler M, Abdat Y, Zandi M, Michael BD, Coutinho E, Nicholson TR, Easton A, Pollak TA. Mental health outcomes of encephalitis: An international web-based study. Eur J Neurol 2024; 31:e16083. [PMID: 37797295 DOI: 10.1111/ene.16083] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/07/2023] [Accepted: 09/18/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND AND PURPOSE Acute encephalitis is associated with psychiatric symptoms. Despite this, the extent of mental health problems following encephalitis has not been systematically reported. METHODS We recruited adults who had been diagnosed with encephalitis of any aetiology to complete a web-based questionnaire. RESULTS In total, 445 respondents from 31 countries (55.1% UK, 23.1% USA) responded. Infectious encephalitis constituted 65.4% of cases, autoimmune 29.7%. Mean age was 50.1 years, 65.8% were female, and median time since encephalitis diagnosis was 7 years. The most common self-reported psychiatric symptoms were anxiety (75.2%), sleep problems (64.4%), mood problems (62.2%), and unexpected crying (35.2%). Self-reported psychiatric diagnoses were common: anxiety (44.0%), depression (38.6%), panic disorder (15.7%), and posttraumatic stress disorder (PTSD; 21.3%). Severe mental illnesses such as psychosis (3.3%) and bipolar affective disorder (3.1%) were reported. Self-reported diagnosis rates were broadly consistent with results from the Psychiatric Diagnostic Screening Questionnaire. Many respondents also reported they had symptoms of anxiety (37.5%), depression (28.1%), PTSD (26.8%), or panic disorder (20.9%) that had not been diagnosed. Rates of psychiatric symptoms did not differ between autoimmune and infectious encephalitis. In total, 37.5% respondents had thought about suicide, and 4.4% had attempted suicide, since their encephalitis diagnosis. More than half of respondents (53.5%) reported they had no, or substandard, access to appropriate mental health care. High rates of sensory hypersensitivities (>75%) suggest a previously unreported association. CONCLUSIONS This large international survey indicates that psychiatric symptoms following encephalitis are common and that mental health care provision may be inadequate. We highlight a need for proactive psychiatric input.
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Affiliation(s)
- Matt Butler
- Neuropsychiatry Research and Education Group, King's College London, London, UK
| | - Yasmin Abdat
- Neuropsychiatry Research and Education Group, King's College London, London, UK
| | - Michael Zandi
- Department of Neuroinflammation, University College London Queen Square Institute of Neurology, London, UK
| | - Benedict D Michael
- Department of Clinical Infection, Microbiology, and Immunology, University of Liverpool, Liverpool, UK
| | - Ester Coutinho
- Neuropsychiatry Research and Education Group, King's College London, London, UK
- Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal
| | - Timothy R Nicholson
- Neuropsychiatry Research and Education Group, King's College London, London, UK
| | - Ava Easton
- Department of Clinical Infection, Microbiology, and Immunology, University of Liverpool, Liverpool, UK
- Encephalitis Society, Malton, UK
| | - Thomas A Pollak
- Neuropsychiatry Research and Education Group, King's College London, London, UK
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14
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Mai AS, Chao Y, Xiao B, Zhou Z, Yong JH, Lee ARYB, Tan EK. Risk of Suicidal Ideation and Behavior in Individuals With Parkinson Disease: A Systematic Review and Meta-Analysis. JAMA Neurol 2024; 81:10-18. [PMID: 37955917 PMCID: PMC10644251 DOI: 10.1001/jamaneurol.2023.4207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/08/2023] [Indexed: 11/14/2023]
Abstract
Importance Suicide risk may be increased in patients with Parkinson disease (PD), a common neurodegenerative condition. Mood disorders, especially depression, are prevalent in patients with PD who report suicidality. Objective To address inconsistent results from studies of suicidal ideation and behavior in patients with PD. Data Sources The study team searched MEDLINE and Embase from inception to June 14, 2023, and further screened the bibliographies of relevant studies to ensure a comprehensive search. Study Selection Original studies, published in English, discussing either suicidal ideation, behavior, or both in adults with PD were included. Accepted study designs included cross-sectional, case-control, and cohort studies. Studies that only included patients with PD after deep brain stimulation were excluded. Data Extraction and Synthesis This meta-analysis was conducted in line with the PRISMA guidelines. Two authors reviewed each study and extracted the data independently, with discrepancies referred to a third independent author. Main Outcomes and Measures Outcomes included the prevalence of suicidal ideation and behavior, measured as proportions, and the risk of suicidal behavior in patients with PD relative to controls, measured in both odds ratio (OR) and hazards ratio (HR). Results A total of 28 studies comprising 505 950 PD patients were included in the final analysis. The prevalence of suicidal ideation was evaluated in 14 studies (22.2%; 95% CI, 14.6-32.3) and suicidal behavior in 21 studies (1.25%; 95% CI, 0.64-2.41). Excluding 4 outliers, prevalence of suicidal behavior was significantly higher in prospective studies (1.75%; 95% CI, 1.03-2.95) than retrospective studies (0.50%; 95% CI, 0.24-1.01). Excluding 1 outlier, OR of suicidal behavior was pooled across 10 studies and significant (OR, 2.15; 95% CI, 1.22-3.78; P = .01). HR of suicidal behavior was assessed in 9 studies (HR, 1.73; 95% CI, 1.40-2.14; P < .001). Conclusions and Relevance This meta-analysis involving more than 500 000 patients with PD found 22.2% and 1.25% of patients with PD to have suicidal ideation and behavior, respectively. Patients with PD had 2 times the risk of suicidal behavior than controls. Early recognition and management of suicidality in PD can help reduce mortality.
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Affiliation(s)
- Aaron Shengting Mai
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yinxia Chao
- Department of Neurology, Singapore General Hospital Campus, National Neuroscience Institute, Singapore
| | - Bin Xiao
- Department of Neurology, Singapore General Hospital Campus, National Neuroscience Institute, Singapore
| | - Zhidong Zhou
- Department of Neurology, Singapore General Hospital Campus, National Neuroscience Institute, Singapore
| | - Jung Hahn Yong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Eng-King Tan
- Department of Neurology, Singapore General Hospital Campus, National Neuroscience Institute, Singapore
- Neuroscience and Behavioral Disorders, Duke-NUS Medical School, Singapore
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15
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Mo M, Zacarias-Pons L, Hoang MT, Mostafaei S, Jurado PG, Stark I, Johnell K, Eriksdotter M, Xu H, Garcia-Ptacek S. Psychiatric Disorders Before and After Dementia Diagnosis. JAMA Netw Open 2023; 6:e2338080. [PMID: 37847498 PMCID: PMC10582787 DOI: 10.1001/jamanetworkopen.2023.38080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/27/2023] [Indexed: 10/18/2023] Open
Abstract
Importance Little is known about the specific timing and sequence of incident psychiatric comorbidities at different stages of dementia diagnosis. Objectives To examine the temporal risk patterns of psychiatric disorders, including depression, anxiety, stress-related disorders, substance use disorders, sleep disorders, somatoform/conversion disorders, and psychotic disorders, among patients with dementia before, at the time of, and after receipt of a diagnosis. Design, Setting, and Participants This population-based, nationwide cohort study analyzed data from 796 505 participants obtained from 6 registers between January 1, 2000, and December 31, 2017, including the Swedish registry for cognitive/dementia disorders. Patients with dementia were matched on year of birth (±3 years), sex, and region of residence with up to 4 controls. Data were analyzed between March 1, 2023, and August 31, 2023. Exposures Any cause of dementia and dementia subtypes. Main Outcomes and Measures Flexible parametric survival models to determine the time-dependent risk of initial diagnosis of psychiatric disorders, from 7 years prior to dementia diagnosis to 10 years after diagnosis. Subgroup analysis was conducted for psychiatric drug use among persons receiving a diagnosis of dementia from January 1, 2011, to December 31, 2012. Results Of 796 505 patients included in the study (mean [SD] age at diagnosis, 80.2 [8.3] years; 448 869 (56.4%) female), 209 245 had dementia, whereas 587 260 did not, across 7 824 616 person-years. The relative risk of psychiatric disorders was consistently higher among patients with dementia compared with control participants and began to increase from 3 years before diagnosis (hazard ratio, [HR], 1.72; 95% CI, 1.67-1.76), peaked during the week after diagnosis (HR, 4.74; 95% CI, 4.21-5.34), and decreased rapidly thereafter. Decreased risk relative to controls was observed from 5 years after diagnosis (HR, 0.93; 95% CI, 0.87-0.98). The results were similar for Alzheimer disease, mixed dementia, vascular dementia and unspecified dementia. Among patients with dementia, markedly elevated use of psychiatric medications was observed in the year leading up to the dementia diagnosis and peaked 6 months after diagnosis. For example, antidepressant use was persistently higher among patients with dementia compared with controls, and the difference increased from 2 years before dementia diagnosis (15.9% vs 7.9%, P < .001), peaked approximately 6 months after dementia diagnosis (29.1% vs 9.7%, P < .001), and then decreased slowly from 3 years after diagnosis but remained higher than controls 5 years after diagnosis (16.4% vs 6.9%, P < .001). Conclusions and Relevance The findings of this cohort study that patients with dementia had markedly increased risks of psychiatric disorders both before and after dementia diagnosis highlight the significance of incorporating psychiatric preventative and management interventions for individuals with dementia across various diagnostic stages.
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Affiliation(s)
- Minjia Mo
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Lluis Zacarias-Pons
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Vascular Health Research Group of Girona (ISV-Girona), Institut Universitari d’Investigació en Atenció Primària Jordi Gol i Gurina (IDIAP Jordi Gol), Girona, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
| | - Minh Tuan Hoang
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Shayan Mostafaei
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Pol Grau Jurado
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Isidora Stark
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Johnell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Maria Eriksdotter
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Hong Xu
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Sara Garcia-Ptacek
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
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Hung YA, Liao SC, Chang CM, Chang SS, Yang AC, Chien YL, Wu CS, Gau SSF. Population-attributable risk of psychiatric disorders for suicide among adolescents and young adults in Taiwan. Psychol Med 2023; 53:6161-6170. [PMID: 36349368 PMCID: PMC10520582 DOI: 10.1017/s0033291722003361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/20/2022] [Accepted: 10/06/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Youth suicide rates have increased markedly in some countries. This study aimed to estimate the population-attributable risk of psychiatric disorders associated with suicide among Taiwanese youth aged 10-24 years. METHODS Data were obtained from the National Death Registry and National Health Insurance (NHI) claims database between 2007 and 2019. Youth who died by suicide were included, and comparisons, 1:10 matched by age and sex, were randomly selected from the Registry for NHI beneficiaries. We used multivariable logistic regression to estimate suicide odds ratios for psychiatric disorders. The population-attributable fractions (PAF) were calculated for each psychiatric disorder. RESULTS A total of 2345 youth suicide and 23 450 comparisons were included. Overall, 44.8% of suicides had a psychiatric disorder, while only 7.9% of the comparisons had a psychiatric disorder. The combined PAF for all psychiatric disorders was 55.9%. The top three psychiatric conditions of the largest PAFs were major depressive disorder, dysthymia, and sleep disorder. In the analysis stratified by sex, the combined PAF was 45.5% for males and 69.2% for females. The PAF among young adults aged 20-24 years (57.0%) was higher than among adolescents aged 10-19 years (48.0%). CONCLUSIONS Our findings of high PAF from major depressive disorder, dysthymia, and sleep disorder to youth suicides suggest that youth suicide prevention that focuses on detecting and treating mental illness may usefully target these disorders.
