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Weiss JR, Sharobeam M, Faden J. "The Demons Made Me Do It": When Delusions of Possession Lead to Attempted Inpatient Suicide. J Nerv Ment Dis 2024; 212:68-69. [PMID: 38166184 DOI: 10.1097/nmd.0000000000001720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Affiliation(s)
- Jacob R Weiss
- Department of Psychiatry and Behavioral Science, Temple University Hospital, Philadelphia, Pennsylvania
| | - Monica Sharobeam
- Rowan University School of Osteopathic Medicine, Stratford, New Jersey
| | - Justin Faden
- Clinical Psychiatry and Behavioral Science, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
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2
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Ghanem J, Orri M, Moro L, Lavigne KM, Raucher-Chéné D, Malla A, Joober R, Lepage M. Exploring the Relationship Between Suicidality and Persistent Negative Symptoms Following a First Episode of Psychosis. Schizophr Bull 2023:sbad146. [PMID: 37847817 DOI: 10.1093/schbul/sbad146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
BACKGROUND AND HYPOTHESIS Suicide is a leading cause of death in first-episode psychosis (FEP), with an elevated risk during the first year following illness onset. The association between negative symptoms and suicidality remains contentious. Some studies suggest that negative symptoms may be associated with lower suicidality, while others fail to find an association between the two. No previous studies have specifically investigated suicidality in Persistent Negative Symptoms (PNS) and its associated subgroups. STUDY DESIGN In a large cohort of FEP patients (n = 515) from an early intervention service, we investigated suicidality in those with PNS, secondary PNS (ie, sPNS; PNS with clinical-level positive, depressive, or extrapyramidal symptoms), and non-PNS (all other patients) over 24 months. Patients were categorized into PNS groups based on symptoms from month 6 to month 12, and suicidality was evaluated using the Brief Psychiatric Rating Scale (BPRS). STUDY RESULTS Covarying for age and sex, we found that sPNS had higher suicidality relative to PNS and non-PNS throughout the 24-month period, but PNS and non-PNS did not differ. These differences were maintained after adjusting for depressive symptoms. CONCLUSION We observed that PNS did not significantly differ from non-PNS. However, we identified sPNS as a group with elevated suicidality above and beyond depression, suggesting that sPNS would benefit from targeted intervention and that PNS categorization identifies a subgroup for whom negative symptoms are not associated with lower suicidality.
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Affiliation(s)
- Joseph Ghanem
- DouglasMental Health University Institute, McGill University, Montreal, Canada
- Department of Psychology, McGill University, Montreal, Canada
| | - Massimiliano Orri
- DouglasMental Health University Institute, McGill University, Montreal, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Laura Moro
- DouglasMental Health University Institute, McGill University, Montreal, Canada
- Department of Psychology, Université de Montreal, Montreal, Canada
| | - Katie M Lavigne
- DouglasMental Health University Institute, McGill University, Montreal, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
- McGill Centre for Integrative Neuroscience, Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Delphine Raucher-Chéné
- DouglasMental Health University Institute, McGill University, Montreal, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Ashok Malla
- DouglasMental Health University Institute, McGill University, Montreal, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montreal, Canada
| | - Ridha Joober
- DouglasMental Health University Institute, McGill University, Montreal, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montreal, Canada
| | - Martin Lepage
- DouglasMental Health University Institute, McGill University, Montreal, Canada
- Department of Psychology, McGill University, Montreal, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montreal, Canada
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3
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Xu YE, Barron DA, Sudol K, Zisook S, Oquendo MA. Suicidal behavior across a broad range of psychiatric disorders. Mol Psychiatry 2023; 28:2764-2810. [PMID: 36653675 PMCID: PMC10354222 DOI: 10.1038/s41380-022-01935-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 12/12/2022] [Accepted: 12/16/2022] [Indexed: 01/20/2023]
Abstract
Suicide is a leading cause of death worldwide. In 2020, some 12.2 million Americans seriously contemplated suicide, 3.2 million planned suicide attempts, and 1.2 million attempted suicide. Traditionally, the approach to treating suicidal behavior (SB) has been to treat the "underlying" psychiatric disorder. However, the number of diagnoses associated with SB is considerable. We could find no studies describing the range of disorders reported to be comorbid with SB. This narrative review summarizes literature documenting the occurrence of SB across the lifespan and the full range of psychiatric diagnoses, not only BPD and those that comprise MDE, It also describes the relevance of these observations to clinical practice, research, and nosology. The literature searches contained the terms "suicid*" and each individual psychiatric diagnosis and identified 587 studies. We did not include case reports, case series, studies only addressing suicidal ideation or non-suicidal self-injury (NSSI), studies on self-harm, not distinguishing between SB and NSSI and studies that did not include any individuals that met criteria for a specific DSM-5 diagnosis (n = 366). We found that SB (suicide and/or suicide attempt) was reported to be associated with 72 out of 145 diagnoses, although data quality varied. Thus, SB is not exclusively germane to Major Depressive Episode (MDE) and Borderline Personality Disorder (BPD), the only conditions for which it is a diagnostic criterion. That SB co-occurs with so many diagnoses reinforces the need to assess current and past SB regardless of diagnosis, and supports the addition of charting codes to the DSM-5 to indicate current or past SB. It also comports with new data that specific genes are associated with SB independent of psychiatric diagnoses, and suggests that SB should be managed with specific suicide prevention interventions in addition to treatments indicated for co-occurring diagnoses. SB diagnostic codes would help researchers and clinicians document and measure SB's trajectory and response to treatment over time, and, ultimately, help develop secondary and tertiary prevention strategies. As a separate diagnosis, SB would preclude situations in which a potentially life-threatening behavior is not accounted for by a diagnosis, a problem that is particularly salient when no mental disorder is present, as is sometimes the case.