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Affiliation(s)
- Yi-An Hung
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Shih-Cheng Liao
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
- Department of Psychiatry, College of Medicine, National Taiwan University, Taipei City, Taiwan
- Department of Psychiatry, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu Hospital, Hsin-Chu City, Taiwan
| | - Chia-Ming Chang
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan
| | - Shu-Sen Chang
- Institute of Health Behaviors and Community Sciences, National Taiwan University, Taipei, Taiwan
| | - Albert C. Yang
- Digital Medicine Center / Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Ling Chien
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
- Department of Psychiatry, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Chi-Shin Wu
- Department of Psychiatry, College of Medicine, National Taiwan University, Taipei City, Taiwan
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Zhunan, Taiwan
- Department of Psychiatry, National Taiwan University Hospital, Yunlin Branch, Yunlin, Taiwan
| | - Susan Shur-Fen Gau
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
- Department of Psychiatry, College of Medicine, National Taiwan University, Taipei City, Taiwan
- Department of Psychology, Graduate Institute of Epidemiology, and Preventive Medicine, and Graduate Institute of Clinical Medicine, National Taiwan University, Taipei, Taiwan
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Žuvela T, Filipović-Grčić B, Rušić D, Leskur D, Modun D, Čohadžić T, Bukić J, Šešelja Perišin A. Knowledge and Attitudes towards Epilepsy of Croatian General Student Population and Biomedical Students: A Cross-Sectional Study. Healthcare (Basel) 2023; 11:2550. [PMID: 37761747 PMCID: PMC10531231 DOI: 10.3390/healthcare11182550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/08/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
Epilepsy causes a significant burden to patients as it is linked with various somatic and psychiatric comorbidities, social issues, impaired quality of life, and increased mortality. Improving the population's knowledge and attitudes about epilepsy patients could be beneficial as it could raise social awareness and lead to more social support for patients. For those reasons, a survey-based cross-sectional study was conducted to determine Croatian students' knowledge and attitudes toward epilepsy. A previously developed survey questionnaire was adapted for the Croatian setting and distributed online to the students (n = 544). Croatian students generally had positive attitudes towards people with epilepsy (median score 28.0, interquartile range 29.0-26.0, with the minimum possible score being 0.0 and the maximum 30.0), with the female gender (B (male) = 0.664 (95% CI -1.158, -0.170), p = 0.009), biomedical education (B (other) = -0.442, (95% CI -0.823, -0.061), p = 0.023), and personal experience in the form of witnessing the seizure (B = 0.519 (95% CI 0,098, 0.940), p = 0.016) as predictors of more favorable attitudes. Overall knowledge was satisfactory concerning most items, with the exception of first aid measures and risk factors. Educational intervention targeting bio-medical students and other students who might, in their future professional lives, be responsible for people suffering from epilepsy is needed to improve the gaps in their knowledge.
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Affiliation(s)
| | | | | | - Dario Leskur
- Department of Pharmacy, University of Split School of Medicine, Šoltanska 2, 21000 Split, Croatia; (T.Ž.); (B.F.-G.); (D.R.); (D.M.); (T.Č.); (J.B.); (A.Š.P.)
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18
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Guo X, Lin W, Zhong R, Han Y, Yu J, Yan K, Zhang X, Liang J. Factors related to the severity of obsessive-compulsive symptoms and their impact on suicide risk in epileptic patients. Epilepsy Behav 2023; 146:109362. [PMID: 37499582 DOI: 10.1016/j.yebeh.2023.109362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE To explore relevant factors for the severity of obsessive-compulsive symptoms (OCSs) in adult epileptic patients and investigate whether the severity of OCSs is a mediator in the relationship between depressive/anxiety symptoms and suicide risk in epileptic patients. METHODS This was a cross-sectional study from a hospital in Northeast China. Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Neurological Disorders Depression Inventory for Epilepsy (NDDIE), Generalized Anxiety Disorder (GAD-7), and Nurses' Global Assessment of Suicide Risk (NGASR) were used to assess the severity of OCSs, depressive symptoms, anxiety symptoms, and suicide risk in epileptic patients, respectively. The independent factors of the severity of OCSs and their mediating effects in the relationship between depressive/anxiety symptoms and suicide risk were evaluated by regression analyses and mediator models, respectively. RESULTS NDDIE scores (β = 0.404, p < 0.001), GAD-7 scores (β = 0.247, p = 0.009), and polytherapy (β = 0.119, p = 0.032) were the independent factors of Y-BOCS scores. The Y-BOCS scores partially mediated the relationship between GAD-7 scores and NGASR scores (standardized coefficients of indirect effect = 0.109, Bootstrap 95% CI = 0.024 to 0.214). Still, they did not mediate the relationship between NDDIE scores and NGASR scores (standardized coefficients of indirect effect = 0.062, Bootstrap 95% CI = -0.024 to 0.169). CONCLUSIONS Depressive symptoms, anxiety symptoms, and polytherapy are independently associated with the severity of OCSs in epileptic patients. Depressive and anxiety symptoms mediate the effect of the severity of OCSs on suicide risk in epileptic patients completely.
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Affiliation(s)
- Xin Guo
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Weihong Lin
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Rui Zhong
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Yujuan Han
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Jieyang Yu
- Department of Pediatric Neurology, the First Hospital of Jilin University, Changchun, China
| | - Kangle Yan
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Xinyue Zhang
- Department of Neurology, The First Hospital of Jilin University, Changchun, China.
| | - Jianmin Liang
- Department of Pediatric Neurology, the First Hospital of Jilin University, Changchun, China.
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Hedna K, Waern M. Use of Psychoactive Medications and Risk of Suicide in Late Life (75+): A Total Population Study. Drugs Real World Outcomes 2023; 10:491-498. [PMID: 37421593 PMCID: PMC10491562 DOI: 10.1007/s40801-023-00380-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 07/10/2023] Open
Abstract
BACKGROUND Psychoactive medications play an important role for the mental health and risk of suicidal behaviour in the oldest segment of the population (75+). A better understanding of psychoactive medication use is advocated to prevent suicide in this age group. PURPOSE We investigated the risk of suicide associated with the use of psychoactive medications in the total population aged ≥ 75 years, with and without exposure to antidepressants. METHOD A national population-based register study, including all Swedish residents aged ≥ 75 years between 2006 and 2014 (N = 1,413,806). A nested case-control design was used to investigate psychoactive medications associated with suicide among users and non-users of antidepressants. Risk estimates were calculated in adjusted conditional logistic regression models for the entire cohort and by gender. RESULTS Suicide occurred in 1305 persons (907 men and 398 women). Among them, 555 (42.5%) were on an antidepressant at the time of suicide. Adjusted incidence rate ratio (aIRR) for suicide was increased in those who were on hypnotics in the total cohort (aIRR 2.05, 95% confidence interval 1.74 to 2.41), in both users and non-users of antidepressants and for both genders. Elevated suicide risk was observed in those who concomitantly used anxiolytics with antidepressants (1.51, 1.25 to 1.83). Decreased risk of suicide was observed among those who were on anti-dementia drugs, in the total cohort (0.33, 0.21 to 0.52) and in both users and non-users of antidepressants. Use of antipsychotics and mood stabilisers showed no effect on suicide risk. CONCLUSION Use of hypnotics and concomitant use of anxiolytics with antidepressants was associated with increased risk of late-life suicide. Our findings suggest the need for careful evaluation of the benefit-risk balance of psychoactive medications as well as their availability as a possible suicide means. Future research should consider the indication of use of the psychoactive medications and the severity of psychiatric and medical illnesses of the patients.
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Affiliation(s)
- Khedidja Hedna
- AgeCap Center, Department of Psychiatry and Neurochemistry, Gothenburg University, 41345, Gothenburg, Sweden.
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Statistikkonsulterna Västra AB, Gothenburg, Sweden.
| | - Margda Waern
- AgeCap Center, Department of Psychiatry and Neurochemistry, Gothenburg University, 41345, Gothenburg, Sweden
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Psychosis Clinic, Gothenburg, Sweden
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20
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Mo M, Xu H, Hoang MT, Jurado PG, Mostafaei S, Kåreholt I, Johnell K, Eriksdotter M, Garcia-Ptacek S. External Causes of Death From Death Certificates in Patients With Dementia. J Am Med Dir Assoc 2023; 24:1381-1388. [PMID: 37421971 DOI: 10.1016/j.jamda.2023.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/25/2023] [Accepted: 05/30/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVES We aim to analyze the risk of death from specific external causes, including falls, complications of medical and surgical care, unintentional injuries, and suicide, in dementia patients. DESIGN Swedish nationwide cohort study integrating 6 registers from May 1, 2007, through December 31, 2018, including the Swedish Registry for Cognitive/Dementia Disorders (SveDem). SETTING AND PARTICIPANTS Population-based study. Patients diagnosed with dementia from 2007 to 2018 and up to 4 controls matched on year of birth (±3 years), sex, and region of residence. METHODS The exposures of this study were diagnosis of dementia and dementia subtypes. Number of deaths and causes of mortality were obtained from death certificates compiled into the Cause of Death Register. Hazard ratios (HRs) and 95% CIs were estimated using Cox and flexible models, adjusted for sociodemographics, medical and psychiatric disorders. RESULTS The study population included 235,085 patients with dementia [96,760 men (41.2%); mean age 81.5 (SD 8.5) years] and 771,019 control participants [341,994 men (44.4%); mean age 79.9 (SD 8.6) years], over 3,721,687 person-years. Compared with control participants, patients with dementia presented increased risk for unintentional injuries (HR 3.30, 95% CI 3.19-3.40) and falls (HR 2.67, 95% CI 2.54-2.80) during old age (≥75 y), and suicide (HR 1.56, 95% CI 1.02-2.39) in middle age (<65 y). Suicide risk was 5.04 times higher (HR 6.04, 95% CI 4.22-8.66) in patients with both dementia and 2 or more psychiatric disorders relative to controls (incidence rate per person-years, 1.6 vs 0.3). For dementia subtypes, frontotemporal dementia had the highest risks of unintentional injuries (HR 4.28, 95% CI 2.80-6.52) and falls (HR 3.83, 95% CI 1.98-7.41), whereas subjects with mixed dementia were less likely to die from suicide (HR 0.11, 95% CI 0.03-0.46) and complications of medical and surgical care (HR 0.53, 95% CI 0.40-0.70) compared to controls. CONCLUSIONS AND IMPLICATIONS Suicide risk screening and psychiatric disorders management in early-onset dementia and early interventions for unintentional injuries and falls prevention in older dementia patients should be provided.