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Affiliation(s)
- Yingcheng E Xu
- Department of Psychiatry and Behavioral Health, Cooper Medical School of Rowan University and Cooper University Health Care, Camden, NJ, 08103, US
| | - Daniel A Barron
- Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center, Philadelphia, PA, 19104, USA
| | - Katherin Sudol
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, 37212, USA
| | - Sidney Zisook
- Department of Psychiatry, University of California San Diego School of Medicine, San Diego, CA, 92103, USA
| | - Maria A Oquendo
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
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4
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F E Almond M, L Nicholls T, L Petersen K, C Seto M, G Crocker A. Exploring the nature and prevalence of targeted violence perpetrated by persons found not criminally responsible on account of mental disorder. BEHAVIORAL SCIENCES & THE LAW 2023. [PMID: 37134138 DOI: 10.1002/bsl.2626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 04/10/2023] [Accepted: 04/17/2023] [Indexed: 05/04/2023]
Abstract
Although mental illness has a demonstrated link with violence, the prevalence of targeted (planned and goal-directed) violence perpetrated by individuals with mental illness and its association with psychiatric symptoms is relatively unexplored. File information was compared for all 293 individuals found not criminally responsible due to mental illness in British Columbia between 2001 and 2005, of whom 19% had committed targeted violence. Most individuals with targeted offenses displayed at least one warning behavior before their offense (93%); all displayed delusions and approximately one third exhibited hallucinations. Compared to individuals who perpetrated non-targeted offenses, the individuals with targeted offenses displayed greater proportions of threats/criminal harassment, had female victims, displayed a psychotic disorder and/or personality disorder, and displayed delusions during the offense. This implies that severe psychiatric disorders do not preclude the perpetration of planned violence and suggests that exploring symptoms of mental illness that may be proximally indicative of targeted violence is important in preventing future acts.
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Affiliation(s)
| | - Tonia L Nicholls
- University of British Columbia, British Columbia, Vancouver, Canada
- British Columbia Mental Health and Substance Use Services, British Columbia, Vancouver, Canada
| | - Karen L Petersen
- University of British Columbia, British Columbia, Vancouver, Canada
- British Columbia Mental Health and Substance Use Services, British Columbia, Vancouver, Canada
| | - Michael C Seto
- University of Ottawa Institute of Mental Health Research at the Royal, Ontario, Ottawa, Canada
| | - Anne G Crocker
- Université de Montréal, Quebec, Montreal, Canada
- Institute National de Psychiatrie Légale Philippe-Pinel, Quebec, Montreal, Canada
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5
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Yin Y, Tong J, Huang J, Tian B, Chen S, Tan S, Wang Z, Yang F, Tong Y, Fan F, Kochunov P, Tan Y, Hong LE. Auditory Hallucinations, Depressive Symptoms, and Current Suicidal Ideation or Behavior Among Patients with Acute-episode Schizophrenia. Arch Suicide Res 2023; 27:323-338. [PMID: 34689715 PMCID: PMC9682271 DOI: 10.1080/13811118.2021.1993399] [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] [Indexed: 10/20/2022]
Abstract
Suicide risk and auditory hallucinations are common in schizophrenia, but less is known about its associations. This cross-sectional study aimed to determine whether the presence and severity of auditory hallucinations were associated with current suicidal ideation or behavior (CSIB) among patients with schizophrenia. We interviewed 299 individuals with schizophrenia and acute symptoms and reviewed their medical records. Measurement included the Psychotic Symptom Rating Scale (PSYRATS-AH), the Calgary Depression Scale for Schizophrenia (CDSS), and the Positive and Negative Syndrome Scale. Logistic regression and path analysis were used. The CSIB prevalence was higher among patients with current auditory hallucination than those without (19.5% vs. 8.6%, crude odds ratio = 2.58, p = .009). Lifetime auditory hallucination experience (adjusted odds ratio [AOR] = 3.81; 95% CI: 1.45-10.05) or current auditory hallucination experience (AOR = 3.22; 95% CI: 1.25-8.28) can elevate the likelihood of CSIB while controlling for depressive symptoms and lifetime suicide-attempt history. Among those with auditory hallucinations, the emotional score of the PSYRATS-AH was positively associated with the CDSS score and there was a small indirect effect of the CDSS score on the association between the emotional domain score and CSIB (bias-corrected 95% CI, 0.02-0.20). In conclusion, the presence of auditory hallucinations was strongly associated with CSIB, independent of depressive symptoms and lifetime suicide attempts. Suicide risk assessment should consider auditory hallucination experience and patients' appraisal of its emotional characteristics. Future cohort studies are necessary to provide more conclusive evidence for the mediating pathways between auditory hallucinations and CSIB.HIGHLIGHTSThe presence of auditory hallucinations was associated with current suicidality.Auditory hallucinations' emotional severity was related to depressive symptoms.The severity of auditory hallucination was not directly associated with suicidality.
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Affiliation(s)
- Yi Yin
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, P. R. China
| | - Jinghui Tong
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, P. R. China
| | - Junchao Huang
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, P. R. China
| | - Baopeng Tian
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, P. R. China
| | - Song Chen
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, P. R. China
| | - Shuping Tan
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, P. R. China
| | - Zhiren Wang
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, P. R. China
| | - Fude Yang
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, P. R. China
| | - Yongsheng Tong
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, P. R. China
- Beijing Suicide Research and Prevention Center, WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, P. R. China
| | - Fengmei Fan
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, P. R. China
| | - Peter Kochunov
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, USA
| | - Yunlong Tan
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, P. R. China
| | - L. Elliot Hong
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, USA
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6
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Attributes of auditory hallucinations that are associated with self-harm: A prospective cohort study. Schizophr Res 2023; 251:30-36. [PMID: 36529105 DOI: 10.1016/j.schres.2022.12.008] [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: 06/21/2022] [Revised: 11/06/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Abstract
There is a well-documented epidemiological association between auditory hallucinations and self-harm in the general population. However, there has been limited research examining specific characteristics of auditory hallucinations (e.g., type, source, or context of voices) as correlates of self-harm. We used prospective data from the Tokyo Teen Cohort to explore whether characteristics of voices reported at age 14 were differentially associated with self-harm behaviors at ages 14 and 16. Among respondents with auditory hallucinations, respondents who experienced voices that "said something bad" about them or commented on their thoughts and actions were most likely to report concurrent self-harm, whereas positive or praising voices were protective. Negative voices continued to predict self-harm two years later, at age 16, even with adjustment for self-harm at age 14. The age of the voices, source of the voices, and context (e.g., falling asleep or while sick) was not associated with likelihood of reporting concurrent or subsequent self-harm behaviors. Assessing for negative voices in particular, rather than auditory hallucinations or psychotic experiences more broadly, may provide a more specific indicator of risk for self-harm among adolescents. The real-world utility of these epidemiological findings should be further examined in clinical settings.
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7
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Chalker SA, Parrish EM, Martinez Ceren CS, Depp CA, Ilgen MA, Goodman M, Twamley EW, Doran N. Crisis service utilization following completion of a suicide safety plan for Veterans with and without affective and nonaffective psychosis. J Psychiatr Res 2022; 154:219-223. [PMID: 35961177 DOI: 10.1016/j.jpsychires.2022.07.034] [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: 05/12/2022] [Revised: 06/30/2022] [Accepted: 07/19/2022] [Indexed: 10/16/2022]
Abstract
OBJECTIVE Psychosis is associated with increased suicide risk. Safety planning is a suicide prevention practice that is associated with decreased suicidal behavior and psychiatric hospitalizations. A common feature of safety planning is listing of crisis line numbers. The primary purpose of this study was to compare Veterans with and without psychosis who completed a safety plan in terms of their next year crisis service use, including Veterans Crisis Line (VCL) calls, and suicidal behavior. METHODS Data were drawn from the VA San Diego's electronic medical record system for (N = 1602) safety plans from 2018 to 2021. Clinical records of crisis services and suicide attempt/death were recorded for one year after the safety plan. RESULTS Following completion of a safety plan, Veterans with psychosis were more likely to have a next year psychiatric hospitalization (OR = 4.1), emergency department visit (OR = 2.3), and psychiatric emergency clinic visit (OR = 2.2) than those without psychosis. In contrast, there were no group differences in likelihood of calling the VCL. CONCLUSIONS Veterans with psychosis who recently completed a safety plan do not show elevated rates of VCL use that are commensurate with increases in crisis service use. Interventions for this high-risk group may focus on understanding the motivation and ability to call the VCL as ways to enhance safety planning.
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Affiliation(s)
- Samantha A Chalker
- VA San Diego Healthcare System, San Diego, CA, USA; University of California, San Diego, Department of Psychiatry, La Jolla, CA, USA.
| | - Emma M Parrish
- University of California, San Diego, Department of Psychiatry, La Jolla, CA, USA
| | | | - Colin A Depp
- VA San Diego Healthcare System, San Diego, CA, USA; University of California, San Diego, Department of Psychiatry, La Jolla, CA, USA
| | - Mark A Ilgen
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; University of Michigan, Department of Psychiatry, Ann Arbor, MI, USA
| | | | - Elizabeth W Twamley
- VA San Diego Healthcare System, San Diego, CA, USA; University of California, San Diego, Department of Psychiatry, La Jolla, CA, USA
| | - Neal Doran
- VA San Diego Healthcare System, San Diego, CA, USA; University of California, San Diego, Department of Psychiatry, La Jolla, CA, USA
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8
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Grover LE, Jones R, Bass NJ, McQuillin A. The differential associations of positive and negative symptoms with suicidality. Schizophr Res 2022; 248:42-49. [PMID: 35933743 DOI: 10.1016/j.schres.2022.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 06/27/2022] [Accepted: 07/24/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND Suicide is one of the leading causes of death in people with schizophrenia. Identifying risk factors for suicide in schizophrenia is therefore an important clinical and research priority. METHOD A cross-sectional secondary analysis was conducted on the DNA Polymorphisms in Mental Illness Study (DPIM) data. Suicidality data was extracted, and the number of positive and negative symptoms were established for a total of 1494 participants. Logistic and negative binomial regression analyses were conducted to assess for associations between positive or negative symptoms and suicidal ideation, attempt, or number of attempts, whilst adjusting for potential confounders. RESULTS Negative symptoms were associated with a reduction in the risk of suicidal ideation (odds ratio [OR]: 0.83; 95 % CI: 0.75-0.91) and suicide attempt (OR: 0.79; 95 % CI: 0.71-0.88) after adjusting for age and sex. Positive symptoms were associated with an increased risk of suicidal ideation (OR: 1.06; 95 % CI: 1.03-1.09), suicide attempt (OR: 1.04; 95 % CI: 1.00-1.07) and number of suicide attempts (incidence rate ratio [IRR]: 1.05; 95 % CI: 1.01-1.08). Further adjusting for depressive symptoms slightly increased the magnitude of associations with negative symptoms but attenuated associations between positive symptoms and suicidality to the null. CONCLUSIONS Negative symptoms are associated with a reduced risk of suicidality, whilst positive symptoms are associated with an increased risk of suicidality. Depressive symptoms may confound or mediate these associations.