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Affiliation(s)
- Minjia Mo
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Hong Xu
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Minh Tuan Hoang
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Pol Grau Jurado
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Shayan Mostafaei
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Ingemar Kåreholt
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Department of Neurobiology, Aging Research Center, Center for Alzheimer Research, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Institute of Gerontology, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Kristina Johnell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Maria Eriksdotter
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Sara Garcia-Ptacek
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden.
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21
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Andersen AH, Illes Z, Roessler KK. Regaining Autonomy in a Holding Environment: Patients' Perspectives on the Existential Communication with Physicians When Suffering from a Severe, Chronic Illness: A Qualitative Nordic Study. JOURNAL OF RELIGION AND HEALTH 2023; 62:2375-2390. [PMID: 36071298 DOI: 10.1007/s10943-022-01658-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/25/2022] [Indexed: 06/15/2023]
Abstract
Patients experience existential themes as pivotal in their lives, in order to be able to live with a severe, chronic illness; however, physicians report a hesitative approach to existential communication. The current study investigated Nordic patients' experiences of existential communication with their physicians related to the treatment of multiple sclerosis or chronic pain. Semi-structured interviews with 23 patients were analyzed following Interpretative Phenomenological Analysis. Physicians focusing on medical aspects at the expense of psychological and existential aspects of being ill was experienced by patients as challenging their treatment and well-being. For making a shared decision with the physician on their treatment, patients needed a transition from being dependent to being autonomous. A holding environment and existential communication about transitional objects such as relationships with something bigger than themselves, as nature or religion, supported this autonomy. The analysis showed that existential communication not only supported patients in developing and regaining autonomy but also functioned as a moderator for illness-related distress, as a prevention of withdrawal from treatment, and as significant for patients in relation to living with chronic illness. Further education in existential communication is desirable, to support physicians integrating existential dimensions in consultations and shared decision-making with patients suffering from a severe, chronic illness.
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Affiliation(s)
- Aida Hougaard Andersen
- Department of Psychology, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark.
| | - Zsolt Illes
- Department of Neurology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Kirsten Kaya Roessler
- Department of Psychology, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark
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22
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Sariaslan A, Larsson H, Hawton K, Pitkänen J, Lichtenstein P, Martikainen P, Fazel S. Physical injuries as triggers for self-harm: a within-individual study of nearly 250 000 injured people with a major psychiatric disorder. BMJ MENTAL HEALTH 2023; 26:e300758. [PMID: 37380367 PMCID: PMC10577735 DOI: 10.1136/bmjment-2023-300758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/15/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Although there is robust evidence for several factors which may precipitate self-harm, the contributions of different physical injuries are largely unknown. OBJECTIVE To examine whether specific physical injuries are associated with risks of self-harm in people with psychiatric disorders. METHODS By using population and secondary care registers, we identified all people born in Finland (1955-2000) and Sweden (1948-1993) with schizophrenia-spectrum disorder (n=136 182), bipolar disorder (n=68 437) or depression (n=461 071). Falls, transport-related injury, traumatic brain injury and injury from interpersonal assault were identified within these subsamples. We used conditional logistic regression models adjusted for age and calendar month to compare self-harm risk in the week after each injury to earlier weekly control periods, which allowed us to account for unmeasured confounders, including genetics and early environments. FINDINGS A total of 249 210 individuals had been diagnosed with a psychiatric disorder and a physical injury during the follow-up. The absolute risk of self-harm after a physical injury ranged between transport-related injury and injury from interpersonal assault (averaging 17.4-37.0 events per 10 000 person-weeks). Risk of self-harm increased by a factor of two to three (adjusted OR: 2.0-2.9) in the week following a physical injury, as compared with earlier, unexposed periods for the same individuals. CONCLUSIONS Physical injuries are important proximal risk factors for self-harm in people with psychiatric disorders. CLINICAL IMPLICATIONS Mechanisms underlying the associations could provide treatment targets. When treating patients with psychiatric illnesses, emergency and trauma medical services should actively work in liaison with psychiatric services to implement self-harm prevention strategies.
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Affiliation(s)
- Amir Sariaslan
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Henrik Larsson
- School of Medical Sciences, Örebro University, Örebro, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Keith Hawton
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Joonas Pitkänen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- International Max Planck Research School for Population Health and Data Science, Rostock, Germany
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Centre for Health Equity Studies (CHESS), Stockholm University and Karolinska Institutet, Stockholm, Sweden
- Max Planck Institute for Demographic Research, Rostock, Germany
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK
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23
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Tellez-Martinez A, Restrepo-Martinez M, Espinola-Nadurille M, Martinez-Angeles V, Martínez-Carrillo F, Easton A, Pollak T, Ramirez-Bermudez J. Suicidal Thoughts and Behaviors in Anti-NMDA Receptor Encephalitis: Psychopathological Features and Clinical Outcomes. J Neuropsychiatry Clin Neurosci 2023; 35:368-373. [PMID: 37151035 DOI: 10.1176/appi.neuropsych.20220200] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
OBJECTIVE A wide variety of neuropsychiatric symptoms are described during the acute phase of anti-N-methyl-d-aspartate receptor encephalitis (ANMDARE), including psychosis, mania, depression, and catatonia, but there are few reports on suicidal thought and behaviors in ANMDARE. To address this gap in the literature, the authors measured the presence of suicidal thoughts and behaviors among a large cohort of Mexican patients diagnosed with definite ANMDARE. METHODS This observational and longitudinal study included patients with definite ANMDARE hospitalized at the National Institute of Neurology and Neurosurgery of Mexico between 2014 and 2021. Suicidal thoughts and behaviors were assessed before and after treatment by means of a clinical interview with relatives and a direct clinical assessment with each patient. Thoughts of engaging in suicide-related behavior and acts of suicidal and nonsuicidal self-directed violence before and during hospitalization were recorded. RESULTS From a total sample of 120 patients who fulfilled the diagnostic criteria for definite ANMDARE, 15 patients (13%) had suicidal thoughts and behaviors during the acute phase of the disease. All 15 of these patients experienced psychosis and had suicidal ideation with intention. Three patients engaged in preparatory behaviors and seven carried out suicidal self-directed violence. Psychotic depression and impulsivity were more frequent among those patients with suicidal thoughts and behaviors than among those without any form of suicidality. Four patients engaged in self-directed violence during hospitalization. Remission was sustained in 14 of 15 patients, with suicidal ideation and self-directed violence persisting during follow-up in only one patient. CONCLUSIONS Suicidal thoughts and behaviors are not uncommon during the acute phase of ANMDARE. On the basis of our sample, the persistence of these features after immunotherapy is rare but may be observed. A targeted assessment of suicidal risk should be strongly considered in this population.
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Affiliation(s)
- Alberto Tellez-Martinez
- Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery of Mexico (Tellez-Martinez, Restrepo-Martinez, Espinola-Nadurille, Martinez-Angeles, Martínez-Carrillo, Ramirez-Bermudez); Encephalitis Society, Malton, and Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom (Easton); Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London (Pollak)
| | - Miguel Restrepo-Martinez
- Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery of Mexico (Tellez-Martinez, Restrepo-Martinez, Espinola-Nadurille, Martinez-Angeles, Martínez-Carrillo, Ramirez-Bermudez); Encephalitis Society, Malton, and Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom (Easton); Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London (Pollak)
| | - Mariana Espinola-Nadurille
- Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery of Mexico (Tellez-Martinez, Restrepo-Martinez, Espinola-Nadurille, Martinez-Angeles, Martínez-Carrillo, Ramirez-Bermudez); Encephalitis Society, Malton, and Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom (Easton); Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London (Pollak)
| | - Victoria Martinez-Angeles
- Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery of Mexico (Tellez-Martinez, Restrepo-Martinez, Espinola-Nadurille, Martinez-Angeles, Martínez-Carrillo, Ramirez-Bermudez); Encephalitis Society, Malton, and Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom (Easton); Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London (Pollak)
| | - Francisco Martínez-Carrillo
- Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery of Mexico (Tellez-Martinez, Restrepo-Martinez, Espinola-Nadurille, Martinez-Angeles, Martínez-Carrillo, Ramirez-Bermudez); Encephalitis Society, Malton, and Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom (Easton); Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London (Pollak)
| | - Ava Easton
- Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery of Mexico (Tellez-Martinez, Restrepo-Martinez, Espinola-Nadurille, Martinez-Angeles, Martínez-Carrillo, Ramirez-Bermudez); Encephalitis Society, Malton, and Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom (Easton); Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London (Pollak)
| | - Thomas Pollak
- Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery of Mexico (Tellez-Martinez, Restrepo-Martinez, Espinola-Nadurille, Martinez-Angeles, Martínez-Carrillo, Ramirez-Bermudez); Encephalitis Society, Malton, and Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom (Easton); Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London (Pollak)
| | - Jesus Ramirez-Bermudez
- Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery of Mexico (Tellez-Martinez, Restrepo-Martinez, Espinola-Nadurille, Martinez-Angeles, Martínez-Carrillo, Ramirez-Bermudez); Encephalitis Society, Malton, and Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom (Easton); Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London (Pollak)
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24
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Maxfield M, Peckham A, James DL, Lathrop L, Fiske A. Anticipated suicidal and death ideation in response to an imagined dementia diagnosis: A qualitative study. DEMENTIA 2023:14713012231171490. [PMID: 37092692 DOI: 10.1177/14713012231171490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Alzheimer's disease and related dementias are prevalent, highly impactful, and feared diagnoses. A mixed methods study using semi-structured interviews was conducted to clarify causes of dementia-related anxiety. Fifty community-dwelling adults aged 58 to 89 (M = 70.92, SD = 6.08) were recruited from a university participant registry and Memory Clinic; none had dementia diagnoses. Analyses revealed that 42% (n = 21) of participants anticipated suicidal or death ideation if diagnosed with dementia. Among participants endorsing anticipated suicidal or death ideation, responses ranged from active, specific plans, including interest in physician-assisted suicide, to more passive wishes to hasten death rather than continue to live with dementia. Within reports of both anticipated suicidal and death ideation, three subthemes emerged. Participants reported concerns about becoming a burden to others, the devaluation of life/loss of self with dementia, and the desire for (and anticipated thwarting of) personal control as factors contributing to their anticipated responses to a dementia diagnosis. Statements of anticipated suicidal and death ideation were contingent on a dementia diagnosis and may reflect errors in affective forecasting. Nevertheless, given the prevalence of dementias and older adults' elevated rates of suicide, the intersection of these two public health issues warrants greater attention.