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Affiliation(s)
- Laura E Grover
- Molecular Psychiatry Laboratory, Division of Psychiatry, University College London, Rockefeller Building, 21 University Street, London WC1E 6DE, UK.
| | - Rebecca Jones
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7BN, UK
| | - Nicholas J Bass
- Molecular Psychiatry Laboratory, Division of Psychiatry, University College London, Rockefeller Building, 21 University Street, London WC1E 6DE, UK.
| | - Andrew McQuillin
- Molecular Psychiatry Laboratory, Division of Psychiatry, University College London, Rockefeller Building, 21 University Street, London WC1E 6DE, UK.
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González-Rodríguez A, Seeman MV. Differences between delusional disorder and schizophrenia: A mini narrative review. World J Psychiatry 2022; 12:683-692. [PMID: 35663297 PMCID: PMC9150033 DOI: 10.5498/wjp.v12.i5.683] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 03/23/2022] [Accepted: 04/21/2022] [Indexed: 02/06/2023] Open
Abstract
Psychotic syndromes are divided into affective and non-affective forms. Even among the non-affective forms, substantial differences exist. The aim of this relatively brief review is to synthesize what is known about the differences between two non-affective psychoses, schizophrenia and delusional disorder (DD), with respect to clinical, epidemiological, sociodemographic, and treatment response characteristics. A PubMed literature search revealed the following: in schizophrenia, hallucinations, negative symptoms and cognitive symptoms are prominent. They are rare in DD. Compared to schizophrenia patients, individuals with DD maintain relatively good function, and their delusions are believable; many are beliefs that are widely held in the general population. Treatments are generally similar in these two forms of psychosis, with the exception that antidepressants are used more frequently in DD and, for acute treatment, effective antipsychotic doses are lower in DD than in schizophrenia. It is with the hope that the contrasts between these two conditions will aid in the provision of safe and effective treatment for both that this review has been conducted.
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Affiliation(s)
- Alexandre González-Rodríguez
- Department of Mental Health, Mutua Terrassa University Hospital, University of Barcelona, Barcelona 08280, Spain
| | - Mary V Seeman
- Department of Psychiatry, University of Toronto, Toronto M5P 3L6, Ontario, Canada
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10
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Hospital-Based Suicides: Challenging Existing Myths. Psychiatr Q 2022; 93:1-13. [PMID: 33169312 DOI: 10.1007/s11126-020-09856-w] [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] [Accepted: 11/03/2020] [Indexed: 10/23/2022]
Abstract
Myths are widely held and often based on false beliefs. To improve patient safety and speed the translation of research to clinical practice, we highlight and then debunk 10 common myths regarding the assessment, treatment, and management of hospitalized patients at risk for suicide. Myths regarding hospital-based suicides are examined and empirical evidence that counters each myth is offered. Ten common myths regarding hospital-based suicides are found to be untrue or unsupported based on existing empirical evidence. Rethinking common beliefs and practices that lack empirical support and seeking alternatives based on research evidence is consistent with an emphasis on evidence-based practices leading to improved patient care and protection.
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Rimvall MK, Kelleher I. Confide in me: Why clinicians should ask about auditory hallucinations to understand risk for suicidal behaviour. Schizophr Res 2021; 228:314-315. [PMID: 33497904 DOI: 10.1016/j.schres.2020.12.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 12/27/2020] [Accepted: 12/28/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Martin Køster Rimvall
- Child and Adolescent Mental Health Centre, Mental Health Services, Capital Region of Denmark, Gentofte, Denmark; Department of Child and Adolescent Psychiatry, Region Zealand, Roskilde, Denmark
| | - Ian Kelleher
- School of Medicine, University College, Dublin, Ireland; Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland; Lucena Clinic Child and Adolescent Mental Health Service, Rathgar, Dublin, Ireland.
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Fochtmann LJ, Medicus J, Hong SH. Performance in Practice: Practice Assessment Tool for the Care of Patients With Schizophrenia. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2020; 18:402-423. [PMID: 33343252 PMCID: PMC7725154 DOI: 10.1176/appi.focus.20200034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Schizophrenia is associated with significant health, social, occupational, and economic burdens, including increased mortality. Despite extensive and robust research on the treatment of individuals with schizophrenia, many individuals with the illness do not currently receive evidence-based pharmacological and nonpharmacological treatments. The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia, Third Edition, aims to enhance knowledge and increase the appropriate use of interventions for schizophrenia, thereby improving the quality of care and treatment outcomes. To this end, this evidence-based Performance in Practice tool can facilitate the implementation of a systematic approach to practice improvement for the care of individuals with schizophrenia. This practice assessment activity can also be used in partial fulfillment of Continuing Medical Education and Maintenance of Certification, part IV, requirements, which can also satisfy requirements for the Centers for Medicare & Medicaid Services Merit-based Incentive Payment System program.