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Affiliation(s)
- Molly Maxfield
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
- Center for Innovation in Healthy and Resilient Aging, Arizona State University, Phoenix, AZ, USA
| | - Allie Peckham
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
- Center for Innovation in Healthy and Resilient Aging, Arizona State University, Phoenix, AZ, USA
| | - Dara L James
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
- College of Nursing, University of South Alabama, Mobile, AL, USA
| | - Laura Lathrop
- Department of Psychology, University of Denver, Denver, CO, USA
| | - Amy Fiske
- Department of Psychology, West Virginia University, Morgantown, WV, USA
- Injury Control Research Center, West Virginia University, Morgantown, WV, USA
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25
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Easton A, Pollak T. Encephalitis matters. Lancet Neurol 2023; 22:300. [PMID: 36828008 DOI: 10.1016/s1474-4422(23)00066-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 02/17/2023] [Indexed: 02/23/2023]
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26
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Erlangsen A, Qin P, Madsen T, Hawton K, Osler M, Hjorthøj C, Benros ME, Ethelberg S, Mølbak K, Laursen TM, Nordentoft M, Nilsson SF. Association between SARS-CoV-2 infection and self-harm: Danish nationwide register-based cohort study. Br J Psychiatry 2023; 222:167-174. [PMID: 36636817 PMCID: PMC10895503 DOI: 10.1192/bjp.2022.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Case studies have linked SARS-CoV-2 infection to suicidal behaviour. However, conclusive evidence is lacking. AIMS To examine whether a history of SARS-CoV-2 infection or SARS-CoV-2-related hospital admission was associated with self-harm in the general population and in high-risk groups. METHOD A cohort design was applied to nationwide data on all people aged ≥15 years and living in Denmark between 27 February 2020 and 15 October 2021. Exposure was identified as having had a positive SARS-CoV-2 PCR test, and further assessed as SARS-CoV-2-related hospital admission. Rates of probable self-harm were examined using adjusted incidence rate ratios (aIRRs). The following subgroups were identified: (a) lower educational level, (b) chronic medical conditions, (c) disability pension, (d) mental disorders, (e) substance use disorders, and history of (f) homelessness and (g) imprisonment. RESULTS Among 4 412 248 included individuals, 260 663 (5.9%) had tested positive for SARS-CoV-2. Out of 5453 individuals presenting with self-harm, 131 (2.4%) had been infected. Individuals with a history of a positive SARS-CoV-2 test result had an aIRR for self-harm of 0.86 (95% CI 0.72-1.03) compared with those without. High rates were found after a SARS-CoV-2-related hospital admission (aIRR = 7.68; 95% CI 5.61-10.51) or a non-SARS-CoV-2-related admission (aIRR = 10.27; 95% CI 9.65-10.93) versus non-infected and not admitted. In sensitivity analyses with a more restrictive definition of self-harm, a positive PCR test was associated with lower rates of self-harm. CONCLUSIONS Individuals with a PCR-confirmed SARS-CoV-2 infection did not have higher rates of self-harm than those without. Hospital admission in general, rather than being SARS-CoV-2 positive. seemed to be linked to elevated rates of self-harm.
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Affiliation(s)
- Annette Erlangsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark; Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Copenhagen, Denmark; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; and Center of Mental Health Research, Australian National University, Canberra, Australia
| | - Ping Qin
- National Center for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Trine Madsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark; Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Copenhagen, Denmark; and Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Keith Hawton
- Centre for Suicide Research, University of Oxford, Oxford, UK; and Oxford Health NHS Foundation Trust, Oxford, UK
| | - Merete Osler
- Center for Clinical Research and Prevention, Bispebjerg & Frederiksberg Hospitals, Copenhagen, Denmark; and Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Carsten Hjorthøj
- Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Copenhagen University Hospital, Hellerup, Denmark; and Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Michael E. Benros
- Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Copenhagen, Denmark; and Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Steen Ethelberg
- Infectious Disease Epidemiology & Prevention, Statens Serum Institut, Copenhagen, Denmark; and Department of Global Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kåre Mølbak
- Epidemiological Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark; and Department of Veterinary and Animal Science, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Munk Laursen
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
| | - Merete Nordentoft
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark; Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Copenhagen, Denmark; and Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Sandra Feodor Nilsson
- Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Copenhagen University Hospital, Hellerup, Denmark
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Narindrarangkura P, Alafaireet PE, Khan U, Kim MS. Predicting suicide attempts among people with diabetes using a large multicenter electronic health records dataset. Int J Psychiatry Med 2023:912174231162477. [PMID: 36872916 DOI: 10.1177/00912174231162477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
OBJECTIVE People with diabetes have a higher risk of suicidal behaviors than the general population. However, few studies have focused on understanding this relationship. We investigated risk factors and predicted suicide attempts in people with diabetes using the Least Absolute Shrinkage and Selection Operator (LASSO) regression. METHOD Data was retrieved from Cerner Real-World Data™ and included over 3 million diabetes patients in the study. Least absolute shrinkage and selection operator regression was applied to identify associated factors. Gender-, diabetes-type-, and depression-specific LASSO regression models were analyzed. RESULTS There were 7764 subjects diagnosed with suicide attempts with an average age of 45. We found risk factors for suicide attempts in diabetes patients, such as being an American Indian or Alaska Native (β = 0.637), atypical agents (β = 0.704), benzodiazepines (β = 0.784), and antihistamines (β = 0.528). Amyotrophy had a negative coefficient for suicide attempts in males with diabetes (β = -2.025); in contrast, it had a positive coefficient in females with diabetes (β = 3.339). Using MAOI had a negative coefficient for suicide attempts in T1DM patients (β = -7.304). Aged less than 20 had a positive coefficient for suicide attempts in depressed (β = 2.093) and non-depressed patients with diabetes (β = 1.497). The LASSO model had 94.4% AUC and 87.4% F1 score. CONCLUSIONS To our knowledge, this is the first study using LASSO regression to identify risk factors for suicide attempts and diabetes. The shrinkage technique successfully reduced the number of variables in the model to improve overfitting. Further research is needed to study cause-and-effect relationships. The results may help providers identify high-risk groups of suicide attempters among diabetes patients.
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Affiliation(s)
| | - Patricia E Alafaireet
- Department of Health Management and Informatics, 14716University of Missouri, Columbia, MO, USA
| | - Uzma Khan
- Cosmopolitan International Diabetes and Endocrinology Center, Columbia, MO, USA.,Department of Medicine, 14716University of Missouri, Columbia, MO, USA
| | - Min Soon Kim
- Institute for Data Science and Informatics, 14716University of Missouri, Columbia, MO, USA.,Department of Health Management and Informatics, 14716University of Missouri, Columbia, MO, USA
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Zhang X, Clarke C, Ding R. Living with dementia: Why I am thinking of 'death'. DEMENTIA 2023; 22:807-819. [PMID: 36809154 PMCID: PMC10088338 DOI: 10.1177/14713012231158859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
BACKGROUND AND AIMS Dementia is recognized globally as a massive burden on public health and wider society. It is a major cause of disability and mortality amongst older people. China has the largest population of people with dementia worldwide, accounting for approximately 25% of the entire global population of people with dementia. The study investigated the perceived experiences of care giving and care receiving in China, with one area identified in the data concerning the extent to which the participants discussed death. The research also explored the meaning of living with dementia in modern China, where the economy, demography and culture are rapidly changing. METHOD The qualitative approach of interpretative phenomenological analysis was used for this study. Semi-structured interviews were used for data collection. FINDING The paper reports on one specific finding concerning death as a way out of the situation that participants found themselves in. CONCLUSION The study described and interpreted one of the specific issues, 'death', in the participants' narratives. This finding reflects how psychological and social factors, such as stress, social support, healthcare cost, caring burden and medical practice have created the participants' thoughts of 'wishing to die' and the reasons why they believe 'death is a way to reduce burden'. It calls for an understanding, supportive social environment and a reconsideration of a culturally and economically appropriate family-based care system.
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Affiliation(s)
- Xiubin Zhang
- National Heart and Lung Institute, 4615Imperial College London, London, UK
| | | | - Rong Ding
- School of Heath in Social Science, The University of Edinburgh, Edinburgh, UK
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29
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Pagonabarraga J, Álamo C, Castellanos M, Díaz S, Manzano S. Depression in Major Neurodegenerative Diseases and Strokes: A Critical Review of Similarities and Differences among Neurological Disorders. Brain Sci 2023; 13:brainsci13020318. [PMID: 36831861 PMCID: PMC9954482 DOI: 10.3390/brainsci13020318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/05/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
Depression and anxiety are highly prevalent in most neurological disorders and can have a major impact on the patient's disability and quality of life. However, mostly due to the heterogeneity of symptoms and the complexity of the underlying comorbidities, depression can be difficult to diagnose, resulting in limited recognition and in undertreatment. The early detection and treatment of depression simultaneously with the neurological disorder is key to avoiding deterioration and further disability. Although the neurologist should be able to identify and treat depression initially, a neuropsychiatry team should be available for severe cases and those who are unresponsive to treatment. Neurologists should be also aware that in neurodegenerative diseases, such as Alzheimer's or Parkinson's, different depression symptoms could develop at different stages of the disease. The treatment options for depression in neurological diseases include drugs, cognitive-behavioral therapy, and somatic interventions, among others, but often, the evidence-based efficacy is limited and the results are highly variable. Here, we review recent research on the diagnosis and treatment of depression in the context of Alzheimer's disease, Parkinson's disease, and strokes, with the aim of identifying common approaches and solutions for its initial management by the neurologist.