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Affiliation(s)
- Laura J Fochtmann
- Department of Psychiatry, Stony Brook University, Stony Brook, New York (Fochtmann); Division of Policy, Programs, and Partnerships, Department of Practice Management and Delivery Systems Policy, American Psychiatric Association, Washington, D.C. (Medicus, Hong)
| | - Jennifer Medicus
- Department of Psychiatry, Stony Brook University, Stony Brook, New York (Fochtmann); Division of Policy, Programs, and Partnerships, Department of Practice Management and Delivery Systems Policy, American Psychiatric Association, Washington, D.C. (Medicus, Hong)
| | - Seung-Hee Hong
- Department of Psychiatry, Stony Brook University, Stony Brook, New York (Fochtmann); Division of Policy, Programs, and Partnerships, Department of Practice Management and Delivery Systems Policy, American Psychiatric Association, Washington, D.C. (Medicus, Hong)
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Violence and Suicide Risk Assessment in Youth with Psychotic Disorders: Practical Considerations for Community Clinicians. Child Adolesc Psychiatr Clin N Am 2020; 29:43-55. [PMID: 31708052 DOI: 10.1016/j.chc.2019.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Psychosis is a unique and significant risk factor associated with violent and suicidal behavior and warrants special consideration. This article presents a careful review of the literature on violence risk and psychosis and suicide risk and psychosis as it pertains to youth or those who have been newly diagnosed with or are at high risk for psychotic disorders. Each topic is covered in reference to general considerations and specific psychotic symptoms (eg, hallucinations, delusions, paranoia). The reader can refer to practical boxes to assist in identifying relevant risk factors and examples of questions to ask the patient and family.
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Abstract
BACKGROUND Psychotic disorders, as well as psychotic symptoms, are associated with a greater lifetime risk of suicidal behavior (SB). It is not known, however, whether psychotic symptoms are independent predictors for short-term SB. METHODS Data were collected from 201 psychiatric inpatients at Mount Sinai Beth Israel Hospital. Self-reported psychotic symptoms were assessed using the Brief Symptom Inventory (BSI). Postdischarge SB defined as an aborted, interrupted, or actual suicide attempt was assessed using the Columbia-Suicide Severity Rating Scale (C-SSRS), during the 4 to 8 weeks following discharge from an inpatient psychiatric unit (n=127, 63% retention). Logistic regressions were performed to assess the relationships between psychotic symptoms and SB, controlling for primary psychiatric disorders. RESULTS Self-reported psychotic symptoms were associated with subsequent postdischarge SB. There was no significant difference between the SB versus no SB groups on the basis of primary psychiatric disorder. Self-reported psychotic symptoms remained an independent and significant predictor of postdischarge SB when the analysis controlled for primary psychiatric disorder. CONCLUSIONS These results suggest that psychotic symptoms are a dimensional predictor of near-term postdischarge SB and are a necessary component of suicide risk assessment during inpatient hospitalization, independent of psychiatric diagnosis.
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Spikol A, Murphy J. 'Something wasn't quite right': a novel phenomenological analysis of internet discussion posts detailing initial awareness of psychosis. CLINICAL SCHIZOPHRENIA & RELATED PSYCHOSES 2019:CSRP.SPJM.032819. [PMID: 30939035 DOI: 10.3371/csrp.spjm.032819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION A significant number of psychosis studies have focussed on and have attempted to model and frame the earliest psychosis experiences. Using a wide array of methodologies and targeting a variety of 'at risk' groups, researchers have offered much to inform our treatment responses, and understanding of psychosis onset and development. OBJECTIVES Due to the nature of scientific investigation however and investigator led exploration, those who experience psychosis are rarely afforded ultimate free rein to dictate and direct the exchange of information or to impose their unique narrative on that which is being explored. In an attempt to address this, the current study opportunistically harvested rich self-report data from replies to the question, "People that have been diagnosed with schizophrenia, what was the first time you noticed something wasn't quite right?" on the internet discussion forum Reddit.com. METHODS User data was analysed using Interpretive Phenomenological Analysis to identify key themes in participants' first experiences and initial awareness of psychosis. RESULTS While respondents varied widely in their recounted experiences and chose to describe these experiences in a variety of ways, analysis showed that (i) respondent distress was associated with psychosis onset timeframe, negative-voice auditory hallucinations, visual hallucinations, paranoid delusions, and insight (ii) early childhood psychosis experience resulted in novel explanatory schemas and psychosis/distress progression with contributory factors in adolescence and (iii) 41.3% of the sample reported self-realisation in gaining insight and greater insight was associated with help-seeking behaviour. CONCLUSIONS This novel use of publicly shared experiential data might enrich our existing qualitative literature concerning early psychosis.
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Affiliation(s)
- Amanda Spikol
- School of Psychology, Ulster University, Northern Ireland
| | - Jamie Murphy
- School of Psychology, Ulster University, Northern Ireland
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Scheinost D, Tokoglu F, Hampson M, Hoffman R, Constable RT. Data-Driven Analysis of Functional Connectivity Reveals a Potential Auditory Verbal Hallucination Network. Schizophr Bull 2019; 45:415-424. [PMID: 29660081 PMCID: PMC6403094 DOI: 10.1093/schbul/sby039] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Schizophrenia is a severe global health problem, with over half of such patients experiencing auditory verbal hallucinations (AVHs). A better understanding of the neural correlates differentiating patients experiencing AVHs from patients not experiencing AVHs and healthy controls may identify targets that lead to better treatment strategies for AVHs. Employing 2 data-driven, voxel-based measure of functional connectivity, we studied 46 patients with schizophrenia or schizoaffective disorder (28 experiencing AVHs and 18 not experiencing AVHs). Twenty healthy controls matched for age, gender, ethnicity, education level, handedness, and estimated verbal intelligence were included for comparison. The intrinsic connectivity distribution (ICD) was used to model each voxel's connectivity to the rest of the brain using a Weibull distribution. To investigate lateralization of connectivity, we used cross-hemisphere ICD, a method that separates the contribution of each hemisphere to interrogate connectivity laterality. Patients with AVHs compared with patients without AVHs exhibited significantly decreased whole-brain connectivity in the medial prefrontal cortex and posterior cingulate cortex, less lateralized connectivity in left putamen, and more lateralized connectivity in left interior frontal gyrus. Correlations with Auditory Hallucination Rating Scale (AHRS) and post hoc seed connectivity analyses revealed significantly altered network connectivity. Using the results from all analyses comparing the patient groups and correlations with AHRS, we identified a potential AVH network, consisting of 25 nodes, showing substantial overlap with the default mode network and language processing networks. This network as a whole, instead of individual nodes, may represent actionable targets for interventions.
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Affiliation(s)
- Dustin Scheinost
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT,To whom correspondence should be addressed; Magnetic Resonance Research Center, 300 Cedar St, PO Box 208043, New Haven, CT 06520-8043, USA; tel: 203-785-6148, fax: 203-737-1124, e-mail:
| | - Fuyuze Tokoglu
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT
| | - Michelle Hampson
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT
| | - Ralph Hoffman
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - R Todd Constable
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT,Department of Neurosurgery, Yale School of Medicine, New Haven, CT
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Abstract
The risk of suicide is greatly increased in individuals with schizophrenia. Previous research has identified several potential risk factors for suicidal behavior in schizophrenia, although their ability to independently predict suicide is limited. The objective of this review was to systematically analyze and identify the interaction between the proposed risk factors in the literature that may predict suicidal behavior in schizophrenia. Articles that explored suicidal behavior and suicide risk in schizophrenia that were published between 1980 and August of 2015, indexed in PubMed, MEDLINE, and Scopus were systematically reviewed. Many studies proposed a range of biopsychosocial risk factors that may independently lead to suicide in schizophrenia. These risk factors appear to be mainly related to stress, a history of suicidal behavior, and psychotic symptoms. It is clear, however, that many of these factors do not act independently and in fact require the reciprocal interaction of several of them to pose a risk for suicide in schizophrenia. Independently, the power of many risk factors to predict suicide is limited. Future studies should continue to adopt a multidimensional approach by considering the interaction of several factors in assessing the risk for suicide in schizophrenia.
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Huang X, Fox KR, Ribeiro JD, Franklin JC. Psychosis as a risk factor for suicidal thoughts and behaviors: a meta-analysis of longitudinal studies. Psychol Med 2018; 48:765-776. [PMID: 28805179 DOI: 10.1017/s0033291717002136] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Research has long noted higher prevalence rates of suicidal thoughts and behaviors among individuals with psychotic symptoms. Major theories have proposed several explanations to account for this association. Given the differences in the literature regarding the operationalization of psychosis and sample characteristics, a quantitative review is needed to determine to what extent and how psychosis confers risk for suicidality. METHODS We searched PsycInfo, PubMed, and GoogleScholar for studies published before 1 January 2016. To be included in the analysis, studies must have used at least one psychosis-related factor to longitudinally predict suicide ideation, attempt, or death. The initial search yielded 2541 studies. Fifty studies were retained for analysis, yielding 128 statistical tests. RESULTS Suicide death was the most commonly studied outcome (43.0%), followed by attempt (39.1%) and ideation (18.0%). The median follow-up length was 7.5 years. Overall, psychosis significantly conferred risk across three outcomes, with weighted mean ORs of 1.70 (1.39-2.08) for ideation, 1.36 (1.25-1.48) for attempt, and 1.40 (1.14-1.72) for death. Detailed analyses indicated that positive symptoms consistently conferred risk across outcomes; negative symptoms were not significantly associated with ideation, and were protective against death. Some small moderator effects were detected for sample characteristics. CONCLUSIONS Psychosis is a significant risk factor for suicide ideation, attempt, and death. The finding that positive symptoms increased suicide risk and negative symptoms seemed to decrease risk sheds light on the potential mechanisms for the association between psychosis and suicidality. We note several limitations of the literature and offer suggestions for future directions.