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Affiliation(s)
- Javier Pagonabarraga
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
- Department of Medicine, Autonomous University of Barcelona, 08193 Barcelona, Spain
- Centro de Investigación en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 28031 Madrid, Spain
- Correspondence:
| | - Cecilio Álamo
- Department of Biomedical Sciences (Pharmacology), Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28801 Madrid, Spain
| | - Mar Castellanos
- Department of Neurology, A Coruña University Hospital and Biomedical Research Institute, 15006 La Coruña, Spain
| | - Samuel Díaz
- Headaches Unit, Department of Neurology, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
| | - Sagrario Manzano
- Department of Neurology, Infanta Leonor University Hospital, 28031 Madrid, Spain
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30
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Association of intellectual disability with overall and type-specific cardiovascular diseases: a population-based cohort study in Denmark. BMC Med 2023; 21:41. [PMID: 36747218 PMCID: PMC9903576 DOI: 10.1186/s12916-023-02747-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/20/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Individuals with mental health problems have been shown to have an increased risk of cardiovascular disorder (CVD), but little is known about the risk of early-onset CVD among those with intellectual disability. We aimed to investigate the association between intellectual disability and subsequent CVD, taking into consideration the severity of intellectual disability and neurodevelopmental and neurologic comorbidity. METHODS This population-based cohort study used individual-level linked data from Danish national health registries. Participants were all live-born singletons born in Denmark during 1978-2016 (n = 2,288,393). Follow-up began from birth and continued until the onset of CVD, death, emigration, or December 31, 2018, whichever came first. Clinical diagnosis of any CVD or type-specific CVDs was identified in the Danish National Patient Register. Time-varying Cox regression analyses were used to estimate the hazard ratio (HR) of intellectual disability associated with overall and type-specific CVDs. RESULTS A total of 11,954 individuals received a diagnosis of intellectual disability (7434 males and 4520 females). During a median follow-up time of 18.5 years (interquartile range, 18.1 years), 652 individuals with intellectual disability (5.5%) received a diagnosis of CVD (incidence rate, 2.4 per 1000 person-years), compared with 78,088 (3.4%) CVD cases in individuals without intellectual disability (incidence rate, 1.9 per 1000 person-years), corresponding to a HR of 1.24 (95% CI, 1.15-1.34). Increased risks of CVD were similar in both childhood (HR, 1.24; 95% CI, 1.08-1.43) and early adulthood (HR, 1.25; 95% CI, 1.14-1.38). For type-specific CVDs, intellectual disability was significantly associated with cerebrovascular disease (HR, 2.50; 95% CI, 2.02-3.10), stroke (HR, 2.20; 95% CI, 1.69-2.86), heart failure (HR, 3.56; 95% CI, 2.37-5.35), hypertensive disease (HR, 1.30; 95% CI, 1.22-1.39), and deep vein thrombosis (HR, 2.10; 95% CI, 1.60-2.75). Stratified HRs of overall CVD were 1.14 (95% CI, 1.01-1.30) for borderline/mild intellectual disability, 1.25 (95% CI, 1.01-1.54) for moderate intellectual disability, and 1.91 (95% CI, 1.47-2.48) for severe/profound intellectual disability. After the exclusion of individuals with neurodevelopmental and neurologic comorbidity, intellectual disability remained significantly associated with increased risks of CVD. CONCLUSIONS Individuals with intellectual disability had increased risks of early-onset CVD, in particular, for cerebrovascular disease, stroke, heart failure, and deep vein thrombosis, and the risks also increased with the severity of intellectual disability. Our findings highlight the awareness of increased risks of CVD in intellectual disability patients.
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31
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Nafilyan V, Morgan J, Mais D, Sleeman KE, Butt A, Ward I, Tucker J, Appleby L, Glickman M. Risk of suicide after diagnosis of severe physical health conditions: A retrospective cohort study of 47 million people. THE LANCET REGIONAL HEALTH. EUROPE 2023; 25:100562. [PMID: 36545003 PMCID: PMC9760649 DOI: 10.1016/j.lanepe.2022.100562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The diagnosis of a severe physical health condition can cause psychological distress and lead to severe depression. The association between severe physical health conditions and the risk of suicide, and how the risk of suicide changes in the months following diagnosis, are not clear. METHODS We estimated whether a diagnosis of severe physical health conditions is associated with an increase in the risk of death by suicide using a dataset based on the 2011 Census linked to hospital records and death registration records covering 47,354,696 people alive on 1 January 2017 in England. Patients diagnosed with a low-survival cancer, chronic ischaemic heart disease, chronic obstructive pulmonary disease, or degenerative neurological condition were matched to individuals using socio-demographic characteristics from the Census. Using the Aalen-Johansen estimator, we estimated the cumulative incidence of death by suicide occurring between 1 January 2017 and 31 December 2021 (registered by 31 December 2021) in patients and matched controls, adjusted for other potential confounders using inverse probability weighting. FINDINGS Diagnosis of severe conditions was associated with an increased risk of dying by suicide. One year after diagnosis, the rate of suicide was 21.6 (95% confidence intervals: 14.9-28.4, number of events (N): 39) per 100,000 low-survival cancer patients compared to 9.5 (5.6-14.6, N:16) per 100,000 matched controls. For COPD patients, the one-year suicide rate was 22.4 (19.4-25.5, N:208) per 100,000 COPD patients (matched controls: 10.6, 8.3-13.0, N:85), for ischaemic heart disease 16.1 (14.1-18.2, N:225) per 100,000 patients (matched controls: 8.8, 7.1-10.4, N:128), for degenerative neurological conditions 114.5 (49.6-194.7, N:11) per 100,000 patients. The increase in risk was more pronounced in the first six months after diagnosis or first treatment. INTERPRETATION A diagnosis of severe physical illness is associated with higher suicide risk. The interaction of physical and mental illness emphasises the importance of collaborative physical and mental health care in these patients. FUNDING The Office for National Statistics. KES is the Laing Galazka chair in palliative care at King's College London, funded by an endowment from Cicely Saunders International and the Kirby Laing Foundation.
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Affiliation(s)
- Vahé Nafilyan
- Health Analysis and Life Events Division, Office for National Statistics, Newport, UK
| | - Jasper Morgan
- Health Analysis and Life Events Division, Office for National Statistics, Newport, UK
| | - David Mais
- Health Analysis and Life Events Division, Office for National Statistics, Newport, UK
| | - Katherine E. Sleeman
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Asim Butt
- Health Analysis and Life Events Division, Office for National Statistics, Newport, UK
| | - Isobel Ward
- Health Analysis and Life Events Division, Office for National Statistics, Newport, UK
| | - James Tucker
- Health Analysis and Life Events Division, Office for National Statistics, Newport, UK
| | - Louis Appleby
- Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, UK
| | - Myer Glickman
- Health Analysis and Life Events Division, Office for National Statistics, Newport, UK
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32
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Cervantes PE, Brown DS, Horwitz SM. Suicidal ideation and intentional self-inflicted injury in autism spectrum disorder and intellectual disability: An examination of trends in youth emergency department visits in the United States from 2006 to 2014. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:226-243. [PMID: 35608134 PMCID: PMC9684352 DOI: 10.1177/13623613221091316] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
LAY ABSTRACT Youth suicide is a major problem in the United States and globally, but little is known about suicide risk in autistic youth and youth with intellectual disability specifically. Using data from the National Emergency Department Sample, which is the largest database of emergency department visits in the United States, we found that emergency department visits with a suicidal ideation or intentional self-inflicted injury diagnosis were more common in autistic youth and youth with intellectual disability than in youth without these diagnoses (i.e. the comparison group). This was true when examining both suicidal ideation diagnoses and intentional self-inflicted injury diagnoses at emergency department visits. In addition, the number of emergency department visits with a suicidal ideation or intentional self-inflicted injury diagnosis increased more from 2006 to 2014 in autistic youth and youth with intellectual disability compared with the comparison group. We also found both similarities and differences when examining factors, such as age, sex, and co-occurring mental health conditions, related to emergency department visits with a suicidal ideation or intentional self-inflicted injury diagnosis across groups that may be helpful for understanding suicide risk. It is urgent that we improve our understanding, assessment, and treatment of suicidality and self-harm in these groups through more research and clinical efforts.
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Affiliation(s)
- Paige E. Cervantes
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
| | - Derek S. Brown
- Brown School, Washington University in St. Louis, St. Louis, MO
| | - Sarah M. Horwitz
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
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Filser M, Buchner A, Fink GR, Gold SM, Penner IK. The manifestation of affective symptoms in multiple sclerosis and discussion of the currently available diagnostic assessment tools. J Neurol 2023; 270:171-207. [PMID: 36129540 PMCID: PMC9813146 DOI: 10.1007/s00415-022-11359-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 08/27/2022] [Accepted: 08/29/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION In addition to physical and cognitive symptoms, patients with multiple sclerosis (MS) have an increased risk of experiencing mental health problems. METHODS This narrative review provides an overview of the appearance and epidemiology of affective symptoms in MS such as depression, anxiety, bipolar disorder, euphoria, and pseudobulbar affect. Furthermore, the association between affective symptoms and quality of life and the currently used diagnostic instruments for assessing these symptoms are considered whereby relevant studies published between 2009 and 2021 were included in the review. RESULTS Patients with mild and moderate disability more frequently reported severe problems with depression and anxiety than severe mobility problems. Apart from the occurrence of depression, little is known about the association of other affective symptoms such as anxiety, bipolar disorder, euphoria, and pseudobulbar affect and subsyndromal symptoms, which fail to meet the diagnostic criteria but are nevertheless a significant source of distress. Although there are a few recommendations in the research to perform routine screenings for diagnosable affective disorders, a standardized diagnostic procedure to assess subsyndromal symptoms is still lacking. As the applied measurements are diverse and show low accuracy to detect these symptoms, patients who experience affective symptoms are less likely to be identified. DISCUSSION In addition to the consideration of definite psychiatric diagnoses, there is an unmet need for a common definition and assessment of disease-related affective symptoms in MS. Future studies should focus on the improvement and standardization of a common diagnostic procedure for subsyndromal affective symptoms in MS to enable integrated and optimal care for patients.
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Affiliation(s)
- Melanie Filser
- Department of Experimental Psychology, Heinrich Heine University, Düsseldorf, Germany.,COGITO Centre for Applied Neurocognition and Neuropsychological Research, Life Science Centre, Düsseldorf, Germany
| | - Axel Buchner
- Department of Experimental Psychology, Heinrich Heine University, Düsseldorf, Germany
| | - Gereon Rudolf Fink
- Department of Neurology, University of Cologne, Cologne, Germany.,Institute of Neuroscience and Medicine (INM-3), Research Centre, Cognitive Neuroscience, Jülich, Germany
| | - Stefan M Gold
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin (CBF), Charité Universitätsmedizin Berlin, Berlin, Germany.,Medical Department, Section Psychosomatics, Charité Universitätsmedizin Berlin, Berlin, Germany.,Institute of Neuroimmunology and Multiple Sclerosis (INIMS), Center for Molecular Neurobiology, University Medical Center, Hamburg-Eppendorf, Germany
| | - Iris-Katharina Penner
- Department of Neurology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany. .,COGITO Centre for Applied Neurocognition and Neuropsychological Research, Life Science Centre, Düsseldorf, Germany. .,Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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34
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Wang H, Zhang Y, Tan G, Chen D, Fu Y, Liu L. Suicidality and epilepsy: A systematic review and meta-analysis. Front Psychiatry 2023; 14:1097516. [PMID: 37065883 PMCID: PMC10090680 DOI: 10.3389/fpsyt.2023.1097516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/16/2023] [Indexed: 04/18/2023] Open
Abstract
Background We aimed to evaluate the association between epilepsy and suicidality, including suicidal ideation, attempts and completed suicide. Methods We systematically searched PubMed, Embase, Cochrane Online Library, and Clinicaltrials.gov from 1946 to June 21, 2021 and assessed the quality of the studies using the Newcastle-Ottawa Scale. We calculated the pooled OR and the crude rate for suicidal ideation, suicide attempts and completed suicide in patients with epilepsy (PWE). Results We screened 2,786 studies and included 88 articles with 1,178,401 PWE and 6,900,657 participants as controls. Search terms included epilepsy and suicide. The pooled rates of suicidal ideation, suicide attempts and completed suicide in PWE were 19.73% (95% CI: 17.00-22.62%), 5.96% (95% CI: 4.82-7.20%), and 0.24% (95% CI: 0.11-0.42%), respectively. Compared to the control group, PWE were at a significantly higher risk of total suicidality (pooled OR, 2.60; 95%: 2.13-3.18), including suicidal ideation (pooled OR, 2.70; 95% CI, 2.21-3.30), suicide attempts (pooled OR, 2.74; 95% CI, 2.08-3.61) and completed suicide (pooled OR, 2.36; 95% CI, 1.45-3.83). Subgroup analyses showed significant differences in the subgroups of the measurement of suicidality. Conclusion The rate of suicidal ideation, suicide attempts and completed suicide in PWE were about 19.73, 5.96, and 0.24%. And there was an increased risk of suicidality in PWE especially temporal lobe epilepsy and drug-resistant epilepsy. Clinicians need to be aware of this risk in PWE with early identification and prevention at the time of diagnosis.Protocol Registration: PROSPERO CRD42021278220.
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Affiliation(s)
- Haijiao Wang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha City, China
| | - Yu Zhang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
- Department of Neurology, Chengdu Shangjin Nanfu Hospital, Chengdu, China
| | - Ge Tan
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Deng Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yaoqi Fu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Ling Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Ling Liu,
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35
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Alothman D, Card T, Lewis S, Tyrrell E, Fogarty AW, Marshall CR. Risk of Suicide After Dementia Diagnosis. JAMA Neurol 2022; 79:2796654. [PMID: 36190708 PMCID: PMC9531071 DOI: 10.1001/jamaneurol.2022.3094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/01/2022] [Indexed: 11/14/2022]
Abstract
Importance Patients with dementia may be at an increased suicide risk. Identifying groups at greatest risk of suicide would support targeted risk reduction efforts by clinical dementia services. Objectives To examine the association between a dementia diagnosis and suicide risk in the general population and to identify high-risk subgroups. Design, Setting, and Participants This was a population-based case-control study in England conducted from January 1, 2001, through December 31, 2019. Data were obtained from multiple linked electronic records from primary care, secondary care, and the Office for National Statistics. Included participants were all patients 15 years or older and registered in the Office for National Statistics in England with a death coded as suicide or open verdict from 2001 to 2019. Up to 40 live control participants per suicide case were randomly matched on primary care practice and suicide date. Exposures Patients with codes referring to a dementia diagnosis were identified in primary care and secondary care databases. Main Outcomes and Measures Odds ratios (ORs) were estimated using conditional logistic regression and adjusted for sex and age at suicide/index date. Results From the total sample of 594 674 patients, 580 159 (97.6%) were controls (median [IQR] age at death, 81.6[72.0-88.4] years; 289 769 male patients [50.0%]), and 14 515 (2.4%) died by suicide (median [IQR] age at death, 47.4 [36.0-59.7] years; 10 850 male patients [74.8%]). Among those who died by suicide, 95 patients (1.9%) had a recorded dementia diagnosis (median [IQR] age at death, 79.5 [67.1-85.5] years; median [IQR] duration of follow-up, 2.3 [1.0-4.4] years). There was no overall significant association between a dementia diagnosis and suicide risk (adjusted OR, 1.05; 95% CI, 0.85-1.29). However, suicide risk was significantly increased in patients diagnosed with dementia before age 65 years (adjusted OR, 2.82; 95% CI, 1.84-4.33), in the first 3 months after diagnosis (adjusted OR, 2.47; 95% CI, 1.49-4.09), and in patients with dementia and psychiatric comorbidity (adjusted OR, 1.52; 95% CI, 1.21-1.93). In patients younger than 65 years and within 3 months of diagnosis, suicide risk was 6.69 times (95% CI, 1.49-30.12) higher than in patients without dementia. Conclusions and Relevance Diagnostic and management services for dementia, in both primary and secondary care settings, should target suicide risk assessment to the identified high-risk groups.
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Affiliation(s)
- Danah Alothman
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Timothy Card
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Sarah Lewis
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Edward Tyrrell
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Andrew W. Fogarty
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Charles R. Marshall
- Preventive Neurology Unit, Wolfson Institute of Population Health, London, United Kingdom
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Tang WK, Tsoi KKF, Chung CP, Kim JS. Risk of self-harm in post TIA patients: A population-based cohort study. J Psychosom Res 2022; 159:110937. [PMID: 35605442 DOI: 10.1016/j.jpsychores.2022.110937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The purpose of this study was to determine whether individuals who have experienced a transient ischemic attack (TIA) have an increased risk of self-harm behaviors. METHODS In this matched cohort study, we reviewed the electronic health records of all patients admitted for any reason to Hong Kong public hospitals between January 1, 1993, and December 31, 2019. We selected a post-TIA cohort consisting of 37,356 patients and a comparison cohort comprising 37,352 subjects. All participants enrolled in this study were followed up until a diagnosis of self-harm, death from other causes, or the end of 2020, whichever occurred first. Univariate Cox proportional hazards regression models were used to calculate the risk of self-harm since the onset of TIA. RESULTS Throughout the 27-year study period, the number of individuals exhibiting self-harm behavior in the TIA and comparison groups was 1031 (2.76%) and 512 (1.37%), respectively. The TIA group had a higher proportion of subjects with self-harm (χ2 = 178, p < .001). The incidence rates of self-harm were 33.94 and 19.27 per 10,000 person-years in TIA patients and comparators, respectively. Compared with the comparators, the adjusted hazard ratio for self-harm in TIA patients was 1.63 (95% confidence interval, 1.46-1.82). CONCLUSIONS TIA is associated with an increased risk of self-harm. Healthcare professionals should help identify patients at heightened risk and provide efficient and targeted prevention strategies for this population.
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Affiliation(s)
- Wai Kwong Tang
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, SAR, China.
| | - Kelvin K F Tsoi
- Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, SAR, China; Stanley Ho Big Data Decision Analytics Research Centre, Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Chih-Ping Chung
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; College of Medicine, National Yang Ming Chiao Tung University, Hsin-Chu, Taiwan
| | - Jong S Kim
- Department of Neurology, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
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Abstract
PURPOSE OF REVIEW Epilepsy has a bidirectional association with suicidality, and epilepsy patients are at much higher risk for suicide than the general population. This article reviews the recent literature on suicide risk factors, assessments, and management as they pertain specifically to suicidality in people with epilepsy, a population that requires unique considerations. RECENT FINDINGS Risk factors for suicidality include younger age (independent of comorbid psychiatric disorders), poor social support, psychiatric comorbidity (depression, anxiety, obsessive-compulsive symptoms, and alcohol use), and epilepsy-related factors (more frequent seizures, temporal lobe epilepsy, and drug-resistant epilepsy). Most clinicians agree with the need for addressing suicidality; however, there is inconsistency in the approach to caring for these patients. An example neurology clinic-based approach is outlined. Although PWE are at risk for suicide and risk factors have been characterized, care gaps remain. Screening strategies may help close these gaps.
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Affiliation(s)
- Luciana Giambarberi
- Department of Psychiatry, Wake Forest University School of Medicine, Winston-Salem, NC, USA. .,Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Heidi M Munger Clary
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Kanner AM. Suicidality in Patients With Epilepsy: Why Should Neurologists Care? Front Integr Neurosci 2022; 16:898547. [PMID: 35712347 PMCID: PMC9196893 DOI: 10.3389/fnint.2022.898547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 03/30/2022] [Indexed: 11/26/2022] Open
Abstract
Suicidality is a relatively common comorbidity in patients with epilepsy (PWE). Population-based studies have revealed lifetime prevalence rates of 25% of suicidal ideation (SI). In addition, PWE without comorbid psychiatric disorders has two to three higher risk of committing suicide and this risk increases by 12- to 32-fold in the presence of various psychiatric disorders. Risk factors are multiple and include socio-demographic, genetic, age and gender, and psychiatric comorbidities. Among the latter, mood, anxiety, and psychotic disorders have been found to be common risk factors for suicidality in PWE, but iatrogenic causes resulting from pharmacotherapy with antiseizure drugs or epilepsy surgery can also cause SI and behavior. Suicidality and epilepsy have a complex bidirectional relation, whereas PWE are at increased risk of suicidality and vice-versa. Common pathogenic mechanisms operant in both conditions may explain this bidirectional relation. SI can be easily identified in outpatient epilepsy clinics with screening instruments and can be treated and thus prevent its escalation to suicidal attempts and completed suicide. The aim of this manuscript is to review these data in detail.