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Affiliation(s)
- X Huang
- Department of Psychology,Florida State University,Tallahassee, FL,USA
| | - K R Fox
- Department of Psychology,Harvard University,Cambridge, MA,USA
| | - J D Ribeiro
- Department of Psychology,Florida State University,Tallahassee, FL,USA
| | - J C Franklin
- Department of Psychology,Florida State University,Tallahassee, FL,USA
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Slotema CW, Blom JD, Niemantsverdriet MBA, Sommer IEC. Auditory Verbal Hallucinations in Borderline Personality Disorder and the Efficacy of Antipsychotics: A Systematic Review. Front Psychiatry 2018; 9:347. [PMID: 30108529 PMCID: PMC6079212 DOI: 10.3389/fpsyt.2018.00347] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 07/10/2018] [Indexed: 01/26/2023] Open
Abstract
Background: Auditory verbal hallucinations (AVH) are experienced more frequently by patients with borderline personality disorder (BPD) than previously assumed. However, consensus is lacking on how to treat them. Objective: To provide a systematic review of studies reporting on AVH in patients with BPD, with a focus on the efficacy of treatment of psychotic symptoms. Methods: For this review a systematic search was made in the PubMed and Ovid databases, and mean weighted prevalence rates, adjusted for sample size, were computed. Results: The search yielded 36 studies describing a total of 1,263 patients. Auditory hallucinations (including AVH) were reported in 27% of hospitalized BPD patients; AVH were reported in 25% of all patients and in 24% of outpatients. Of the hallucinating patients, 78% experienced AVH at least once per day, for a duration of several days to many years. On the whole, patients with BPD regarded their voices as malevolent and omnipotent in nature. Compared to patients with schizophrenia, the phenomenological characteristics of AVH were similar and the ensuing distress was equal or even higher, whereas scores for other positive symptoms were lower. The presence of AVH in BPD was associated with an increase of suicide plans and attempts, and more frequent hospitalization. Moreover, AVH in the context of BPD were associated with higher prevalence rates for post-traumatic stress disorder and emotional abuse. The efficacy of antipsychotics was investigated in 21 studies. Based on these studies, we conclude that both typical and atypical antipsychotics tend to have positive effects on AVH experienced in the context of BPD. The efficacy of cognitive-behavioral therapy and non-invasive brain stimulation has not yet been systematically assessed. Conclusions: These findings indicate that AVH experienced in the context of BPD are in need of proper diagnosis and treatment, and that antipsychotics tend to be beneficial in treating these (and other psychotic) symptoms.There is an urgent need for studies assessing the efficacy of cognitive-behavioral therapy and non-invasive brain stimulation in this underdiagnosed and undertreated group.
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Affiliation(s)
- Christina W Slotema
- Department of Personality Disorders, Parnassia Psychiatric Institute, The Hague, Netherlands
| | - Jan Dirk Blom
- Department of Personality Disorders, Parnassia Psychiatric Institute, The Hague, Netherlands.,Faculty of Social and Behavioural Sciences, Leiden University, Leiden, Netherlands.,Department of Psychiatry, University of Groningen, Groningen, Netherlands
| | | | - Iris E C Sommer
- Department of Neuroscience, University Medical Center Groningen, Groningen, Netherlands.,Department of Psychiatry, University Medical Center Utrecht, Utrecht, Netherlands
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Ftouh M, Gad ES, Seleem MA, Saada S, Mubarak AA. Suicidal Ideation in an Egyptian Sample of Hospitalized Patients with Acute Psychosis. CLINICAL SCHIZOPHRENIA & RELATED PSYCHOSES 2017:CSRP.MFEG.071317. [PMID: 28777032 DOI: 10.3371/csrp.mfeg.071317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Suicide mortality is 12 times higher in psychotic patients compared to the general population. Identifying characteristic of suicidal patients among this group might help in preventing such behavior. AIMS To assess the predictors of suicidal risk in patients hospitalized due to acute psychosis. METHODS One hundred and fifty patients (age 18 - 60 years) admitted with acute psychotic features were recruited. Patients were evaluated clinically by The Arabic version of Mini International Neuropsychiatric Interview (M.I.N.I.). Suicidal ideation was assessed using the Scale for Suicide Ideation (SSI). RESULTS Forty four out of 150 patients (29.33%) reported having current and/or previous history of suicidal ideation. Patients with major depression showed the highest suicidal tendencies followed by delusional disorder then bipolar disorder, psychosis related to substance abuse and schizophrenia. The more severe the psychotic symptoms, the more suicidal tendencies shown by patients. Predictors for suicidal ideations included diagnostic category, severity of psychotic features, unemployement and younger age CONCLUSION: Patients with psychosis that require admission to the hospital carry a high risk of suicidal ideation and behavior. Factors like unemployment, young age and psychiatric diagnosis and severity of psychosis could be predicting factors.
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Affiliation(s)
- Maha Ftouh
- Tanta Mental Health Hospital, Tanta, Egypt
| | - El-Sayed Gad
- Department of Psychiatry and Neurology, Tanta University, Tanta, Egypt
| | - Mohammad A Seleem
- Department of Psychiatry and Neurology, Tanta University, Tanta, Egypt
| | - Sameh Saada
- Department of Mental Health, Faculty of Education, Al-Azhar University, Cairo, Egypt
| | - Ahmed A Mubarak
- Department of Psychiatry and Neurology, Tanta University, Tanta, Egypt
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Yamaguchi T, Fujii C, Nemoto T, Tsujino N, Takeshi K, Mizuno M. Differences between subjective experiences and observed behaviors in near-fatal suicide attempters with untreated schizophrenia: a qualitative pilot study. Ann Gen Psychiatry 2015; 14:17. [PMID: 25904969 PMCID: PMC4405822 DOI: 10.1186/s12991-015-0055-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 03/31/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In cases of untreated schizophrenia, the patients' entourage often does not recognize the psychotic symptoms of the patient and the possibility that the patient may attempt suicide. The aim of this study was to investigate the discrepancies between the subjective experiences and observed behaviors in near-fatal suicide attempters with untreated schizophrenia. METHODS A semi-structured interview was carried out with seven near-fatal suicide attempters with untreated schizophrenia to examine the subjective experiences at the time of the suicide attempt. The families of the patients were also interviewed to determine their recognition of the patients' psychotic symptoms and the suicidal ideation. The interview data were analyzed qualitatively. RESULTS Six subjects were undergoing exacerbation of the psychotic symptoms at the time of exhibiting the suicide-related ideation. One subject had been in a prolonged depressive state before attempting suicide. Although all the patients experienced severe distress due to psychotic symptoms and depressive mood, they all exhibited only low level or no help-seeking behavior, and six of seven families had not recognized the change in the patient's mental condition. CONCLUSIONS Appropriate information about schizophrenia should be provided to the general public so that any help-seeking by the patients with this disease is not overlooked. In addition, accessible early intervention services for psychosis should be established.
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Affiliation(s)
- Taiju Yamaguchi
- Department of Neuropsychiatry, School of Medicine, Toho University, 6-11-1 Omori-nishi, Ota-ku, Tokyo 143-8541 Japan
| | - Chiyo Fujii
- Department of Forensic Psychiatry, National Center of Neurology and Psychiatry, National Institute of Mental Health, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo 1878553 Japan
| | - Takahiro Nemoto
- Department of Neuropsychiatry, School of Medicine, Toho University, 6-11-1 Omori-nishi, Ota-ku, Tokyo 143-8541 Japan
| | - Naohisa Tsujino
- Department of Neuropsychiatry, School of Medicine, Toho University, 6-11-1 Omori-nishi, Ota-ku, Tokyo 143-8541 Japan
| | - Kiyoaki Takeshi
- Department of Neuropsychiatry, School of Medicine, Toho University, 6-11-1 Omori-nishi, Ota-ku, Tokyo 143-8541 Japan
| | - Masafumi Mizuno
- Department of Neuropsychiatry, School of Medicine, Toho University, 6-11-1 Omori-nishi, Ota-ku, Tokyo 143-8541 Japan
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22
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McCarthy-Jones S, Thomas N, Strauss C, Dodgson G, Jones N, Woods A, Brewin CR, Hayward M, Stephane M, Barton J, Kingdon D, Sommer IE. Better than mermaids and stray dogs? Subtyping auditory verbal hallucinations and its implications for research and practice. Schizophr Bull 2014; 40 Suppl 4:S275-84. [PMID: 24936087 PMCID: PMC4141311 DOI: 10.1093/schbul/sbu018] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 01/24/2014] [Accepted: 01/27/2014] [Indexed: 12/17/2022]
Abstract
The phenomenological diversity of auditory verbal hallucinations (AVH) is not currently accounted for by any model based around a single mechanism. This has led to the proposal that there may be distinct AVH subtypes, which each possess unique (as well as shared) underpinning mechanisms. This could have important implications both for research design and clinical interventions because different subtypes may be responsive to different types of treatment. This article explores how AVH subtypes may be identified at the levels of phenomenology, cognition, neurology, etiology, treatment response, diagnosis, and voice hearer's own interpretations. Five subtypes are proposed; hypervigilance, autobiographical memory (subdivided into dissociative and nondissociative), inner speech (subdivided into obsessional, own thought, and novel), epileptic and deafferentation. We suggest other facets of AVH, including negative content and form (eg, commands), may be best treated as dimensional constructs that vary across subtypes. After considering the limitations and challenges of AVH subtyping, we highlight future research directions, including the need for a subtype assessment tool.
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Affiliation(s)
- Simon McCarthy-Jones
- Department of Cognitive Science, ARC Centre of Excellence in Cognition and Its Disorders, Macquarie University, Sydney, Australia; Department of Psychology, Durham University, Durham, UK;
| | - Neil Thomas
- Brain and Psychological Sciences Centre, Swinburne University, Melbourne, Australia; Monash Alfred Psychiatry Research Centre, Melbourne, Australia
| | - Clara Strauss
- School of Psychology, University of Sussex, Sussex, UK; Sussex Partnership NHS Foundation Trust, Sussex, UK
| | - Guy Dodgson
- Early Intervention in Psychosis, Northumberland, Tyne and Wear NHS FT, Newcastle, UK
| | - Nev Jones
- Department of Psychology, DePaul University, Chicago, IL
| | - Angela Woods
- Centre for Medical Humanities, Durham University, Durham, UK
| | - Chris R Brewin
- Division of Psychology & Language Sciences, University College London, London, UK
| | - Mark Hayward
- School of Psychology, University of Sussex, Sussex, UK; Sussex Partnership NHS Foundation Trust, Sussex, UK
| | - Massoud Stephane
- Department of Psychiatry, Oregon Health and Science University, Portland, OR
| | - Jack Barton
- Department of Psychology, Durham University, Durham, UK
| | - David Kingdon
- Department of Psychiatry, University of Southampton, Southampton, UK
| | - Iris E Sommer
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
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