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Jeong SH, Hoon Kim S, Lee DW, Park EC, Jang SY. Association between new-onset Parkinson's disease and suicide risk in South Korea: a nationwide cohort study. BMC Psychiatry 2022; 22:341. [PMID: 35581575 PMCID: PMC9115980 DOI: 10.1186/s12888-022-03990-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/12/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Parkinson's disease (PD) is an increasingly common neurodegenerative disease in an aging society. Whether PD is associated with an increased suicide risk is unclear. Thus, we investigated the effect of new-onset PD on suicide. METHODS Using the National Health Insurance Service Senior Sample Cohort of South Korea, 17,143 incident PD patients and 17,143 risk set controls, matched by propensity score, were selected for follow-up. The incidence rate of suicide and 95% confidence interval (CI) were calculated based on a generalized linear model of the Poisson distribution. Effect sizes were expressed as hazard ratios (HRs) using the Cox proportional hazards model with a robust variance estimator that incorporated clustering within matched pairs. RESULTS The incidence rate of suicide was 206.7 cases per 100,000 person-years (95% CI, 172.8-246.9) among the PD cohort. Compared to the matched controls, patients with PD were 2.64 times (HR, 2.64; 95% CI, 1.31-5.30) more likely to commit suicide during the first 180 days of follow-up and 2.47 times (HR, 2.47; 95% CI, 1.42-4.28) within the first 365 days of follow-up. During the entire follow-up period, patients with PD were 2.26 times more likely to commit suicide than were their matched controls (HR, 2.26; 95% CI, 1.67-3.06). CONCLUSION Our findings indicated an increased risk of suicide in patients with new-onset PD, regardless of the period after diagnosis. Incorporating mental health care with social and environmental interventions into primary care and PD-specialized care can help reduce suicide risk in people with PD, improving suicide prevention, identification, and risk assessment.
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Affiliation(s)
- Sung Hoon Jeong
- grid.15444.300000 0004 0470 5454Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea ,grid.15444.300000 0004 0470 5454Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Seung Hoon Kim
- grid.15444.300000 0004 0470 5454Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea ,grid.15444.300000 0004 0470 5454Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Doo Woong Lee
- grid.15444.300000 0004 0470 5454Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Eun-Cheol Park
- grid.15444.300000 0004 0470 5454Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea ,grid.15444.300000 0004 0470 5454Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Suk-Yong Jang
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea. .,Department of Healthcare Management, Graduate School of Public Health, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Intra-Cardiac Arrest Transport and Survival from Out-of-Hospital Cardiac Arrest: A Nationwide Observational Study. Resuscitation 2022; 175:50-56. [PMID: 35487463 DOI: 10.1016/j.resuscitation.2022.04.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 11/20/2022]
Abstract
AIM To assess whether intra-cardiac arrest transport as compared to continued on-scene resuscitation was associated with improved clinical outcomes among out-of-hospital cardiac arrest patients in Denmark. METHODS This was an observational study using data from population-based registries in Denmark. Adults (aged ≥18 to ≤65 years) with an out-of-hospital cardiac arrest attended by Emergency Medical Services (EMS) between 2016 and 2018 were included. The primary outcome was survival to 30 days. Time-dependent propensity score matching was used to match patients transported to the hospital within 20 minutes of EMS arrival to patients with assumed on-scene resuscitation (with or without subsequent intra-cardiac arrest transport) at risk of being transported within the same minute. RESULTS The full cohort included 2,873 cardiac arrests. The median age was 56 (quartiles: 48 to 62) years, 1987 (69%) were male, and 104 (4%) were transported within 20 minutes. A total of 87 transported patients were matched to 87 patients at risk of being transported based on the propensity score. Although not reaching statistical significance, in comparison with on-scene resuscitation, intra-cardiac arrest transport was associated with increased survival to 30 days (risk ratio, 1.55; 95%CI, 0.99 to 2.44; P = 0.06). Similar associations were observed for return of spontaneous circulation and survival to one year. CONCLUSIONS Among patients aged 18 to 65 years, intra-cardiac arrest transport was associated with a non-significant increase in survival within 20 minutes of EMS on-scene arrival. However, the results did not eliminate the potential for bias and the results should be interpreted carefully.
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Alothman D, Marshall CR, Tyrrell E, Lewis S, Card T, Fogarty A. Risk of mortality from suicide in patients with Huntington's disease is increased compared to the general population in England. J Neurol 2022; 269:4436-4439. [PMID: 35344078 PMCID: PMC9293836 DOI: 10.1007/s00415-022-11085-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 02/06/2022] [Accepted: 03/15/2022] [Indexed: 12/02/2022]
Abstract
Objective To examine the relative risk of suicide mortality in patients with Huntington’s disease (HD). Methods A case–control study design was used. We used linked electronic records from primary care, secondary care and Office for National Statistics from England from 2001 through 2019. Controls were matched to cases by general practice and suicide date. Odds ratios (ORs) were adjusted for gender and age at suicide/index date. Results Data were available for 594,674 individuals. Patients with HD who died from suicide were significantly younger at time of death than patients with HD who died from causes other than suicide (p < 0.001). The adjusted OR for HD was 9.2 (95% confidence intervals, CI 4.9–17.4) compared to those without HD. The increase in risk was higher amongst the younger age group who were ≤ 45.8 years at suicide/index date (OR 54.5, 95% CI 10.8–276.1). Conclusion The markedly elevated suicide risk in patients with HD suggests that implementation of suicide risk assessment may improve survival in individuals with these diseases, especially in younger patients. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-022-11085-z.
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Affiliation(s)
- Danah Alothman
- School of Medicine, University of Nottingham, Nottingham, UK.
| | - Charles R Marshall
- Preventive Neurology Unit, Wolfson Institute of Population Health, London, EC1M 6BQ, UK
| | - Edward Tyrrell
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Sarah Lewis
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Timothy Card
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Andrew Fogarty
- School of Medicine, University of Nottingham, Nottingham, UK
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Naismith H, Howard R, Stewart R, Pitman A, Mueller C. Suicidal ideation in dementia: associations with neuropsychiatric symptoms and subtype diagnosis. Int Psychogeriatr 2022; 34:1-8. [PMID: 35331357 DOI: 10.1017/s1041610222000126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To investigate factors associated with suicidal ideation (SI) around the time of dementia diagnosis. We hypothesised relatively preserved cognition, co-occurring physical and psychiatric disorders, functional impairments, and dementia diagnosis subtype would be associated with a higher risk of SI. DESIGN Cross-sectional study using routinely collected electronic mental healthcare records. SETTING National Health Service secondary mental healthcare services in South London, UK, serving a population of over 1.36 million residents. PARTICIPANTS Patients who received a diagnosis of dementia (Alzheimer's, vascular, mixed Alzheimer's/vascular, or dementia with Lewy bodies) between 1 Nov 2007-31 Oct 2021: 18,252 people were identified during the observation period. MEASUREMENTS A natural language processing algorithm was used to identify recorded clinician recording of SI around the time of dementia diagnosis. Sociodemographic and clinical characteristics were also measured around the time of diagnosis. We compared people diagnosed with non-Alzheimer's dementia to those with Alzheimer's and used statistical models to adjust for putative confounders. RESULTS 15.1% of patients had recorded SI, which was more common in dementia with Lewy bodies compared to other dementia diagnoses studied. After adjusting for sociodemographic and clinical factors, SI was more frequent in those with depression and dementia with Lewy bodies and less common in those with impaired activities of daily living and in vascular dementia. Agitated behavior and hallucinations were not associated with SI in the final model. CONCLUSIONS Our findings highlight the importance of identifying and treating depressive symptoms in people with dementia and the need for further research into under-researched dementia subtypes.
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Affiliation(s)
- Hamish Naismith
- Central and North West London NHS Foundation Trust, London, UK
- UCL Division of Psychiatry, London, UK
| | - Robert Howard
- UCL Division of Psychiatry, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Robert Stewart
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Alexandra Pitman
- UCL Division of Psychiatry, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Christoph Mueller
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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Schmutte T, Olfson M, Maust DT, Xie M, Marcus SC. Suicide risk in first year after dementia diagnosis in older adults. Alzheimers Dement 2022; 18:262-271. [PMID: 34036738 PMCID: PMC8613307 DOI: 10.1002/alz.12390] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/30/2021] [Accepted: 04/26/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Receiving a diagnosis of Alzheimer's disease or related dementias (ADRD) can be a pivotal and stressful period. We examined the risk of suicide in the first year after ADRD diagnosis relative to the general geriatric population. METHODS We identified a national cohort of Medicare fee-for-service beneficiaries aged ≥ 65 years with newly diagnosed ADRD (n = 2,667,987) linked to the National Death Index. RESULTS The suicide rate for the ADRD cohort was 26.42 per 100,000 person-years. The overall standardized mortality ratio (SMR) for suicide was 1.53 (95% confidence interval [CI] = 1.42, 1.65) with the highest risk among adults aged 65 to 74 years (SMR = 3.40, 95% CI = 2.94, 3.86) and the first 90 days after ADRD diagnosis. Rural residence and recent mental health, substance use, or chronic pain conditions were associated with increased suicide risk. DISCUSSION Results highlight the importance of suicide risk screening and support at the time of newly diagnosed dementia, particularly for patients aged < 75 years.
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Affiliation(s)
| | - Mark Olfson
- Columbia University, Department of Psychiatry and the New York State Psychiatric Institute
| | - Donovan T. Maust
- Department of Psychiatry, University of Michigan, Ann Arbor, Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Ming Xie
- University of Pennsylvania, Department of Psychiatry
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Rota S, Boura I, Wan YM, Lazcano-Ocampo C, Rodriguez-Violante M, Antonini A, Chaudhuri KR. Spotlight on non-motor symptoms and Covid-19. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2022; 165:103-133. [PMID: 36208897 PMCID: PMC9270874 DOI: 10.1016/bs.irn.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Coronavirus Disease 2019 (Covid-19) pandemic has profoundly affected the quality of life (QoL) and health of the general population globally over the past 2 years, with a clear impact on people with Parkinson's Disease (PwP, PD). Non-motor symptoms have been widely acknowledged to hold a vital part in the clinical spectrum of PD, and, although often underrecognized, they significantly contribute to patients' and their caregivers' QoL. Up to now, there have been numerous reports of newly emerging or acutely deteriorating non-motor symptoms in PwP who had been infected by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), while some of these symptoms, like fatigue, pain, depression, anxiety and cognitive impairment, have also been identified as part of the long-COVID syndrome due to their persistent nature. The subjacent mechanisms, mediating the appearance or progression of non-motor symptoms in the context of Covid-19, although probably multifactorial in origin, remain largely unknown. Such mechanisms might be, at least partly, related solely to the viral infection per se or the lifestyle changes imposed during the pandemic, as many of the non-motor symptoms seem to be prevalent even among Covid-19 patients without PD. Here, we summarize the available evidence and implications of Covid-19 in non-motor PD symptoms in the acute and chronic, if applicable, phase of the infection, with a special reference on studies of PwP.
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Psychiatric comorbidity and risk of premature mortality and suicide among those with chronic respiratory diseases, cardiovascular diseases, and diabetes in Sweden: A nationwide matched cohort study of over 1 million patients and their unaffected siblings. PLoS Med 2022; 19:e1003864. [PMID: 35085232 PMCID: PMC8794193 DOI: 10.1371/journal.pmed.1003864] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 11/05/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Persons with noncommunicable diseases have elevated rates of premature mortality. The contribution of psychiatric comorbidity to this is uncertain. We aimed to determine the risks of premature mortality and suicide in people with common noncommunicable diseases, with and without psychiatric disorder comorbidity. METHODS AND FINDINGS We used nationwide registries to study all individuals born in Sweden between 1932 and 1995 with inpatient and outpatient diagnoses of chronic respiratory diseases (n = 249,825), cardiovascular diseases (n = 568,818), and diabetes (n = 255,579) for risks of premature mortality (≤age 65 years) and suicide until 31 December 2013. Patients diagnosed with either chronic respiratory diseases, cardiovascular diseases, or diabetes were compared with age and sex-matched population controls (n = 10,345,758) and unaffected biological full siblings (n = 1,119,543). Comorbidity with any psychiatric disorder, and by major psychiatric categories, was examined using diagnoses from patient registers. Associations were quantified using stratified Cox regression models that accounted for time at risk, measured sociodemographic factors, and unmeasured familial confounders via sibling comparisons. Within 5 years of diagnosis, at least 7% (range 7.4% to 10.8%; P < 0.001) of patients with respiratory diseases, cardiovascular diseases, or diabetes (median age at diagnosis: 48 to 54 years) had died from any cause, and 0.3% (0.3% to 0.3%; P < 0.001) had died from suicide, 25% to 32% of people with these medical conditions had co-occurring lifetime diagnoses of any psychiatric disorder, most of which antedated the medical diagnosis. Comorbid psychiatric disorders were associated with higher all-cause mortality (15.4% to 21.1%) when compared to those without such conditions (5.5% to 9.1%). Suicide mortality was also elevated (1.2% to 1.6% in comorbid patients versus 0.1% to 0.1% without comorbidity). When we compared relative risks with siblings without noncommunicable diseases and psychiatric disorders, the comorbidity with any psychiatric disorder was associated with substantially increased mortality rates (adjusted HR range: aHRCR = 7.2 [95% CI: 6.8 to 7.7; P < 0.001] to aHRCV = 8.9 [95% CI: 8.5 to 9.4; P < 0.001]). Notably, comorbid substance use disorders were associated with a higher mortality rate (aHR range: aHRCR = 8.3 [95% CI: 7.6 to 9.1; P < 0.001] to aHRCV = 9.9 [95% CI: 9.3 to 10.6; P < 0.001]) than depression (aHR range: aHRCR = 5.3 [95% CI: 4.7 to 5.9; P < 0.001] to aHRCV = 7.4 [95% CI: 7.0 to 7.9; P < 0.001]), but risks of suicide were similar for these 2 psychiatric comorbidities. One limitation is that we relied on secondary care data to assess psychiatric comorbidities, which may have led to missing some patients with less severe comorbidities. Residual genetic confounding is another limitation, given that biological full siblings share an average of half of their cosegregating genes. However, the reported associations remained large even after adjustment for shared and unmeasured familial confounders. CONCLUSIONS In this longitudinal study of over 1 million patients with chronic health diseases, we observed increased risks of all-cause and suicide mortality in individuals with psychiatric comorbidities. Improving assessment, treatment, and follow-up of people with comorbid psychiatric disorders may reduce the risk of mortality in people with chronic noncommunicable diseases.
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Affiliation(s)
- Elena Portacolone
- Address correspondence to: Elena Portacolone, PhD, MPH, MBA, Institute for Health & Aging, University of California San Francisco, 490 Illinois Street, 12th Floor, San Francisco, CA 94158, USA. E-mail:
| | - Amy L Byers
- School of Medicine, University of California San Francisco, San Francisco, California, USA
- San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - Jodi Halpern
- University of California Berkeley-University of California San Francisco Joint Medical Program, School of Public Health, University of California, Berkeley, California, USA
| | - Deborah E Barnes
- School of Medicine, University of California San Francisco, San Francisco, California, USA
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Schneider B, Reif A, Wagner B, Wolfersdorf M. [Why do we require clinical guidelines for suicide prevention?]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 65:58-66. [PMID: 34967913 PMCID: PMC8732821 DOI: 10.1007/s00103-021-03468-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/26/2021] [Indexed: 11/28/2022]
Abstract
Trotz der Relevanz des Themas Suizidalität und gut bekannter Risikofaktoren gibt es bisher keine deutsche Leitlinie zur Suizidalität im Erwachsenenalter. In diesem Beitrag werden zunächst die Geschichte und die Hintergründe der Arbeit mit Leitlinien beschrieben. Der aktuelle Stand der Leitlinien für psychische Erkrankungen in Deutschland wird dargestellt und auf suizidpräventive Inhalte hin untersucht. Die Notwendigkeit evidenzbasierter Suizidprävention und einer spezifischen Leitlinie zur Suizidprävention bei Erwachsenen wird diskutiert. Nur durch gezielte Suizidpräventionsstrategien und Interventionen für die jeweiligen Risikogruppen und unter Beachtung von Alters- und Geschlechtsspezifität kann für alle Betroffenen eine flächendeckende, gut erreichbare, bedarfs- und versorgungsgerechte, finanzierbare sowie nachhaltige medizinische Versorgung auf einem hohen Niveau sichergestellt werden. Dies gilt für den ambulanten und den stationären Bereich sowie für deren Schnittstellen. Bei Suizidalität handelt es sich um ein diagnoseübergreifendes, in unterschiedlichen Versorgungskontexten auftretendes Syndrom mit komplexem Behandlungsbedarf, weshalb intersektorale und multiprofessionelle Aspekte in einer entsprechenden Leitlinie besonders zu adressieren sind. Wissenschaftliche Evidenz und interdisziplinärer Konsens unter Expertinnen und Experten zum Umgang mit suizidalem Verhalten in der medizinischen Versorgung können dazu beitragen, Morbidität und Mortalität im Zusammenhang mit Suizidalität zu reduzieren. Im August 2021 wurde die Finanzierung einer S3-Leitlinie „Umgang mit Suizidalität“ vom Innovationsfonds des Gemeinsamen Bundesausschusses bewilligt.
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Affiliation(s)
- Barbara Schneider
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie, Johann Wolfgang-Goethe-Universität Frankfurt/Main, Frankfurt/Main, Deutschland. .,Abteilung für Abhängigkeitserkrankungen, Psychiatrie und Psychotherapie, LVR-Klinik Köln, Wilhelm-Griesinger-Str. 23, 51109, Köln, Deutschland.
| | - Andreas Reif
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie, Johann Wolfgang-Goethe-Universität Frankfurt/Main, Frankfurt/Main, Deutschland
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Joiner TE, Robison M. Robin's Wish and the Complex Causal Web of Death by Suicide. Arch Suicide Res 2021; 27:275-279. [PMID: 34632954 DOI: 10.1080/13811118.2021.1988786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The documentary film Robin's Wish aims to reclaim the media scrutiny around Robin Williams' death, fixating on causation being solely attributed to a postmortem diagnosis of which Williams was unaware-Lewy Body Dementia. The film and other sources as well defined and animated the view that Williams' death by suicide was fully a result of this medical condition, dismissing any possible role for mental disorders. The need to distance from mental disorders can have a palpable undercurrent of stigmatization of them; the documentary missed the opportunity to make its point and simultaneously build allyship with others who have lost someone to suicide who were clearly battling a mental disorder. In this context, we emphasize the importance of looking at causation mediationally (e.g., a neurological condition triggering a major depressive episode culminating, in turn, in death by suicide). Only through encompassing all elements and complexities of the human spirit and condition can we appropriately pay tribute to those we have lost to suicide and simultaneously de-stigmatize mental disorders.
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Nakamura K, Sekijima Y. [Genetic counseling and predictive testing for hereditary neuromuscular diseases]. Rinsho Shinkeigaku 2021; 61:588-593. [PMID: 34433746 DOI: 10.5692/clinicalneurol.cn-001608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Recent progress in genetic analysis can provide a precision diagnosis for many hereditary neuromuscular diseases in daily practice. Moreover, disease-modifying therapies such as nucleic acid medicine for patients with several neuromuscular diseases (i.e., hereditary ATTR amyloidosis, spinal muscular atrophy, and Duchenne muscular dystrophy) have been approved in Japan. For all neurologists, knowledge and practical skills of genetic counseling, especially predictive testing, will increase in importance. To promote personalized medicine for patients with neuromuscular diseases and their families, it is necessary to develop of genetic counseling systems, including nurturing genetic professionals.
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Affiliation(s)
- Katsuya Nakamura
- Center for Medical Genetics, Shinshu University Hospital.,Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine
| | - Yoshiki Sekijima
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine
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Minen MT, Stieglitz EJ. Wearables for Neurologic Conditions: Considerations for Our Patients and Research Limitations. Neurol Clin Pract 2021; 11:e537-e543. [PMID: 34484952 DOI: 10.1212/cpj.0000000000000971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 07/07/2020] [Indexed: 12/24/2022]
Abstract
Purpose of Review In 2019, over 50 million Americans were expected to use wearables at least monthly. The technologies have varied capabilities, with many designed to monitor health conditions. We present a narrative review to raise awareness of wearable technologies that may be relevant to the field of neurology. We also discuss the implications of these wearables for our patients and briefly discuss issues related to researching new wearable technologies. Recent Findings There are a variety of wearables for neurologic conditions, e.g., stroke (for potential arrhythmia capture), epilepsy, Parkinson disease, and sleep. Research is being performed to capture the risk of neuropsychiatric relapse. However, data are limited and adherence to these wearables is often poorly studied. Summary The care of neurology patients may ultimately be improved with the use of wearable technologies. More research needs to examine efficacy and implementation strategies.
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Affiliation(s)
- Mia T Minen
- Division of Headache Medicine (MTM), NYU Langone Departments of Neurology and Population Health, New York, NY; and CIPPA/US (EJS), New York, NY
| | - Eric J Stieglitz
- Division of Headache Medicine (MTM), NYU Langone Departments of Neurology and Population Health, New York, NY; and CIPPA/US (EJS), New York, NY
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